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Okay, into the chatroom. Today we're going to be talking about one of actually my favorite topics. It is all about why dogs cough. Jason, are you ready? Are you excited? 

I'm super excited. I'm always excited, but I'm even more excited because of our guests today. 

I know we have a great guest. So let's get him on in here joining us again because he is a friend of the show. Joining us again is Dr. Richard stone who is a board certified veterinary internist and also serving right now he is the vice president of medicine for Blue Pearl. Let's see if we could we just call it blue pearl. We shorten it but it's what is it blue pearl, Animal Health Blue Pearl. Give it to me Richard 

Blue Pearl Pet Hospital

Blue Pearl Pet Hospital. That's right. I thought it was blue pearl saves all pets. No. Is that not? I've been saying it wrong. All right, we try we try it. I love it. That's fantastic. We do we do try don't we? All of us. Sundays, Jason tries more than others. But anyway, everyone else should also do a fair disclosure that Richard and Dr. Jason were in vet school together. If you don't already know that were founding members of GOTM and Anders Dr. Andrews Kulhavy, another friend of the show, he should check out his episode, if you haven't already about a veterinarian in Hong Kong. They were the founding members of GOTM. 

I just said that. But I'm glad that we repeated because it's important to know you left out as president of medicine bluepearl. All right, founding God and that's what it should say on his LinkedIn now we're probably getting more traction in the world. I'll update you she's gonna update that. Okay. All right. So, but let's let's talk about it. Because I think it's one of the most common complaints we hear from pet owners, or at least I do, they will come into the ER for it, they'll come into the regular general practice for it. They have to come into the specialty hospital for the coughing dog. Yeah. So what do you think about when you hear someone's there to be seen because their dog is coughing? Dr. Stone, what goes through your head? You know, there's a few ways we can think about it. But I'll tell you, sometimes dogs cough and it doesn't have to be a big deal. If it's a transient, like, they coughed a few times, and it resolved because they were eating and they got something caught back in their pharynx kind of in the back of their mouth, or they were eating grass and the gag a little bit after doing that that's not a disaster, right? That's okay. persistent cough, however, that can indicate some sort of health problem. So okay, we got to differentiate what's causing that whenever we see that, okay, this isn't just two or three coughs and it's going away, but it's continuing to happen throughout the day. So when you're looking at the frequency, or like for, I guess, the duration, the chronicity of that cough, how long they've been coughing? Because we do we have we have clients, you know, pet owners that will call and say my dog coughed? Do I need to bring them in? What do I do? You know, and I'm like, I don't like did it just conflict a one time?

You know, so what I guess what constitutes in your mind? Or how do you describe that for clients? When the COP is legit, and needs to be seen?

is kind of the question you just said, which is like, Okay, did this just happen once and it's resolved? Or is are we continuing to cough? And if we're continuing to cough, like even within one day, I would say, well, we'll probably need to be seen, because there's a lot of things that cause an acute cough, meaning a cough of relatively short duration, that we want to sort out, some of those things can be contagious, so we need to sort that out. And there's a different category that we would call a chronic cough, where you get beyond say, two weeks of coughing, we start thinking about other what we call differentials, other disease processes that can cause that to happen that we diagnose and treat in a totally different way. Okay.

All right. So let's let's focus. let's kind of take this in in a stepwise fashion. So How about how about those acute cough? So when I when you say acute cough, like to me, I feel like that's they've been coughing for like, maybe a couple of days. Yeah, right. That'd be how you would see that as well.

Here's what typically happens, someone calls into As my dog's coughing we get them in to be seen. And when it's an acute cough like that there's a few things that are that we're thinking about immediately top of mind. We only start with a physical exam and a history though, right? So we ask all the questions related to how long has it been going on that anything happened prior to the cough during the cough, any other symptoms of illness, right? Then we also have to consider things like the patient's age, because surprise there's, there's some infectious diseases that the younger dogs might be more likely to encounter in their environment. We got to think about all of that. And then we

wait a minute, I gotta interrupt for a second. Right. Jason, Did you just hear Dr. Stone? Did he? Did he say that old age is a disease? And

He almost said that?

Did I hear it? Yeah.

I said specifically, young age might get you in more trouble sometimes. Yeah, old

disease. So what are we really talking about? That's exactly what we said.

