RPM TUESDAY NIGHT LIVE: Laryngeal Paralysis

off sunning himself somewhere in the Red Sea. Um, I'm not sure what the quality of the water is right now, but that's a joke between me and Connor. But you know, we're looking forward to, uh, giving you some gems of information tonight. Um, so down below me on my left down there is Karen Reed, our special guest. Hi, Karen. And down on my right is Conor Dr. Conor Brady is there, so he's with us as always. So guys, we hope you're going to enjoy tonight. Lots of information, maybe a bit more clinical tonight than necessarily nutrition, but believe it or not, Karen's going to give us some nutritional benefits of how to feed a long-term dog with this problem, a raw diet. So hopefully we'll get a good rounded figure. So actually, do you know what I'm going to do? Just because I always know what Conor's going to talk about. So I'm going to ask Karen. Welcome, welcome, welcome. How— what have you been doing this week? What's your thing of the week?

My thing of the week? I just do lots of work for Conor. That's all I do.

Oh my God, you're not supposed to say that. All my finest work is Karen, to be honest.

Basically, Conor's done nothing. I've just done all the work so far this week.

I'm going to go through through the list of things that people that work behind Conor and produce his excellent dogsfirst.ie website and rewrites it from his—

that's exactly it. Yes, that's exactly all I do. That is all I do.

You are, you're just mad into canine nutrition. Like, it's, it's, it's just, uh, just like when you're, you just enthuse. Like, is that the word? What's the word where you just absolutely, when you're talking to somebody about dogs like you've been working with dogs like all your life really, you know, and then you've got your canine nutrition stuff, which is why Cara and myself have been working together on trying to get the Dogs First site back up and running, which requires going back over articles and getting the latest science of the last 10 years and looking at what I wrote and vomited out 10 years ago and saying, okay, we need to bring up to speed and whatnot. And so that's what Cara's been doing, but it's been brilliant. So welcome on, Cara. We're going to appreciate your insight on this because you are very present in all the laryngeal paralysis groups, and this is something that's very close to your heart. As you can see, Lord Newton is there behind you hanging up on the wall, and that's the boss. So we can't wait to hear about this 15-year-old dog still doing zoomies and giving everybody great hope. And before we start on laryngeal paralysis, we are at patreon.com/rawpetmedics. We've got all the Nick's holiday pictures and we'll pop them up there at the end of the show. So quick, get in your patronage now so you can see that. I don't know if that's good for business or bad. So, but listen, before we talk about this particular subject, I just want to touch on something I posted up during the week, Wren. It was about a veterinary clinic over in the US, and they had written on the bottom, it was a general intake sheet for dogs, and at the bottom they said there's going to be a $25 surcharge for raw-fed dogs. And look, you could— we don't need to kind of get into the whole, like, listen, that's so obviously ridiculous. How do you filter out your raw, your cats eating prey and all this nonsense. It's like, it's so ridiculous. And the safety would be on the side of raw, in my opinion, although supported by the data that we have. But like, have you— what's your opinion on that? What do you think about a surcharge? As a guy who ran an extremely busy veterinary clinic, what about that? Isn't that ridiculous?

Yeah, still do. Just come fresh from work. So, you know, he's retired me already. Yeah, look, do you know what? I look at this and think, if you're managing an inpatient in a hospital situation, surely, surely to God, you're going to be doing that in a clinical manner with gloves, you know, some PPE of some description so that you don't get covered in all sorts of stuff and then move to the next patient and handle them with the same sort of all over you. Yeah, I am gobsmacked that anybody is putting a surcharge on top of that for an individual raw, because, you know, if they're handling inpatients properly, you'd think that they're going to be sterile between— yeah, I do not see any kennels of worth with people with drinks and food and, you know, doing, you know, just happen to be sitting down amongst the patients while they're eating their lunch. That is not what modern veterinary medicine is about. And, you know, realistically, you know, them talking about putting surcharges on for that sort of stuff is, yeah, it smacks a little bit of just trying to make a bit of extra money from, yeah, possibly industry-owned.

I mean, Mars have 2,000 veterinary hospitals, more than 50,000 vets on the payroll, or they own all the diagnostics. So you could easily have a clinic that is perhaps Mars-owned. I know that sounds very dark and we are touching very close to getting in trouble, but there is allusions to that.

Chocolate factory owned.

Yeah, yeah, apart from chocolate manufacturer. But a lot of people posted up that it's happening in the UK, so there's 2 or 3 people that'll probably be on here tonight and they said this actually happened in the UK as well. And so do you remember there was back in the day, there was words from on high to say to segregate raw-fed dogs. Did that ever come into practice?

Yeah, certainly there were certain veterinary colleges, okay, or, you know, the universities that train vets that had some of their professors getting a little bit antsy about people feeding raw for no particular reason other than pure bias. And hey presto, you know, it just happened that their departments were being, you know, provided for by some of those well-known brands of foods that aren't fresh. And therefore, you know, it sort of did smack a little bit of, you know, who's put you up to this? You know, where's your science? You're actually just doing it from a personal bias rather than any evidence out there. And we're still battling that, you know, this proposed possibility of a faintest thing. And if you want to know more about that, if you look back to February's podcast, you'll see us talking on, harping on about bacteria and that side of things. Because, you know, at the moment it just seems to be absolute bunkum that we're getting, you know, a storm about. And, you know, we're still not seeing the evidence. There's, there's still too many papers out there propositioning that this is how they perceive, um, that sort of infection has got. And as Connor beautifully said on that night, you know, far more food poisonings come from raw carrots than probably come from any sort of meat. So I think we need to be really taking it with a pinch of salt.

