Chylothorax

Experience Comes at a Cost

In all walks in life one learns with the passage of time. We all know the phrase "It's easy to be wiser after the event". Sadly that's true for all of us and we should learn from it. But it comes with a Cost.  We both think of such events as "Pearls of Wisdom", in which we learn something new every day. We store this "Lesson learned" in our memory, and use it when a similar occasion arises, providing one knows about it initially but not if they don't take the time to read and grasp all forms of information placed at their disposal.

However people seldom bother to read all articles about medical matters or health problems. They glance and "say can't be bothered with all that" Well, if you're still with me so far, be patient, read on and you may find yourself in the exact same situation in future as I describe. If you do and recall my words in time, you may just save your Afghan from much pain and suffering.

THE PROBLEM

I note various references have been made to Chylothorax in our Breed by some breed stalwarts over a period of years and that this is suggested as coming from hereditary causes, i.e. congenital. Gossip and innuendos are rife when you do not understand the subject. My task is not to give a sermon but attempt to educate all persons who may be interested in this much maligned subject, but primarily in the welfare of their hound. It is absolute rubbish to either infer or suggest this is a Disease caused by Hereditary or Generic history within the Breed, and more particular held against any one Kennel. Much rumour exists in our Breed as Myth and Authoristic rumours (much like the story of there being two types and CH Zardin was the role model, both being untrue.) But that's a story to evolve in another article, at another time if, people are interested.

THE SUBJECT MATTER "CTX"

 Similarly it is with the case with CTX over the years about Chylothorax, more commonly referred to as CTX.I have studied the subject in depth and at great length  and learned from the writings, experiments and papers of Theresa W Fossum, over the last 3 years, who is one , if not the leading renowned World specialist of this subject in Texas University. USA.

Now are in the position to know as much about this matter as anyone in the breed in the UK, as well as Sylvia Evans, the latter having reported on some Afghans who had apparently died with this problem. She has shouted the cause on numerous occasions quite rightly.

"DODGER" was a dog who it is written elsewhere in another well published article as one who tragically died with CTX. It is worthy to note the Vet concerned actually wrote that "He died with this very rare condition going on to state it was a one in a two million occurrence"   I have never seen anywhere such a categorical statement but it is enough to describe this rare condition.

Other known UK participants have been Jayne Edwards, Gillian Knight. Just to name a few previous interested parties who allegedly had an Afghan diagnosed with CTX.

I actually wrote an article and published for Wikipedia on the subject in April 2008 dismissing reports about the disease in Afghan Hounds as being prevalent and congenital. At the same time I wrote and issued a global Challenge for any person to produce evidence or to prove that CTX is or was genetic. I am still waiting.

Although cases have and will continue to exist, where CTX develops it is mainly caused by other causes.

EVALUATION OF CTX

Almost everywhere one investigated the subject; one reads the disease was a predisposition in Afghan hounds. Thus putting up the breed as one of the main diseases for mortality, which is not true. Of course, Afghans are not the only breed who seems to be highlighted, but they stand out! My findings did certainly not support this myth, and neither does consulting our own Kennel Club here in the UK. In fact investigation into OUR BREEDS HEALTH PROBLEMS carried out by them into the cause of Mortality in over 143 Afghans by the B.S.A.V.A dying in our breed in the UK, produced 21 known causes, not one was listed categorically as dying from CTX; however certain other causes they list have played their part in CTX resulting in death, i.e. from other known and unknown causes. Trauma is mentioned as the cause in 5 Afghans due to RTA, in other words due to an external influence. but nothing as genetic. Sinics will say "well that is not proof it is not congenital and may well shrug their shoulders and scoff." In reply I say with evidence there is no evidence whatsoever recorded that it is congenital or generic. And until proven otherwise, it is INNOCENT.

DEFINITION IN SIMPLE TERMS

So what is CTX? For the uninitiated. It is a rare complex disorder in Domestic animals. As an aside it is prevalent in Cats and found in the Human race, mostly children.

