Buddy and Teddy, recent patients at the Foster Hospital for Small Animals at Tufts, are healthy and home with their families thanks to a team of critical care veterinarians
Buddy, a Coonhound mix, made a full recovery after a diagnosis of polyradiculoneuritis, a rare neurological disease. Photo: Courtesy of Ronnie Passarelli
When a dog is ill enough to require being put on a ventilator, the prognosis is often dire. The number of animals who can resume living normal, healthy lives after being so sick that they require ventilation has increased, but the success rate is still only around 30% to 50%, depending on the underlying reason for ventilation.
Recently, two very sick dogs at the Henry and Lois Foster Hospital for Small Animals—Buddy, a Coonhound mix, and Teddy, a French bulldog—were among the lucky ones.
Buddy, now three years old, came to Foster Hospital for Small Animals in June 2021 after experiencing sudden paralysis. He received a diagnosis of polyradiculoneuritis, a rare neurological disease.
“We don’t have a good understanding of the disease because we don’t see it very often,” says Alexandra Pfaff, clinical assistant professor in the Department of Clinical Sciences at Cummings School of Veterinary Medicine at Tufts University. “It’s considered an autoimmune disease, so the body one day decides that nerves need to be attacked.”
Most of the time, says Pfaff, polyradiculoneuritis initially manifests as weakness in the back and legs. Within a day or two, it can progress to paralysis of almost every muscle in the body, to the point where the animal can’t blink their eyes, swallow, or breathe.
“Buddy arrived to us at a point where he was already completely paralyzed and had lost function in his eye muscles,” says Pfaff. “He was at very high risk of breathing failure and was put on the ventilator right away. He was a very intense case.”
Buddy remained on a ventilator for two weeks, which is an unusually long time. The longer a patient is on a ventilator, the more likely they will experience complications. However, it is often necessary to try the ventilator, even with the complications, for the best possible outcome. Buddy developed pneumonia as well as a pneumothorax, which occurs when air builds up within the chest, often due to the airway-pressure that the ventilator delivers itself.
“This decreases the odds of successful outcome and makes everything more complicated,” says Pfaff. “But he overcame all of those things.”
Teddy, a French bulldog, couldn’t breathe because of severe pneumonia, and was ventilated for three days that were touch and go. Photo: Courtesy of Jenny Seeche
Teddy, the French bulldog, was an example of a patient that couldn’t breathe because of severe pneumonia, meaning the lungs themselves were affected. Theoretically, he had much lower odds of a positive outcome than a dog that gets ventilated because of a neuromuscular disease, says Pfaff.
French bulldogs are among the breeds of dogs (including pugs and Pekingese, among others) that are brachycephalic, or “flat faced,” with shortened skulls and nasal passages.
“Unfortunately, their anatomy leads to a lot of breathing problems,” says Pfaff. “They’re also prone to reflux of stomach fluid, and some of it gets aspirated into the lungs, and then they can develop pneumonia.”
Teddy responded relatively quickly to treatment and was ventilated for just three days, but those three days were touch and go. Based on radiographs of his lungs, the critical care team thought that, in addition to pneumonia, he had developed acute respiratory distress syndrome (ARDS).
“When pneumonia is really severe, it causes such unrelenting inflammation in the lungs that as a secondary reaction, the immune system produces so many toxins that are supposed to kill the bacteria, but it damages the lung tissue even further, leading to more severe lung injury,” she says. On top of it, Teddy, like Buddy, also developed a pneumothorax.
Critical Teaching Opportunities
The fact that these dogs were ventilated for such different reasons provided excellent learning opportunities for the critical care residents.
“Mechanical ventilation is a skill set that all veterinary criticalists need to have because we’re the only specialty that does it for extended periods, so it’s a necessity for training the residents,” says Alexia Berg, clinical assistant professor in the Department of Clinical Sciences at Cummings School.
Berg points out that not all mechanical ventilation is the same. Ventilating a heart failure patient is different from ventilating a neuromuscular patient or a patient with either lung disease or sepsis. “There’s a lot of nuances to it,” she says. “You can read about it in textbooks obviously, and we do, but there’s nothing quite like doing it and practicing it and tweaking things to try to improve the treatment. It’s incredibly important to have that kind of variety of cases, because even though they were both young dogs that were mechanically ventilated to a successful outcome, at their core they were very different patients because their diseases were dissimilar.”
Patients on ventilators also require one-on-one, round-the-clock care. “The machine is performing a basic life function for them, so someone who is trained in ventilation has to be nearby at all times,” says Berg. “In the event that there’s a problem with the machine or a tube gets occluded, things can go from being perfectly fine to not okay in a matter of seconds.”
The fact that Buddy and Teddy survived their ordeals was an uplifting and encouraging experience for the whole team.
Berg praises the dedication of everyone that was involved in the intensive care required for these dogs. “Everybody did an awesome job to get these young dogs home to their families and back to living happy dog lives.”
