Thank You Sponsors! 10/3/15. Brachycephalic Airway Syndrome. Breathless in Seattle Kristin Kirkby Shaw, DVM, PhD Diplomate ACVS & ACVSMR

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1 10/3/15 Breathless in Seattle Kristin Kirkby Shaw, DVM, PhD Diplomate ACVS & ACVSMR October 11, 2015 Copyright 2015 Animal Surgical Clinic of Sea:le. All rights reserved. Thank You Sponsors! Brachycephalic Airway Syndrome and Brachycephalic anatomy what makes them so cute! Components of BAGS more than you may have been taught. History and examination and what the owners think. Surgical intervention when is the best time? Medical management beyond the airway. Prognosis the sad truth? Copyright 2015 Animal Surgical Clinic of Sea:le. All rights reserved. 1

2 Rise of the Frenchie: A Global Welfare Issue? French BD Breed Ranking USA: #38 UK: # # #4 Severity of respiratory signs are worsening due to selectve breeding 60% of owners do not recognize signs of significant BAS Liu, N, et al. Plos One 2015; How does severe brachycephaly affect dog s lives? Results of a structured preoperatve owner questonnaire Frauke S. Roedler, Sabine Pohl, Gerhard U. Oechtering 100 questonnaires (61 pugs, 39 FB) Mean age: 3.3 y (8 mo- 11 y) First clinical signs at ~1 year (3 mo- 4 y) 82% said clinical signs became more severe over Tme How does BAGS affect your dog? Loud breathing 100% when exercising 91% while sleeping 66% at rest Choking fits: 70% 40% at least once a week Collapsed at least once: 36% CyanoTc 20% >once a year 7% > once a week Reverse sneeze: 73% 2

3 What is the most restrictve problem for your dog? Exercise Intolerance How long can you go for a walk with your dog? = = How much Tme does your dog need to recover? = = 3

4 Summer is not a bulldog s friend Temperature > 66 o F led to worsening of respiratory signs 46% of dogs have problems eatng at least once a day: FB more frequent than Pugs Components of BAGS Nasal StenoTc nares, aberrant conchal growth, deviated septum Pharyngeal Excessive nasopharyngeal turbinates, elongated & thickened som palate, everted tonsils, redundant pharyngeal Tssue, macroglossia Glonc Everted laryngeal saccules, laryngeal edema, laryngeal collapse Tracheobronchial HypoplasTc trachea, bronchial collapse GastrointesTnal 4

5 10/3/15 The consequences of no nose Copyright 2015 Animal Surgical Clinic of Sea:le. All rights reserved. The domino effect: Part 1 Stenotic nares! overgrown conchae!e/tsp! everted tonsils and everted saccules! laryngeal edema!laryngeal collapse Copyright 2015 Animal Surgical Clinic of Sea:le. All rights reserved. Intranasal mucosal contact points Schuenemann R JAAHA

6 Septal deviations in most Pugs Schuenemann R JAAHA 2014 Conchae Nasal mucosa Olfaction Thermoregulation evaporative cooling Airflow past the conchae is a negative feedback for growth (this means the nares must be open) Aberrant conchae present in 100% of brachycephalics and often cause obstruction (Oechtering et al. 2007) Copyright 2015 Animal Surgical Clinic of Sea:le. All rights reserved. Respiratory Signs Snoring, stertor "Cough" Reverse sneeze Stridor Dyspnea Tachypnea Heat & exercise intolerance Cyanosis/ Syncope PROGRESSIVE! 6

7 97% had esophageal, gastric or duodenal Some of these dogs didn t have clinical signs of GI disease Severity of respiratory signs influences severity of GI, and vice versa The domino effect: Part 2 Hiatal hernia! gastroesophogeal reflux! regurgitation! esophagitis, laryngitits Gastrointestinal Clinical Signs Gagging Coughing Retching RegurgitaTon VomiTng Dilated stomach Flatulence 7

8 No aspiraton pneumonia, mortality 3.3% Good- excellent improvement 88% of respiratory disorders 91% of GI disorders Compared to other studies, decreased and improved prognosis with combined GI management GI Medical Management Omeprazole 0.7 mg/kg q 24 h 1 week at a Tme For life FamoTdine 1 mg/kg q h Cisapride 0.2 mg/kg q 8 h +/- Sucralfate q 12 h +/- Prednisone 0.5 mg/kg q 12 h Poncet CM et al. JSAP 2006 Brachycephalic airway obstructive syndrome in dogs: 90 cases ( ) Fasanella FJ, et al. JAVMA 2010 English BD 61%, Pugs 21%, Boston Terriers 9% ESP 94%, stenotc nares 77%, everted laryngeal saccules 66%, everted tonsils 56% Most dogs had 3 or 4 components Dogs with SN more likely to have ELS Dogs with ELS more likely to have ET Post op complicatons 12% 8

9 10/3/15 Surgical correction of brachycephalic syndrome in dogs: 62 cases ( ) Riecks TW, et al. JAVMA 2007 English BD, Pug, Boston Terrier English BD most likely to have hypoplastc trachea No dogs had everted saccules alone 94% good- excellent outcome Mortality 3.2% Favorable long- term outcome, regardless of age, breed, number/ combinaton of diagnoses BAGS: Surgical approach Alaplasty and ESP early in life; some dogs need additonal surgery later in life Excise laryngeal saccules and everted tonsils Laser- assisted turbinectomy? Remember surgery is only part of the answer Copyright 2015 Animal Surgical Clinic of Sea:le. All rights reserved. 9

10 End Stage Laryngeal collapse Tie- back Permanent tracheostomy Heat stroke AspiraTon pneumonia Copyright 2015 Animal Surgical Clinic of Sea:le. All rights reserved. Clients need to be educated on the realites of owning a bulldog Use tongue to gauge quitting time Stop Playing Here! No reserves lem! 10

11 Take Home Recommendations Correct stenotc nares and ESP EARLY! (~4 months of age) May need additonal surgery later in life Weight management Avoid excess pantng (remember the domino) Do not walk/ exercise when >66 o F Use a harness Light sedaton and ant- inflammatories PRN Treat GI component THANK YOU! Questions? Copyright 2015 Animal Surgical Clinic of Sea:le. All rights reserved. 11