Today I’m going to stray from my usual topic of travel and instead share the story of my dog Audi and our experience with spontaneous pneumothorax, bullae, surgery and what came next. We’ve spent the past few weeks going through tests, x-rays and surgery without any clear answers on what caused this, what we could do about it and if it would happen again.
There is very little information on bullae in canines available on the internet and I came across another blogger who shared their story (back in 2010) and I was astounded by the number of people still commenting in 2013 saying they were going through the same thing and wondering where the answers were.
Here’s our story, I hope it helps:
Audi is a 3.5 year old spayed female Labrador, Border Collie and who-knows-what mix. She weighs about 50 pounds and has a history of ear infections but otherwise has always been very healthy and active.
One night, I noticed her breathing was abnormally fast and shallow. The next day, a Sunday, she was coughing and continued to breath very fast but was not showing signs of any severe respiratory distress (gasping, blue tongue, etc..). I took her to see my normal vet first thing Monday morning. My vet listened to her lungs, heard some concerning lack of lung noise and decided to take a chest x-ray. She found the pneumothorax. She prescribed antibiotics because Audi had a slight fever and because there wasn’t an obvious traumatic cause she wanted to give it a week and see if the issue resolved itself.
A week later, we had another x-ray and the pneumothorax had not changed. My vet referred me to Michigan State University Veterinary Teaching Hospital, one of the best in the nation. They took blood samples and performed more x-rays which showed the pneumothorax and the possible existence of bullae. Blebs or bullae are simply air pockets in the lungs that can burst and release air into the chest causing the spontaneous pneumothorax. Her blood gas results came back normal.
I dropped her off the next day for a CT scan. It confirmed the existence of multiple small accumulations of gas in her lung tissue and one large ruptured and leaking bleb. Surgery is the best and most successful treatment for bullae. Since she was already under anesthesia from the CT I gave the OK for her to go right into surgery to remove the tissue. They also inserted a chest tube to drain and monitor any air or fluids left in her chest cavity after surgery.
I was able to take her home two days after surgery and she is supposed to be breathing better but it was going to be a long recovery from the sternotomy. She was on two types of pain killers, Tramadol and Rimadyl. Her incision, 20 staples long, was clean and healing well.
Five days after surgery I called the surgeon with concerns about her continued rapid breathing and she told me to bring her in that day. The results of the biopsy were in and they needed to speak to me anyways about what she called a chronic and asthmatic condition.
They listened to her lungs and didn’t hear anything abnormal so I decided to forego another x-ray. The cause of rapid breathing after surgery was most likely pain or discomfort so she was given a third pain killer, Gabapentin. She had some fluid accumulation around her incision, they said this was normal and could be helped by applying a heat pack to it for a few minutes a day.
The biopsy results showed inflammation, remodeling and allergen trapping in her airways. Typically, allergens leave the lungs when you exhale but they were attaching to hers, adding to the severity of the inflammation and remodeling. When remodeling occurs, it can weaken the walls of the lungs and lead to pulmonary blebs (of bullae) formation. The remodeling of the lung tissue is permanent but by reducing and controlling the inflammation we can prevent further damage.
We have to wait until she is off of her post-surgery pain medication before we can perform a blood allergen test to see which allergens are causing the inflammation. The next step is to start her on pill-form steroids for a month to correct the inflammation. After that she will have to be administered steroids through an inhaler twice a day for the rest of her life.
Audi is so young and has been an amazing companion and borderline-perfect dog. I’m going to keep doing everything I can to make sure she has a long HAPPY life. I’ll be sure to update this post with any future developments on her condition.
UPDATE (September 2013)
Audi is a week into oral steroid treatment. She has most of the side effects we were warned about; increased appetite, thirst, panting. Her allergen test came back and turns out she is allergic to just about everything. The allergens they found in her lung tissue included grass, trees, plants, dust mites and cat dander. The most significant reaction coming from dust mites and grass. There’s no way to avoid all of these things so the inhaler is really our best hope at controlling her condition.
I attempted to switch to an Internal Medicine Specialist in Chicago, where I now live, but after the consultation they set me on a different treatment plan and gave me perscriptions for a nebulization unit, Albuterol and Flonase. They weren’t able to view Audi’s scans and allergen test so I was at first slightly, and then increasingly, concerned about this plan of action.
I spoke with my Internal Medicine Specialist at MSU again and she also had concerns about the nebulization and the use of flonase. After a few failed attempts to reach the Chicago IMS to get my questions answered I decided to say “screw it” and continue Audi’s treatment at MSU, drive be damned.
UPATE (October 2013)
Audi has been on the oral steroid for over a month. The side effects have remained the same, mostly increased thirst and appetite. I have the Aerodawg chamber and I’m just waiting to receive the inhaler medication. I ordered them from CanadaDrugs.com. It was recommended by my veterinarian that I look into getting the prescription filled in Canada because it would be a lot more cost effective. CanadaDrugs.com had the best reviews of the online Canadian pharmacies that I looked at and I was able to take 25% off my first order. Once I recieve the inhalers and will start giving Audi a few “poofs” a day and begin tapering off the oral steroid.
UPDATE (November 2013)
Audi has been receiving two ‘poofs’ a day for almost a week. When she initially started the oral steroid she lost a few pounds but since then has gained them all back, plus a few extra. She is still ravenously hungry all the time and drains her water dish as soon as I set it down. This has led to a few unfortunately accidents and extra loads of laundry to wash her dog bed. We have begun to taper off her oral steroid so I’m hopeful that her outrageous hunger and thirst will be coming to an end soon. There hasn’t been any significant increase in her respiratory rate so that would indicate that her disease isn’t flaring up again…yet.
UPDATE (February 2014)
It’s been about 3 months since our last Audi update. She is doing really well. She has been completely weened off of the oral steroid for a while now and I slowly noticed a decrease in her hunger and thirst. She had a check-up about a month ago and our Internal Medicine Specialist said everything looked great and that Audi seemed to be recovery very well, probably because of her young age. Her personality is definitely back to normal. I hadn’t noticed it at first but over time she started to act happier and more energetic. She is still on two ‘poofs’ a day and will continue that way for at least 6 months. It’s been an extremely cold winter in Chicago but it doesn’t appear to be affecting her condition. She turns 4 next week and the fact that she is happy and semi-healthy starts to make up for all of the drama we’ve gone through these past 5 months.
UPDATE (February 2015)
One year later and Audi is still going strong. I have her down to one poof of the inhaler per day. She seems to be doing well and more importantly she seems happy. Tomorrow, she will be 5 YEARS OLD! Can’t believe she’s already 5 and after what we’ve been through I’m so glad she’s reached this milestone.
UPDATE (MAY 2017)
Audi is still in good health and has officially made it to her “senior” years.