Collapsing trachea, heart murmer, breathing issues, ALP at 1900

[cinest]

Gizmo is a 6 year old, 16 lb Maltese. This past Sunday he developed a horrible honking breathing episode. I felt it was related to his front paws, he was walking only a couple of steps and he had to sit down. This breathing problem lasted and lasted. I continually rubbed behind his ears and down his neck. At 2 AM, when my husband came home from work, we took him into a vet emergency center. On the way his breathing worsened. If I put him on the seat beside me rather than on my lap it seemed to be a little better. His tongue was blue. When we got there, they put him on oxygen, tranquilized him and took xrays. Result was, he probably has a collapsing trachea, his liver was large but his heart looked the right size. They wired the xrays to a radiologist who also felt the it was a collapsing trachea. After he was somewhat settled we went home with a cough med and antibiotic and instructions to bring him in for follow=up.
Next day we decided to take him to his regular vet and see what she said. She agreed with the emergency room vet but did do a blood test. It came back and everything was normal except ALP, it was 1886. I asked what that could mean, she said maybe Cushing's but that we have to get the breathing issues resolved.
Gizmo has back leg weakness which was diagnosed as cruciate ligament ??We actually had a second opinion which confirmed it but they could not show it to us on xrays.
So now I have been researching Cushing's and find that back leg weakness and panting excessively are symptoms. I also find that the weakness goes to the front legs.
My question is, if collapsing trachea can be a sign of Cushing's and if we can't treat or do anything about it how will his breathing get better.
That ALP is mighty high, does the high result signify the worst Cushing's?

[labblab]

Hello, and welcome to you and Gizmo. I’m surely sorry, though, for the problems that have brought you to us. We’ll do our best to offer you our thoughts and suggestions.

I do think Cushing’s is a possibility. As you’ve already discovered through your reading, collapsing trachea, hind-end muscle weakness, cartilage/ligament damage, and elevated ALP can all result from Cushing’s. One diagnostic challenge, however, is that the two specialized blood tests for Cushing’s can both return “false positives” in the presence of other illnesses or bodily stresses. For this reason, it’s generally not a good idea to try to test when a dog is acutely ill. This may be part of your vet’s reasoning about working to try to first stabilize Gizmo before progressing to Cushing’s testing. Hopefully a combination of rest and medication will help ease the severity of his breathing issue. You are right, though — in the long run, you will want to try to treat Cushing’s if it is the underlying cause of these problems.

Have you noticed any other symptoms that are typical of Cushing’s: excessive hunger/thirst/urination, skin or coat issues, pot belly, seeking out cool places to lie down? As far as the elevated ALP, exceedingly high readings can result from Cushing’s but this does not necessarily mean a more advanced case or a poorer prognosis. There are some liver-soothing supplements that your vet might choose to prescribe while you are sorting things out, however, and we can talk about them in another post.

Depending upon how much experience your regular vet has had with both collapsing trachea and Cushing’s, you might be well served to request a referral to an internal medicine specialist (which may be the type of vet who you already saw at the ER clinic). An experienced specialist may be better able to judge the best diagnostic and treatment path forward. For instance, I think steroids are sometimes prescribed to ease collapsing trachea, but they might be adding fuel to the fire for a Cushpup who is already suffering from elevated cortisol. On the other hand, a brief course of supplemental steroids might help ease a respiratory crisis. I just don’t know, but a specialist would be a better judge of issues like that. I know it may mean more expense in the short run, but it may clarify things and make for a smoother treatment course in the long run.

Anyway, these are my first thoughts about Gizmo’s situation. Again, I’m really glad you’ve found us and I look forward to talking more.

Marianne

[Squirt's Mom]

Hi and welcome to you and Gizmo!

Marianne has gotten you off to a great start as usual (she is one of our gurus here ;) ) so I only have one thing to add.

Talk to his vet about using Adequan injections for the trachea. A doctor in Little Rock ARK that a rescue I work with used told me he had used this drug with success in small dogs that had collapsing trachea.j At the moment I can't remember the protocol for this but I will do some looking and get back to you. I know he helped several dogs with this approach, tho.

