If you’re searching for answers to questions about canine laryngeal paralysis, we’re glad you’re here. As a follow up to her ultimate guide on laryngeal paralysis in dogs, integrative veterinarian Dr. Julie Buzby shares her answers to questions from readers, with a special section on doxepin for dogs. Knowledge can inform our decisions and bring peace to our hearts. Hope and help are here.
21 questions about canine laryngeal paralysis answered by Dr. Buzby
If your dog suffers from lar par, I’d like to offer hope by sharing this message I received from one reader…"There is life with lar par and we are living it." ~ K.A. and her 14-year-old Springer Click To Tweet
When it comes to laryngeal paralysis, I firmly believe that we all have a lot to learn. By no means do I have all the answers to questions, but as a veterinarian, I have access to professional resources and research. Thanks to both, as well as my own experience with my patients, I’ve compiled answers to these 21 lar par FAQs about everything from doxepin to tie back surgery.
Doxepin for dogs with lar par
First, Doxepin for dogs with laryngeal paralysis deserves its own section of FAQs. If your dog has been diagnosed with lar par, you’ve probably read enough to know that doxepin is promising, controversial, and confusing all in one. Let’s shed some light on doxepin for dogs with lar par.
1. Does doxepin help dogs with lar par?
To date, the use of doxepin for dogs with lar par has been considered “anecdotal,” meaning based on personal accounts but not research. And I can provide my own personal accounts of doxepin helping my patients.
Interestingly, doxepin is purported to help 50% to 75% of dogs with lar par. And doxepin’s efficacy seems to be black and white. Either it doesn’t really work well, or it works quite well. Thus, I believe doxepin has the potential to noticeably help dogs with laryngeal paralysis.
However, it’s also important to note that doxepin is not the appropriate treatment for dogs in crisis. Generally, veterinarians prescribe doxepin for dogs who are symptomatic but stable. It’s just one tool in the toolbox for vets who are trying to help their patients suffering from lar par.
2. What kind of drug is doxepin?
Doxepin is a tricyclic antidepressant drug with antihistamine properties. Also, it has sedating effects.
3. Why is sedation helpful for dogs with lar par?
With laryngeal paralysis, stress compounds the problem. So much so, that keeping your dog calm is as important as keeping your dog cool. The “perfect storm” for these dogs is the combination of environmental stress, heat/humidity, and respiratory distress.
Because of this disastrous trifecta, sedative medications are sometimes prescribed for dogs with lar par. However, I believe doxepin is a better all-around choice because it seems to provide direct benefit to the function of the larynx and can also be sedating.
4. In what ways is doxepin reported to help dogs with lar par?
When it works, doxepin seems to reduce the respiratory effort for dogs and makes their breathing quieter. They often experience less stridor (rough breathing), less coughing, and less anxiety. This translates into improved quality of life for both the dog and family.
Please do keep in mind that we now believe laryngeal paralysis is an early symptom of a progressive, neurodegenerative process called geriatric onset laryngeal paralysis polyneuropathy or “GOLPP.” Since there are no treatments for degenerative neuropathies at this time, doxepin is working strictly to aid the breathing component. In other words, it’s not treating the underlying cause. Nonetheless, it can be a wonder drug for certain dogs.
5. I’ve heard there’s a research study on doxepin for dogs with laryngeal paralysis. Where can I read the results?
A five-year study called “Prospective Randomized Clinical Trial of Doxepin in Canine Laryngeal Paralysis” was recently completed. Led by Dr. Mark Rishniw at Cornell University along with veterinarians at Red Bank Veterinary Hospital in New Jersey, the study evaluated 40 Labrador Retrievers with laryngeal paralysis over a one-month period. Twenty of the dogs received doxepin and 20 served as the “control,” only receiving a placebo.
The research paper, which contains much awaited results, is currently undergoing a standard prepublication process called “peer review.”
You can expect results very soon!