Okay, the age thing is a good point to bring up though, right? Because if we think about it, there's certain and people may not know this, there's certain intestinal parasites, that when young puppies get them migrate through the lungs on their way to get to the intestines, and that can actually cause a little bit of a cough as well. Now, you're probably going to see other symptoms, but we think about all the things that can impact the lungs and the airways. In younger dogs, we do worry about things like parasites and infectious conditions. Okay. When I say infectious, I mean, bacteria, viruses, things like that, that we actually usually vaccinate for. That young puppies might not still encounter those diseases, right. So when I hear that a dog has been acutely coughing, so it's been going on for maybe a day, maybe a couple of days, not two weeks or more, but but but short, short order like that, I start trying to run down the list of Okay, could this be something infectious or traumatic? One of those things that comes on relatively quickly, that we need to diagnose and treat, in particular, if it's infectious, because if it's infectious means it could be contagious. I have a question.

And it's everything I asked usually pertains to me, right. So this is all I care about is me. So Dr. Stone, my first question is none of those. Okay, my first question is, can you demonstrate it for me? Now? Is that a terrible question to ask a client? Or am I just being silly? Because then I record it, right? And then I use it for No, I'm just kidding. But I asked, Hey, what does it sound like? Can you go and demonstrate it for me? And a lot of people kind of laugh at it. But I think it may be an important question. Not all costs are created equal. Is that Is that a true statement? Or is that completely false?

No, that's actually very true. It's a good, it's a good question. And I thought you were asking me to demonstrate it at first. No, I

will later though.

in the exam room, so the physical exam portion of things, you know, what we were talking about earlier, is like what's already running through my mind when I hear his dog having an acute cough, whether they're younger dog or some, in some cases, an older dog, let's say been boarding or has been around a lot of other dogs at the dog park. There's certain infectious diseases I think about when we do our physical exam. We're trying to localize the cough. Basically, when we do a complete exam to make sure we're not missing anything else. We miss any other conditions or symptoms. But then we do things like we actually palpate we feel the larynx and the trachea to see if there's sensitivity there. We listen to the lungs to see if there's abnormal sounds down low. We try to understand when they cough, is it more of a harsh what we call an upper airway cough, where they like cough and gag, or is it a lower airway cough, which sometimes can be a little bit softer. And you can sort of hear it down in their thoracic wall and your stethoscope, you can hear something down in their lungs. When we localize a cough like that, it's actually very important because there are certain things that I do not expect to hear if let's say this is a simple, we call infectious tracheobronchitis, meaning I got a literally kennel cough, I expect that the trachea the upper airway is gonna be little bit sensitive. We probably coughing gag a bit whenever we cough, right? I hope to not hear fluid sounds or harsh lung sounds down low because that might be well, then that means maybe it's not just a simple upper airway here. And from nowhere, infection, but maybe it's lower in the lungs.

I do have to interrupt for just a second because I think I heard a band phrase.

I know, I knew I'm surprised you didn't stop right away.

I know. But if he was on a roll, and it was all such good stuff. I

just loved it and never want to interrupt dr. stone when he gets rolling. No, no,

he's a stone rolling down the hill. What is it? That's right. So we have a band phrase here in the chat room. We have banned the phrase kennel cough. Hmm, yes, most recently Dr.

Jin has banned. I don't I want to make that very clear.

I have but but let Okay, so so we're gonna focus on that. So remember, folks, we're still talking about those acute coughs that are just a couple of days in duration less than two weeks for sure. And most often, we find those in those younger dogs that are social, like he mentioned, they're get bored if they see other dogs or social dogs. So if your dog has a calendar that's busier than yours, you might have a social dog. So Uh, when when we talk about kennel cough, because I know right now, every single pet owners, I know, but I'm using it to discuss it as it sounds right. So it's fair. Every single pet on the rules it's like, like, well, of course I do. Every single pet owners ears perked up because they're like, wait, what, because everybody has heard of the dreaded kennel cough. And the reason it's a banned phrase in the chat room is because A, we now know and now dog lifestyles, you don't actually have to put your dog in the kennel for them to be exposed and potentially infected with some of the pathogens, the viruses, the bacteria that combine to produce that clinical syndrome. And in fact, now we don't call it kennel cough, if you want to appear learned in your social circles, right? You call it canine infectious respiratory disease complex CRDC, or just a coffin dog. So I know, I know, Dr. Stone just had a momentary lapse there. And

Dr. Stone just wants to sound like a normal person doesn't want to have all those words rolling off his tongue, semantics

are so important.

You bring up a good point. Now granted, for a lot of clients, the historical terminology of kennel cough is well known. But you bring up a great point. And that is, there's actually been an evolution to in what some of the pathogens are that dogs are exposed to go back to 2000 and pre 2004, let's say right, what was a long time?

Y'all, y'all were still in school, I was out. But that was the flu, right? We did we know? Well, we didn't talk about canine influenza. But even more importantly, people were still thinking that coughing dogs were because of a single pathogen infection called short Atella tele. And now we know where to tell us not even in the top three, most often producing that coughing dot like you got to go pretty far down the list to get to Bordetella. But what a client's always come in asking for I need my dog's Bordetella vaccination. And I say do you do? Yeah, no, let me help you. What you need is a vaccination against upper respiratory infection. Because Bordetella is really kind of a big player.

