Nasal passage and nose problems in dogs

Nasal Passage and Nose problems in dogs

Nasal or pharyngeal obstruction

Question: Dr. Mike, I have been trying to identify the source of a nasal or pharyngeal obstruction in my sweet lab, Molly. She is a found dog of unknown age, probably 8 or so. In April, I took her to my vet, thinking that she had something in her nose. She was sneezing at times, but sounded as if she was snorting, etc. He said probably allergies.Benadryl and eventually pred was rx`d. I took her in again about a month or more ago. She had not really gotten better but had acutely worsened that week. I was afraid she was about to obstruct!!! It was worse at night and worse w/her head positioned forward, so she(we) did not sleep. I started laying her on her back w/my finger in her mouth so that she would breathe thru her mouth and it seemed to help. The strangest thing is that she has her normal boundless energy, no problem w/exertion. I am thinking this is totally mechanical....we are now a couple of months down the road. I have had her to 4 different vets. She has had one vet remove a front tooth that was abcessed and he took a look in her nose w/a short scope to no avail. After that, she had one episode of expelling watery, bloody drainage and seemed better for about 12 hours. It was back to the usual by bed time that nite. The next surgery she had was a vet who does a lot of dentistry. He found a large tooth that was fractured. She had a sinus full of abcess and they flushed it, gave her Baytril and did cultures. We had a referral to Auburn for eval by this time. I did not go because the cultures were still pending, she seemed a bit better. She was quite miffed at all of the fuss by this time. The cultures grew pseudomonas and a bug called Simonsiella ( I think ). The path stated that this was non-pathogenic. My vet questioned that it was found in such massive quantities that it might be indicative of another problem or pathogenic in that quantity. He was calling the pathologists. Molly is still snorting. She is most uncomfortable at nite. She swims and fishes like you would not believe. This does not look to be comfortable,but she acts happy most of the time. She snorts when drinking and eating, but gets and keeps it all down. I don`t know what to do next. I guess the referral to a teaching center is inevitable. I hate to drag her around like that. She does not like it at all. When we are in the car heading to yet another appt, she won`t even let me pet her and leans as far away from me as poss. Anyway, I wondered if this rang any bells for you or if you knew about the organism they found. I realize that my vets are probably at the end of their dx capabilities and I need to go to Auburn or Florida as they are closest to me. Any advice??Thanks, Pattie

Answer: Pattie- I think that you are probably right that the next best step is to have Molly examined at one of the teaching hospitals. If there isn`t a big difference to you in which one you go to and if one of them offers MRI and the other doesn`t, I`d go to the one with the MRI machine, personally. If one or both offers CT scanning, instead, that is a good second choice. Most of the veterinary schools do enough endoscopsy to have a variety of endoscope sizes so that examination of the nasal passages in this manner will be possible, as well. I can only find one report of infection that was felt to be caused by the Simonsiella organism. It is from Veterinary Pathology, Jan. 1988, and Simonsiella (no species reported in the abstract) was reported to be the infective organism in a severe lip ulcer in a dog. So I guess this would be a very unlikely pathogen but can`t be entirely ruled out. Looking for and correcting teeth problems is a good choice for any pet with unilateral nasal drainage, so it was definitely a good thing to correct those problems. Pseudomas infections can be very difficult to clear permanently (the often appear to respond well to treatment and then come back when treatment is stopped). It may be necessary to use antibiotics for a long time to totally eliminate this infection (months). Fungal infections sometimes occur in nasal passages and dogs have a nasal mite, Pneumonyssoides caninum, that can cause chronic nasal irritation. It is usually possible to find this mite on endoscopic examination based on clinical reports but I don`t have an endoscope so I have no personal experience to draw on to be sure that is the case. Milbemycin and ivermectin are both capable of killing these mites. Other causes of nasal infection include nasal passage worm infections (capillariasis). Allergies (which I think of as a rare cause in dogs), eosinophilic rhinitis (occurs for unknown reasons) and nasal cancers. Unfortunately, nasal cancers are probably the most common cause of persistent nasal exudates in older dogs, so this has to be a strong consideration. Finally, there is the possibility of a nasal foreign body. These can be almost anything that can be inhaled into a nose, or vomited into the nose when a dog throws up. The most common ones are things like blades of grass, corn stalks, seeds and other "natural" objects. However, we have seen a toothpick in a nasal passage and I have heard reports of all sorts of things, including candy wrappers, small pieces of aluminum foil, pieces of disposable diapers and teeth. The only way to find these things is to look for them and the better the imaging capabilities, both with endoscopy and MRI or CT scanning, the better the chance of finding the culprit, so one of the vet schools is probably the best choice since they are most likely to have these capabilities. Good luck with this. Mike Richards, DVM 8/27/2001

