When a dog “chokes,” check out its mouth

“Our dog is choking!” the voice shouted frantically. It was one o’clock in the morning and I had been sound asleep.

“Try to calm down,” I said, in what I hoped was a reassuring tone. In 30 years of practice, I’ve seen hundreds of people misconstrue relatively minor problems as life-threatening situations, but I cannot recall ever seeing a dog truly choke. “What breed of dog?” I asked sleepily.

“Part Labrador,” the caller replied with mounting panic. “Can we come right down?”

“Is it an in-sound, or an out-sound?” I yawned. I could almost hear the woman wondering “What kind of quack is she? What does any of this matter? He’s choking!”

Let’s take a hypothetical dog. Call him Gasper. He’s perfectly healthy. Suddenly one night he starts making this weird spasmodic noise. It sounds like he’s dying. Maybe he’s stretching his neck out funny, his chest is heaving, or he’s gagging like he’s got something stuck. Is he choking?

There’s a good chance Gasper is suffering from pharyngeal gag reflex — or, more poetically, a reverse sneeze. Although it looks and sounds scary, reverse sneezing is not serious. It is caused by a minor, temporary malpositioning of the flexible tissues of the soft palate and throat, or by irritation or inflammation leading to throat spasms.

Initiating causes may include allergies, infections, trauma, insect stings, or environmental irritants like chemical cleaners, perfumes, or smoke. Reverse sneezing may also happen spontaneously while eating or drinking or when overly excited. It is particularly common in smooshed-faced breeds, like pugs or bulldogs, in which the normal mouth and throat structures are all pushed together due to the shortened face.

Reverse sneezing rarely requires medical treatment. Gently massage Gasper’s throat and calm him. If that doesn’t work, try my old-timey remedy. Feed a few pats of butter, then some warm broth. Don’t laugh. Butter lubricates, warm broth relaxes and irrigates, and the act of swallowing often flips things back into place. Now eliminate environmental irritants. Put out that cigarette. It’s not good for you anyway. Eschew those scented candles. Get Gasper out of your sawdust-laden workshop.

You get the picture. That’s usually all you need to do, although frequent recurrent episodes may warrant more in-depth investigation. Talk with your veterinarian, but preferably not at one in the morning.

Honker, the little Yorkie, has a different diagnosis. She honks like a goose whenever she gets overexcited. When she calms down, the honking usually stops, but not always. Honker has a collapsing trachea, a common condition in toy breeds. The windpipe, technically called the trachea, is normally held open by rigid C-shaped rings of cartilage.

But Honker’s tracheal rings have a structural weakness. When she pants or barks a lot, her windpipe flattens, lessening air flow and creating a tickling sensation that leads to the cough. Her trachea becomes inflamed. The more excited or anxious she gets, the worse the honking. Mild cases can often be managed by calming Honker. More serious cases require medications, which may include cough suppressants, bronchodilators, and steroids.

A very small percentage of dogs have severe collapsing trachea that does not respond adequately to medical treatment. Because this can be life-threatening, surgical options such as placing a tracheal stent to keep the airway open must be considered. Although not without some risk, these procedures are sometimes necessary to provide an acceptable quality of life.

“We dropped a rib bone and he swallowed the whole thing,” the woman cried with increasing agitation. “He’s choking! Can we come now? ”

“Okay,” I yawned again. The caller was so upset, I was not going to cause further delay with more questions. “Come right over.”

I got dressed, wondering vaguely why they were eating ribs in the middle of the night, made a cup of tea, and groggily reviewed the possibilities while awaiting their arrival. A bone in the stomach is pretty straightforward. If the pieces are small relative to the size of dog, we generally start with conservative medical treatment, seeing if the objects eventually pass in the poop. Inducing vomiting is generally not recommended as convulsively heaved-up sharp bone shards can damage the esophagus.

But when a bone makes it down to the stomach in a large dog, it usually doesn’t cause any immediate visible distress. This dog was acting uncomfortable enough at home to freak out the owner. It was conceivable the bone was stuck in his esophagus.

The esophagus. Ah. There’s the rub. The esophagus is a tube that goes from mouth to stomach via the chest. If a bone lodges in the esophagus, there is no easy way to get it — not without fancy equipment that I don’t have — and the next ferry to get them off to a high-tech emergency hospital wasn’t for five hours.

I made a mental plan. Radiographs first to determine size and location of the bone. Then I would call in my assistant, anesthetize the patient, pass a large flexible tube into the esophagus, and see if I could gently dislodge the bone, pushing it down into the stomach. But this could be risky. If the bone tore the esophagus, well, that’s a world of trouble.

The choking dog looked pretty calm as he sauntered in, tail wagging. I relaxed a notch. As we led him into the exam room, he paused and opened his mouth. He tilted his head, stretched his neck, and vaguely lifted his front leg. I relaxed further. I knew what this was. No anesthesia necessary. No stomach tube. No drama.

“Hold him steady,” I instructed, grabbing an instrument and opening the dog’s mouth. A big bone lay across the roof, firmly wedged in place between the molars on either side. I dislodged the bone with my tool, showed it to the owners, then gave the dog a liver treat, which he ate eagerly.

“If I’d known that’s all it was, I would have done it myself,” the owner pronounced.

Yup, I thought silently. And I would still be asleep.