- Tiffany Downing, RVT
Geriatric Onset Laryngeal Paralysis & Polyneuropathy (GOLPP)
Updated: Jan 30
GOLPP is a progressive, degenerative disease that unfortunately does not have a cure.
There are, however, things you can do to help your dog with the different aspects of living with the disease and many dogs can still maintain good quality of life and lifespan with proper care.
What is Geriatric Onset Laryngeal Paralysis & Polyneuropathy?
GOLPP is the term used to describe a grouping of three interconnected conditions caused by degradation of the dog’s nervous system: Laryngeal Paralysis, Megaesophagus, and Paraparesis, usually starting with the hind legs.
The Larynx’s (aka the voice box) main functions are to protect the airway when we are eating and drinking, to open up wider when we need to take bigger breaths, and of course to make vocal sounds. It does this by opening and closing folds of cartilage on each side of the opening to the trachea, the primary airway to the lungs.
When the muscles controlling those cartilaginous folds start to fail due to Laryngeal Paralysis (aka LarPar), they no longer open and close like they used to. LarPar dogs then struggle to breathe normally, have difficulty cooling themselves in hot weather, and are at higher risk for aspiration. They might cough or just have louder breath sounds with even minimal exercise. Sometimes, a change in the sound of their bark is the first thing a pet parent notices. Dogs in severe respiratory distress will have pale or blue coloration of their gums and may completely collapse. Dogs in this state require emergency veterinary care immediately.
Megaesophagus occurs when the esophagus (the tube that connects your mouth to your stomach) loses its strength and elasticity. As food slides down, instead of being pushed along to the stomach, it builds up in the esophagus, causing further distention and enlargement. Because there isn’t enough muscle strength to move the food along, dogs with Megaesophagus often regurgitate their food. Since dogs with GOLPP aren’t able to protect their airway as a normal dog would, this significantly increases their risk of aspiration which can then turn into pneumonia.
Hind Limb Paraparesis means that the dog’s hind limbs become weak and uncoordinated due to neurological deficits (the nerve pathways between the brain and the legs stop conducting signals). They may stumble or even knuckle over their paws and will progressively lose strength and muscle mass. This part of GOLPP is often misdiagnosed as arthritis, hip dysplasia, or “just getting old”.
Who is at Risk for GOLPP?
Labrador Retrievers certainly seem to be the breed most commonly affected by GOLPP, but Golden Retrievers, Borzoi, Newfoundlands, Greyhounds, German Shepherd Dogs, Siberian Huskies, and other large breeds, as well as mixed breeds, are known to be affected. While there is a congenital form, GOLPP typically affects middle-aged to senior and geriatric dogs, with the average age of onset at 11 years old.
In the beginning stages of reaching GOLPP as a diagnosis, there are other conditions that must first be ruled out. This is done by performing comprehensive bloodwork and radiographs. Megaesophagus may be visible on your dog’s x-ray, but sometimes requires more specialized imaging to clearly visualize. Your vet should also perform a thorough neurological exam to identify any delays or deficits in your dog’s reflex responses. If your dog’s blood work is within normal limits for their age and no other life-threatening conditions are discovered with radiographs, they will recommend sedating or anesthetizing your dog so they can examine their laryngeal function. Unfortunately, you can’t ask a dog to open up and “saw ahhhh” while a scope is used to look down their throat, so sedation or anesthesia is required to properly perform this exam. During this sedated exam, the veterinarian will watch how your dog’s laryngeal folds behave as they breathe to determine if one or both sides of the larynx are affected. Additional diagnostics like Nerve biopsies and Nerve conduction tests may be recommended as well.
While there is no cure for GOLPP or even one single treatment, there are ways to treat the symptoms of GOLPP to keep your dog more comfortable.
