Everted Laryngeal Saccules (ELS) — Part II
February 1, 2007 by AKC Gazette Breed Columnist • Categories: Breed Columns, Health
It was dark when we pulled out of the driveway. On Sunday, June 25th the first fingerlings of light were making their way over the New York City skyline. Our destination — Okemos, Michigan, 689 miles ahead. Three Norwich Terrier girls were tucked into the car along with their paperwork — ready for their appointment with William E. Schultz, D.V.M. first thing Monday morning. Dr. Schultz has been working with the Norwich and Norfolk Terrier Club to diagnose, treat and study Everted Laryngeal Saccules (ELS) and Upper Airway Syndrome (UAS) in our breeds. To date he has scoped over 65 Norwich Terriers and the number continues to edge up.
My three bitches had varying degrees of UAS. My oldest, Mazie, was a very noisy breather, often seeming to struggle to get her breath. Razzi sometimes panted but it had never been a cause for concern. Keri was and is asymptomatic. I thought it would be good to find out just where they all stood—both for my own awareness as a breeder and to contribute to the study. So, thus it was, we arrived promptly at 8 AM Monday morning for our scheduled appointment with Dr. Schultz.
Mazie is 11 years old; Razzi nearly 7. Dr. Schultz wanted full blood panels done on the older girls pre-op. Superchem/CBC profiles/heartworm-lyme-erlichia totaled $334.42. The girls were each in turn, lightly anesthetized and then examined with a laryngoscope. Dr. Schultz was kind enough to let me stay in the OR as an observer. So I was able to see quite vividly the degree each had been affected via his state-of-the-art video-otoscope.
The procedure is straightforward. Dr. Schultz first “challenges” the saccules, lightly touches them in a gag reflex test, and if they appear and expand he can tell the degree to which his patient is affected. Keri had small tissue filled saccules. After administering additional anesthesia (sevoflourane), Dr. Schultz was able to excise those in under 4 minutes. Razzi’s were much larger and fluid filled. They were still fairly dense but they completely occluded her vocal folds. Dr. Schultz was able to remove the laryngeal saccule tissue with his laser in under 7 minutes.
Mazie, however had huge saccules as well as a very mild elongated soft palate. I stood in the OR in shock, seeing the visual proof of the burden under which she has been laboring for most of her life. Within a quarter of an hour, Dr. Schultz’s laser had vaporized the tissue.
The total cost to me was $1403.17. The benefit to Mazie/Razzi/Keri — priceless. Afterwards, they were all placed on antibiotics to ward off infection. Since there is a risk of swelling, steroids are a post-op must as well. Recovery is short. Their barks were all affected however-somewhat akin to laryngitis, but their voices returned within a few weeks. If I had to do it again, I probably would not have done Keri as she is totally asymptomatic. Mazie is vastly improved. She still snores but the struggle for breath is a memory. Razzi had to return in September to have more tissue removed. The saccules may have multiple layers.
Dr. Schultz categorically states that our breed universally has ELS. “If you have your Norwich Terrier examined, plan on having the surgery too.” Now it is up to us to recognize this widespread problem and take action through scoping, cooperation with the club, a push for grant funding from the CHF to sponsor research, selective breeding and informing practitioners.
Sue Lawrence is chairing the NNTC Health and Genetics Sub-Committee for Research on Upper Airway Syndrome in the Norwich Terrier. Having had her own terrible experience with ELS, she has stepped up to the plate to help our breeds fight this threat. she hopes that we as breeders can work with the veterinary profession to get the word out. “Some of these professionals might need to be informed of what is normal for our breed.” According to Sue, it is normal in Norwich to have a slightly longer soft palate than most other breeds of their size. They also have more tissue in the upper airway and a slightly smaller trachea than other breeds. The Committee has issued a call for pedigrees both of affected and clear NT’s. To participate, please contact Sue at (248) 356-8250 or at bluwaterterriers@sbcglobal.net.
Twelve years ago, Fraya Katz took her little girl Ariel Pinkrose to vet after vet searching for the cause of Rosie’s breathing problem. “I got diagnoses of long soft palate(she doesn’t have one) allergies, sinus problems, paralyzed larynx—everything but the right diagnosis.” She finally found a vet, Cheryl Mehlhaff Schunk, DVM, ACVS, who scoped, recognized ELS and operated. Ariel Pinkrose is now 17 years old.
— Leandra Little, AKC Gazette Breed Columnist