6. If doxepin can be helpful for dogs with lar par, might other medications similar to doxepin be helpful too?
This is part of the doxepin mystery, but doxepin is the only medication that seems to improve the symptoms of lar par in dogs. Other drugs with similar mechanisms of action, like amitriptyline, have not been efficacious—that is to say effective.
Which leads us to the million dollar question…
7. How does doxepin work for canine laryngeal paralysis?
The short answer is this: We do not really know.
The long answer is based on a compilation of theories and observations. We know that the mechanism of action is not primarily from doxepin’s sedative effects because other sedating medications in dogs don’t work nearly as well to improve the dog’s breathing. There’s something special about doxepin.
I’ve seen guesses about it affecting neuropathic pain and reducing spasms of laryngeal muscles.
We know that doxepin has anticholinergic effects—which means that it blocks the effects of a chemical signal in the nervous system. Plus, it has antihistamine and antidepressant effects. But frankly, we do not know how doxepin helps dogs with lar par.
8. Is doxepin safe for my dog with lar par?
Here’s the good news—doxepin, along with other medications in its class, are generally considered safe. This is notable because if doxepin helps a dog with lar par, he will probably be on it for the rest of his life.
We’ve already mentioned that it can be sedating. Because of the anticholinergic effect, doxepin can increase the dog’s heart rate. For this reason, it should be used judiciously in dogs with heart disease, especially at higher doses. It is contraindicated in dogs with glaucoma, which means it should not be used.
9. What is the dose of doxepin for dogs with laryngeal paralysis?
It is my practice to avoid discussion of drug dosages in our blogs, and that is even more relevant here because doxepin is a prescription drug being used “off label” for laryngeal paralysis.
However, here are some general dosing guidelines:
- Dogs are typically given the medication twice per day (every 12 hours).
- Capsules come in 25, 50, 75, and 100mg. Dosage is based on a dog’s body weight and severity of disease.
- Typically, higher doses of doxepin are required for more severe cases of laryngeal paralysis.
10. Can my dog who is on CBD also take doxepin?
Always speak with your veterinarian about the drugs and supplements that your dog is taking, as interactions are both possible and potentially very dangerous. However, I do not know of any red flags for dogs taking CBD and doxepin together.
11. Would doxepin or tie back surgery be better for my dog?
Compared to surgery, doxepin is a much more conservative option. Therefore, it’s often used as a “first line” treatment for dogs with “noncritical” laryngeal paralysis. This is how I use it for my own lar par patients who are breathing well overall.
But I have to confess that tie back surgery, in my experience, is often the appropriate long term choice for patients with laryngeal paralysis. At minimum, tie back surgery is worth researching, considering, and discussing with your veterinarian.
12. I’m trying to decide whether or not tie back surgery is the best choice. Will lar par surgery really help my dog?
Dr. Buzby: There was a time when I was on the fence about whether or not the rewards of tie back surgery outweighed the risks.
However, today I can say wholeheartedly that I would choose surgery (performed by a veterinary surgeon) for my own dog. For a comprehensive overview of the benefits and risks, please check out my article on tie back surgery for dogs. For success stories from dog owners who have been in your shoes, read on…
“Oscar, our 13-year-old, career-change yellow Lab had tie back surgery for lar par and for the last year of his life breathed so much easier. The small chore of changing his food, watching him eat, standing, and making sure he didn’t eat or drink too fast was worth it…We were so happy to spend the money to give him a last 9 months of freedom from stress!” ~ Janelle
“My 13-year-old mutt was diagnosed with lar par last year. He had slight relief on doxepin, but as the weather got warmer, he got worse. He had tie back surgery done and is now living his best life as a 14.5 year old. Surgery can be expensive, but I highly recommend it! It immediately changed his quality of life, and mine, as I didn’t have the constant anxiety of worrying about him.” ~ Liz
“My Springer collapsed after a grooming appointment and was rushed to the ER. She was stabilized and subsequently scoped. She was diagnosed with bi-lateral lar par. In retrospect and after learning more about this disease, the symptoms had been there for a while. We also live in the deep South where the heat and humidity are oppressive. We had two options: surgery or euthanasia. Even though she was a senior (12), she was in good health overall. Surgery has given us more quality time with her and she is doing very well now at 14 years old. We are 30 months post op. We’ve had two incidences of AP [aspiration pneumonia] that were identified quickly and responded to treatment. There is life with lar par and we are living it.” ~K.A.
