Can anyone guess what would make this Pomeranian have a Goose Honking cough?

This little Pomeranian came into the hospital last month with the owner complaining of a goose honking cough. The owner was frustrated because the dog was

coughing all day and all night. The owner was sure that her dog had kennel cough. After speaking with the owner, it became apparent that this dog had pretty much always had a cough but it has become much worse in the last couple of months. Kennel Cough, or Infectious Tracheobronchitis, is a transient infection that is contagious between dogs and usually does not last more than 2 to 3 weeks. The fact that this dog had been coughing its entire life was concerning. I was able to listen to the lungs, listen to the upper airway, and listen to the heart with my stethoscope and determine that the heart sounded normal. There was a normal rhythm with no evidence of a murmur and the lungs sounded clear. I was able to elicit a loud cough with manipulation of the windpipe or trachea along the lower part of the neck. Since the dog was older and had this cough for a long time, I did some diagnostic testing. The first thing I did since I saw this dog in Florida and there is a large incidence of heartworm disease, was a heartworm test. This was negative. The next thing I did was I did a CBC (complete blood count) to evaluate the red blood cells and the white blood cells and I did a chemistry blood evaluation. The chemistry portion evaluates the kidney, liver, and electrolytes. The bloodwork was completely normal. I also did radiographs. The radiograph of the chest revealed what we refer to as a collapsing trachea. In plain English, a collapsing trachea is simply the windpipe (tube that carries air down into the lungs) flattens out and the lungs do not get air properly. When you look at this radiograph, you are looking at the chest of the dog laying on his side with the x-ray beam going through. You can see the neck and the chest. Inside the chest you can see the heart and lungs. When you look at the neck region, you can see the wind pipe or trachea going from the back of the head down into the chest. If you look carefully, you can see that the diameter of the trachea narrows to almost being flat before it enters the chest and then it opens up again very wide inside the chest. The loud goose honking cough is from the abnormal pattern of air going into the chest.

What I explain to owners of dogs with collapsing trachea is that excitement, heat, and humidity always make the situation worse. I recommend people keep their animals in a cool environment when it is hot outside. We often use anti-inflammatories such as a short course of tapering steroids, cough suppressants, and sometimes antibiotics if we believe there is a secondary bacterial infection. I also explain to owners that it is necessary to use a harness instead of a leash with a collar with dogs that have a collapsing trachea. The collar of the leash only makes the cough worse by placing pressure on the neck. Most of the time, medical therapy works very well. However, in cases where medical therapy does not work, there is a surgical option where surgeons place a stent or permanent structure that opens the trachea permanently.