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Dr. Kara
Dr. Kara, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 15168
Experience:  Over 20 years of experience as a veterinarian.
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My name is ***** *****, it's my pug, My vet showed me her

Customer Question

My name is ***** *****, it's my pug
JA: Thanks. Can you give me any more details about your issue?
Customer: My vet showed me her lung X-ray is 2/3 white and the lungs are sort of lying upon themselves from a collapsed trachea, my pug is 16, the prednisone stopped the honking noise but the antibiotic causes her to vomit, I 'm wondering if the vet is sugar coating the situation as when I asked her if this will shorten her life at all, she said oh no she will live a lot more than 1 year?
JA: OK got it. Last thing — Veterinarians generally expect a deposit of about $19 to help with your type of question (you only pay if satisfied). Now I'm going to take you to a page to place a secure deposit with JustAnswer. Don't worry, this chat is saved. After that, we will finish helping you.
Submitted: 10 months ago.
Category: Dog Veterinary
Expert:  Dr. Kara replied 10 months ago.

Hello, my name is***** and I have over 20 years of experience as a veterinarian.

I am sorry to hear that your pup has compromised lungs, and thus a decreased ability to exchange oxygen.

While a collapsed trachea can cause a cough, especially with excitement or exercise, I would not expect it to cause 2/3 of the chest to look white.

That usually indicates either pleural effusion (fluid in the space between the lungs and chest wall, due to infection, bleeding, inflammation, lymphatic duct being blocked, compressing the lungs and making them look like they are "floating") or pulmonary edema (fluid or tissue in the lung fields due to infection, heart disease, bleeding or altered blood flow or air flow due to a blocked airway or twisted lung lobe).

Here is a link to a picture of pleural effusion. Note that the lung fields have sharp edges, but the lungs themselves look small, don't extend to the chest wall and look like they are floating on fluid:

https://classconnection.s3.amazonaws.com/324/flashcards/1732324/png/pleural_effusion1355257413022.png

Here is a link to a picture of pulmonary edema. Note that the lung edges are not well defined, the white areas are patchy in some places rather that solid, and airways (bronchi) are outlined clearly due to fluid in the lungs around the airways rather than the fluid being outside the lung.

http://www.neuropetvet.com/wp-content/uploads/2015/07/rad-neurogenic-edema.png

If your little one has tracheal collapse she is more prone to developing secondary aspiration pneumonia. That will show up as white that looks like pulmonary edema in the front, bottom part of her lungs.

Aspiration pneumonia can be treated with antibiotics, so perhaps that is what your veterinarian means by this not shortening her life. But if she cannot tolerate the antibiotic she is taking now then she may need a different one.

If she had heart disease causing fluid tom accumulate in her lungs I would expect steroids to make her worse.

It is possible that there is a tumor in her chest causing pulmonary edema, as some types of cancer (for example lymphoma) do shrink with steroid use, although the effects are often short term.

In short I would want to be clear what is causing her lungfields to look abnromal, and if we believe this is related to aspiration pneumonia then we need to get her on an antibiotic her body tolerates.

Please let me know if you have any further questions.

Customer: replied 10 months ago.
hi, i am Randy I did not finish typing out my question when I hit enter and was not able to type anymore but i also wanted you to know that she has been making a "honking" noise for approx. 2 months. So ... Ian wondering, with approx. 2/3 of her lungs ( on her lung X-ray) being white and the radiologist says this white area is her lung tissue "laying down on top of itself", wouldn't you say she is suffering or would you say this area of white lung can come back to normal ...if she has a severely narrowed collapsed trachea? She is 16 years old. She is not overweight, she never was overweight.Is she at an end of life situation?The x-ray of her lungs do not look like the two examples you gave me the links to.
Lungs seem clearly defined at the edges with approximately 2/3 of them ( this 2/3 area starts to be white about 25% of the way down the lungs and continues to spread out from there to cover a wider area as it draws nearer to the bottom of the lungs.Our vet said that her lungs were this way because she was not taking deep breaths and her lungs have not been filling up and expanding as she breathes due to the collapsed trachea?
He is not sure if there is a bacterial component present.
This is the DACVR's findings:
Thorax: Regarding the right lateral and ventrodorsal thoracic radiographs :
The intrathoracic trachea is severely reduced in size and is almost completely collapsed at the thoracic inlet.There is mild increased soft tissue at the caudodorsal margin of the heat but this is also summated by increased pulmonary opacity on the lateral projection.The increase in caudal hilar pulmonary opacity is largely due to summated vascular markings and mild respiratory motion.There is no evidence of pulmonary parenchymal changes on the ventrodorsal radiograph. The mild increase in bronchial markings is within normal expectations for patients age.
Conclusion:
Tracheal Collapse. This is the likely cause for clinical signs.
Mild left atrial enlargement may be present, but is not likely clinically relevant.
What are your thoughts?
Customer: replied 10 months ago.
Thank You in advance.
Expert:  Dr. Kara replied 10 months ago.