Yeah, Nikki Kamek's study there from New Jersey and Helsinki study, 16,000 people part of that study. I mean, incredibly safe was the response. I mean, if you tested a household asking about food poisoning incidents in the household, the figures would be way higher. 1 in 7 Americans are getting food poisoning, you know, enormous amounts of reporting hospital with salmonella from the food they're eating. Is this a reason not to eat fresh food? Anyway, we've killed that point a number of times. Should we get straight into laryngeal paralysis? Who wants to? I think, Brendon, do you want to tell us a little bit about laryngeal paralysis? What is this? Yeah, tell me what it is.

Okay, okay. So, look, you know, as we named it tonight, you know, it's a little bit of cough, splutter, and choke. This is really for those people that have had a pet, maybe cat or dog, that has probably suffered a chronic cough with no temperature, no particular sort of chest issues, seems to come from the upper respiratory area. So we're talking around the throat, but there's no soreness of the throat. And as I say, no temperature. They're not down in the dumps particularly, but they come in with this this change in cough. And actually, sometimes until the vets actually ask the question, people don't always perceive actually, yes, the bark has changed, or the meow has gone. Okay. And they do more of a silent, like that, because you couldn't hear that, could you? So, you know, it's just a tiny little bit of a squeak. Okay. Or the bark has gone from a deep "roar" to more of a "whistle" sort of noise. And those are sort of like alarm bell signs that actually there is something else that could be going on. And I'm going to try and do a little bit of a demo for those people that know a little bit about anatomy but don't necessarily know what's going on in the back of the throat. So I'm going to stand for this just so you've got a background. Okay, and we're going to see if this works. So here we go, demo. So what I love to do is show clients this, okay? So my two fingers here is effectively the epiglottis, and that normally closes over when they're swallowing food just to protect the larynx, okay? The secondary thing that happens is these two fingers here are your vocal cords, okay? And what we call the arytenoid cartilages control that and actually will open that when they want to breathe louder. Okay, breathe, sorry, harder, or they'll close, especially if there's food sensed in that area or mucus, and they'll actually snapshot to protect food from going down the windpipe. So behind here is the windpipe. Okay. And what we actually get is when we've got a nerve, usually the right recurrent laryngeal nerve, damaged, then this starts to flap. So we'll get withdrawal of one side and we'll get flapping around of the larynx at the back there. And that is what's causing that weird rough noise. They can't create a nice tight vocal singing voice. It is just literally flapping around. If it's really severe, both nerves can get damaged and you then just sort of like all of this. And that's when we can actually do some surgery to tie those back. So they're permanently open. But then, as we're going to talk to Karen about, we've got to manage that process of how we feed them because there's no longer protection of snapping shut to protect food going down the airway. Okay, so I hope that's clear.

Yeah, it's really clear.

Conor's looking at it going with a frowny face.

Yeah, no, that's my concentrating face. People always say, look, this doctor's studying. No, that's my—

That's when he's on the loo and he's concentrating.

My resting bitch face is what my wife calls it.

But anyway, so that's really what we're dealing with. Okay, and we've got to look at that, and we can see that sometimes when we have them sedated and look down the back of their throats, and we can actually still see whether the larynx can move under sedation or not. So that's a diagnostic tool. Okay, so hopefully that gives you a little bit of an outline, and that can happen definitely in cats, but also most commonly in dogs. And there are certain breeds, certainly the Labradors, the Retrievers, quite a few of the larger breeds, and we're going to talk about why that might be soon, that will get this problem usually later in life. So, you know, especially if we're seeing a dog around 10 years old and we start to get that, then that's something to look at. Another sort of area that sort of crops to mind, if your dog rolls on its back, okay, and is, you know, playing around, and then all of a sudden it gets this and chokes, okay, that can often be just because of the saliva and the stuff going down, but they can't stop it going down the airway, so they actually do a whole hack cough to try and get it out, okay. And sometimes quite an ineffectual cough, you know, it'll be— they'll make a right deal of it because they just can't snap that larynx shut and then produce the pressure to then cough it out.

Yeah, okay. I hear a lot about— I hear a lot, just to kill this off straight away, I heard there's different grades of this. So it can be, you can have like a, you know, level 1, 2, 3, 4. And what about megaesophagus? Is that the same disease as laryngeal paralysis? Is that like level 5 laryngeal paralysis where the thing is just a straight shoot down? And this is— is that what megaesophagus is? Just what's the difference between those two?

Okay, so megaesophagus is really paresis and paralysis of the food pipe going through the chest. So you're building up food within the food pipe.

Okay.

Paresis is a weakness. So you talked about grading. Okay. So we can have a weakness in that nerve that it's not communicating correctly through to whatever area. So the esophagus in megaesophagus, which is the food pipe, or to the larynx in the laryngeal paresis, is where the vocal cords can still move, they just can't do it as well as they were. So it's not fully paralyzed. They're still doing something to move it. But ultimately, that can become something where it just becomes totally flaccid. Okay.

Okay. And I have a second question. Why is it that this disease is often related to weakness in the hind limbs and a bit of neuropathy and that kind of stuff? What's the link between those two things?

Okay, so really interesting. And this comes back to why I think the primary cause is trauma, usually from an inappropriate accident on the lead. So that could be, you know, yes, there are lots of other traumas, you know, surgery to the neck, you know, hitting a tree at speed, you know, because there's some daft dogs out there that do that, or even hitting the owner's legs just behind the knee at speed could be one of them. But, you know, being hit by another dog. But we all know, we've all seen those people out there on the park where the dog has hurtled off on an extendable lead and it's come to the end of the lead. Before you know it, the owner does not let go of that lead. They hold on to it and the dog goes like that. Or those unfortunate trainers or owners that have been taught to train by using a check chain. Okay, so a check chain or a prong collar, not something that's legal in the UK, but certainly we do see prong collars around the world, especially in the US and Canada. They are something that's there and they are taught to do that as a sudden, you know, to check them from moving forward. It's not supposed to be a choke chain of actually holding on to it and throttling them, but a check chain, which is a smart—

What about the slip lead that the breeders use? That, um, I say breeders in shows, I'm not picking on the breeders here, the slip lead just goes up underneath the chin, do you know?