That's right. And you bring a good point to that often that this is one of those unique scenarios where you can have a multifaceted infection, some of the organisms that are grown in pets whenever so if we do a, let's say, a sampling of a dog with one of these upper respiratory disease complex type coughs, right, we think it's an acute infection. So they've been caught something and we we go and screen them with, say PCR testing, things will pop up on some of that testing that we're not even quite sure what we should do it. Perfect this. So if I grow say one of the organisms is called mycoplasma,

or even a pneumo virus now, like that's the big one running around,

you know, but it demonstrates what you said, Jen, which is like there's complexity, even in something as simple as an infection, it can be multiple pathogens, or multiple organisms, and they're contributing that cough. But that's one of many reasons why a young dog can cough, like there's so many other things, but I'll tell you what I find to be diagnosed a few times, but it's probably one of the least common causes of cough. Oftentimes, when dogs are coughing very harshly because of that upper respiratory disease complex, infectious condition. People are concerned that they're choking on something that they've inhaled something and they're choking on it. Yeah, it does happen. I have used a bronchoscope to pull acorns out of a dog's trachea on more than one occasion. It happens occasionally. It's exceedingly exceedingly rare. So more often than not when they have that harsh cough, very sensitive trachea. Usually not because they're, quote unquote, choking on something. It's usually something else.

Yeah, that's very, that's very interesting. All right. So now we know to beware of acorns, if we didn't know already, which is awesome. Like, I can't believe you actually have an acorn problem.

We know who to call. Holy

moly. Yeah. Richard. really rare, exceedingly rare. Yeah, it is. It's a good point, because people often think their dog is choking. And they're not even though it seems like they're trying to hack something up, right? They're trying to cough out fluid that is in their lungs, but they're not going to click, they can't cough it out. It's not available to be coughed. So okay, so we know that a lot of times it's an infectious cause for that acute cough of less than two weeks duration, and typically in younger dogs, but luckily, and I'm just gonna, like put a button on the acute cough and say, we can prevent that.

Oh, yeah. That's right. Now, I want to call something out. There's one other very important cause of acute cough. It's actually a chronic condition, but it will present acutely with cough. We've been talking about airway disease the whole time. The trachea, lungs, you know, the where the air moves through to oxygenate your body. Let's not forget About cardiac disease.

Oh, yeah. Oh, yeah. Now listen, to me that is when a cough is not just a cough is, is when it involves like we start talking about other systems and, and that sort of thing. So so let's just we're going to wrap up our acute cough here, because that's Tremaine. Don't

don't wrap it up. Yeah, this is another listen again, all about me. So another question I always ask or try to differentiate, especially over the phone, and maybe this is wrong, like to be told I'm wrong, is what I do. productive, non productive, wet, dry. So are these acute sort of infection like upper respiratory disease caused? Are they more of a dry kinda cough? A wet cough, productive cough? How else could you characterize it? This is just for the non maybe the non veterinary knows like the the non veterinarian? Folks we have out there that have dogs, they can help more accurately describe the cough. A to their veterinarian, because it's probably going to be over the phone, right? It's one of those things where, Hey, should I come in? Or not? And it's gonna be one of the questions you asked. Dr. Stone, you're gonna have to ask it. And maybe they need to know kind of what that means. So when I'm asking, dry, wet, productive, non productive, what am I asking?

So I think what you're asking there, when you talk about coffee, you're asking the client that the pet owners describe does is something brought up whenever they cough, because like if we see something like mucus or blood, or something like that, sometimes that could indicate a kind of an upper airway type issue, sometimes with deeper pneumonias. Deeper is more and more serious, often, they might have the sounds really gross, but purulent accident, which means like infectious material that can be coughed up, that's called pus.

Yeah.

Or what sounds gross period. Excellent. Sounds very smart. Yeah.

And then sometimes in dogs with, say, heart conditions, they will present acutely with cough at times, it is possible for them to produce fluid when they cough, I want to just warn everybody, there's a lot of dogs that have any one of these conditions, and they don't produce anything. So like that can happen. So it's fine to ask the question, but I think we got to keep in mind that for some dogs, even if they are producing something coughing something up, they swallow at university. Right.