For Laryngeal Paralysis, the Gold Standard treatment is a surgery called a Laryngeal Tie-Back, which should be performed by a Board-Certified Veterinary Surgical Specialist. Most General Practice Veterinarians are not equipped for this specialized surgery. The procedure involves anchoring at least one of the Laryngeal Cartilage folds open, so that the dog can breathe more easily. The downside is that this also means that the larynx cannot properly close to food or liquids, so dogs that enjoy swimming or tend to eat/drink very quickly are at high risk for aspirating (breathing in) water or food into their lungs. Aspiration pneumonia is a serious, potentially life-threatening condition that requires strong antibiotics, sometimes multiple courses, to treat but fortunately it usually responds well to medical treatment. The goal of Laryngeal Tie-Back surgery is to improve quality of life for the affected dog, but it will not improve laryngeal function. Dogs that are unable to get Laryngeal Tie-Back surgery will continue to struggle to breathe, remain at risk for heat stroke during warmer weather, and they still have an increased risk for aspiration. Both surgical and non-surgical patients will need to live in a calm environment, as stress can also instigate respiratory distress.
For Megaesophagus, there is no treatment. Instead, changes to the dog’s feeding routine are key for reducing food regurgitation, therefore improving Quality of Life. Many patients with this condition do better with a softened or liquid diet over kibble. They also need a little help from gravity to get the food where it needs to go. This might look like raising your dog’s food bowl or even feeding your dog on stairs with the bowl at the highest step. For the worst cases of Megaesophagus, a Bailey Chair is an excellent option. The Bailey Chair is sometimes called a dog high chair and it certainly looks like one. The concept is that by feeding the dog in an upright position and then keeping them in that position for a short time after feeding, gravity helps pull the food down out of the esophagus into the stomach, after which the dog can safely resume normal activity and retain all the nutrition of the meal. Your veterinarian may also prescribe medications to support the gastrointestinal system.
For the hind limb paresis, Physical Rehabilitation is the best course of treatment to maintain strength and coordination in those limbs for as long as possible. By using exercises and treatments specifically designed for GOLPP patients, CROC can slow down your dog’s muscle wasting and neurological decline. Because Physical Rehabilitation at CROC is performed by experienced and licensed veterinary professionals, our team knows how to handle medically fragile patients, carefully challenging your dog’s body without overworking them or putting them at risk for heatstroke.
What Does Rehab for GOLPP Look Like?
First, our team will evaluate your dog to determine how far their GOLPP has progressed so that we can truly tailor your dog’s therapy to their condition. You will be sent home with target exercises specifically prescribed for you and your dog to do together between Rehab Sessions. Generally, in-clinic Physical Rehabilitation for GOLPP includes:
Target exercises to work on balance, coordination, and strength
Hydrotherapy for safely improving stamina and maintaining muscle
Thermotherapy, Therapeutic Massage, and Laser Therapy to soothe sore, overworked muscles
Veterinary Medical Acupuncture to stimulate the nervous system and reduce pain
Because CROC utilizes an Underwater Treadmill for hydrotherapy sessions, your dog is at significantly lower risk of aspiration than if they were swimming in a pool since we have precise control over the water level and your dog will remain on their feet for the session. Underwater Treadmill therapy is also more effective for strengthening the back legs than swimming. Lastly, CROC maintains the water at a therapeutic temperature to help support arthritic joints and relax tight muscles, while the buoyancy helps your dog get all the benefits of a high-resistance work out with little to no impact.
Through their recovery process, CROC continues to challenge your pet with a variety of exercises while also treating any pain that your pet experiences. Thermotherapy and Therapeutic Massage help to relieve tense muscles and increase blood flow. Therapeutic Laser therapy not only helps increase circulation to the tissues, but it also encourages healing at a cellular level. Veterinary Medical Acupuncture stimulates the nervous system while also releasing endorphins which helps with pain relief.
As your dog’s physical abilities change, CROC continues to adjust their therapy as needed at every single session to make sure they get the most benefit out of every visit. Fortunately, while your dog will be predisposed to pain from compensating for their weak back legs, the disease process itself is not painful.
