Acupuncture for Collapsing Trachea?
 

Would welcome input on the most successful treatments for collapsing trachea. Further, has anyone used acupuncture, and if so was it successful?

Remy is now 14. He was at UC Davis last Thursday with their cardiac team to follow up on his heart murmur and MMVD. Good news is the echo / xrays and all labs show his heart has remained stable since the murmur was initially diagnosed in 2020. Only his upper heart chamber is enlarged (lower has remained static) and his lungs are clear - no congestive heart failure. While his heart condition is super positive news, the xrays show compression along the full length of the trachea. And he is coughing.

I have had him in front of multiple vets for the coughing with no positive result. We have tried cough suppressants (no effect), hydrocodone (no effect) and gabapentin was suggested but I did not feel the vet was credible so I did not try it.

UC Davis has him on a course of antibiotics - doxycycline, in the event there is some secondary infection impacting his breathing. We are on day 5 of the 14 day course. So will see what impact it has.

At this point I am exploring more holistic possibilities. CBD oil. Bone broth. Glucosamine. Acupuncture. These are all on the "dart board" to consider. I have calls into two new vets - both take a more natural approach - but pending their input thought I would see what wisdom may be out on YT.

Any input is welcome! :)

Unfortunately a regular X-ray is not the proper tool to diagnose CT. A Fluoroscopy would be the imaging needed to diagnose that way. Is it definitely CT? Some times is something else like reverse sneezing. Also has a round of prednisone been done incase it is just inflamed?

I would say stick with UC Davis. None of the things you mentioned will hurt him but not going to heal whatever the root cause is.

For the cough, I would just keep him calm and cool ... obviously he does have CT because it was visualized on xray. Of course, there is no way to know the severity of it without a flouroscopy as Taylor mentioned.

I have found that CT dogs each respond to different protocols. Have you tried lomotil? I have a foster who is on it for CT and it is helping him. Many of the specialists are now using it.

Here is a good link to read....I would pay particular attention to medical management of CT:

https://smallanimal.vethospital.ufl....heal-collapse/

Replying to both responses above, with some additional info.

Regarding CT - the xrays do show narrowing along the length of the trachea. So to some extent we are dealing with CT.

It remains unclear if the cough is directly correlated to the CT. Even UC Davis was unsure. But the antibiotic course makes sense, and his east coast vet in NH has also agreed it is the best next step to address any potential secondary infection in his lungs.

Remy seems to be responding to the doxycycline and I will be reaching out to UC Davis at the end of the 14 days with a status. His cardiac doctor will give me additional input at that point.

At the end of last week, we also consulted a holistic vet here in Carmel. She thinks we may be dealing some degree of megaesophagus and lung aspiration. With age it is possible to see an onset of megaesophagus, apparently, and I am now learning more about this potential condition. He has had a few episodes of regurgitation (as compared with vomit) but it is not a regular occurrence. Further, his cough typically ends with him trying to purge - like he is trying to cough up matter. The characteristics of the cough have led her down this path, which actually makes more sense to me than CT related cough. If he has had aspiration of matter into his lungs that certainly will cause the lung sounds, cough, etc. The antibiotic course is the right step to address any infection caused by aspiration.

Made immediate changes to his feeding protocol. Now using raised bowls - and hand feeding. Small meatball sized pieces fed slowly. The holistic vet has added a few nutritional supplements to help boost his immune system.

In summary, there has been improvement. Coughing is not as frequent and the duration of each episode is shorter. He is sleeping at least 4-5 hours steadily at night which is much better for his people. Energy level remains strong.

While we are still not 100% sure what we are dealing with (after 9 months of multiple vet visits) it seems we are getting closer to a solution. My goal is to eliminate the cough, and implement necessary lifestyle and diet changes to adapt to whatever condition we are dealing with. Further, implement any nutritional supplements that can help his body better handle the degeneration associated with aging.

One additional comment - we did discuss the use of acupuncture with the holistic vet and she did not feel it was a correct treatment for his situation.

I seriously doubt the megaesophagus diagnosis, but it also could be diagnosed with a flouroscopy.

As for aspiration, the cough is constant and awful AND should have shown up on chest rads.

The fact that xrays showed a collapsed trachea (unknown degree without a flouroscopy), would make me more inclined to treat as such.

As I mentioned above, they are now using Lomotil which I have used for years for CT pups. Most do well on it, showing some improvement. With CT, you never really totally eliminate coughing.

Hopefully the doxy might settle things....he very well could have an upper respiratory infection.

Will look forward to updates.

Thanks very much. Will inquire re fluoroscopy when I follow up with Davis at the end of the week. I may have to take him back up there to meet with their internal medicine team. Thus far we are only with the Cardiac team. As great as Davis is, there is not a lot of cross-over. One appointment and one team at a time. And internal medicine has months long wait lists. I digress...