In the end, in Dogs it is fatal... so what is it in lay terms?"CTX is, and to the point is non infectious to other forms of life.  CTX in simple terminology is a collection of CHYLE, a milky white and sometimes pink substance located in the plural space. It is Lymphatic fluid from the intestine due to a high concentration of fat that is or has leaked out from the thoracic duct. This would otherwise be carried intact to enter the blood stream. Repair of this duct is impossible, for the exact leakage and rupture, which can be as little as a pinhole is almost impossible to locate, and certainly too late when discovered and found by the Vet ( always assuming they had experience of the symptoms seen and are diagnosable very early on). Anything that causes rupture to this duct will cause seepage and effusion of fluid into the pleural space.This as an after effect ,can cause extreme and sometimes immediate fatality if not treated as soon as it is apparent.However almost everyone I have spoken to over the years has never heard of this word unless it has happened to your Afghan and say "Why do we need to take notice"... why indeed is my reply. To prove my point Sylvia Evans tried to organize a symposium with a well known specialist here in the UK and received no support whatsoever! It was aborted!

SYMPTOMS

 So what are the broad symptoms..?

Many things I tell people, but one sure sign is the "Sphinx effect" in which difficulty occurs in respiration and breathing. The dog will sit in the sphinx position, hence the term used.  NOW before you all dash off to your Vet because you see your dog sitting as I describe, I must emphasize only suspect something IF it is accompanied by one of the complaints listed above.I do not want to panic" Keepers of the Breed" with paranoia. Stop, think and listen... then decide. In this case if you actually suspect something is wrong don't hesitate seek medical assistance.

If you remember nothing else in future "think Sphinx position" and CTX will enter your mind.All dogs will in this situation take up this position to ease their breathing. Other accompanying forms are refusal to eat, often with vomiting, chest pain, discomfort... moaning, murmuring, forceful coughing, lethargy, loss of appetite, etc, but not necessary restricted thereto, all of which can cause blood clots that elevate pressures in the blood stream. These conditions will eventually lead to a lack of Oxygen in the lungs.Immediately one suspects this, the dog should be taken to the vet. Ironically my own vet when consulted had only seen one case at their surgery in 45 years with a GSD, never an Afghan.

AT THE VETS

I cannot over emphasize that Time is the Essence, a phrase more apt. At the very first examination by the vet one is often asked "can you tell me anything that has happened to your Afghan in the past period? Anything strange you can call to mind that will help in my diagnosis?"Of course you are mystified, for at this juncture you will be not aware of the serious of the life threatening CTX, yet to be established.Just think Afghans run and run, often they will collide with each other. Would you see it every time? NO... usually it will occur outside when you are not present. Such side impact of the way I describe will and can be one of the main causes to develop Trauma. Another very common factor is "Road accident"(RTA)Insist as soon as you are pretty sure something or event has happened prior to your visit and you have similar symptoms, ASK immediately for an x ray and a Blood Test from a Spinal tap.The immediate confirmation of the presence of CHYLE is made by undertaking a Spinal Tap, in which fluid is drawn out through the vertebrae by a needle and the contents analyzed. The presence of TRIGLYCERIDE as seen in the blood will confirm the presence of CHYLE. The obvious discolourisation in the test tube will be another pretty positive sign to the naked eye.

IDEOPATHIC CTX

Predisposition suggests it occurs in mostly Deep "barrel-chested breed (of which Afghans form part)......but to actually state this is Hereditary or Congenital is unfounded.......

" THERE IS NOT ONE SINGLE CASE TO CONFIRM OR TO RE-AFFIRM THIS UNFOUNDED STATEMENT."