I'm glad you found us and look forward to learning more soon!
Hugs,
Leslie

[Squirt's Mom]

Ok...the protocol Dr. Smith (now retired) used was an Adequan injection once a week for 6 weeks then once a month thereafter. We tried it on a little rescue I had but she also had a tumor between her trachea and heart. We did this hoping it would strengthen the trachea enough to hold the tumor away from the heart but it was too late to help Josie. :( The tumor had already grown too large.

Here is a post on Facebook from a vet that uses Adequan for this condition - https://m.facebook.com/Pomeranian.Dogs/posts/1191355694224176?comment_id=1191375997555479&comment_tracking=%7B%22tn%22%3A%22R0%22%7D

And a link from DVM360 on the condition in general and treatment options (Adequan is not mentioned but a new approach using stents is) - http://veterinarycalendar.dvm360.com/tracheal-collapse-proceedings?id=&pageID=1&sk=&date=

[cinest]

Thank you so much. It is a relief to know that there is something else for the breathing. I'm going to check that Adequan.
Yes, Gizmo seeks coolness. He will push aside our verticals to sleep against the sliding glass door.I think he urinates a lot but he does drink a lot.
His panting and leg weakness occurred after he got his rabies shot. In fact, his sister, Lulu got leg weakness right after the shot but after a year she regained the ability to jump up on couches, Gizmo never regained it. I stopped all injections because of this weakness and panting that developed.
I had 4 Maltese, but Tebow, the Dad, died suddenly last summer. I do think he had Cushings. When he developed the excessive panting the vet did xrays and said everything looked fine. He too had back leg weakness, panting so loud it woke me up. I also noticed his hair had thinned out on is belly. I attributed it to age. He would sleep either on the tiled bathroom floor or next to the toilet bowl. He died in June when he was 7. Gizmo and Lulu are 6. The Mom, Brie, is the only one who doesn't have or had back leg weakness, she had her booster Rabies shot when she was pregnant.
A relative of mine had Brie's brother. He too just died. He went to the same vet as mine and when he died I called the vet and asked if we had some heredity type condition going on. I was told no because that pup had just had a check up 5 months ago and he was fine.
This is so frightening. A family of 5 Maltese, 2 have died...I am sick with worry. I feel so stupid and so responsible. Years ago, because of the excessive panting, I looked it up and found Cushing's but I decided it was the rabies shot.
Today, Gizmo is better. How can this be. It doesn't make sense. Collapsing trachea doesn't get stronger does it?

[cinest]

I forgot to mention not only rabies shot given, both my boys were neutered. Neither of them had that panting before shot and neutering.

[labblab]

Gosh, I’m so sorry about your losses! As far as we know, there is no hereditary link to Cushing’s. But I imagine it’s possible that some other type of disease or physical vulnerability has been transmitted in the family line.

I wish I was more knowledgeable about tracheal collapse, but I’m afraid I’m not. If Gizmo is doing better today, perhaps the cough medicine and antibiotics are helping. For how long a time is he supposed to keep taking them?

Marianne

[cinest]

He is on antibiotic for 7 days and today is 6 days. The sedating cough med will last a few more days but they did mention giving it to him as needed, before any stressing causing activity, for the rest of his life. His blue tongue seems to be under control now, maybe because he isn't coughing.

[Harley PoMMom]

Welcome to you and Gizmo from me as well!

My non-cush pom, Marvin, has a collapsed trachea and it is being medically managed with Hydrocodone. He is also getting the Adequan injections which started in June last year and it does seem to have helped. For the whole month of June he received the Adequan injection twice a week and now he gets them once a month. My vet charges $32.00 per injection and since the vet tech can give them he doesn't have a long wait to be seen. What cough medication is Gizmo taking?

Lori

[cinest]

Thank you Lori. Gizmo is taking Hydrocodone 2 x a day. It is every day for now. (1.7 ml each time) So far, no more coughing episodes but the sound of his snoring is scary. He is still on Doxycycline for 5 more days. Cindy