The strange thing with all of this is the cough is not activity or exercise induced. If this were CT, every vet is saying he would not be able to exercise. He is happy (excited!) walking 1 mile everyday. Sometimes more. (I pick him up on the hills here in Carmel) and he will happily play fetch. No coughing, no respiratory distress.

However, he regularly coughs after eating. One adjustment that has made an immediate difference - feeding Remy upright in his Outward Hound pouch. It is kind of like a "Baby Bjorn" - I wear it like a backpack only in the front with him outward facing. It is something we have started to use here on long walks when I don't want him doing the big hills. It is easier for me to carry him this way as he is balanced in front of me. In the last 24 hours I have tried feeding him in it. He seems ok with the process. Sits happily as I hand feed. After he eats I keep him in the pouch walking around for about 15 minutes. Coughing does not occur. Maybe I am on to something....

The only thing I can say is that CT pups all have varying symptoms. I had one who only showed symptoms when he slept....presumably because of pressure placed on his trachea. He also was able to run and play.

I hope he continues to do well.

As for specialists, that often happens. You deal with one specialty at a time. The only time I have seen them work together at the hospital I go to in Houston, is when a pup is hospitalized. Usually, internal med is IMO the best way to start.

Please keep us posted!

Yes, will post updates.

Interesting comment re the one dog who presented symptoms at night. While Remy does have bouts of coughing during the day, it is at night where we really struggle. He sleeps only about 3-4 hours and then wakes up coughing, seemingly out of nowhere.

I am doing a coughing diary at the suggestion of our holistic vet here.

The input is very much appreciated.

Noted on the Lomotil.

And noted on the Prednisone suggestion above.

Will bring up both when on next round of conversations with the vets.

A diary is a great idea!

I will look forward to seeing his progress. He is lucky to be so cared for

Update

Called Davis this AM and they had a cancelation. Remy is scheduled with their internal medicine team on 1/24. Hopefully they will provide the long elusive diagnosis.

Right now our situation varies daily. We had several nights where he slept 6+ hours. (super excited about that!) Then he suddenly reverts to waking every 2-3. Same with daily coughing. Some days hardly at all. Others, frequent bouts. No obvious pattern. Fingers crossed the Davis diagnostics next month will give us something conclusive.

That's great you have an appointment. Hopefully Davis can get a diagnosis for you.

The pup I mentioned would sometimes really get bad at night and I would end up in the EC with him. My vet made a little "cocktail" injection for him. I was a combo of a tranquilizer and something for the cough. Maybe something along that line will help at night? Might want to ask them at Davis if it does not stop.

One other thing.....get a couple of videos of him when he is coughing. It will be helpful for the vets!

Yes have lots of videos. And they have been emailed / shown to many vets. At first his cough would not present when we were in front of the vet so the video was pretty important to demonstrate the situation. Remy has been the star of my iphone for the past few months, LOL.

My inexperienced opinion is we are dealing with some mix of CT plus something in the esophagus, and on top of that anxiety.

He will sleep comfortably for 3-4 hours then wakes coughing and the coughing frequently ends with a gagging / trying to spit something out.

Davis sent me Trazadone - just received it in the mail. Am going to try it out. It is a sedative. Only plan for night use from now until our visit later this month.

Fingers crossed for Davis Internal Medicine to work some magic re a diagnosis.

The Trazadone might really cut down on that nighttime stuff....sure hope so!!
Yes, hopefully, they will get to the bottom of it.

Thanks for updating! LOL I get it about the phone. I have a little neuro pup here who had a terrible time with seizures a couple of months ago and I wore my phone OUT. Thankfully, we have the right "cocktail" for her and she has been seizure free since being in ICU for a weekend and follow up MRI.

Update

Remy saw the internal medicine team at Davis on Jan 24th.

Their assessment - airway disease, specifically airwave collapse and bronchitis. Esophagus is fine. Heart stable. Multiple xrays demonstrate the trachea is narrowed. There is a crackling sound detected in his lungs. Two new meds prescribed: Flovent inhaler and Theophylline (bronchodilator).

The Theophylline seems to be making a difference. It is a pill given twice daily. The Inhaler is another story. It is a human inhaler and I have to give him the propellant with a mask on - that has to stay over his nose and mouth for 30 seconds / 8 complete breaths. Let's just say this is going to require some adaptation.

As far as diagnostics... they did not do a fluoroscopy. We did discuss it. The docter said the number of xrays clearly showed her what was going on with the trachea so she did not need additional assessment of that and the fluoroscopy would not help to further assess the lower lungs. As a result it was her opinion it would not offer any new info.

