CHYLOTHORAX - WITH THE LID OFF
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
NB: No part of this article may be copied or published anywhere without the
specific undertaking in writing from the Author
Copyright - Dan James - Jahadi Afghans 2009