Safety for GOLPP Patients
Changing Habits: Remember that GOLPP is a chronic, progressive disease; it never goes away and will continue to worsen. At home, some simple changes can make all the difference to help your dog maintain good quality of life. The goal with home modifications is to make mobility as easy as possible, reduce falling injuries, reduce risk of aspirating food or water, and to reduce risk of heat stroke. Adding rugs or yoga mats to hard slippery floors will help your dog grip the ground better and stay on their feet when getting around their home. Assisting your dog up or down stairs, or even just blocking them off from your dog altogether, will be necessary for safety reasons. Ramps may be helpful for them to traverse small sets of stairs or make it easier to get in and out of the car, but these should also be used under supervision. Raising the food and water bowls may help reduce regurgitation from the megaesophagus, but you may also need to have a schedule for access to these resources or start using a Bailey Chair depending on your dog’s symptoms. Lastly, temperature control will be incredibly important at home. Your dog will not be able to cool themselves on a hot day like a normal dog can. Avoiding strenuous exercise and maintaining cool temperatures inside with Air Conditioning and/or fans is a non-negotiable part of living with this condition.
Swimming: Sadly, swimming is NEVER appropriate for GOLPP patients. There is a video viewable at this link, https://www.caninerehaboc.com/post/swimming, that provides a visual for this, but we’ll explain here too. When dogs swim, they generally paddle fiercely with their front legs while keeping their back legs tucked up alongside their body. This type of movement means they are overworking their already strained front legs while barely working the back legs that actually need the exercise. Swimming also puts immense stress and twisting movements on the spine. Most importantly, swimming puts a GOLPP dog at extremely high risk of aspiration on dirty pool water.
Aspiration Pneumonia: The GOLPP dog will forever be at increased risk for aspiration pneumonia, so it’s important to familiarize yourself with the signs and symptoms. Catching aspiration pneumonia early will make it easier and cheaper to treat and get your dog breathing easier sooner. Signs of pneumonia include lethargy, coughing, sneezing, nasal discharge, inappetence, and/or fever. If you even slightly suspect that your GOLPP dog may be exhibiting signs of aspiration pneumonia, have them seen by a veterinarian as soon as possible. This is usually confirmed by radiographs of their lungs and then antibiotics are sent home, as well as appetite stimulants if needed.
Chiropractics: We know this is a soft spot and that many people enjoy chiropractic for themselves. In our industry, it is a very controversial and divisive topic. We do not want to shame anyone for previous choices made with the intention of helping their pet. We do feel compelled as thoroughly educated Veterinary Medical Professionals to share our perspective. At CROC, we have treated multiple patients that were receiving chiropractic care and were in significant pain when they came to us, which resolved when chiropractic sessions stopped while proper Physical Rehabilitation Therapy continued.
A good percentage of CROC patients arrive here after being referred by their veterinarian. Because of this, we have developed very close relationships with the local Neurological and Orthopedic Veterinary Specialists. CROC does not offer Chiropractic services because not a single one of these Board-Certified Specialists will support or recommend Chiropractic for GOLPP patients. Even when consulting with Boarded Neurologists outside of Orange County, we have yet to find one that would approve of their patients undergoing Chiropractic treatments. At this time, there are no Peer-Reviewed studies to substantiate claims that Chiropractic is an appropriate (or even safe) treatment for Veterinary patients. In addition, the American Veterinary Medical Association, America’s leader in advancing the science and practice of veterinary medicine to improve animal and human health, has not published any policies supporting Chiropractic.
If your dog is experiencing enough pain that you are exploring other treatments like Chiropractic, please check in with us or your regular veterinarian first. There are certainly better and safer options for pain relief available.