Right. And I would agree like the truly productive conflict we think of with people, it just just really doesn't happen with dogs in our like, we're not going to perceive that. Right, right. Yeah, they don't, they don't, they don't Hawk up along, you know, like, they just they just cough and cough and cough. So, all right, so so acute cough, young dog less than two weeks duration, most of the time, we're looking for an infectious cause. And this is just, if you needed a sign right now like to get your dog up to date on their upper respiratory vaccination. This is it, consider this it, you now have permission, in fact, encouragement, get your dog vaccinated for upper respiratory disease. And we're going to take a short break, but then we're going to come back and we're going to talk about those those coughing dogs that are not acute necessarily, they may look that way. They may. You may think they just started coughing, but maybe it's more chronic, and it's gonna be a bigger win a cough just isn't just a cough. All right, we'll be right back. Merck animal health is committed to disease prevention in our animal companions. The nopi vac portfolio of industry leading vaccines empowers veterinarians to have a broader impact on pets and their owners. Merck Animal Health Philosophy is driven by innovation. Continuous research and development ensure the latest technological advances are available to provide reliable protection. So ask your veterinarian about Nobivac vaccines for your pets.

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Okay, so we're back so we have talked about we had we did coughing break. So we Hey,

I'm sorry. That's great. I love it.

Wow, okay. I mean, Dr. Stone, he doesn't change as he No, no.

I would have laughed if it was funny. Anyway,

holy moly. It's a tough room today in the chat room. But thanks for hanging with us. So we're back with Dr. Richard stone vice president of medicine for Blue Pearl, Animal Hospitals bluepearl Veterinary Hospital. I'm never going to get it right. Okay, because we just call them blue barrel. But we're so excited that he's joining us because he's a super smarty. He is boarded veterinary internal specialist. So an internist, and we're talking about when a cough isn't just a cough. So we've talked about those acute coughs. And as a reminder, less than two weeks, typically of duration, usually much shorter, a couple of days, up to two weeks. Usually, that's fine, we find that in younger dogs, I'm going to say like two or three year old dogs are younger. And now if it's not one of those largely infectious causes, if it's not just upper airway, like what are what are we looking at there? How, how does that how does that cough or that presentation in the exam room differ?

Sure, good question. So there's some other things that we might consider. And this is where, you know, we could categorize based on breed size of dogs are certain things that we might see more frequently. But there's a few things that I want to call out across the United States and other parts of the globe there. Other infectious conditions that we commonly see that can eventually result in a cough for a number of different reasons. One being heartworm disease. Oh, yeah. Which is can get heartworm infection, it's actually not in their lungs so much as the arteries in their lungs. But that can lead to inflammation and symptoms well beyond just a call. Okay, so I want to call that out when you are making a plug for ensuring that your pets are vaccinated. I think making a plug for ensuring that if you're in a heartworm endemic area that you're aware of that you've talked to your veterinarian about that and you're managing that risk appropriately.

Okay, people, he's going all around it, just get your dog on heartworm prevention, but Okay, that's it, it's really easy. It's much cheaper than treating the disease. And it's way better for your pet. So just put them on heartworm prevention. That's a good point.

Now, if we're dealing with say a more a more chronic type of cough, there's a few different diseases that I would definitely want to consider. But I want to remind again, if it's short duration, cough, even it's not a younger dog, let's say an older dog, 13 year old dog, 12 year old dog, in certain breeds to if they're coughing, and it sounds not like the typical harsh cough, but maybe they've been breathing faster than normal. And they're maybe a little lethargic or slower with respect to their their activity. And now they've got this cough, and maybe it's even a soft cough, we still want to get that checked out. Because some dogs over time develop cardiac disease that can lead to cardiac failure. And what I mean by that is, for a number of reasons, whether it's the muscle portion of the heart pumping, or it's the valves in the heart that are supposed to be sealed, and then they start leaking. If that happens, pressure builds up in the lungs, and fluid can leak out into the parts of the lungs that are supposed to be filled with air. And that can result in fast, rapid breathing, coughing as well can happen. And although that happens quickly, from the standpoint of a cough coming on, you'll you'll just notice suddenly one day were coughing, the condition has been brewing under the surface for goodness, probably years. And in particular, if you have a dog that is a Doberman, they can be prone to certain conditions, like dilated cardiomyopathy where the heart gets bigger and weaker over time. That's called the basketball

heart. Jason, do you remember that? From

listening to Dr. Stone,

please carry on giant basketball heart.

Yeah. Now, I also want to call out there's a lot of small breed dogs that have what we call a heart murmur. And there's a leak in the in the often the mitral valve, what are the valves in the heart that makes this noise when we listen with our stethoscope, this abnormal noise, not every dog with a heart murmur ends up having heart failure, but it's an important piece of information to know. So that if if the murmurs getting louder over time, and your veterinarian tells you that and then one day a year down the road, your dog starts having a bit of a soft cough, let's not ignore it, let's get them into the veterinarian and get

what do you mean? I'm not asking you to, to demonstrate by any means, but what do you mean by soft cough versus the harsh cough? I think I know but but for the listeners and the viewers, what kind of what do you mean, the

harsh cough is usually upper airway trachea, where there's sort of like a real heart hack and a gag at the end of it, they can do that sort of thing. You don't always see that with heart failure. Dogs, sometimes their breathing even at rest is more rapid than normal, breathing heavier and faster than normal. And then you might hear kind of just a soft little cough, little little, like, kind of like that. You did kind of cough like okay, all right.

