AFGHANS ARE US -HEALTH

CHYLOTHORAX

Reproduced from an article written by Sylvia Evans for the EEAC magazine

In the 2004 edition of the EEAC magazine I included a piece on LUNG LOBE TORSION & Jo Boulter kindly shared her experience with her dog “DODGER”, sadly I have to record that “DODGER” has since died & Jo once again was prepared to share with us her experience which is included here. Thank you Jo.

In both the 2004 Lung lobe torsion article, & Jo's piece, the medical condition CHYLOTHORAX is included as these two separate conditions may occur simultaneously.

I did attempt to explain, in brief, CHYLOTHORAX in the 2004 article but in response to a number of questions I have had during the year, I include here further detailed information on this condition.

It is NOT common, but neither is it UNCOMMON and it certainly is not RARE!

For reasons, not completely understood, the Afghan Hound has been identified, in a number of studies, as a breed with a greater degree of risk for the development of this condition, so it is useful to have this for reference purposes.

Hopefully, by creating a greater AWARENESS of this disease within our breed, the owner can be one step ahead, when TIME might be of the essence, should a situation arise where your dog presents with significant breathing difficulties, although I must hasten to add, NOT ALL respiratory problems result from CHYLO!....BUT.... at the least, appropriate non-invasive diagnostic investigations can be instigated earlier rather than later in such a situation.

Whilst we may be hearing a little more about Chylothorax, in the UK Afghan scene, it is a condition long recognized in the USA and it is significant to note that this condition was recorded and reported in the EASTERN EXPRESSION magazine, 10 years ago when club member Maureen Paxton wrote about her young dog “JIM.” *but some ten years on, there is more expertise referral available & possibly better understanding of the condition,

CHYLOTHORAX

The chest cavity, sometimes referred to as the thoracic cavity, is a negative pressure compartment containing the heart & the lungs. In respiration, with air taken in, a passive process, the diaphragm drops , as the inspired air rushes into the lungs via the trachea (windpipe) & the lobar bronchi. If for any reason there is an obstruction within the chest cavity from air or fluids, the lungs are unable to expand fully and a difficulty in breathing will be noted, from laboured or difficult breathing to a rapid short gasping of breath. If the process of respiration is hampered, the proper oxygen and carbon dioxide exchange is impaired resulting in metabolic abnormalities.

When AIR occupies the thoracic space, the condition is known as a Pneumothorax.

When blood occupies the space this condition is known as a Haemothorax.

Fluid that occupies the pleural space (which is the membrane lining the thorax and enveloping each lung) is known as an Effusion.

A Pneumonia is an infection of the lung tissue itself.

When fats are digested and absorbed from the digestive system, the end product is a milky substance which is known as CHYLE.

This fluid enters the lymphatic system from the small intestines into a structure known as the thoracic duct. This fluid then travels through the chest cavity, again a passive process , due to negative pressure, to enter another large vessel in the chest cavity to continue through the general circulation.

Any increased chest pressure can cause a disruption of this flow resulting in a lymphatic leak of the chyle into the chest....hence the term CHYLOTHORAX.

Increased chest pressure can result from trivial trauma such as a forceful cough or excessive vomiting. to more serious trauma such as a tumour within the chest; the trauma from an outside force, such as a road traffic accident.

An enlarged heart can cause increased pressure as can the aforementioned lung torsion.

Sometimes the cause may be unknown, referred to as IDIOPATHIC.

Chylothorax can also occur following traumatic chest surgery.

Any rapid accumulation of a sizeable quantity of fluid within the chest space will have an immediate effect on the mechanical process of lung function, necessitating the prompt drainage of the accumulating fluid.

As I have said, the Afghan Hound is a breed identified as being at a greater degree of risk to CHYLOTHORAX. in its idiopathic form.

An abnormality within the thoracic duct has been suggested as a possible cause but although this is a factor and may be demonstrated, particularly in the younger animal, many of the dogs may reach middle aged before they develop clinical signs. The possibility that these same dogs may have had a mild effusion for many years and have coped without demonstrating any significant severe symptoms to bring the matter to their owner’s attention is always possible.

Lung Lobe Torsion, as aforementioned , has also been shown to be associated with the condition but it is NOT understood whether the Chylothorax caused the torsion or vica-versa.

Surgical procedures, such as removal of the affected lung lobe, does not always guarantee stoppage of the leaking chyle.

SIGNS and SYMPTOMS

The most common clinical sign of a CHYLOTHORAX is difficult, laboured breathing (the vets will term this dyspnoea).

Symtoms may present for varying periods of time, with normal periods of interaction. Less frequently a cough may be a significant part of the overall deteriorating picture and may proceed the dyspnoea by varying periods of time, days/weeks with a gradual build up of the chyle within the chest cavity.

Less commonly loss of appetite & a fatigue may also be noted.

The dog will show signs of rapid, exaggerated respiratory movement particularly at rest. It will be quiet and may prefer to stand or adopt a sitting or upright position as opposed to lying in its side.

