The recent new medical term for me was not corona virus — at least not last month. Instead it was brachycephalic airway obstructive syndrome. No, not my airway – Rosie’s.
Brachycephalic means “shortened head”. The syndrome goes by various acronyms. I’ll settle for BAOS, which along with the others refers to a cluster of anatomic abnormalities seen in brachycephalic breeds that contribute to dysfunction of the upper airway.
You’ve seen lots of dogs that are brachycephalic – pugs, bulldogs, boxers, Frenchies, and other breeds that have been developed to have shorter heads and noses than those of their ancestors. They’re cute — but because of the changes in physiology brought about by those short heads and noses, they tend to have breathing difficulties.
Signs and symptoms of BOAS in order of seriousness
- Breathing difficulty: Noisy/labored breathing. Open-mouth breathing. Extending head and neck to keep airway open.
- Stress and heat intolerance during exercise.
- Snoring/gagging/choking/regurgitation/vomiting/susceptibility to pneumonia.
- Collapse/death
The symptoms seem to show up when a dog’s around four. Rosie came to me with the condition. I thought at first she was panting so much because she’d gone from about 5000’ altitude to 7000’, but she never acclimated. In fact, she got worse over the first several months, arriving here at level 1-2, and moving on to level 3 in short order. I couldn’t sleep at night worrying that she was going to die.
In January I took Rosie to my vet to have her spayed. We discussed her BOAS issue and the consequences of not treating it. Rosie’s condition would be aggravated by heat come summer, and by being overweight. She was overweight partly because she couldn’t exercise. She couldn’t exercise because she couldn’t breathe. She could never rest deeply, because she was always struggling for breath. She was always starved for oxygen. Her whole body was stressed with the effort of trying to suck in air.
Not only all that, but over time the cartilage of her trachea could collapse and she would suffocate to death — if she didn’t die from pneumonia first.
What a horrible way to go. My vet couldn’t do the surgery, so he recommended a veterinary hospital in Albuquerque. I made the arrangements and in mid-February I handed the leash of my little dog over to a veterinary tech, worried as hell and not a little afraid for the outcome, too.
First, Rosie had to be sedated for the surgical veterinarian to examine her to determine the position of the soft palate, checking for masses and/or extra pharyngeal tissue, and evaluating the laryngeal, tonsil, pharynx, and upper airway structures. The good news was that there was no evidence of cancer as a cause, nor was there any evidence of tissue erosion due to regurgitation/vomiting. To no one’s surprise, Rosie was a prime candidate for surgery.
The bad news was that Rosie’s trachea is way small for her size. Her airway structure was such that even with the surgery Rosie would always have breathing issues. Still, the laser surgery to trim the extra tissues would mean she’d have a chance at a longer and more comfortable life. So I gave the word to go ahead.
The procedure
To cut to the chase, everything went swimmingly. Within short order Rosie was coming out of the anesthesia. Not that she was going to be released to come home.
Rosie needed to be under close observation till the next day, just in case. Any swelling would close her airway. Any vomiting in reaction to drugs, to the surgery itself, or any number of reasons, could cause her to aspirate into her lungs. Any excitement or activity that would cause her to breathe heavily could cause bleeding that she might aspirate into her lungs.
When I picked her up I was a nervous wreck. Rosie was still mildly sedated but even so she was panting and hacking and generally doing everything the vet told me to discourage. She would not calm down. Worse, the sedative I was supposed to give her was a prescription I had to pick up before leaving town. My friend Laura was with me. We took turns walking Rosie around the Wal-Mart parking lot very slowly while waiting for the prescription, during which time a new issue developed – Rosie couldn’t stop peeing. Nobody had mentioned anything about this. She was dripping pee all over the place, and panting, and gagging, and making all kinds of horrible sounds.
I was beyond myself and I’m sure my agitation wasn’t helping Rosie at all. In my defense I thought my dog was going to die! I cursed the pharmacy for taking so long, cursed Rosie, cursed the veterinary hospital, cursed the Department of Transportation for every bump in the road as we headed for home, and cursed anything else I could think of to curse, including myself for having agreed to rescue this problem dog.
When the sedative hit her system and Rosie went to sleep in the back seat, I almost wept in relief.
Post-surgery at home
House training seemed to be a thing of the past. Rosie pooped in the house. She peed — big lakes everywhere on my floors. This was a dog that just a day or two before had no problem at all using the dog door to go outside.
I emailed my vet. He said it was the steroid, prednisone, that was meant to keep the swelling down but that also made her pee a lot. But why was she going potty inside? The dog door was the same one that had been there two days ago, that she used just fine.
Worse, Tux the tomcat started peeing in the house, too.
I may never know the reasons for that sudden failure of house training, but I did not allow myself to yell at Rosie and trusted that over time it would improve. In fact, while it seemed to take forever for Rosie’s training to kick in again it was only a matter of a week. Tux, it turned out, had a UTI and is on meds for that. Thank the gods.
Meanwhile, I had to keep Rosie sedated if I couldn’t keep her calm. I had to soak her food, couldn’t let her chew on bones, couldn’t let her out of the house or her dog pen lest she start to breath heavily, couldn’t let her get overheated lest she start panting, couldn’t let her bark.
Let me tell you, when you’ve got to provide a calm, quiet environment for a patient it’s just amazing how much happens to cause excitement. People will show up. Coyotes will come too close to the house. Tux, Lili, and Rosie will bicker like kids in the back of the car on a long trip. The metal roof will pop when the sun hits it. All cause for barking and excitement.
It’s been just four weeks today but it’s been four weeks of hell.
The light at the end of the tunnel
I am happy to report that Rosie is doing very well. She’s lost weight. She’s breathing much easier. She and the cats are working on a renewal of their truce. No more accidents in the house (well, Tux hasn’t gotten the complete message yet, but he’s improving). I’ve been letting Rosie out of the dog pen when I’m home during the day. She’s been finding old bones and bringing them into the house (I think that’s a hint). This morning she chased a rabbit and came back all dancing and proud, and she wasn’t gagging. Pretty soon we can start going on walks again.
Yeah, Rosie still snores, wheezes, and occasionally gags. I guess she’ll do that for the rest of her life. But she’s definitely the new and improved version of a BAOS dog, and I think she’s more cheerful for it.
I certainly am.
PS Thanks go to Jack Duncan, DVM and to the Veterinary Emergency & Specialty Center, Albuquerque, for taking such good care of my Rosie.
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Here it is nine months since Rosie came into my life and I am pleased to tell you I have nothing special to report about her. As the weather gets warmer I do have to be more careful about letting her come with me on walks, given her compromised respiratory system. She’s way better now than before her surgery, but she’ll never be an athlete. I can’t take her far and I can’t expect fast. Heat + effort + a partially blocked trachea = potential for over-stress. For Rosie it could be fatal. When I take her with me I plan on short, slow walks, with plenty of stops to wait for her to catch up on her own time.
It had to happen, of course. The honeymoon always ends. Life moves on and the fresh new relationship gradually transforms into an old familiar one. Allowances for past traumas, habits, and reactions give way to impatience with behaviors based on the past. It’s here and now — let’s get on with it, it feels like. At least for me. 
Rosie barked today. Seriously barked, not just a passing woof. A neighbor who had been moving some dirt with his tractor right outside the house was walking around on foot, assessing what he’d done and what he needed to do next. He came close to the back door and for some reason Rosie didn’t like that at all. 
I didn’t know whether to laugh or scream when I came home the other day and found this. Rosie had torn open a bag of plastic bags that was headed for recycling. They were everywhere.