So you see, yeah, you see the sort of gundog, but when they're doing that, they've often, they've often taught those dogs to walk to heel appropriately. And I would always say, you know, for me, and you're a behaviourist, uh, and you've had some, you know, uh, influence on, uh, training organisations in the past, and I would just say You know, my personal feeling is if you want to— and Karen, actually, you can come in on this because you've done a lot of work with dogs and walking and things like that, you're probably experienced as well— but my personal feeling is that if you're training a dog to heel, then as soon as the dog gets in front of you, you change direction. They very quickly will follow you, okay? You know, rather than allowing them to pull And actually all I need to do is put my foot down hard now on the ground and my spaniel immediately knows that I'm probably going to change direction and comes back to heel. So I don't even need to change direction. It literally is just that slap on the tarmac with my foot and she's back.

So are you talking about damage to the neck? Because when I asked about neuropathy, are you talking about damages to nerves now? Is that where you think that weakness in the hindquarter is?

Yes.

So now the interesting thing is if you think of the spinal cord, okay, the vertebrae, like this, okay, and above that is the actual bit that holds the cord and below is the vertebral bodies and nerves come out here, okay, either side. Actually, the nerves that feed the back legs are actually running along the bottom of the spine. So actually, if there's any damage to any of the discs within this area, not only does those discs impinge the nerves coming out in the neck, that can affect especially around the lower neck area into that larynx. And it's the recurrent laryngeal because it comes out and back up the neck. Okay. Also, what can happen is that the bulging disc can impinge on the nerves that feed through to the back legs. So it could still be a physical trauma that is leading to those sort of neuropathies. There is something really interesting that we touched on before the show, which is also about the issues of some of the toxins, some of the neurotoxins that we can find in some foods. The aflatoxins, for instance, can affect the nerves, so they could cause general neuropathies. And we talk about that in— you've got a really great study, the thing about the megaesophagus and those things. But, you know, it could be that that is also an influence. But I would expect raw food feeders should not experience it at all if it was all down to that.

Yeah, what about Newton? Did Newton get any of that, Karen?

Yeah, I mean, we got Newton, came to us at 15 months old, we adopted him, and before he came to us, he, he would have had some pretty harsh, um, old-school training like Brendan was saying with the checking. Um, and he actually came to us with a bit of a weird cough, and at the time the vet said he had kennel cough. So got him over that, and it never really seemed to go away. So we were kind of used to Newton always having this weird little cough when he got excited. Like you said, Bren, if he laid on his back, he'd all get up and cough, but it never bothered him. He never— he's always been crazy, running, no exercise intolerance. But I was always aware of laryngeal paralysis, just always worked with dogs. Every time I went to the vet, which wasn't very often, it'd be, just check his throat for laryngeal paralysis. No, no, it's not that, it's probably a bit of a weakness from the kennel cough.

So they didn't check, they wouldn't check when you asked them to check.

No, I mean, it's when they're young, they're kind of— it's— they will check his throat, and as soon as they touch his throat, he will cough. So they were always— they were always aware that it could be laryngeal paralysis, but it wasn't like it was affecting his life. He wasn't coughing all the time, so it was always on our radar, um, because just— he'd always had this cough. Um, but it was only when he got to about 12 that, um, his bark did change slightly, and he got a bit of hind leg weakness, as you were just saying about But at 12, you kind of start to think, is it a bit of arthritis setting in? So you don't really take a lot of notice. He was having hydrotherapy, fine. And then what happened with Newton was he— we went out for a walk one day and he went in the water, having a great time as usual, no problems. Got out of the water and started coughing, started gagging. Then it came more distressed and thought, this isn't right. And he was coughing more, coughing more, then he was struggling to breathe, then he just collapsed. So he— we were out on a walk about a mile from our van. So yeah, he's on the— on his side, completely collapsed. Um, and I just thought— went over, pulled his tongue out, thought he's eating something in the water. So checked his throat, nothing. And checked his heart, and his heart also stopped, which is fun because Newton— Newton has to have added drama. Newton can't just do things.

Absolutely. Yeah, full maximum drama.

Immediately, like, Steve Mum's on the phone. I started CPR on him because luckily I knew how to do it. Wow. Got him back, heart started again. We just had to carry him for about a mile to the van. Had to keep stopping because his tongue was blue. He was gone. Pumping his heart again, kept trying to pull his tongue out. No idea at that point, we thought it was his heart. So finally got to the, um, vets. Long story short, he had a scope a couple of weeks later and he had severe bilateral laryngeal paralysis. So what happened to him they just shut and they didn't open because he was literally— there was no air.

Wow. Oh my God.

So he's that bad that he— and after that, if— because in— I'm sure Brendan will say, like, in warmer weather, that's when laryngeal paralysis dogs will suffer more because they're panting more, they can't regulate their temperatures because they can't get enough oxygen in. So it was— unfortunately, this was in June and it was becoming hot, and his surgery ended up being an emergency because he had another breathing crisis. And collapsed in the van on the way to the hospital, which was fun, and took straight in an oxygen chamber. And 4 days later he had the tie back and has been amazing ever since.

Like, literally, is this the surgery where they tie back both sides then? When you say bilateral, does that mean both sides have to be tied back? He's just got to be—

Newton had, um, Newton, Newton had his left side tied back, and our surgeon was amazing, and she tries to tie back as little as she can so the hole is as small as possible. So the— if the fold can't shut anymore, it's called a breathing crisis. But it's also not big enough that food can go down. I mean, I still have to be super careful how he eats because of aspirating and stuff. But, um, yeah, she's— she did an amazing job. So only one side is tied back. So this is why when he goes out and he pants, you'll still hear a bit of what I call a strider. So when he breathes a little bit, because the other side is still flapping around. But obviously he's not at risk of having that breathing crisis. Stasis like he did, because he's got an open airway now. So, um, he literally— I remember at rest, I remember doing his breathing rate, his respiratory rate at rest, um, the few nights before his surgery, and it was 40, 43 breaths per minute. That was at rest. He hadn't been doing anything. And literally the day he came home from surgery, it was 10. So that's how much he was struggling to breathe.

