Full Title: The Effects of Pet Massage On Laryngeal Paralysis
Author: Kathleen M. Keller
Date of Publication: December 15, 2021
Research Paper Text:
“He’s a healthy dog as long as we can keep him breathing…” I made that statement back in 2019 after rushing my 11 year-old Labrador Pal to his vet.
I had come home from work on a beautiful summer day and let the dogs out to run. As I sat on the swing, I noticed Pal laying on the ground acting like he was trying to throw up. As I approached him, I saw white froth coming from his mouth. I thought he was choking, so I grabbed his muzzle and opened his mouth to do a finger sweep. To my dismay his gums were blue. He couldn’t breathe! I rushed him to the vet’s office where he was given oxygen with albuterol and then placed into an oxygen cage. Then I was introduced to the reality of Laryngeal Paralysis.
Laryngeal paralysis, also known as “lar par”, is a condition that affects the larynx in a dog’s throat. The larynx contains cartilage and sits over the trachea which allows air to flow from the nose and mouth into the lungs. Muscles pull the cartilage of the larynx away from the opening of the trachea to allow air in and it closes when a dog is eating and drinking. With laryngeal paralysis, the nerves of these muscles weaken and/or become paralyzed resulting in these muscles relaxing causing the cartilage to fall inward. This results in an obstruction of the airway since the cartilage of the larynx is partially blocking the opening and compromising the dog’s ability to breathe.
The cause of laryngeal paralysis can be either idiopathic or congenital. The majority of cases are considered idiopathic, or unknown. However, in certain cases, trauma to the throat or neck, tumors in the throat or chest, and hormonal diseases such as Cushing’s and hypothyroidism have been associated with laryngeal paralysis. In some cases, dogs are born with congenital laryngeal paralysis.
Laryngeal paralysis can affect any dog breed. However, it occurs more often in medium to large breed dogs and more frequently in males than in females. The most commonly affected breeds for idiopathic laryngeal paralysis are Irish Setters, Golden, and Labrador Retrievers. The congenital form, where clinical signs usually occur early in life, is seen in Siberian Huskies, Bull Terriers, and Dalmatians.
Research has shown that idiopathic laryngeal paralysis is actually part of a progressive general neuropathy or neuromuscular disease and that the laryngeal paralysis is one of the first signs of this disease. The condition eventually affects the esophageal function and leads to generalized neurologic dysfunction, especially in the back legs. The term Geriatric Onset Laryngeal Paralysis and Polyneoropathy (GLOPP) has been applied to describe these findings.
The clinical signs of laryngeal paralysis can vary widely and be quite subtle. Laryngeal paralysis is probably more common than is diagnosed. This is mainly due to the fact that the initial signs often only involve shortage of breath, noisy breathing, or a cough. In Pal’s case, the initial sign of a cough first occurred in January 2019: five months before his collapse. This initial episode was treated as bronchitis. At that time, the vet addressed the possibility that the cough could be related to laryngeal paralysis. Pal was put on a treatment plan for bronchitis and rechecked two weeks later. At that time, he showed improvement yet still had a loud pant while exercising. The plan was to monitor his progress.
The most common sign is coughing, especially after exertion or exercise, followed by difficulty breathing, stridor, which is a high-pitched whistling sound when taking in a breath, exercise intolerance, and a change in the bark. While the dog is eating, gagging or coughing may occur due to the flaps not closing entirely to protect the airway. In sudden, severe cases, the dog may develop respiratory distress with bluish mucous membranes in the mouth and possible collapse. Pal experienced the latter in June 2019.
Diagnosing laryngeal paralysis starts with a complete physical exam and is based on medical history and clinical signs. The vet will listen to and watch the symptoms the dog is exhibiting.
Bloodwork, and possibly urine work, may be performed to check the function of the adrenal gland and thyroid to ascertain if there are any other medical issues present. A chest x-ray will be performed to identify the condition of the lungs, esophagus, and if aspiration pneumonia has occurred. An examination of the larynx with an endoscope or laryngoscope can be performed to ascertain the condition of the larynx. This is done under mild sedation. An ultrasound scan, done by an experienced radiologist or ultrasonographer, produces images of the neck area and evaluates the movement of the muscles in the larynx. In Pal’s case, although the vet was fairly certain in her assessment of laryngeal paralysis, he underwent all of the testing to confirm.