But there's a definite, there's a definite difference, right? The harsh cough is no way else to describe it. It's just hard, like, oh my gosh, it's almost painful. It hurts to watch and listen to versus the other one, which is like, Oh, that's cute. Right? Yeah.

And I think that's the important thing is it may not sound as dramatic as say the other costs we were talking

about, but it might actually be more more serious, right? It's

right. That's right. Yeah. And

I also think it's important to throw out there since French bulldogs are now the number one breed. I don't think we should go a single episode without mentioning that. But since French bulldogs are now that everyone read, read

for what like what does that mean? Most Popular mo What's popular for people, everybody, like?

Everybody likes them. So there's, there's a whole lot of noise going on in the airway of a lot of bull dogs, right. And so I think I think we should mention to folks that if you have a dog like brachiocephalic, you know, as much face dog like a Pekinese, or, or a French Bulldog, you should really make sure that you pay particular attention to their breathing patterns during the day. activity levels is, especially as they age, because it can be a little more complicated to tease out what's going on with that, with that dog, if they start with it with a cough. Sounds right.

That's a great call, like airway confirmation, the shape of the airway. It's remarkably different across dog breeds. And that can contribute to their their tendency to have airway problems. While we're on that, maybe it's worth mentioning, as we move into the sort of chronic type cough, the longer term costs, we were talking about earlier, doing a physical exam, we try to localize the cough. Well, in some smaller breed dogs, particularly smaller breed dogs as they age, they have a tendency to develop something that we traditionally call collapsing trachea. Okay,

which sounds horrific.

That's right. It does. It does. That's right, it does it and there's a couple of different things that can cause it. But basically, over time, there can be this sort of flattening and softening of the airway, the trachea up here, that should be as sort of a solid ring. And a little bit of muscular band that keeps the airway open. I mean, it makes sense to all of us, right, and with the airway open, so that we can move air freely, without a lot of turbulence, like, like a straw. But if it starts to flatten, it actually creates more turbulence, it narrows the lumen, the opening, and it becomes harder at times to move air. This can happen in the upper airway of some small breed dogs, it's not exclusive to small breed dogs, but they tend to be more prone to it. And you might notice that more with excitement, or if they're pulling on the leash, we might see it at times when they're inhaling. And other times when they're exhaling, depending upon what part of the airway is collapsing. That's something again, that would involve a physical exam to localize where the coughs coming from, and then maybe something like X rays to look at the airways, Diana. Now

listen, I didn't know that that like that's that. That's a little bit of news to me that the that they can as they age develop collapsing trachea. I honestly thought it was something that usually the onset was when they were young, maybe like a year. And, you know, really was what they were, it was kind of a congenital issue. So I had no idea that they could develop that as the tissue aged. That's interesting.

Yeah, but you make a good point, there's likely a congenital component to this. And when I say as they age, I mean, it's progressive. It doesn't just happened one day, it takes time for some of these changes to take place. There are congenital forms of it, where they they're born with kind of a an odd kink, or what we call confirmation of the trachea. And that makes it more prone to do that. So some dogs, you're right, it's from extremely young adulthood that they're doing this and in others, they may be four or five, six years of age, when it really starts to worsen because they started with a normal tracheids. Over time, it's it's gotten weaker and weaker.

Yeah, that's interesting, huh? All right. Jason, I feel like you had a thought bubble popping over your head. No,

you're incorrect. I had no bubble. I thought that was interesting.

Okay. Okay. So so we talked about, we mentioned the heart, right? Heart disease. And I think that's always that, like, for those of you out here don't know, like when we take x rays, and we have a cat because we have a coughing dog. And we don't think it's infectious. And so we take some X rays, like we play the game of is it hard? Or is it long? Is it hard? Or is it long? Because it can be pretty hard? Oh, my gosh, yes. And so it can be difficult to determine that. And that's when we get back in the room. Or at least for me, I go back in the room and I started asking even more specific questions about when the cough happens, you know, is it when they wake up in the morning? Is it you know, then they have to stop. They're running after the ball so they can cough a little and then run some more. So

Dr. Stone and say, What do you think?

There you go, you can also do that. But so so if it's not hard, is there another sort of chronic source of a cough that you think about most often with, with dogs when they when they cough? Absolutely.

