If your senior dog has been diagnosed with laryngeal paralysis you may wonder if tie back surgery is the right treatment option. You may know the risks and benefits, yet you may feel overwhelmed by the decision. Integrative veterinarian Dr. Julie Buzby became a proponent of tie back surgery, not by what she’d learned in veterinary school, but by learning from her patients. On the blog this week, she shares the stories of two dogs with laryngeal paralysis whose owners chose tie back surgery and had no regrets. While there is no one-size-fits-all solution to a disease like lar par, our hope is that these stories are helpful as you wrestle with your decision.
Struggling to breathe: Max’s story
“Trouble breathing” is not something I ever like to see on my list of appointments. Breathing issues can be true emergencies and many times end with me sharing bad news to owners.
I didn’t have to ask why Max was there to see me that day. His respiratory effort and heart rate were extremely labored—so much so, I could hear him struggling to breathe down the hallway. Although his tail was still wagging, you could tell that he was tired, anxious, and fighting.
Max was a 12-year-old, rather chunky, yellow Labrador Retriever. He always panted when he was happy and excited, but lately he was even breathing heavily at rest. His bark turned raspy, and he sometimes coughed and gagged after drinking water. He used to outlast the grandkids in the pool, but now he grew tired after just a few laps.
The day he came to see me, I ordered X-rays and bloodwork, and sedated Max for a laryngeal exam. This confirmed my suspected diagnosis — laryngeal paralysis.
Max’s parents wanted to understand all the treatment options. Understandably, they were adamant that they never wanted to see him struggle to breathe like this again. We talked about medications, home management principles, and alternative therapies. But mostly we talked about tie back surgery—the most common surgical procedure used to “open” the airway for dogs with laryngeal paralysis.
Before diving into the benefits and risks of tie back surgery for dogs, we need to understand laryngeal paralysis. You can find comprehensive information about this condition by reading my ultimate guide to laryngeal paralysis in dogs, but let’s briefly review.
What is laryngeal paralysis?
Laryngeal paralysis, or “lar par” as it’s sometimes called, is a condition where the muscles controlling the laryngeal opening do not function properly. But the problem goes deeper. The muscles are not the root issue. The nerves which control those muscles are the real problem.
Laryngeal anatomy in dogs
To understand how tie back surgery may improve a dog’s life, it’s important to have a basic understanding of laryngeal anatomy.
The larynx houses the vocal cords, which is why it’s also known as the “voice box.” It is composed of muscles and cartilage, and is situated at the opening of the windpipe (trachea) in the back of the throat. The opening to the esophagus is adjacent to the larynx.
In a healthy animal, muscles open the larynx during breathing and close the larynx when swallowing to prevent food or water from entering the lungs. Two cartilage flaps — one on the left and one on the right of the larynx — function like a set of double doors that open and close to control what enters the trachea.
Laryngeal paralysis explained
For dogs with laryngeal paralysis, the cartilage “doors” are broken. They may not open or only partially open. Turbulent, restricted airflow going past poorly functioning cartilage fold(s) causes the noisy, raspy breathing we associate with this condition. (Do you get the visual picture on why the its called the “tie back” surgery?)
The weak folds also increase the risk of aspiration (food or water being inhaled into the lungs) since the “door” to the upper airway doesn’t shut properly, leaving the airway unprotected during eating and drinking. If you have ever taken a drink and ended up coughing and sputtering because it “went down the wrong pipe” you have some idea what this is like.
Signs of laryngeal paralysis in dogs
Laryngeal paralysis commonly affects older, large breed dogs. Clinical signs, like those Max had, include:
- Raspy breathing
- Changes in the dog’s bark
- High-pitched noisy breathing (stridor) which may worsen with exercise or excitement
- Coughing or gagging, especially when drinking or eating
- Lack of energy
- Increased panting/respiratory effort
Increased difficulty breathing can cause a dog to become anxious, which in turn increases respiratory effort even more. In some cases this can snowball into a respiratory distress crisis. For many pet parents, the motivation to prevent recurrence of a life-threatening respiratory crisis is the number one factor in their decision to proceed with the tie back surgery for their dogs.
Progression of laryngeal paralysis
Laryngeal paralysis is a progressive disease. Symptoms usually start out mild and become more obvious with time. Some dogs also develop generalized weakness in their hind end because we now believe that laryngeal paralysis is one component of a condition called Geriatric Onset Laryngeal Paralysis Polyneuropathy (GOLPP). The word “poly neuropathy” means many nerves are involved and explains why the nerves and not the muscles are the real problem with lar par.
How do veterinarians treat laryngeal paralysis?
Unfortunately, there is no effective long-term non-surgical medical treatment for laryngeal paralysis. Dog parents may use these strategies to manage milder cases:
Home management changes:
- Eliminate the use of a neck lead (collar)
- Restrict activity
- Avoid overheating
- Reduce anxious situations
- Changing at mealtime
- Anti-anxiety medication
- Anti-reflux medications
- Physical therapy
While these nonsurgical treatment options can help manage mild to moderate cases, as the disease progresses, often tie back surgery offers the greatest opportunity for best quality of life.
