Humphrey went to the groomer on January 18. A few days later, he started to have chills now and then - the humans thought nothing of it because it was winter, even though he's a dog who doesn't usually shiver much. He sneezed and had nasal discharge (unusual for him, but it wasn't persistent so they just wiped his nose and ignored it).
Less than a week later, he developed a cough. Between the cough, chills, and sneezing, the humans presumed it was an upper-respiratory virus, such as kennel cough, so they called the Essex vet and made an appointment. In the mean time, they made chicken broth (because chicken soup contains the amino acid cysteine, which has anti-inflammatory and mucus-thinning properties that make it great for colds and flus). They held him near a hot vaporizer and the steam seemed to relieve his cough pretty quickly and for a few hours. He also received some dog CBD oil, which is said to have cumulative anti-inflammatory properties. Within two days, he was a LOT better. In a few more days, it was gone.
Then, the big snowstorm hit! His veterinary appointment was cancelled! By the time the snow was cleared away and the clinic re-opened, there didn't seem to be any point in bringing him in because his cough was history, for now.
A month later, Humphrey showed signs of an ear infection so he went in to see the vet. The humans asked the vet to check his chest in case there was any sign of lingering infection. She said his breathing, lungs and heart sounded great.
A week after that veterinary appointment, the cough returned!
A little game of peek-a-boo in the vet's lobby
Though he had the cough, just like last time Humph's appetite and energy levels were not affected. In fact, any time there was something interesting going on, he didn't cough at all. And the humans could stop the cough just by giving him a snack or saucer of milk! The timeline went like this:
- He woke up from a 4-hour nap on Sunday the 27th (uncharacteristically having slept on his left side) and that was the onset of the cough. That day, the cough was pretty persistent for about 2 or 3 hours, and it almost seemed as though he had a particle lodged in his throat that was tickling him. When given some sugar-free ice cream, it stopped for hours, but then in came back.
- That night of the 27th, he woke every few hours with the cough, then he got a steam treatment with the vaporizer, and it seemed to stop for short periods of time.
- The next morning (28th) it started up after breakfast, but the humans managed to suppress it by keeping him distracted for about 5 hours with constant activity. Then he had a 4 or 5 hour nap with no coughing. After dinner, the cough returned and he had a late-day vet appointment.
This time, the humans went to a different vet (not that it matters) within a day of the cough's onset.
Dr. M heard the cough, and immediately said, this sounds like kennel cough in the middle of the illness. He demonstrated the different coughs, and said, watch I'll induce the cough in a way that shows it's kennel cough. He rubbed Humphrey's upper chest a certain way and produced a cough.
Humphrey's temperature was normal, and his heart sounded fine (in fact, Dr. M said his heart murmur was so faint he couldn't detect it). His gums looked very good - a signifier that he was getting sufficient oxygen in his system.
Dr. M then recommended a chest x-ray, just to be sure that Humphrey had no fluid in his lungs or chest. Dr. M talked at length about what sort of diuretic would be necessary should he find signs of fluid (it seemed that perhaps he assumed there was fluid? or maybe he was just warning Humphrey in case).
Ruh-roh!
The chest x-ray revealed something that we knew existed - and Dr M (like Dr Y a few years back) got very concerned about the look of Humphrey's pre-existing tracheal deviation (which is where the trachea curves instead of lying flat - and in Humphrey's case this is a result of surgery some 7 years ago). About 3 years when Dr Y noticed unusual breathing, he took an x-ray, notice it, and sent Humphrey to the cardiologist immediately. The cardiologist investigated, and concluded this was not something to worry about.
Back to Dr. M - he had a similar reaction to Dr. Y. Dr. M explained that the x-ray didn't look great - Humphrey's liver is enlarged (not new, but it's probably more enlarged than before due to his age), which is pressing on the diaphragm, which is then pressing on the trachea. And Dr. M believes this to be causing the cough.
Dr. M's interpretation of the x-ray effectively negated his initial diagnosis of kennel cough. He may be correct, or he may have been thrown off (like Dr. Y) by the weird appearance of Humphrey's chest cavity.
The next order of business became how do we make Humphrey more comfortable? Dr. M was convinced that Humphrey was very uncomfortable, and noted that he had abdominal breathing (which then disappeared, and shocked Dr. M - again this is something Humphrey has had for at least 10 years, so it may not be cause for concern).
Dr. M wanted to try an injection of an NSAID (metacam) to see if that would relieve the cough. It did not!
Dr. M also recommended Theophylline, a non-steroidal bronchio-dilator that can be effective in cases of tracheal collapse (see this 2019 retrospective study). The problem with that drug is that about 30% of dog patients experience unpleasant side effects, mainly in the tummy. At this writing, Humphrey has not had it.
When asked, Dr. M said it may not be a bad idea for Humphrey to get re-assessed by his cardiologist (he had a clean bill of health about 6 months ago when he saw her last).
Finally, Dr. M was concerned about Humphrey's appearance, that he "looks" like a dog with Cushings. This fact has been a running joke with Humphrey's Toronto veterinarians. He's been tested multiple times, always negative (so far, anyway).
Dr. M felt that given Humphrey's age and how fragile he is, he didn't think it would be appropriate to do bloodwork, at least not during that appointment.
We'll see if the cough resolves with conservative treatment again, and if we can keep it away.