13. Years ago, my Irish Setter had debark surgery for lar par. What’s your opinion on this surgical option?
Dr. Buzby: This surgery has fallen out of favor in modern veterinary medicine—both for preventing dogs from barking and for treating lar par. While the debark is a much less difficult and thus a “cheaper” procedure to perform on a dog, it’s also more risky, associated with more complications, and ultimately less effective for treating the condition. Today the tie back procedure is the gold standard.
14. It breaks my heart to see my dog with GOLPP struggle to get up off the ground. What can I do for my dog with laryngeal paralysis and hind end weakness?
Dr. Buzby: Neurologic weakness and slipping are biomechanical problems which medication does not treat that effectively. Treatment of geriatric onset laryngeal paralysis polyneuropathy (GOLPP) should be multimodal. In other words, your veterinarian will likely recommend a combination of medicine, supportive care, and home management practices.
One of the best-kept secrets for GOLPP dogs is the use of ToeGrips® dog nail grips. Placed on the toenails, ToeGrips provide both stability and increased conscious proprioceptive stimulus. They can help improve mobility and confidence for dogs with GOLPP.
Our blog readers explain ToeGrips® dog nail grips for GOLPP dogs:
“I had a Border Collie with GOLPP…Fortunately for us, the laryngeal component of his neuropathy never got severe enough to require surgery. His hind end weakness did become problematic though, and the ToeGrips we got from Dr. Buzby’s were a great help his last few months. With good vet assistance and support, my boy made it just shy of 16, so there is good hope for those dealing with this problem for extended periods with good quality of life.” ~Lynda
“We lost our amazing foster failure, “clown in a Dogsuit,” Labrador, Beau to GOLPP…not from a breathing crisis as doxepin did help him tremendously, but due to the overall nerve degeneration and mobility and esophageal issues. We have tried to make something good come from his loss by helping others navigate the disease and passing on all the cooling and calming tricks we learned along the way. He also left his DNA at UW-Madison for their study in lar-par/GOLPP and at Cornell for their Biobank and Labrador Health Study. He lives on through the research done with his DNA. And we did used ToeGrips for Beau with success too!!” ~Ally
15. Why is heat stroke more likely for dogs with laryngeal paralysis?
Dr. Buzby: Dogs pant to cool off, and dogs with laryngeal paralysis are much more prone to heat stroke because of their inability to dissipate heat. As dogs with laryngeal paralysis begin to overheat, they begin to breathe harder, but they can’t move air efficiently. This creates a vicious cycle where neither the exchange of air nor the dog’s attempt to cool the body works properly, often leading to heat stroke in dogs.
16. My dog makes a coughing noise that sounds like croup or a barking seal. He also gags or wretches but nothing comes out. Is gagging and coughing associated with lar par?
Dr. Buzby: Yes, I would definitely consider what you are describing to fit with laryngeal issues. However, “inspiratory stridor” (raspy, rough breathing) is considered the gold standard symptom. I recommend discussing your dog’s symptoms with your veterinarian. A laryngeal exam under sedation is considered the gold standard for diagnosis.
17. When going for a walk my dog pulls. Can leashing pulling cause lar par?
Dr. Buzby: There are documented cases of dogs developing laryngeal paralysis from damage to the nerves innervating the larynx as a result of the following:
- Neck surgery
- Cancerous tumor growth
- Deep trauma (bite wound)
However, these cases are really the minority. I asked an expert board-certified veterinary neurologist, Dr. Bill Thomas, to explain why…
Dr. Bill Thomas: The most important thing to understand about laryngeal paralysis in dogs is that it’s almost always a polyneuropathy—that is, a disease affecting multiple peripheral nerves. If you do electrodiagnostic testing on dogs with laryngeal paralysis, you typically find other nerves are also abnormal.
