Tracheal Stent Placement & Laryngeal Sacculectomy: Cookie

13-year-old Cookie was referred to our specialist Dr Nathalee Prakash with a history of stertor (noisy breathing), coughing and voice change. She had been admitted to After Hours Emergency for recurring episodes of respiratory distress and cyanosis.

* When there is not enough oxygen being carried to the body by red blood cells, the skin and mucous membranes can turn a bluish or purplish colour. This condition is known as cyanosis. 

Thoracic radiographs showed markedly narrowing of the cervical trachea to the extent of the thoracic inlet. Tracheal collapse syndrome is a debilitating condition common in small breed dogs. Intraluminal tracheal stenting is a minimally invasive procedure that can improve the quality of life for dogs like Cookie with severe TCS.

Cookie had been admitted to After Hours Emergency for recurring episodes of respiratory distress. Intraluminal tracheal stenting is a minimally invasive procedure that can improve the quality of life for dogs with severe TCS.

what is tracheal collapse SYNDROME?

The trachea, or windpipe, is a tube that delivers air to and from the lungs during respiration. There are small rings of cartilage along the tracheal wall to maintain the tube shape and keep the airway open. If the cartilage becomes weak, the tracheal rings flatten, making it difficult for air to get to the lungs. Signs of tracheal collapse include coughing, noisy breathing, exercise intolerance. Some dogs turn cyanotic when stressed or excited.

A self-expanding nitinol tracheal stent was deployed under fluoroscopic guidance to hold Cookie’s trachea open and help her breathe again. Watch fast-motion video below.

After tracheal stent placement by specialist Dr Nathalee Prakash and Dr Anthony Goh, assisted by vet tech Marco, laryngeal sacculectomy was performed by Dr Dennis Choi to help Cookie breathe more easily.

Laryngeal sacculectomy (surgical removal of laryngeal saccules) is often required for dogs experiencing compromised upper airway flow. The soft tissue masses protrude into the airway just in front of the vocal cords and obstruct proper airflow.

Both procedures were successful. Cookie was closely monitored in our hospital for a few days before discharge for home care.

Post-procedural medication included a broad-spectrum antibiotic, corticosteroid, anti-tussive and bronchodilator therapy. One month post-stenting, Cookie is doing well. She coughs when excited and sometimes at night. There is no stertor or episodes of fainting. Cookie continues to enjoy family activities with her sister Baby – bike rides almost every evening!

cookie and her wonderful family – a chance meeting

A meeting purely by chance. About 10 years ago, Cookie ran out of her house on one occasion and was found by Karen’s family. That was how 2 families got to know one another. When Cookie’s family had to relocate and couldn’t take their dogs along, Karen’s family decided to adopt both Cookie and sister Baby.

It is wonderful the 2 closely-bonded sisters can continue to stay together when their first family was relocated, all thanks to big-hearted folks like Karen and family.

“Besides her collapsed trachea, Cookie is generally healthy for her age. We decided to let Cookie go through tracheal stenting so she can live longer. She and Baby are always a part of our family activities. We are glad to find out about this procedure that can help her.” ~ Karen

A family that exercises together stays healthy together! Karen’s family takes Cookie and Baby on bike rides almost every evening. When she is not out and about, Cookie enjoys sitting by the full-length window and watch the world go by. #KeepingFamiliesTogether


Intraluminal tracheal stent placement is a palliative, minimally invasive procedure to restore an obstructed or narrowed tracheal lumen.
  • TCS is common in small breed dogs. These patients usually present with a distinctive honking cough and may show signs of breathing difficulty, cyanosis and fainting episodes during stress.
  • Diagnosis of TCS can be made by chest radiographs but as the collapse is dynamic, fluoroscopy and endoscopic examination may be required in some cases.
  • Management of TCS consists of weight loss, use of harnesses instead of collars to reduce tracheal pressure, limiting exposure to respiratory irritants (e.g. smoke, dust).
  • The stent reduces but does not resolve coughing completely. Concurrent conditions such as bronchial collapse, chronic bronchitis and congestive heart failure should be evaluated and managed to optimise success post-stenting.
  • Intraluminal tracheal stenting can result in rapid and significant improvement of clinical signs in patients with severe TCS. However, it should be considered as a palliative procedure and reserved for dogs who do not respond to medical management.

We welcome medical stories of your animal friends to educate and inspire others. Email us at comms@mountpleasant.com.sg and be part of Mount Pleasant community over at our Website and Facebook.

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