Yeah, so it was Yeah, and I just want to point out two things to all of those guys out there as well. One is brilliant that you have been understanding to do the CPR. I think I'd encourage far more owners to take on board some of those first aid courses that teach them how to do CPR for pets. Okay, and, you know, brilliant, well done. I mean, you know, gobsmackingly that you've managed to do that, because even with CPR without any of the other adjunctive stuff such as the ability to shock the heart and things like that, you know, actually only 5% of cases— that's right, 5% of cases— will recover with CPR from a stopped heart. Okay, so that's— so even though it's something that's taught on those first aid courses, you know, reiterate, you know, you do need to be pretty close and pretty on it to get them to recover like that.

Wow, 1 in 20 shot, Karen, that is some— what a job you did, and multiple times.

Absolutely brilliant.

I mean, absolutely brilliant.

And it's weird because we thought he did have a heart problem, but once he had his op, about 2 months after, his heart was completely back to normal, and the vet said it was purely because he wasn't getting enough oxygen. I mean, he had muscle wastage in his back legs. About 4 months after the surgery, muscle just came back because he was getting the right oxygen. Yeah, obviously I don't want to scare anybody who's watching this because not every dog will go into a breathing crisis, but I think it was difficult for us because Newton had always had a little cough, so nothing was different to us. But if you start noticing your dog gets an abnormal cough, and it's, it's really a honking cough and a gag— they gag a lot, um, especially on excitement and stuff— that's what I say, he'd always done it, so it's really hard for us, and progressed so, so quickly with him. As soon as the warm weather started, he just— it literally was— say, he just out of the blue just collapsed. We just, yeah, had no idea.

And where did you get your CPR training? Where did you get yours?

I did it, um, years ago when I did my canine nutrition diploma. Part of it was health and like first aid as well, um, and being a dog walker for 11 years, I just made a point of learning everything I could because your dogs will catch you out all the time. So, um, yeah, that was— I'm so glad I did. And like you said, Bryn, anyone should learn that that's got a dog because he wouldn't be here if we didn't do that.

So I mean, a heads up to Rachel Bean, who I know is a veterinary nurse, has done them sort of nationwide and has done quite a lot. There are a few nurses out there doing those, uh, courses now. We as a practice also have a nurse that does those, uh, emergency and first aid courses for pet owners. So there are lots of places. Maybe contact your local practice and just double-check whether they've got a course, and then also look online. I'm sure there's plenty. If you put in animal first aid, there'll be courses near you around the world because it doesn't— it's not just the UK, you know, there's people over in America Canada and Australia.

There's one in Ireland here, K9 First Aid, one by Jenny Hale and Corina Kerrigan. Just to give them a plug, check it out, k9firstaid.ie. They're very good as well. But even a YouTube video, guys, is better than nothing. They say any CPR is better than no CPR. So, but listen to this, guys, listen to the prevalence of laryngeal paralysis in dogs. This is a bit scary. Much like pancreatitis, when you look under the hood, you find an awful lot of us 2/3 of healthy cats and dogs with some degree of it by mid-age. Listen to this about laryngeal paralysis. This is the results of studies of 250 otherwise non-laryngeal paralysis dogs who turned up on the veterinary table, and they had a look at them, and 25% of the dogs examined had some degree of laryngeal paralysis or paralysis. Affected dogs were significantly older than unaffected dogs. There was a trend for the severity to increase in age, no difference between sexes, and overweight animals had a significantly higher grade than those with a normal conditional score. Labs, Rottweilers, Setters most likely affected. I just thought, well, when they look, there's an awful lot of this going on, which kind of does reinforce the physical kind of trauma, physical damage bit of it, or some other common factor across all these breeds. And that is bloody scary. The natural thing that comes into this is that, right, you've now got open food pipe, open their windpipe, and we do not want any water or food. A little bit of water probably wouldn't be the end of the world. I see some of the top people in this where the dogs are running through the water. I see Newton's 15 years old now, guys, and he's a big lab. He's not a small lab, lean and just a perfect looking lab, but he's running around in the waters. But I would be more worried about food. How do you work the food side of things, Karen?

Well, basically our surgeon said to us that Whenever a dog with LP eats, you need to make sure the food's as smooth as possible. So even if you feed kibble, a lot of people on— there's a fantastic group, if anyone's watching, the laryngeal paralysis support group on Facebook. They are so amazing, such good help. Well, such a help for me. And a lot of people in there feed kibble, and they will soak the kibble and just make sure it's in a really smooth ball. Obviously, depending on the size of your dog, like golf ball for Newton size. Um, but obviously Newton's on raw, so you need to just make sure the food's as smooth as possible. No dust, no sort of fatty liquids. So if you feed like tins of food in gravy, you probably want to avoid the gravy somehow, because obviously if any of that sort of fatty liquid gets into the lung, that's when bacteria is gonna start to— like you say, the water isn't usually a huge problem because they will cough. Like Newton, if he has a drink, sometimes will just cough any water up that goes down.

Okay.

And obviously our surgeon said it's a good thing if they do cough after a drink because they're it's not going down the wrong hole. So, but yeah, no dust, no sort of bits. And the most important thing is, which Newton's really happy with, is they just have to swallow it whole. So yeah, no, no sort of chewing or crunching bits. Like, he can't have— he can't have bones anymore, sadly. I know a lot of dogs after the op do, but Newton has always tried to swallow bones however big they are. He just wants to get them down him. So I tried it a couple of times and literally was pulling them out of his throat.