Max’s story continues
Max’s parents decided to start with conservative treament. His owner only walked him on a harness, restricted exercise to the cooler times of day, and started him on medications. Some days were better than others, but he did okay.
But I’ll never forget the day his mom rushed him into the clinic in true respiratory distress. He was in a life-threatening crisis. Thankfully, we were able to stabilize him with IV medications and oxygen therapy, so Max could be referred to a soft tissue veterinary surgeon. The specialist discussed treatment options and pros and cons. Max’s family decided tie back surgery was the right decision for him.
What is tie back surgery for dogs?
While there are different surgical treatment options available, the most common procedure performed by veterinary surgeons is a unilateral arytenoid lateralization, or “tie back” surgery.
Tie back surgery for dogs involves changing the anatomy of the larynx. During tie back surgery, the veterinary surgeon makes a small incision in the side of the dog’s neck and sutures the cartilage flap on one side of the larynx in a permanent, semi-open position. Think about it as permanently propping one of the “doors” of the larynx partially open to improve air flow.
By opening just one side, the surgeon achieves a sort of happy medium with larynx function. The cartilage flap cannot close and cause breathing obstruction, but it also is not completely open, which would make it even more difficult to protect the airway from aspiration—food or water going down that wrong pipe.
What can I expect after tie back surgery for dogs?
To give you a better idea of what to expect after tie back surgery for dogs, let’s check in with Max again.
Post-operative instructions after tie back surgery for dogs
Max’s tie back surgery was hugely successful and his mom followed the surgeon’s post-operative instructions to the letter. For six weeks, Max was “grounded.” He went for a few five-minute walks a day mostly for potty breaks. She kept Max from getting too active or excited as much as possible—no easy feat since Max, even with his grey muzzle, was known to clear multiple coffee tables a day with his wagging tail.
Setting expectations after tie back surgery
At his next appointment, Max’s mom had some concerns to discuss with me. Although he didn’t breathe with the same disturbing effort, his breathing was still louder than it was before his laryngeal paralysis started and his bark still sounded hoarse.
Max’s owner was relieved but disappointed when I explained to her that these symptoms are normal for dogs with laryngeal paralysis even after tie back surgery and are unlikely to resolve.
If your dog has tie back surgery, keep in mind that the surgery does not restore normal function to the larynx, so some of the clinical signs of lar par may still present after surgery. And like any surgical procedure, there are potential risks to anesthesia and surgery. A tie back surgery does not guarantee success.
But a tie back surgery can help your dog breathe better, feel better, and greatly reduce the risk of severe respiratory distress—that life-threatening breathing crisis.
I think it’s helpful to consider the thoughts of other dog parents who’ve been in your shoes.
The Tie Back Surgery Study by Dr. Mary Gardner
Dr. Mary Gardner, co-founder of Lap of Love Veterinary Hospice, recently surveyed 422 people whose dogs had been diagnosed with laryngeal paralysis. Roughly half of those had chosen tie back (or similar) surgery for their dogs, and the other half were managing the condition nonsurgically.
More than half of the respondents whose dogs had the tie back surgery reported that after recovering from the procedure, their dogs played more, were more active, and slept better. Eighty-seven percent indicated that their dogs had more energy. Perhaps most interestingly, 9 out of 10 of those people said they would do it again.
Long-term restrictions after tie back surgery
Like Max’s mom, owners of dogs who have tie back surgery should abide by the following rules:
1. Use a harness instead of a collar.
Use a harness when walking your dog on a leash to take pressure of the neck.
2. Prevent your dog from overheating.
Even after tie back surgery, our canine companions with laryngeal paralysis continue to be at a higher risk of developing heat stroke in dogs. This is because they still may not be able to cool themselves adequately when panting.
Pay attention to the temperature and humidity outside, restrict walks to the cooler part of the day, and keep the house cool in the summer. Air conditioning serves to lower the temperature and reduce humidity—both key to the well-being of lar par dogs.
3. Avoid taking your dog swimming.
Ideally, avoid swimming. The tie back surgery opens half of the larynx permanently, so the risk of aspirating while swimming can be high.
If you have a dog who loves to swim, it might be an option to let them do so when using a dog life vest that has been modified to protect the airway. But before allowing your dog to swim with the modified life vest, please consult with your veterinarian or veterinary surgeon as it may not be a safe option for all dogs.
4. Help your dog achieve an ideal weight.
Ensure your dog is the ideal weight with the canine body condition score. If your dog is overweight, work with your veterinarian to develop a weight loss program. Losing excess fat around the chest and throat can make breathing easier.