Once Pal’s diagnosis was confirmed, within days he was scheduled for surgery. His case was considered severe due to his sudden collapse. The goal of surgery is to open the airway, help reduce stridor, and improve respiratory distress. Pal underwent Arytenoid Lateralization Larynoplasty surgery better known as ‘tie back’ surgery. This involves tying back the collapsed cartilage to the larynx with a single suture. This allows for the airway to be permanently open enough to prevent airway compromise or future breathing episodes. The downside to this surgery is that with part of the airway tied open, risk of aspiration pneumonia is increased.
There are, however, other options to treating laryngeal paralysis. In mild cases where there is no history of respiratory distress, changing to a harness from a collar puts less pressure on the upper airway. Feeding the dog from a raised platform, using canned or moistened food and slowing down water intake can help to reduce coughing and aspiration. Other options include restrictions on exercise in warmer weather to reduce airway swelling, weight loss, and anti-inflammatory medications to assist in swelling reduction. In dogs who have lar-par and have separation anxiety or storm fears, sedatives or tranquilizer medications have been recommended.
Another treatment option is acupuncture, a Chinese Medical Philosophy, in which fine needles are inserted into specific locations in the body known as acupuncture points. These needles are then manipulated which trigger the release of endorphins, increase blood circulation, and stimulate the nerves.
Finally, there is a drug called Doxepin that may provide some relief. However, a recent publication on a double-blind, randomized, placebo-controlled trial concluded that Doxepin did not appear to improve any measures of owner-assessed quality of life in the dogs.
So where does pet massage fall into the treatment of laryngeal paralysis? The main goal of pet massage is to create balance within the dog. Massage is in the body of the dog, not on it.
Through a series of touches, the massage reaches every part of the body. A light touch brings awareness not only to the coat and upper layers of connective tissues, but the surrounding superficial muscles. A stronger touch brings awareness to the deeper muscles, tendons, joints, and ligaments. Mobilization of the joints encourages body-movement awareness and allows for self-exploration in the movement to rediscover a place of comfort.
In her blog Naturally Healthy Pets, Dr. Judy Morgan, who practices both holistic and traditional medicine, suggests that following traditional Chinese Medicine, massage could play a part in helping dogs with laryngeal paralysis. Through this method, there are four presentations and different therapies for laryngeal paralysis based upon the color of the tongue. Although the food therapies are different for all four presentations, three of the four benefits from massage along the sides of the neck, lower jaw, and thoracic inlet. These massages should last for three to five minutes and be done twice daily.
With this in mind, I have placed more attention on the front of the neck in my full body massages. By utilizing several massage techniques, the hope is to at least provide some relief for dogs who have laryngeal paralysis, but more so to prevent the occurrence of it altogether. I start with scratching of the neck and lower jaw by gently rubbing up and down from the chest to the jaw. This helps to stimulate cardiovascular, neurologic, and lymphatic circulation. Then I knead and roll the skin and coat on each side of the neck which helps to increase blood circulation and lymphatics deep within the muscles as well as releasing superficial restrictions between the skin and underlying tissue. Lastly, I perform positional release over the neck. My hands cradle the area around the larynx and I am still. During this holding pattern, the body takes control as it shifts internally, experimenting with different ways of positioning itself. The rest of the massage covers the rest of the body including the other area of concern with laryngeal paralysis: the hind legs which has been shown to be a result of the progression of GLOPP. I believe these techniques are beneficial to the health of a dog with laryngeal paralysis. There have not been any scientific studies done to confirm this.
While there is no cure for laryngeal paralysis, with the above-mentioned treatments including massage, the outlook for dogs who have this condition can go on to live full natural lives. It is important for their owners to remain vigilant and seek medical attention immediately should there be any noticeable changes.
The Spruce Pets. com; Adrienne Kruzer; 5-21-21
ACVS.org; American College of Veterinary Surgeons
First Vet.com; Dr Tina Pilgrim; 9-9-21
American College of Veterinary Services
VCA hospital.com; Krista Williams, Ernest Ward
PubMed.ncbi.nih.gov; Doxepin; Mark Rishniw; 5-17-21
Wholistic Paws Vet.com; Dr Krisi Erwin
Naturally Healthy Pets; Dr Judy Morgan; 8-10-21
Canine Massage for Passionate People; Jonathan Rudinger; 2019
The Labradorsite.com; Pippa Elliot; 12-31-18