So it was too terrifying.

And he has marrow bones because he's always been good eating never bites down, so he just really— so that's kind of for his teeth cleaning, and he really enjoys them. But anything, even things like these sort of the bully sticks, he'll just try and swallow them, so I can't let him have anything like that now. But, um, yeah, just the food needs to be smooth, needs to be in a ball so they can just literally swallow it. So whatever you sort of feed, that's the best way, um, to do it. And there's a— there's dispute really with whether to raise bowls. I've never really done it with Newton. I mean, just where we live now, it's they're on a step anyways, they are raised. But, um, there's— our surgeon didn't seem to think you needed to raise food bowls or water bowls. But if you've got a dog— again, it's so different for every dog— but if you've got a dog that just, you know, some— especially Labs, they'll just inhale water. They just stick their head in and it holds it out with their nose. Yeah, Newton's never done that. He's always been quite gentle with it. I think it's the part of the Golden Retriever in him that's a bit more gentle. But If you've got a lab that literally inhales water, you might want to get one of those slow-down bowls, you know, the ones with the— that stops the level of the water coming out.

Yeah.

Um, so yeah, that's, that's basically it really. And when, when he came home, I hand-fed him for about 6 weeks, um, which is fun because I'm a veggie, so rolling meat into— yeah, tripe was really—

oh, you don't want to be playing with that. That's the worst meat to be playing with. That is just—

yeah, it was basically how I did it. I rolled it up and I would— it's almost like I stuffed it in his mouth, so He swallowed it. He was loving life, I think. Yeah. But, and I found with Newton and what a lot of, um, LP— that dogs with LP, the owners find is to feed them little and often. So again, Newton's loving life because about every 3 hours he has like a few meatballs. So, um, again, it started at 3 hours and in lockdown it was like every 2 hours. He's like, where's food? So now it's like every 2 hours.

Yeah.

So, uh, so yeah, that's just something personally I do, and I know a lot of of people do with dogs with LP, just because again, Brendan could probably touch on this a bit, I don't know, but a lot of LP dogs also seem to suffer with reflux and issues like that.

Yeah.

And I don't know, I, I'm obsessed with the vagus nerve and I know that that innervates a lot of that area and obviously it goes into the gut. I don't know if that, um, I'm always trying to look into more about that because it seems that most LP dogs seem to have issues with motility and reflux. And unfortunately, it's the reflux a lot of the time because the bile comes up that can go into the lung and then causes aspiration pneumonia. So trying to get on top of that reflux is such a battle for a lot. I'm quite lucky with Newton, but he did have it when he first come back from his op. But the amount of drugs he was on— again, going to the nutrition— I needed to heal his gut. So he did probiotics, all the stuff you do. And I'm really lucky now that he doesn't And if he has some meat sometimes with a bit too much bone in it, he'll be burping and I can smell it. I smell a bile straight away smell on his breath.

Wow.

So I know he needs something.

Yeah.

And this fits that group of diseases that also occur from where those parasympathetic nerves come out of the lower cervical spine, so the lower part of the neck, including Horner's syndrome, which also comes in there where they get an unequal pupil size. And we'll do another live about about that, just so that people know what Horner's syndrome and the different things are with that. But including, you know, back to the megaesophagus stuff and, you know, how the cardiac sphincter of the stomach closes and opens properly. So again, if you've got links, and it depends on the level of trauma in that area, and some of those breeds, interestingly, you can get those that are predisposed to Wobbler's syndrome, and that's where those parts of the vertebra that are down at that end of the neck aren't actually in line. So they actually have a slight kink in the vertebral space, which means that there's an impingement on those nerves. Now we call them wobblers because usually their back leg wobble, okay, but actually all of the nerve outflows will also be affected. So that's why some of those, like the setters particularly, can also be affected with Something that's interesting, I've seen a few people talk about their dogs have been in for operations and had some issues, and there is some damage that can occur inadvertently from the cuffs of tubes being blown up too high. So they, you know, effectively it can cause some irritation and inflammation and then resultant collapse of the cartilage in the throat, and that can give a very similar appearance and quite a lot of short brachycephalic dogs. So that's the short-nosed dogs like the pugs, etc., that again can— and there's another, the Norfolk Terrier is a classic— that can suffer from a collapsed trachea, a long soft palate, and actually a weakness in the cartilages around here. So there's a little bit of things of working out whether it's a primary primary paresis or paralysis, or a secondary due to other pathology that's going on in that area. So really interesting to hear Karen's experience with this.

What about other treatments, guys? So like, you know, first of all, is there any drugs or natural treatments that can ease these guys' sufferings? And the second one is chiropractic, acupuncture. What about those two? If it's a nerve thing, why wouldn't a little sorted out?

The only thing I ask you— Oh, he's better. The only thing I saw, I think it was last year or the year before, Nick did a jaw-jaw with a group of people, and Tony Nevin was on there, and he's an osteopath, an animal osteopath and human, I do believe. And he absolutely shocked me and Nick because he said that if he get asked a question about laminal paralysis, because Newton does suffer with the polyneuropathy side, he's got a weird misfiring of nerves where he thinks if you touch certain part of his body, he thinks his ear is itching. And I mean, it's quite funny, bless him, but yeah. And he's got a bit of a nerve in his leg that kicks off like this and it will make him fall. And he's got sort of ataxia, and it all comes from this misfiring of nerves. He's got a physio in certain places, she touches him, something else will kick off somewhere else. And, um, Tony Nevill was saying that, um, if you get— if he gets dogs coming to him early enough, so if you just get that little— that when they start coughing or maybe their bark changes, if they come into him, he's actually— the cases he's managed to, um, cure was like 50/50. He like literally said that he can work so much on the throat and then, like Brendan's saying, the back of the neck where there's maybe trauma to the spine and all that nerve issue. He said like dogs haven't actually had gone on to have surgery because he's been able to ease the symptoms if he gets them early enough. I mean, Newton was far too late by the time he's collapsing. Wow. It was just astounding. I'd never heard that before. I didn't think there was anything you could do other than surgery, as Nick was sort of shocked as well.

