1.5 yr old pug on Dex for laryngeal collapse

My 1.5 year old pug was diagnosed at 10 months old with laryngeal collapse (no known treatment) - stage 2 veering on 3, tracheal collapse and also bronchial collapse (one of the main bronchial tubes collapses when he breathes). He is doing well and has always done well. Symptoms are that you can tell be puts in a bit of effort to breath and has audible breathing. We keep him very calm.

He was put on dex after his pallet reduction/dental surgery in April. Hair has not grown back. He has a bony forehead (looks kind of like a klingon) and is starting to develop a rounder belly. He was on .5mg of dex twice a day until a month and a half ago. I now have him on .5mg once a day. His breathing is not as good as it was before the reduction. It is a balance. He is also on 1000mcg flovent twice a day just in case it helps.

I have an appointment at the University of Montreal Vet School in St. Hyacinth on Friday about blood work and discuss the dance of steroids to keep inflammation down and cushings. Most of the info I see on line is regarding naturally occurring cushings. I wish I knew what was more life threatening - the laryngeal collapse (which they want to keep from progressing)/tracheal collapse/bronchial collapse or the cushings. He is obviously very sensitive to the dexamethasone.

I would like some feedback on those of you knowledgeable in cushings? Should I be requesting something specific with the blood work?

Thank you!

Have him checked for a liver shunt. That is actually quite common for pugs, and usually shows up in them as puppies or up to a few years old. Does he have any behavioral changes?

Are you saying that he has diagnosed cushings? I'm no expert on cushings, but I would go out on a limb and say I'm quite experienced with pugs. We've had a number of pugs in rescue that suffered from collapsed trachea.

The tracheal issues are part of the pug makeup to an extent, and bad breeding can make them much worse, but true collapsed trachea is something you'll need to manage for life. I assume you had more than one opinion on the CT diagnosis? It is often misdiagnosed. The main symptom is coughing and wheezing. Especially the coughing.

You don't say his weight, but any excessive weight can stress the breathing. Also, never, ever use a collar on him. Always a harness. Any pressure on the trachea is bad.

I have heard of surgery for CT, such as rings or stents, but I am not sure how many vets actually do them. I believe in the US, there are very, very few veterinary medical schools that will, and the outcome is no guarantee.

The cushings symptoms would be due to steroids. Steroid I read can cause cushings. Not sure if its any different than naturally occurring (pituitary or adrenal) cushings.

The veterinary hospital has agreed to do a tie back for his laryngeal collapse but only if I do a tracheotomy - if he ever has surgery. Its not the norm for collapse but there is a journal article with a small study (15 dogs I think) that was promising. It was diagnosed by endoscopy. I am a member of a great pug forum. No collars, bought him central air, keep him calm - no excitement.

He is overweight. The dexamethasone makes him absolutely ravenous. Bordering on cruelty. He has lost a kg. We give him low calorie food, buy him bullysticks/bull wrinkles which take him a very long time to eat, and give him green beans to help keep him occupied. He was not like this at all before the dexamethasone. We used to have to dance to get him to eat.

Thank you for your reply. I don't know what people did before forums.

Yes, steroids can cause what is called, iatrogenic cushing's syndrome. Usually, you decrease the steroid and the cushings starts to go away. However, you can't just remove them from steroids, that has to be done via a vet gradually and with the various issues I don't know if he can go off the steroids or not.

Any specific testing for cushings would be off due to the steroid use too.

Some of the others will be along to give their thoughts.

Again, welcome to the forum.

Sharlene and Molly Muffin

Hello and welcome from me, too.

Gosh, I am sorry for the magnitude of the problems you are having with such a young boy! I am afraid you are finding yourself in a situation that will require some very expert advice. It sounds as though you are being forced to balance a very delicate set of conflicting issues arising from the need for the anti-inflammatory action of a steroid vs. the serious consequences of longterm use. We can confirm that steroid use can indeed produce the very same symptoms associated with elevated levels of natural cortisol. What I do not know, though, is whether there is a alternative to the steroid that will provide your dog with the same degree of relief re: his tracheal and bronchial issues.

I am really glad you will be going in for the specialty consultation. Perhaps there are some other medications that can be substituted for the steroid. In terms of testing, the ACTH blood test is the "gold standard" for iatrogenic Cushing's. But in your dog's case, I'm guessing there is little doubt but that the dex is causing these new problems. The bigger question will be, is there a different treatment that can be substituted?

Marianne

Has anyone mentioned Adequan shots to you? My dog has tracheal problems also and she gets these shots every 3 weeks. I have noticed a sizeable difference in her since starting them. Maybe you could ask your vet about them. Blessings
Patti