Reverse sneezing

Why is Rover making that horrible snorting sound?

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Dogs rarely ever get things stuck in their throat. —Lorraine Sue-Fern Yeung

The movie had just gotten to a good part when my phone buzzed out the Morse code for S.O.S! I have an ongoing emotional negotiation with my iPhone when it comes to choosing sounds and alerts for my answering service. The sounds need to be mellow enough not to provoke an adrenalin-laden flight-or-fright response every time I’m paged … yet loud enough to wake me from deepest sleep for those midnight emergencies. I used the “cricket” tone for a long time. It was calming. But eventually I began associating the lovely sound of real crickets with impending crisis, ruining my ability to enjoy summer evenings in the backyard, so I had to change it.

Of course, sitting in the theater, my phone was muted, so just the vibration alerted me. S.O.S! I looked discreetly at the text. “Dog with something stuck in throat.” In all my years of practice, I have gotten hundreds of these calls. The dog almost never actually has something stuck in its throat. Owners call because their dogs suddenly begin gagging or snorting repeatedly in a loud, explosive way. People are often very distressed, convinced the dog is dying. The dog is not dying. The dog is not choking. The dog is experiencing a common, usually benign, condition called reverse sneeze. Well, technically it’s called “inspiratory paroxysmal respiration,” but that scares people. Reverse sneeze is much friendlier.

So let’s call our dog Oscar. Why is he making that horrible snorting and what do we do? Reverse sneeze is Oscar’s attempt to clear something annoying from his nasopharynx (i.e., where the nasal passages open into the throat). It may be something inadvertently inhaled. A blade of grass. Hair. Dust. Smoke. Or Oscar may have allergies, postnasal drip, or infection with little critters called nasal mites. Any of these may cause irritation or inflammation and predispose to reverse sneeze. If Oscar is a long-nosed breed, these dogs often have an extra-long soft palate that can get flipped into wrong alignment with other structures in the throat. Reverse sneezing helps blow everything back to the correct place.

Most episodes resolve spontaneously in a few minutes … but sometimes they don’t. That’s when I get panicked phone calls. There are only a few situations in which reverse sneezing truly warrants a veterinary visit. If Oscar has significant nasal discharge, nose bleeds, or labored breathing between episodes. If bouts recur frequently, or his face or nose looks asymmetrical. But for a single episode, I love my old farmer’s remedy. Feed Oscar a pat of butter, then a cup of warm broth. Butter lubricates. Warm broth hydrates, rinses, and relaxes. Lapping and swallowing help realign everything. It works almost every time. I get to see the end of the movie. Oscar’s owners don’t have to pay an emergency fee.

But this time it wasn’t so easy. Calling the number the operator had texted, I kept getting a fax machine. I called the service. “Seems like we have the wrong number,” I said. “I’m sure they’ll call again soon with the right one. Ask if the dog is still distressed, or if I can call back after the movie.” Not long after, S.O.S. buzzed again. A text with the correct number and a note: “It can wait til you are done.”

So after John Glenn successfully orbited the earth, I called the client again, with the right number this time. This dog, let’s call her Toni, was not reverse sneezing. The owners had paged me initially because Toni had been pawing frantically at her face, but the owners reported she seemed a bit better now. Pawing at the face is a classic sign that a dog has something stuck not in the throat but in the mouth. Most commonly it’s a stick or bone across the roof, wedged in by the upper teeth on either side. I suggested they examine Toni’s mouth carefully, try to remove any foreign objects, and to call back if they needed further help. The next day, my secretary phoned to check in with them. They reported they had removed a stick from Toni’s mouth and all was now well.

One of my favorite stories is not about an object stuck inside a dog’s mouth … but rather a dog’s mouth stuck inside an object. Drambuie, a goofy Gordon setter of whom I was very fond, once got into the trash and pushed his lower jaw into a big tin can, trying to lick out the food remnants at the bottom. His bottom jaw got stuck inside the can. He banged around, trying to get it off, only succeeding in driving his lower canine teeth up through the can so it was now even more firmly anchored. He then whacked his head around, crushing the can flat so it closely encased his whole bottom jaw. It took two assistants holding him and ten minutes with a pair of tin snips for me to to free him. Luckily he only had minor lacerations on his tongue and lips.

A month after the movie incident, Toni’s owners called to schedule a dental cleaning, citing a case of bad breath. “I’d like to examine her teeth before we book that,” I replied. When Toni arrived, I immediately got a whiff of severe halitosis, yet her teeth had virtually no tartar. Remembering our previous conversation, I opened her mouth wider. Sure enough, there was a stick wedged across the roof. I dislodged it with hemostats, revealing several nasty sores underneath. Had this stick been there since movie day? Had the owners removed one stick but not seen a second? Or was it a new stick Toni had chewed more recently? In any case, it was the source of the odor, and the sores warranted antibiotics and pain medication. Remarkably, Toni had been eating and drinking normally, and not showing any symptoms. “Toni!” I said “Next time, paw your face! Send out an S.O.S.!” Stick … Ouch … Stuck!