So just as you said, typically, the progression is we've done our exam, we've quote unquote, localized the cough to not be up here in the upper airway, we think it's down on the chest. We do the X rays, and let's say there's no heart murmur. And let's say the heart is normal in size on the X rays, and there's no evidence of what we call pulmonary edema, fluid from the heart backing up in the lungs, and we think this looks more like a lung condition. There's several conditions that dogs can get. But the one that jumps to mind most commonly that that I've encountered as an internist is chronic bronchitis. So dogs can be prone to developing chronic inflammation down in their small airways of their lungs, similar to people. You know, when we think about people, we think about asthma and bronchitis, bronchitis, being the more chronic cough with mucus production and that sort of thing. Dogs can actually be prone to that, too. And there's certain environmental triggers. When you overlay that with their particular genetics, they're going to be more prone to developing this.

Okay, interesting. So as so like as, as a pet owner, when we find that and, and if I like the vet comes back in the room, and they're like, yep, looked at those x rays, and also had aI look at those x rays. We've come back and said, It's not cardiac, it's pulmonary. And it looks like chronic bronchitis. And so as a pet owner, am I panicking? What am I doing at that point? Oh, my goodness, well, a good thing. We have another dog, we got an extra set of lungs, like what do we do with the dog that has chronic bronchitis?

Well, good question. So usually, when we're going down that path, and we're thinking it's something down on the lower airways, there's some some options we have, we can do more diagnostics to try to get a more clear picture of what's going on. So we can do things like bronchoscopy where we actually go down with a camera, and we view the inner airways, and they get samples of any material that sounds a little it's usually like we were talking about mucus, pus, those sorts of things. And we can evaluate that for infection, evidence of certain parasites that get deep down in the lungs, or just inflammation, like sterile inflammation. And that's where bronchitis comes in. Okay. Let's say we've diagnosed something like bronchitis, it is manageable. It is manageable, but it does take some diligence, meaning, we have to evaluate the environment for certain triggers. Is there anything that makes it worse at times? So that's going to be digging back into that history that we talked about the whole beginning of this and saying more questions. Yeah, more questions, more questions. And then there's medications, there's typically things that we do to try to reduce inflammation in the lungs, just like they do when people

still like, like, I'm thinking of the big gun, right? steroids, right? That's right. That's right. You could use steroids or even antihistamines. And like, I guess, would you even go into like immune modulating drugs would would you would you pick some of those. So

typically, what happens is, it's it once we've gotten to the point where we see what we call sterile inflammation down in the lungs, we think it's bronchitis, or certain variants of bronchitis because they can be, you might read about pulmonary infiltrates of eosinophils, PE, or eosinophilic, Bronco, Timothy, these are all fancy ways of saying like, there's different versions of inflammation in the lungs. It's not triggered by an infection, we believe it to be an immune thing, like a sterile inflammatory condition. In those conditions, steroids are usually what you reach for. So maybe oral prednisone. But keep in mind, this is a chronic condition and taking chronic oral steroids, steroid pills by mouth is not a great option. Right? So what do we do? Well, in human medicine, they've had a lead on this. And we've since very much adopted this in veterinary medicine, we use inhaled steroids like inhaled Fluticasone. There's a number of different inhaled steroids. And the nice thing about this is they're very potent, and they tend to be more localized. Meaning if you can get your dog to use a little like Arrow dog type like spacer chamber and administer the medication. That way, it tends to deposit most of the effects of steroid effects down in the airways.

So then you're avoiding all the most of the problems. Yeah, well, yeah,

yeah. Now there are challenges because with dogs, unlike people with people, you can inhale deeply through your mouth and get the steroid, more of the steroid down in your lungs. But dogs are usually filtering it through their nasal passages. So a miniscule amount of the medication gets down into their lungs. But when you factor in that you're using a human medication for even a small dog, it works out. And basically what I've seen in practice is, many dogs put on inhaled steroid, when they've got chronic bronchitis, they they do show improvement, they show reduction in their symptoms, less frequent cough, it may not completely go away. So some dogs with a chronic bronchitis will have an occasional cough, that doesn't mean that you failed treatment, it just means we're going to control it. I

would imagine it's pretty tough to get the dog to, like if you have a if you don't have one or two small dogs, if you have an 80 pound dog doesn't always want to do what you you say pretty hard to get them to, to use those inhaled medicines or you know, I don't have any experience in that. So have you do they do okay with that, in general,

they do okay with it, you know, positive reinforcement goes a long way. And the nice thing is, even in the absence of the medicine, because these medications can sometimes be a little bit expensive. You don't want to wait, right? Right. You can even take the little mask space or chamber, put it on their nose for just a moment and then give them a treat or whatever positive reinforcement like dogs will come to be a cost under this, and it's not like the nebulization treatments that you might think of in people where they have to sit for 20. Right. That's what I was thinking. Right? Usually like now, five to 10 breaths, you know,

really manageable for sure. Yeah.