Thank you for the further information.

I would love to see her radiographs.

It does sound like her trachea is very narrowed within her chest, such that there is very poor gas exchange, and thus I can understand that she is probably battling to pull air into her lungs. There also appears to be increased tissue density around the base of the heart where the mainstem bronchi (air ways to her lungs) connect to her trachea. That can be due to lymph node enlarge from infection, collapse and inflammation of the bronchi due to infection or the increased amount of force/pressure as she struggles to pull air into her lungs.

I suspect that there is also some mild to moderate heart enlargement as the heart works hard to circulate blood as best as it can to get oxygen out to the body.

Without observing her I cannot say what her quality of life is now, but I assume she cannot do much with those sort of restrictions to her airways.

I would try adding a bronchodilator to the mix of medication, such as theophylline. It can't hurt and may help.

If she cannot tolerate the antibiotic she was on it is worth trying another. There are several that have good efficacy against the bacteria we tend to find in the respiratory tract.

Tracheal collapse can be miserable, and eventually secondary heart disease often develops.

I understand that you are struggling with whether it is appropriate to consider letting her go via humane euthanasia now. I try and guide clients on this very difficult decision by asking them if they believe they would want to live the way their beloved pet is.

I ask if their pet is still able to do the things that they have always enjoyed (albeit for a shorter period of time).

I also ask if they believe that their pet is comfortable most of the time and is living with dignity.

And I ask if there is something else we can do to improve quality of life, in this case perhaps a bronchodilator may work for a bit.

I ask about their socializing compared to normal. Does she seem to be hiding herself away when she always wanted to be in the middle of things, or is she suddenly clingy when she used to be very independent?

If she cannot walk even a short distance without coughing or needing a rest, if she is eating poorly, then we know that she isn't feeling herself.

You live with her day, so if you honestly answer these questions I believe you will come to the best decision for your girl.

I believe humane euthanasia is a gift we can give our pets when their quality of life is poor, and owners are absolutely the best people to evaluate that. As veterinarians we see pets for a short time when they often have an adrenaline rush from being in the clinic. We often don't see a true picture of day to day life.

Please let me know if you have any further questions.

Customer: replied 10 months ago.
Thank You for your insightful answer.
I will e-mail you her x-rays but could you also recommend ( this would not be any type of prescribing thing), just a recommendation of an antibiotic ?
Expert:  Dr. Kara replied 10 months ago.

You can upload the radiographs here from your computer by clicking on the paperclip icon at the top of the textbox.

Or you can post them to a file sharing site like imgur (imgur.com) and give me the link.

I'm not sure what she has taken but common antibiotics for respiratory infections include Amoxicillin, Clavamox, Cephalexin, and Doxycycline.

Customer: replied 10 months ago.
Here are her x-rays...is there an address i can send them to...i need to send them from another computer ...not this one and its a new computer ...may i send to " just answer " or something with a web address?
Expert:  Dr. Kara replied 10 months ago.

It may take a few days for me to get them but you can send them to customer service and ask that they be directed to Dr. Kara. Make sure to reference this question with the link: http://professional.justanswer.com/chat/index/d9a06cdfa9784d2a86b850090a1b24d3

contact email for customer support is:

*****@******.***

Customer: replied 10 months ago.
Thanks So Much !!! You're an Angel.
They may read From: Computer 1 ***@******.***
and the 2 attachments (x-rays) are titled Molly0000.jpg and Molly 0001.jpg
Thanks again !
Expert:  Dr. Kara replied 10 months ago.

No worries as long as you ask that they forward them to Dr. Kara and you reference this question I can put them together.

Expert:  Dr. Kara replied 10 months ago.
Hi,
I'm just following up on our conversation about your pet. How is everything going?
Dr. Kara

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