CHEST X-RAYS are vital but if the animal is in severe respiratory difficulties, a single exposure with the dog sitting or lying in its most comfortable position may have to be enough as extended shots could put the dog into a life threatening situation before the diagnosis has been confirmed. It may be necessary to give the dog oxygen via a face mask before instigating X-Ray diagnosis.

A thorough blood profile is also necessary to rule out infection and electrolyte abnormalities. Once a diagnosis has been confirmed, the drawing off of the fluid may be undertaken. Besides improving the animal’s respiratory effort, samples of the fluid can be examined for analysis.

Treatment. The management of the condition varies, from conservative medical approach to the more extensive surgical procedures and it is not within the brief of this writer to go into this in detail. (Maureen’s article indicates some of the more conservative treatments used for her dog). A NEW surgical procedure is under study at the University of Wisconsin USA. The whole point of the article is to raise awareness to CHYLOTHORAX, instead of people continually saying CHYLO WHAT!!??? . Prompt Veterinary advice can then be sought.

Cambridge Vet School, previously mentioned, have a lot of expertise in LLT, together with Lung lobe Torsion. Hopefully I may be able to arrange a talk on this condition for a future date .

SYLVIA EVANS. January 2005

DODGER's Story……..postscript to 2004 article

Sylvia,
Just wanted to let you know that after an amazing recovery from his torsion
last November that unfortunately the condition reoccurred and we lost Dodger
two and a half weeks ago.

He was racing on the Sunday, sudden and dramatic breathing difficulties on
the Weds night and by Friday early evening he was no more. In the end he was
on a ventilator and his heart gave in. We are devastated especially after
all we went through last year with his torsion as we really thought we'd
fixed him. Post the op he was better than new - more energy, more of a
devil!

However post-mortem reveals an idiopathic Chylothorax, lots of build up of
Chyle in both lungs which had built
up over several weeks. We believe the build up was so slow that Dodge was
able to cope without showing any signs of discomfort. It appears the front
right lobe had possibly also torsed. Unfortunately he then caught a
'superbug' according to the vet which went for his weakest point (his lungs)
found lots of Chyle and took over incredibly quickly.

I take comfort from the fact it was quick and once again he was back at
Cambridge where I firmly believe they did everything possibly to help him.

I wanted to let you know that unfortunately this story doesn't have a happy
ending but I still know other Affies out there can be diagnosed and saved.
If you ever hear from an owner in the position we were please don't hesitate
to contact us if we can help them talk through anything.

Thanks for the beautiful article on Dodger - its one of my mementoes now!
Kind Regards
Jo

CHYLOTHORAX

Jim our Afghan was put to sleep age one year three months old. He was a normal puppy, no problems at all. The first thing I noticed was he would not lie on his side and was standing a lot. He had a high temperature and was given antibiotics by our Vet; forty eight hours later he was having trouble breathing. An X-Ray wastaken and it showed the chest wall was full of fluid. A drain was put in and two litre's was drained out. After many tests and samples being sent to Kennett and advice from Cambridge Veterinary Hospital, Chylothorax was diagnosed and we were told there was a 40% chance of recovery. Jim stayed at the Vet's for five days with a drain in his chest. We had a dog coat on him at all times so he could not pull the drain out, and he was drained four times a day. On the fifth day he was given an injection in the chest and we bought him home. We had three days to see if this had been successful or not. When the Vet drained the chest, there was five times the amount of fluid that there should have been. It had been so sudden - it seemed as if he had been a healthy dog one day and a very sick dog the next. He was a very brave dog throughout the treatment and won the hearts of the Vet, and all the staff, who had looked after him around the clock.

Not a day has gone by, when I think I must have missed something leading up to his illness. We were glad we had him home for his last three days, these were very special, but then Jim was a very special dog.

WE ASKED OUR VET IF HE COULD EXPLAIN THIS CONDITION TO US. HE KINDLY SENT THE FOLLOWING NOTES

The condition which Jim had, CHYLOTHORAX, is very rare, the chances being approximately one in two million. It is a condition where chyle leaks from the lymphatic system into the chest cavity. The lymphatic system is responsible for the movement of fat around the body, together with having a role as part of the immune system. The cause of Chylothorax is often indeterminate. Damage to the thoracic duct by trauma, neoplasia (cancer) and inflammation are cited as probable causes. A congenital form is seen, particularly in Afghan Hounds, with abnormal connections between lymphatics and the venous systems. Although it was not possible to completely rule out cancer in Jim's case, given his breed and age, the congenital form was considered the most likely. The treatment initially was to feed a low fat diet with the aim of reducing the flow of chyle and then hope the leak would seal itself. The chest drain was used to clear most of the fluid from his chest in order for him to breathe more easily. When it was clear the leak would not stop, we attempted "pleuradhesion" which meant we tried by injection to cause an inflammatory reaction within the chest cavity and so seal the leak. As this condition is so rare it is not an easy one to cure. Given Jim's age, I believe it was completely right to go as far as we did, but when it became clear that the condition was not going to improve, it was kinder to let him go.