I mean, I feel like there's probably some Labrador Retriever out there on this medication, who walks in the room with the breathing apparatus on their nose saying, Give me a treat, Mom, I'm ready. I just feel like that, that probably happens. So okay, so So that's interesting, because a lot of times when I talk to clients about their, their dog, or even their cat having a condition where we're going to treat it with steroids. I just the the the owner just shuts down. They're just like, oh, I don't want to stare at it. I'm like, listen, friends, steroids could do some really great things. I mean, they're really good at what they do. And that's the reason they can be so effective when used appropriately. So yeah, again, I don't know who needs to hear this, but steroids are okay. So, yeah, so do you, do you find you have

the same folks who say kennel cough? They are, it's the same group of people.

Thank you. Probably. So. But, um, so, Richard, do you find that veterinarians, you know, because like, we talked about, like, the subset of pet owners who are just opposed to steroids? Do you find that when you talk with veterinarians, about some of these conditions as well? Do they just kind of cringe or recoil when you say, well, we can use, you know, an inhaled steroid? Or are they all like, oh, yeah, I'm on board.

I think, you know, we tend to get pretty good acceptance of this, because I think almost everyone knows someone who's had asthma or some sort of bronchitis, these steroids are also demonstrated to be way safer with respect to side effects. The problem is if if someone interprets the oral steroid to be the easier route, like, oh, I don't want to mess with the mask and the space? No,

that's why. That's why I was asking you because I figured it would the dogs were probably much more accepting than we would imagine. Most people think I'm never getting my dog to take them. Because it's hard to get a child to do a math little on the dog. But

I agree. But after a dog has been panting and thirsty all the time and woken you up three times in the middle of the night to go outside and go pee. You tend to say, You know what, it is not so bad.

Something else right. Give me something else.

The other thing is, most dogs. I mean, they're not stupid. And if, if, if this relieves a condition and makes them feel better over time, they're not stupid. They feel Yeah. Oh, I feel better after I after I do that. It is a positive reinforcement. And it

may not learn or may take them a little bit longer, but most other, most of their dogs learn pretty quick.

Well, they'll learn faster than the Pekinese. Okay, so let's not slam the French doors. Right? Yeah. Okay. So that those are some pretty kind of heavy reasons for that cough. So let's see the first two we talked about heart disease. We talked about this chronic bronchitis that might pop up. And is there is there another any other kind of chronic cough?

I hear that I'm gonna take from Dr. Stone clients, I mean, immediately go to this. If it's not if you said oh, it's not the upper respiratory disease complex. The next question is, is a cancer? Is my dog dying of cancer? Oh, true. I don't. And I don't know what we did as an industry to sort of create that. Or maybe that's just human nature going to the, as long as it's not the worst case scenario. I thought, okay, I don't know. But most of the times I get the I don't even know how, what the I don't see enough patients really to see to know what the overall percentage of a coffin dog actually translates to cancer, probably not nearly as high as people think. I

will tell you that, although it does happen. So we're talking about our dance stage neoplasia cancer, where it's metastasized, put spread from the single location to regional lymph nodes, and then up into the lungs leave with the

Dr. Stone to give us an entire script. Oh, totally,

totally.

But you know, like, that's kind of how it goes. It is early stage, right? There are certain cancers that are more prone to doing that than others. And then the malignancy is that we think about when we say something's malignant, we mean it's going to spread like that. Here's the unfortunate thing. There are some cancers, it's very important. If you find something like that you address it with your veterinarian, you get the biopsy or the tissue sent in and evaluated for evidence that we're likely to see. Those that have a tendency to spread. We don't always see a cough of that. In fact, we often have to proactively in a patient that's been diagnosed with a malignancy do screening tests, like CT or chest X rays, to see if there's any nodules spread, because they don't always show a cough. Now cough can happen when you've got very advanced spread of cancer in the lungs. But I see plenty of patients that cough isn't really in the equation and we still have to screen them because it can be silent.

I mean, I've seen so Mmm, they come in on emergency. And they're just, you know, they're an older pet, usually a Chihuahua. And they, they have a multitude of health issues, because I mean, they've been around for like, 15 years. And I'll take an x ray. You know, because I hear like reduced breath sounds on both sides or something like this, and I'm not sure what's going on. And I'm thinking heart disease. And I put the extra up there. And I'm like, I'm not like, how is that dog even breathing? Because the whole, the whole entire lung field is obliterated with some kind of abnormal growth. And I say that, okay, it's probably cancer. But I don't know that until like a biopsy, right? So. But the dog was doing fine in the owners perception the day before, literally the day before or two days before. And so it can be really hard for owners to accept that you didn't do anything wrong. The system was compensating like it was supposed to the dog system. And it's just that it's been going on for years. He just didn't tell you.