Yeah, I I remember speaking to a chiropractor, a type of chiropractor, I can't remember what he calls himself, but he was saying that we carry these traumas for years before the actual disease will manifest from the whatever issue. So he says, take for example a difficult birth. A baby can go through a very difficult birth and be left with a few kinks here and there. You can be— you play sports like a lunatic when you're like 6, 7, 8, 10, 15 years old, just getting into rugby and that kind of thing. You take terrible hits but you get over because your body's so malleable, but you carry that kink for ages and your muscles are able to hold your spine straight. But as you get older, things just start to go, I can't hold this anymore. And suddenly issues recurring ear conditions in babies, recurring gastro issues in babies later on in life. And I'm like, oh my God, I can't believe that can be traced back. And he goes, let's start with other damage, he said, but getting them really young. So all his, when you're in his clinic and getting a bit of treatment, 0 to 15-year-olds can walk in for free treatment and they'll just lie up in the bed and he'll just go in 5 or 10 minutes because he's so obsessed about getting it right. And he said, I won't need to see them again. We pay all his bills because we need to see him all the time. I don't personally, it was just after a couple of things. But, um, but yeah, the kids, he says, oh, you just, you won't see them again now. He says, get them early and just fix us and then that's it and they're gone. I know nothing about this end of things, but I had faith in it when he told me that. And he was such a good guy, I just thought, wow, that's, that's bloody— what about acupuncture, Karen? Is that ever Is that a thing?

That's certainly been suggested to me because of more of his polyneuropathy issues, so more of the sort of nerve issues that he has. We're very lucky with him, it doesn't seem to have a lot of hind leg weakness. With him, I don't think there's a lot of feeling in his back end because sometimes he'll be going to the toilet and he won't kind of realize, and then he kind of does and panics. So I think there's definitely a loss— yeah, exactly, there's definitely a loss of sensation there, and you I never used to be able to touch his back feet, but I can now and he doesn't realize I'm touching them. Oh yeah, I mean, you see, you've seen his zoomies.

He's still strong.

I think that's what helps us, and I think that's the diet, being strong. Yeah, muscles that help him, and being lean as well is so important for these dogs. Yeah, because like I said, even though he's had the op, he's still got one side that is faulty. So I still need to be really careful keeping him nice and lean so he's not big, so he's not struggling to breathe. I can't go out with him in hot weather and stuff like that still, because I still have to be super careful. But, um, yeah, he definitely— there's been suggested to me about acupuncture, but I don't— I think it will stress him out. He wouldn't— he's really good with this lady that does his canine massage. He loves that. But I, I don't know how much he would do that.

No, no, his back end is covered in them.

This is true.

There are, there are a couple of things there, you know. I, I always group acupuncture chiropractic, osteopathy, myofascial release. Okay. Yeah. But no, myofascial release is slightly different again. And actually, yeah, there's some cupping stuff that can be done, which is actually strange. It's not pressure in, it's, it's taking and releasing the skin from the underlying fascia and all sorts of benefits there. But you can, if you're ever worried about acupuncture and placing needles in your dog because you might think they're needle shy. You know, there are options with laser therapy. There's lots of people with K-lasers now. I see somebody's mentioned about red light therapy. You know, certainly I tend to find that red light therapy gives a shorter relief for some of those issues, but they're not sort of as long-lived as some of the laser would give. But certainly moving on to acupuncture, I think, is is there. So lots of options in those. There are some herbs and things like that. St. John's Wort, we know, for, you know, keeping ourselves from getting depressed. It has some other neurological effects. That's also found in remedies like Hypericum, is made from that. Okay, so understanding the use of Hypericum. Lathyrus is also one that's used for that sort of laryngeal paresis and singular muscular sort of paralysis areas as well. So can, you know, if you've got certain muscle groups that have thinned down for no other apparent reason, you know, it can be really useful. So there are some things out there.

Definitely. Is there no drugs? I saw there was a new one that came out, and doxepin or whatever it was called, but the latest study was no, not very effective. But is there not like things that can help tell them? It's like anti-inflammatories and whatnot.

No, most people will use an anti-inflammatory. They'll try and just affect what's going on for any nerve outflows. So any impingement that may be aggravated by inflammation, they may use those, may even give steroids, okay, just to try and see if they'll ease them off. Obviously, there are very occasional ones that may be down to immune-mediated disease, which is attacking those those nerves and causing the polyneuropathy. But again, I think there's limited effect in many of these cases for those anti-inflammatories of any description.

No, that's sad to hear.

So I think one thing that I do, you know, Karen touched on earlier, and I think it's really important as we're getting, you know, sort of close to our time, is one of the reasons I mentioned about summer is coming, and this is a really important condition for this, is exactly how the airflow is affected, and therefore the dog's ability to cool themselves down is affected by this condition. Okay, as soon as you get one side, you know, either tied back, as in Karen's, you know, dog with Newton, or you've got just a paresis going on and you've got a flaccid vocal cord flapping away, it diverts the airstream away from going directly over the tongue, okay, to going off to one side, and therefore they're not as efficient at cooling themselves down. So please, please, please, guys, remember, walk your dogs early in the morning or late at night, you know, dusk and dawn stuff. Don't walk them in the heat of the day. Number of dogs that have come in with laryngeal paresis or laryngeal issues. So the bulldogs, etc., that cannot breathe properly over their tongues, that will come in with heat stroke in the summertime because people insist on going out in the middle of the day, have a picnic, take the dog, let it run around like a lunatic, and before you know it, they're in with heat stroke.