Nasal area problems German Shepherd Dog with recent Thrombocytopenia

Question: Hi! I am a subscriber, and I have a couple of questions about my German Shepherd Dogs. First, my 9 1/2 year old bitch, Greta, was just recently hospitalized with Thrombocytopenia. Upon diagnosis, her platelet count had dropped to about 32,000. The next day when she was tested again, it was up to over 230,000. The vet was very pleased with her progress, and sent her home to me with prednisone, an antibiotic, and tagamet tabs for her stomach. At the outset of this problem, Greta`s nasal membranes were VERY inflamed - the one was almost even with the outside of her nostril, and she could barely breathe through her nose. She has been on the meds for almost 3 weeks now, and her nose has decreased in swelling, however now it is very dry to the point of where it looks like it has almost SHRUNK. She has cracks in both nostrils between the top of the nostril and the horizontal surface of the nose. I have been applying vasaline to her nose a couple of times per day, per the vet, but this does not seem to be helping. I know she is also very thirsty from the steroids, however I am not sure I should be giving her all the water she wants - I think if I did this she would float away! Plus she has had some problems w/incontinence - she was usually extremely good about letting me know she had to go potty, but when she was on the 20 mg of pred. twice per day she had 4 accidents in the house. Any suggestions for her nose? Also, she does not really seem herself. She is always tired, and does nothing other than sleep and eat. She seems generally depressed. The vet could not establish a cause for her Thrombo. - said in her case it seemed idiosyncratic in nature. Also, I am continuing to have problems with Indy`s nose being discolored. I am giving him Norwegian Kelp supplements - nothing but kelp in the capsule and I pour it over his food - how much kelp can he have per day before it will become toxic, if that happens with kelp? He`s getting 3 - 550 mg. capsules per day. Is this too much or can he have more? Thanks for your help! Gail

Answer: Gail- I am uncomfortable about water restriction in a dog that is on prednisone or other corticosteroids, although some people have advocated restricting water at night in these patients, for the reasons that you stated-- an increase in urinary accidents in the house and exacerbation of pre-existing incontinence associated with corticosteroid use. I think that it would be a good idea to check with your vet about this, though. I can not find a maximum dosage for kelp, so the best advice I can give is to follow the directions on the package labeling and not to exceed the recommended dosage. If I find something different about this I will try to remember to pass it on. The most common cause of problems with the nasal planum (the normally black area of the nose) in German shepherd dogs is probably discoid lupus. Phemphigus is another possible problem. There are reports of nasal inflammation and necrosis (death of tissue) associated with Rocky Mountain Spotted Fever infections and this would also be a cause of thrombocytopenia. I do not know if this can occur with other tick borne diseases, such as ehrlichiosis or Lyme disease, but I guess it would be a good idea to at least consider these in the diagnostic process. There is a recognized familial cutaneous vaculopathy (inflammation of the blood vessels in the skin) that affects some German shepherds but it usually causes inflammation of the feet and depigmentation of the nose, so if these signs are not present, this may not be as likely to be a problem. There would also be a slight possibility of a cancer such as squamous cell carcinoma affecting the nasal passages. A biopsy of the affected area may be the best way to get a diagnosis, although this can be a difficult area to biopsy. I hope that Greta`s thrombocytopenia remains under control and that there is some improvement in her nasal area at this time. If not, you may need to consider asking about a biopsy or referral to a veterinary dermatologist or internal medicine specialist. Mike Richards, DVM 10/16/2000

Nose crusting and Myositis

Question: Hi: I am wondering what caused the nose of my dog to become cracked and crusty? My samoyed is on medication for myositis (prednisone 15mg every other day) and I noticed her nose was getting crusty. I went to the vet and he put her on niacin and tetracycline. The crusting has gone away. I am wondering if, since she has an auto immune disorder, this was related to that or something else. Thanks! ps: I also have her on B2, L-carnitine and CO-Q10 to help with her myositis. Have you heard of these supplements being helpful or not? Her condition seems to have stabilized and she is playful and has good energy again. Unfortunately, she has gained so much weight! I have her on a regulated diet (morning and evening feedings with LIMITED snacks) but the weight has stayed on. Is this due to the pred?

Answer: P.- The weight gain is very likely to be due to the prednisone. Increased appetite and increased fat deposition occur with corticosteroids, so this is an expected but unwelcome side effect. I have not seen any recommendations specific to masticatory myositis for using B2, l-carnitine and coenzyme Q10, but these are recommended for a variety of neurologic and muscular disorders. All are unlikely to cause problems at reasonable dosages, so I see no reason not to try them. But you can`t really count on a beneficial effect. Crusting of the nose can occur with prednisone usage based on observations of patients in our practice. I have been assuming that this may be due to an increased tendency to get secondary skin infections and general thinning of the skin associated with prednisone but have no evidence to back up those thoughts. Severe cracking of the nasal planum or ulcerated sores around it are more likely to be from a disorder such as phemphigus or discoid lupus. Your vet is treating with medications that are recommended for phemphigus (an immune mediated disorder), so the improvement makes that a little more likely --- but doesn`t necessarily prove the diagnosis. That may not matter at this point since things are improving. In general, having one immune mediated disorder doesn`t seem to predispose dogs to getting other ones. Hopefully, this generality will hold true for your Samoyed, too. Mike Richards, DVM 2/1/2000

Last edited 01/03/05

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