The End Goal
Ultimately, our goal is to try to keep your pet as independently mobile as possible for as long as possible. We can’t stop GOLPP from progressing, but we can slow it down and have multiple methods of treating your dog’s pain and weakness. Because Physical Rehabilitation at CROC is performed in a controlled environment, your GOLPP dog can also come in for therapy on a day that might otherwise be too hot for them to get any exercise.
Tools To Make Your Lives Easier
As your pet’s neurological condition declines, they will frequently drag their hind legs, so it is key to protect their paws from the scuffing and abrasions that will happen. Lots of dog booties are readily available for purchase, but our favorite is a rubber variety called Pawz. We like these best because they protect the paw while still allowing your pet to feel the textures of the ground and providing extra grip. With any dog booties, care should be given to appropriately size your pet’s paws and to only leave them on when your dog is on a surface that is harmful to their skin to rub on. Booties left on for too long can cause skin infections, reduced circulation, or worst case – be chewed off and eaten!
Use of any collars around your dog’s neck will no longer be safe so a good harness is a must! Your dog will increasingly depend on you for assistance, so your choice of harness makes all the difference in comfort for both you and your dog. Our favorite harness for GOLPP dogs is called the Help ‘Em Up Harness. It was created to help owners better assist their dogs without hurting their own backs in the process. It comes in two pieces, one to go around the chest and one to go under and around the pelvis. In the early stages, your pet may not need the back half, but as their coordination and strength declines, the back half of the harness will become necessary. It is comfortable enough that your pet can wear it for extended periods, and it is more ergonomic for you and your dog than just lifting them or using a sling. If you are interested in purchasing this harness for your dog, be sure to speak to us as sizing and fitting your dog can be trickier than it might appear. Please note that this harness still needs to be removed each day and kept clean to prevent any abrasions or skin infections. You can learn more about this harness at https://www.caninerehaboc.com/post/help-em-up.
Is There Anything Else?
One of the best things you can do for your GOLPP dog is keep them lean! We generally recommend a Body Condition Score (BCS) of about 4 out of 9. The less weight there is for them to haul around, the easier it will be to continue lifting and moving their own body. Many GOLPP dogs are also old enough to have developed arthritis, so all the more reason to reduce any extra work on their joints. For more information on the BCS and Weight Management, read our online article https://www.caninerehaboc.com/post/body-condition.
Some dogs will need medication to control their pain. CROC works closely with you to make sure your dog is on the right pain control regimen. Joint supplements are also helpful to support their joints as the front of their body takes on the extra load, compensating for the weaker back end. A supplement for muscle growth/maintenance called Myos Canine Muscle Formula may be helpful for the GOLPP dog and is available online. CROC strongly discourages the use of marijuana products for GOLPP patients. While emerging research shows some promise for marijuana products in veterinary medicine, there is much more to be done and GOLPP patients are already weak and have limited coordination, making them poor candidates for this treatment.
Rear-wheel carts are sometimes an option for GOLPP patients, but this is not commonly recommended as by the time your dog might benefit from the mobility assistance a cart could offer, they are no longer strong enough to be able to pull the cart and the weight of the back half of their body. To learn more about carts, check out our article: https://www.caninerehaboc.com/post/the-wheel-deal
Quality of Life
We touch on this subject for your sake as well as your dog’s. Compassion fatigue is a prevalent concern for clients caring for GOLPP dogs. The hope is that Physical Rehabilitation will help your dog maintain independent mobility for as long as possible, reducing the amount of effort you will need to put into their care as much as we can. For dogs whose GOLPP is more advanced or who don’t have control of their bowels and bladder, the strain on you to keep them clean and safe, as well as the physical strain of carrying them around, is enough to wear down even the most dedicated owners. We bring this up because we want you to know that we are available to you as you navigate your pet’s condition. We frequently support our clients through the big decisions and help them to find the plan that works best for them while keeping quality of life as high as reasonably possible for all involved. GOLPP can be particularly difficult to come to terms with, as these patients generally maintain mental acuity and brightness despite their physical decline.