Aspiration pneumonia after tie back surgery for dogs
Echoing the surgeon’s counsel, I cautioned Max’s owner to watch for signs of aspiration pneumonia, a lung infection which may occur when foreign material (like food particles) enters the lungs. Approximately 15 to 20% of dogs experience aspiration pneumonia after tie back surgery. Since the larynx cannot completely close, the risk of inhaling food and water when eating or drinking is increased. We talked about trying a slow feeder bowl to reduce the aspiration risk by “pacing” Max’s meals.
Signs of aspiration pneumonia in dogs
I also asked his owner to monitor his breathing and temperature for the following changes, which can be early signs of aspiration pneumonia:
- Increased respiratory rate
- Changes in respiratory effort
- Nasal discharge
- Decreased appetite
The conclusion of Max’s story
Despite his modified lifestyle, the tie back surgery drastically improved Max’s quality of life for several years. He breathed more easily and did not have another episode of respiratory distress like the one that lead him to need the tie back surgery. His story is simply one of many that have made me a believer in the life-saving and life-changing benefits of tie back surgery for dogs.
Sadly, the underlying neurologic issues causing Max’s laryngeal paralysis progressed, and he developed significant weakness in his hind end. Nearly two years after his tie back surgery, Max’s mom decided it was time.
Together we celebrated Max’s long life, and the “bonus” time his owners had with him after his tie back surgery. They knew that saying goodbye to a dog is heartbreaking, but it was their final gift to Max.
I want to share one more story with you. It’s a story of finding hope and community in the midst of fear and uncertainty. Keep reading to discover how one dedicated dog mom’s laryngeal paralysis journey with her heart dog, Rusty, led to the creation of a Facebook group that has helped thousands of people whose families have been touched by lar par.
Rusty’s story: Tie back surgery for dogs
Rusty’s story with laryngeal paralysis began simply enough. His owner, Wendy, suspected he had an ear infection, so she scheduled an appointment with her local vet. The day of the appointment, Wendy’s husband noticed Rusty’s breathing had changed.
They both knew something was wrong.
They hurried to the veterinary clinic as Rusty began to struggle. Wendy wisely called to give the clinic a heads up that Rusty had more than just an ear infection. As soon as they pulled in the parking lot, the vet staff rushed them to the treatment area where Rusty received oxygen and medication to get him stabilized.
The vet recognized the urgency of the situation and presumptively diagnosed Rusty with laryngeal paralysis. This was an emergency, and Rusty would need to be transferred for 24-hour care.
After leaving Rusty at a specialty hospital overnight, Wendy and her husband learned the full extent of his condition the following day — one laryngeal fold wasn’t functioning at all, and the other was only functioning at 25%. The vet told them Rusty was a good candidate for tie back surgery.
Because Rusty was 12 years old, Wendy and her husband weren’t sure if tie back surgery was the right course of action. Like many owners of dogs with lar par, they were dubious about the wisdom of putting their senior dog through anesthesia and surgery with no guarantees.
In the end, however, they decided to move forward with it. Rusty recovered from surgery happy and healthy, and Wendy and her husband were incredibly thankful they had decided to do the tie back surgery.
Laryngeal paralysis support group
After walking with her senior dog through a laryngeal paralysis diagnosis and surgery, Wendy and her husband wanted to do something to help others.
“When we were in the heart of Rusty’s situation, there really wasn’t a place for us to go. I would talk to my regular vet, but when I would get off the phone or leave the office, I’d have a million other thoughts and questions. When things went bad fast, we didn’t know who to talk to or where to turn for advice and encouragement. It was just my husband and I trying to figure it out,” Wendy shares.
On Facebook one day, Wendy chatted with a friend through her rescue group who was going through the same thing. As she and her friend talked and offered support to one another, a light bulb clicked on in Wendy’s head. “Maybe if I create a Facebook group, I can help even more people!”
Wendy guessed the group might reach thirty or forty members. Today the group has over four thousand members. As a member of the group, I can personally attest to the compassionate support and valuable information exchanged.
In fact, it’s the group that Dr. Mary Gardner, whose dog also had tie back surgery years ago, surveyed to collect her data. Members discuss “all things lar par” (not just tie back surgery) and respect for whatever choices owners make for their own dog’s situation is a standard Wendy insists upon.
Hope for dogs with laryngeal paralysis
If your dog has laryngeal paralysis and you’re considering tie back surgery, know you’re not alone. There are hope and options for your beloved senior dog. Here are two things you can do today to ease your worries and begin to get the answers that you need.
- Speak with your vet. Ask your vet about specialists in your area who can discuss the pros and cons of tie back surgery for dogs. Even if my clients determine that surgery is not the right course of action after meeting with a specialist, I encourage them to get the second opinion for peace of mind. Knowledge is power.
- Join Wendy’s support group. The Facebook group called Laryngeal Paralysis (LP) Support Group (Dogs) will be a tremendous source of empathetic support and helpful tips.
Are you considering tie back surgery for your beloved dog?
Please comment below. We can all support each other.