Surgical Options

Once GOLPP has been diagnosed, management consists of alleviating upper airway obstruction, minimizing regurgitation and risk of aspiration events, maintaining physical condition and mobility for as long as possible, and owner eduction and support.

Alleviation of upper airway obstruction - surgical management:

Surgical intervention is usually in the form of a unilateral crico- (or less commonly thyro)-arytenoid laryngoplasty (“tie-back”), which asymmetrically widens the rima glottidis. This surgery provides immediate alleviation of signs of upper respiratory obstruction, and greatly improves the quality of life of affected dogs. Some gagging and throat-clearing, however, may persist for some months. Knowledge of laryngeal anatomy is essential and experience with the technique will improve surgical outcome. During the approach, the cranial laryngeal nerve should be protected. Additionally, the thyropharyngeus muscle should be meticulously reapposed to minimize pharyngeal and esophageal dysfunction. Some surgeons propose minimizing the disruption to this muscle by modifying their technique. A ventral laryngotomy with resection of the vocal folds and lateralization of the vocal processes can also be performed, but has yet to show distinct benefit over the more traditional “tie-back”.

Immediate post-operative care

Many of the cases can be discharged on the same day as their procedure, as they are likely to be less stressed at home. If they remain hospitalized, they are fed the morning following surgery with firm meatballs and the surgeon watches them swallowing before discharge.

Long term followup

We highly recommend long-term guidance and communication to owners of affected dogs following surgery – this is what it’s all about. This should be undertaken as a 3-way between the owner, the regular veterinarian and the surgeon. GOLPP owners are dedicated to their long-term companions and are deeply invested in optimizing their quality of life. Areas that should be managed include:

Management of esophageal dysfunction
Physical therapy
Owner education

Management of esophageal dysfunction:

Based on a positional esophagram study performed in 2013, the recommended feeding angle is unclear. Certainly some dogs will have better swallowing function when fed on an incline plane, or fed in sitting position, but other dogs it made no difference, or they were better fed and watered on the floor. We recommend the owner trying out different feeding positions to determine which is best for their dog. If it is at an incline planey, the dog should remain in this more upright position for 10 minutes post-prandially.

Drugs are often used to minimize acid reflux. Metoclopramide is not considered as effective as more recent drugs, but in some dogs it definitely decreases throat-clearing. Cisapride also appears to diminish throat-clearing in some dogs; and the most recent drug of choice is sildenafil. Although there are several reports of their efficacy in improving esophageal function and minimizing gastroesophageal reflux events, there are no reliable, blinded, controlled studies to show which drug is most effective at decreasing aspiration pneumonia

Physical therapy:

Water treadmill physiotherapy, balancing and coordination exercises are highly recommended for all dogs long-term – this cannot be over-emphasized. The aim is to maintain muscle mass and minimize the manifestation of proprioception loss in the face of insidious neurodegeneration. By performing backwards walking, figure of eights and cavalettis, the dogs become aware of their limbs in space and will hopefully have more realization of where they place their limbs. Home exercise is also encouraged, with daily long, slow walks. A number of owners have reported benefits with acupuncture therapy for their dogs.

Owner education:

The development of owner handouts to inform owners about GOLPP appears to be well received (these handouts can be made available to you). Owners need to be educated to identify early signs of aspiration pneumonia (inappetance, lethargy, fever), because early and aggressive treatment of pneumonia will improve outcome. These dogs are almost always regarded as members of their human family. As the condition progresses over months to several years, a variety of hind-limb supports can be utilized. Occasionally dogs may use a cart for several months. Owners typically request euthanasia when their pet becomes non-ambulatory, or experiences repeated episodes of aspiration pneumonia.

It is vital for veterinarians to follow affected dogs out for the remainder of their life – currently recommended every 6 months until their demise (usually around 2-4 years). It is already clear that most dogs will progress at a fairly steady rate, although many dogs will also die of conditions unrelated to GOLPP. There also appears to be a small cohort of dogs with a surprisingly slow rate of neurologic deterioration (4+ years) – this maybe another reason why this disease took so long to be recognized as a generalization neurodegeneration. There exist huge benefits to the owner, dog and attending veterinarian in establishing a relationship with the owner when faced with this disease. This is a time where the owners need us (the veterinarian) to educate them and advise - what to expect, how to manage it, and helping them make the decision to euthanize.

Surgical outcomes are generally excellent in experienced hands

Laryngeal paralysis is a common condition in older dogs, often causing severe upper respiratory signs. Over two-thirds of affected dogs have esophageal dysfunction at time of presentation, typically in the cranial thoracic and cervical esophagus. The laryngeal paralysis in older dogs represents an early onset of an insidiously progressive, generalized neurodegeneration. Surgical outcomes are generally excellent in experienced hands, for immediate alleviation of clinical signs, but it is critical to provide long-term follow-up care to affected dogs to optimize their quality of life. Owner education on the condition is important to manage their expectations. Three-way conversation and communication with owner, primary care vet and specialist is beneficial and educational. Management of swallowing dysfunction and early recognition of aspiration pneumonia will enable early treatment and improved outcomes. Rehabilitation and physical therapy is recommended.