 Almost all forms of CTX are termed IDIOPATHIC CTX

 Whilst some refer to it as a disease, which in itself, I will explain as simply being an abnormal condition that affects any normal function of the animal, it is attributed to certain health problems. Such as Cancer, Heartworm, Cardiac disease, Tumour, Lung Lobe torsion, and Trauma. Etc.The latter and some event that happened to your Afghan earlier, in itself is mostly responsible for thoracic duct puncture due to external impact or pressure and the principal cause of CTX.Simple examples of this can be, sudden side impact, a knock, car accidents, hit by a car door, falling off a grooming table, and the like all can produce this fatal condition later.Immediate action by the vet, can, after the diagnosis of CHYLE, be carried out by draining of the fluid from the chest cavity. This will afford some relief to the dog and their respiratory problems... but in the long term inevitably the symptom re-occurs again. Often the dog will be placed on a low fat diet as an intermediary measure. I say this because this is only a temporary measure.

One has to be careful during anaesthesia due to the sensitivity to such measures, an issue the Afghan shares in common with other Sighthound Breeds. We have personal experience of this. It has not been uncommon to lose a dog during the draining of fluid due to this very problem as our breed has relatively low levels of body fat.

Many journals describe quite correctly as CTX being a rare condition in itself, but as I will describe it is caused by External Influences in the main, "in laymen's words Dogs die with CTX ......Not from it and as a genetically inherited condition".Other clinical methods have been tried with the treatment of the drug" Rutin". Some limited success has been recorded but not to a full recovery. Other methods by way of a "SHUNT" to bypass the thoracic duct have been tried in Michigan and Ohio, again without positive long term success.Immediate treatment must be sought through surgery to prevent scar tissue forming around their organs to protect them from the Chyle fluid.It should be remembered that this condition CTX can be extremely difficult to diagnose.I cannot over emphasize mostly this is IDIOPATHIC CTX i.e. resulting from unknown causes. In this instance other than draining the cavity the fluid will reappear

OUR OWN EXPERIENCE

Most persons will recall we lost our beautiful black bitch "Passionata du Menuel Galopin from Jahadi (our French Import) almost 6 years ago.She developed at first, only a very few of these overall symptoms, only loss of bodyweight, and being slightly listless. Our vet did not associate with CTX. When we took her on the first visit. Later on a Saturday she was seen in the "Sphinx Position" and developed mild coughing and was taken back to the vets in emergency. An immediate x ray determined that cloudy substance CHYLE was present.They tried to drain the effusion from the cavity, but within 4 hours she died. It is not uncommon for animals even during this process to tragically die. We then learned about that word that most cannot spell and let alone say. Since then we have studied from Dr Fossum.When we were asked is there anything strange you can tell us by the vet we said "nothing we can recall"

 3 weeks later our immediate neighbour stopped her car and enquired "Is your bitch Ok? We asked why? And then was told she saw her escape from our property and run into the road and was "apparently" slightly knocked by the car, but then as she said" appears to shake it off and run away." She, seeing her run back thought nothing more of it, thinking it had missed her.This was the first we had heard about this, although we did know she had jumped a 5 foot fence and got out only to be recaptured by Lesley within 5 minutes. We knew nothing about any car incident until related to us later.

Then and only then did we know that was the cause of her Trauma and CTX. Until that time we were unaware of any impact. We have never revealed this publicly as the cause of death until now, both Lesley and I have been devastated not only by her passing but the cause. Thus this impact led to the rupture of the duct, the chest filled up with Chyle and the lack of Oxygen killed her. In these deep "barrel" chested breeds it has been noted it is mainly in middle aged animals

CONCLUSION

I will end my note by repeating CTX having been diagnosed before or after death has never been proved as a cause of development through established genetic problems. If you have reached the end of this article, then cast the words CTX to memory, If at some future date you happen to remember these words and have used them to quickly ascertain the possible cause for sudden illness then come and speak later to me, for I will then be reassured that we may have prevented much pain and suffering to your Afghan.

DAN JAMES.......JAHADI AFGHANS (EST 1961).........FEB2009

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Jahadi1@aol.com

 

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