That's right now, but it demonstrates kind of what we're getting at earlier, which is when we see a dog with a cough is cancer at the top of the list. Certainly not probably not the first, second, third or fourth thing that I'm thinking about. Yeah, they can cough, especially if it's very advanced, but more often than thinking about other things.

Yeah, I mean, I know I'm thinking about, you know, canine infectious respiratory disease complex most often and, yeah, and maybe, maybe also influenza. Yeah. Which

almost got through a whole podcast.

We're talking about respiratory disease, we have to say the word influenza, we have to it's

obligatory. Yes. We're talking about the sun coming up, we got to talk about insulin. I

know it listen. Influences incredible. Okay, so we are coming to the end here. So I do want to give you an opportunity. Dr. Stone, if you if you have any other thing that you you really, like you know that you wish that man I wish I wish people would just know about this, or I wish they would know about that. Or they could do blank that you'd like to share, now would be the time for that. We'd love we'd love to hear it. Excellent.

Well, I want to plug what you said earlier, which is there are a number of these conditions that we can actually prevent, or at least we can lessen the severity of them. So vaccination, as guided by your veterinarian is extremely important. Let's not play that down. Because there are probably many times that your dog and my dog are exposed to something in the environment. We don't even know it because the immune system was working as we expect it to. So vaccination is super important. If you're in an area that's endemic with certain parasites, particularly heartworm disease, heartworm prevention is important. Please do that. And then I think it's a good idea just to know your pet, kind of understand what their resting respiratory rate is, what does it normally look like when they breathe, when they're sleeping, and that sort of thing? That sort of observation is really helpful, because it might help you catch something earlier, if they start with just that little bit of cough that we talked about earlier, like, well, was that a one off thing? Or is that something serious? You can pay attention to it? And in particular, if you see them doing that, and you see more rapid heavy breathing, you might say, You know what, I'm gonna get this checked out now. I'm not gonna wait.

Yes, that was that was pretty concise. That was just for us. Just have that on there. Yeah. And

I'll like, I'll add, like, I love the pet owner that comes in and says to me, Listen, I don't know if I'm crazy or not. But I feel like this is a problem. Because normally it's like this. And you can just tell me, I'm being silly, and it's really okay. And I can I

find something secure and don't and they're embarrassed by them. Like, that's crazy, right? Like,

that's what I tell them.

That's a great honor to notice of small changes. And that's right. And that's what you say, listen to the best or ever. You notice those tiny changes that where another owner might not right, that's

fantastic. And we love to not find problems. Yeah, yeah. Love to not find terrible diseases. Yeah,

yes. I love I love when they come in, and they're like, I don't know what's going on. It's this weird thing I don't like it's a reverse sneeze. And it's totally okay. Because here's how you know, it's okay. And here's how you do it. And I say Goldstar best owner of the day, right? But I also love the ones who's who will say to me, after I do my physical, I've listened to the chest, I've done all the things. And and even if they if they say, Well, I really could start, you know, yes, let's do X rays. Okay, take the x rays, everything's good. And they say no, but there's still just something. There is something I feel like it's something off. Yeah. And I say okay, let's, let's, let's go and like, like, let's now let's go down the path in a stepwise fashion. You know, you know, your pet better than than anyone else. And, and so I love the owner, that's that just insist to me. I get it. I know. But I feel like there's something and is willing to, you know, to take the the journey with me. Let's sort it out. Right. Like, that's great. That's what we're supposed to do. Right when we're charged with their care. That's what we're supposed to do. So, so this has been a wonderful discussion of when a cough may not be just a cough. And I'm so grateful, Dr. Richard stone that you were available to join us again today. We love, love, love having you in the chat room. And I hope that you'll be willing to come back.

Of course, always enjoy it. Thanks. All right.

Well, that's that's all I have Dr. Jason. Oh,

I thought you're gonna forget about me. No, that's all I have. I'm good.

Okay, so get your copy dog to the vet if you've got one, and we'll catch you all in the next episode. The professional Animal Care certification council or PAC brings independent testing and certification to the pet care services industry is your dog daycare or boarding kennel or a groomer manned by pack certified professionals? Don't know if you don't know you got to ask. Look for the pack emblem at your facility to make sure that your pets receiving the highest level of professional pet care because we all know it's safer and a pack your pack CE code for this episode is cc 220085.

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