Yeah, somebody posted up there slippery elm for the acid reflux. I'd actually reach for German chamomile because there's studies behind that and it shows it absolutely works. We've got decent kind of response for acid reflux and using German chamomile, so that'll be my definite go-to. But I'm sure— also, have you tried any of these sort of things in Newton? Do people use that sort of stuff to control their symptoms?

I mean, given one of your products— a bit of a plug there, Conor— the BF8 has worked for him and does if he has a bout of it. Yeah, and I do use SlipReal. I do use that if I just feel like— because I know with him, because he gets really— he'll cough more and it— I can smell just a really biley smell on his breath. It's really strange how suddenly I can smell it. So SlipReal is really good for that. Um, but since the probiotics and since, you know, that really did calm it all down, sort of just doing that gut healing. And say, I think, I think the diet is, is important there with the reflux issues massively.

Because, yeah, I saw somebody with a Labrador that was panicking that she couldn't slow the dog down eating, and no matter what she did, she tried to feed him from the hand, he was getting stressed, he wanted more food. So she just started hiding little tiny pots of food with one meatball in it around the garden, and she'd put 3 out at a time, lock them behind the patio door, walk out, hide them around the garden. He comes out, tries to find them, but it means he has to eat it and go off and find the next thing maybe it's an excitable way to do it, but I thought that was kind of cool. But like what these people, so many people go through, in particular very bad cases. Like it's, uh, on the plus side that the operation was like 90-95% successful. Like people were really happy with the operation. It's just, uh, it's a bit of a shock to the system that you now have this dog that you have to really change a lot of stuff to, to keep them regular. But you are just, uh, proving the button there. Like that's if you do Yeah, taking—

especially Labrador that eats everything— taking them out, like eating grass is so hard with him because they want to do it and, you know, I want to let him do it. That is the one thing that I'm forever having because he'll just be like, and he can't swallow it, and I'm forever pulling it out. And it's pretty terrifying. Yeah, but, um, it is, it is difficult because he wants to eat everything he finds, God knows what, on walks, and he wants to eat it and and I spend all my time literally making these meatballs and like not giving him this, and it's like I go out and it's just inhaling rabbit poo for the whole walk. Yeah, I mean, we're so lucky with him that he's pretty good. We've not had that many issues with him with, you know, sort of bringing up stuff or regurgitating stuff. And we're so lucky, so far nearly 3 years he's had no incidents of aspiration pneumonia, which is obviously such a massive concern, which is why you have to feed them the way you feed them because you don't want anything going down the wrong hole, basically. So, um, yeah, that's why we have to do it that way. And it is for life, you know, for his life now. That's how he has to eat. People, when you're out, can I give your dog a treat? No.

It's like, no, yeah, yeah, it's like he's—

I've tried to give him rabbit ears, and if a bit breaks off, he's choking. I mean, most of the time he will cough it up, but he's just I don't need stress, quite honestly. It's like, it's such a worry.

I can't help but think that the, in line with what we started off with, which is the surcharge for raw-fed pets in clinics, I can't help but worry that a conventional vet would never recommend, you know, fresh food for a dog with laryngeal paralysis because the thinking would be this food is so nuclear toxic that if it was to go down into the lungs, well, bloody hell, you're going to kill them stone dead in the belief that kibble doesn't have those issues. I mean, bloody hell, there's things on kibble you do you not want in your lungs. Mycotoxins being the number one, and it's on every single product they test. I mean, it's rife because it's a cereal-based product, you know.

It's a massive worry of a lot of people that have never fed raw. They'll say to me, aren't you worried about bacteria if it gets in his lungs? Or straight after surgery, they've got like an opening inside, aren't you worried about the raw meat in the— you just have to kind of explain the same thing. It's, you know, it's not, it's not dangerous. It's not, it's not full of bacteria that's gonna go in their lung and kill instantly, you know.

Yeah, we've got— I mean, you can use cooked food for a while after these mega operations and stuff. Duddy had a massive, you know, ate a whole heap of random bits and pieces as a typical cocker spaniel pup. So like, you know, you can give them a bit of cooked food for a while if you're worried, but moving to fresh food, it's good to hear that you do it. Is there many people like you that do fresh feeding of these dogs, Karen, or are you a quieter voice in the group?

On the, on the Laryngeal Paralysis Support Group, there's quite a few people that feed raw. After a few years, people go back to giving bones um, you know, it's, it's just me personally, I know that Newton will just gulp them down, so I can't do it. It's just every dog is so different, um, that I don't. But there are quite a few. Yeah, I mean, there's— there are— they're definitely out there. It's, um, I think it's very difficult when you've got a dog with this condition if you've only fed kibble and you've— they suffer terribly with reflux and things like that. I think you're so terrified to change the way you do things because you're just so scared that dog aspirating. I mean, I feel I know the feeling. It's so scary to think your dog can aspirate and be poorly. I used to be terrified a bit, but now I know with aspiration pneumonia, you just got to look out for certain signs like lethargy, and if they go off their food, if they're coughing more. Like, first thing I did when Newton got surgery was buy a thermometer because you just constantly— if they're off a little bit off, you just want to take the temperature, they'll have a fever and stuff like that. But, um, now I know it's kind of like I look out for it and to catch it early it's, it's not a death sentence, you know. For me, that's not as much of a death sentence as him suffocating to death like he did.

Yeah.

So it was, it was kind of— I mean, the choice was taken away from us with surgery. He had to have it because it was an emergency. But, um, I would always say to someone, if you can get it done earlier rather than— because it will progress. And like me, when it just came on so quickly, yeah, um, he was just collapsed, you know. And by then his heart was weaker because of the lack of oxygen for so long. So people— surgery can be really scary, and I understand it. You won't find anyone that was more terrified of it than me. Yeah. Um, I mean, I contemplated, should we do it or should we just end it for him? That's how scared I was. But it was like, no, you know, we'll probably get 6 months out of him. And 3 years later, here he is.