Many neuropathies affect the longest nerves the most. And the recurrent laryngeal and sciatic nerves are the longest, so they are often the most severely affected. (Meaning symptoms would manifest first and most predominantly in the larynx and hind legs.)
It would be possible for any sort of severe cervical (neck) trauma to affect the recurrent laryngeal nerves. But these nerves are pretty well protected and lie in some loose fascia (connective tissue) right next to the trachea.
So I think it would be pretty hard to damage both of those nerves, one on each side of the trachea, without damaging the trachea or larynx itself. Not to mention all the other important stuff in the neck larynx—esophagus, common carotid, vagosympathetic trunk, jugular veins, vertebrae, and spinal cord. ~ Bill Thomas, DACVIM (Neurology), University of Tennessee
18. Is canine laryngeal paralysis similar to collapsing trachea?
Dr. Buzby: Lar par and collapsing trachea are different structural problems. However, both conditions can manifest with a similar presentation—a dog struggling to breathe because the breathing channel has narrowed. In laryngeal paralysis, it’s because the arytenoid cartilage(s) in the larynx are decreasing air flow. With collapsing trachea, as the name implies, the windpipe (trachea) flattens and airflow is decreased.
Also, collapsing trachea tends to be a small dog issue and lar par is mostly a large breed dog issue. Interestingly enough, the cause in both conditions is unknown.
19. Our dog and his littermate both died from laryngeal paralysis. Is lar par hereditary?
Dr. Buzby: The precise cause of GOLPP, the polyneuropathy associated with laryngeal paralysis, remains unknown. However, since the condition is most common in certain breeds, it makes sense to suspect that there is a genetic factor. But this is just speculation at this point. More research is needed.
Keep in mind that polyneuropathies can have many underlying causes. I’m sure some of those underlying causes are influenced by a hereditary predisposition.
Also, it’s worth mentioning that there is a congenital form of lar par which may show up in very young dogs. (As the name suggests, GOLPP manifests mostly in senior dogs.) For Black Russian Terriers and Leonberger dogs, there are tests for the congenital disease. For more information, please read these articles from veterinary colleges: JLPP in Black Russian Terriers and Genetic Test Available for Early-Onset Inherited Polyneuropathy in Leonberger Dogs.
20. How will I know if it’s time to euthanize my dog who is suffering from laryngeal paralysis? I can’t imagine saying goodbye.
Dr. Buzby: It’s heartbreaking to watch your dear dog declining and trying to make the difficult decision of when to euthanize him or her. I understand because I’ve been there. What I want you to avoid at all costs is the desperation of making this decision while your dog is in a life-threatening breathing crisis.
I would strongly recommend talking to your veterinarian about your thoughts. Your vet is your ally in navigating this heartbreaking journey and will give you honest answers based on his or her observations and examination findings.
Also, I’d like to give you some resources that may help. I’ve written the following articles to address this difficult decision:
- Signs Your Dog is Dying — a caring message to bring you comfort
- Preparing for Your Dog’s Euthanasia — 10 thoughts for peace
- Dog Euthanasia — knowing when it’s time to say goodbye
- Grieving the Loss of a Dog After Euthanasia — finding peace through the difficult process.
21. Are there lar par forums or support groups I can join?
Dr. Buzby: Yes! Getting tips and encouragement from other parents of lar par dogs can help make the journey smoother—for your dog and for you. There is a fantastic private Facebook group called Laryngeal Paralysis (LP) Support Group (Dogs) with 4200 members. I’m confident this group would be happy to provide empathetic support and more helpful tips.
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Do you have questions about canine laryngeal paralysis?
Please keep the questions, comments, and stories coming. We can all learn from each other.