They could do a bronchoscopy - it would be to confirm the lung diagnosis and to determine if there is mucus. If this were to happen it would be at a future date - requires special scheduling. They did indicate it would be risky given his age, and it requires anesthesia for about 30 minutes.

We are going with meds in the near term to see if we can cut the coughing down about 50%

Bottomline, the unfortunate fact is that he is old. At 14 1/2 this is a disease for which their is no cure or silver bullet. We are at symptom management / mitigation. Hoping these two new meds have a demonstrable impact.

Thank you for the update!

Yes, it is true that a flouroscopy is not needed if the collapse shows on an xray. I believe I had noted that previously. The only time it is really needed is when a dog has symptoms of CT and it does not show on xray.

Did you ask about Lomotil? Someone else posted here recently about CT and their pup was put on it and it is helping him.

Yes, 14 1/2 is getting up there. I do hope he is comfortable with the new meds.

So sorry you are dealing with this too! It was a nightmare with Jackson too last year. Cough got so bad and I just felt awful for him -- he was otherwise acting normal.

Our regular vet started with an x-ray and a round of doxycycline to rule out infection. The Doxy seemed to help at first. Vet warned me doxy has anti inflammatory properties though so it could have just been that helping, not necessarily killing infection. Cough came back with full vengeance and our vet tried Jackson on theophylline but he had every side effect -- diarrhea, hyper, anxious, panting, etc. We stopped that. He mentioned prednisone and the Flovent inhaler but he was hesitant to do pred because of his pancreatitis. I asked him to prescribe Lomotil based on research I did and he did prescribe it, but it gave Jax weird poops. We got the inhaler RX and then we got squeezed into the specialist who had a cancellation.

She did a fluoroscopy and saw no signs of Collapsing Trachea or lower airway. They did a tracheal wash under mild sedation and a culture came back and grew 2 types of bacteria -- both resistant to doxy and clavamox. So we did a round of marbofloxacin which really seemed to help and she felt comfortable doing a round of prednisone. His pancreatitis was not affected and I am so glad I did it because it really calmed down the inflammation. We then transitioned him onto the Flovent Aerodawg inhaler and I think it really helps. We also have hydrocodone for bad nights, as of now it seems to work on an as needed basis, but I know eventually I may have to give every 8 hours.

I am sorry you went/are going through as well. I didn't know bronchitis was such a thing in older dogs, but my vet said he sees it often enough. His own 13yr old Pit bull dog is actually on an inhaler as well.

The specialist also ended up doing further testing from his bloodwork and urine results and found he had excessive protein in urine and diagnosed him with PLN which he now takes 2 meds daily for. These seniors are tough.....

Hi Brit, oh my - Jackson and Remy seem to have some similar symptoms. Remy just turned 15 yesterday. It seems like yesterday we met at the dog park in Annapolis, but in reality it was years ago!!!

From your note, I see you also did the doxy, I thought at first it helped but ultimately no long term improvement.

Remys current daily meds include:
1/ benazapril for his heart function (which has remained stable for last three years)
2/ theophylline for lung function
3/ The Flovent inhaler which does seem effective, if hated (!)
4/ pneumotrophin- a holistic treatment for lung function

At this point we feel he is relatively stable and there has been some reduction in the coughing - fewer episodes and severity seems to have lessened

A few lifestyle adjustments have been made as well. He loves eating / drinking from the raised bowls and I think it aids swallowing. He has lost weight and is around 8.5 lbs ( this is due to me making a food change). Finally, I changed out all of his bedding and that seems to have helped at night. I was thinking dust mites etc may have been causing some respiratory issues and new bedding is certainly easy to accomplish.

Long story short I feel he is doing well right now. Best wishes to you and Jackson!!! Our super seniors certainly keep us on our toes.

A follow up on this thread, and a note to Brit and anyone else dealing with similar circumstances

Please look into and consider allergies triggering respiratory issues. I raise this because we recently moved (sold our home in California) and purchased a home in St John, USVI. Remy has been here with me on the island since October and his coughing has essentially disappeared. His CT still results in a symptomatic cough - when excited or after he eats. Otherwise, no coughing. I have a vet here who saw Remy when he initially arrived (she was
Able to observe the coughing) and I have consulted by phone with our other vets - they are all quite amazed - and they are now all saying perhaps allergies were the root cause.

The current thinking is a respiratory irritation / allergen that was present both in NH and CA but is not here. Now the speculation is underway as to what it was. When we return north in April I will be intrigued to see if the coughing reoccurs - and if so there is little doubt it is some allergen.

For us, this has been quite a remarkable shift. And Remy is feeling so much better. He sleeps, is really active and it is a tremendous relief for us to see him feeling better. I have curtailed all medicine except his Benazapril (heart).

Food for thought for anyone else who has a dog suffering in a similar manner.