Did you ever do this operation, Bren? I mean, it must be terrifying the first time you have to do a dog's— get in there at a dog's, uh, you know, um, I can't get the word out. I was going to say voice box, But like, get in at those bits and pieces. And like, how do you even practice that? Because I can't— I assume we practice on dead dogs, but like, dead dogs would not be— you would just do the same operation surely on a dead dog's shoulder. Is that— have you done this operation? Is it scary to do?

It is, it is very scary to do, you know, but it is. And, you know, it's just as I think somebody earlier mentioned, you know, some of the cases where you're dealing with with long soft palates and laryngeal collapse and trying to deal with those brachycephalics. And you have to be on it for their recovery because they can get edema, that's inflammation following the surgery. So some of these actually have to have an extra tube placed in through the trachea so that they can bypass the larynx whilst everything calms down. There are a lot of surgeons now that don't like to do that or don't want to keep them in or don't have the facilities to keep them in overnight, and therefore they will try them at home. And it's looking at the appropriate practice that can now keep an eye on them for sometimes even 2 to 3 days post-surgery to make sure that they've made a full recovery, that all the inflammation has gone down, and that they can cope group back in their home environment. And, you know, I think so many people will have found tonight so helpful from you, Karen, of having experience of how to deal with those patients, you know, from the horse's mouth, so to speak, in the sense of, you know, knowing what, what has worked for your individual case. And there are some groups out there. Are you part of those, Karen, as well?

Yeah, the one I'm on is the laryngeal paralysis support group on Facebook, and they are amazing. They really are. I just wanted to say one thing, because a lot of people ask it on there when people come on and they've got a dog that's suspected laryngeal paralysis. Unfortunately, there are quite a lot of vets that don't know a lot about it, and they'll just say, oh, you don't want to do the surgery, it's such a big risk. All I'd say to those people is insist that you get referred to a board-certified soft tissue specialist, because they're the ones that do this every day. Like, my— our surgeon was like, it takes me 20 minutes, it's the easiest thing in the world, because she knows the anatomy like the back of her hand. If you see those people, they put your mind at ease. I mean, we were so lucky with our vet that he was just like, have the surgery, it's amazing, do it, I'll refer you. Um, so we were very lucky. But I think a lot of people get really, really scared by their sort of their own vet who may not know enough and just says, oh no, you don't want to do that, the rest of their life you've got to feed them this way and that. But soft tissue— I mean, our surgeon was just so laid back. She was like, he's fine, just go live your life. You know, she did she was like, yeah, you can do meatballs if you want, you don't have to. Just, yeah, it's, you know, it's totally different to someone that, fair enough, doesn't have the experience. They're not going to obviously feel the same. But, um, that's all I would say to people because I see that a lot on the group. Oh, my vet didn't recommend it. And sometimes, like with Newton, he had such weak back legs before his surgery, and that can be a reason a vet will say don't have the surgery. They're too weak, their back legs have gone, the polyneuropathy his polyneuropathy is setting already. But it's like Newton had it, and within like 4 or 6 months, he had massive muscles in his back legs because of the oxygen had come back. Yeah. So, you know, that's all I'd say to people is don't kind of be put off. Just go and see that board-certified specialist, you know, the soft tissue surgeon, and get their opinion. That's really, really important.

That's cool. I want to say thanks so much for coming in tonight. That's a, that's a great story, and it's such a kick in the ass a little bit to say, Jesus, could I perform CPR on a dog? I really don't think so. I've seen a few videos. I missed my CPR course because of the birth of my kid, and so like I need to sharpen up a bit. So if that alone is the thing that we, that we kind of enthuse on people today, so that's not good news. And even start with a YouTube video, but guys, get yourself booked into a course. It's so easy. And if it's not your dog, could be somebody else's. I can't help but think, just parting thought for me, and everyone can have a go, but this is mine. An awful lot of this disease that we're seeing in dogs is idiopathic. They can't pin it down when they look and see, is it, is it— most of them do believe that it's, there's a physical trauma is definitely a major factor, but they can't pin it down. And when they test it, the people at the top that are looking at this all the time— you shared with me a brilliant scientist, Karen, I can't remember the lady's name, but she knows more about this than anybody, and she can't give us a definite answer of all the causes of this. I just want to direct people to this TED Talk TED Talk, check it out on YouTube. It's called I Did My Research, Blew the Whistle, and Found Myself at War. Okay, I Did My Research, Blew the Whistle, and Found Myself at War. Check out that TED Talk on YouTube and you tell me what, what after that. It's very, very interesting, but megasophagus in dogs, about one vet tried to tell the world about and the cause of it, and you won't be surprised what it is because I'm smiling and I'm happy. But I believe there's something there because they don't know why it was kicking off the nerves in this instance, and they don't know why it's happening here. But although Brian has made a very, very good case for physical trauma and damage to nerves and whatnot, and I'm totally convinced, as I always am, Brian, when I don't know something and I come into one of these things, you always do the job for me. Takes a while though, takes the 45 minutes.

Just convince Conor every week and then I'm made up.

What am I going to— what do I want to learn about next week. You know, wormholes, like, are they a thing?

Quantum physics, that's what we're doing next week.

I'm not coming on for that one. I'm not coming on.

I'll be missing as well.

I'll be good, thanks.

Yeah, listen, thanks very much, guys. I've got to dash. I've got to—

I've got— and thank you so much, Karen. Um, uh, if any of you want to see pictures of Nick's holiday, uh, then Speak to Conor. I'm not posting anything because I'm away in May and I don't dare think what they might post in those circumstances. So, so that's you, Conor.

Yeah, I'll make money out of it somehow. We'll wait till he gets back anyway.

Yeah, brilliant. Take care, guys. Always great.