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A challenge to this incurable disease! Tracheal collapse is not an incurable disease!

The only one in Japan, the only one in the world. This treatment.

Tracheal collapse is a disease in which the trachea, which carries air in and out of the lungs, collapses in the middle, making it impossible to breathe. The incidence of this disease is high in middle-aged and older small dogs, but it is found in almost all breeds, including Japanese medium-sized dogs and large dogs such as Golden Retrievers and Labrador Retrievers. 

Symptoms begin with a mild cough, which progresses to a choking cough, choking movements, pig-like breathing, goose-back breathing, and in the final stages, cyanosis and difficulty breathing. In the final stage of the disease, the patient develops cyanosis and has difficulty breathing. At our hospital, we have long provided aggressive surgical treatment for this disease. In particular, we have achieved excellent results using Parallel Loop Line Prostheses (PLLP), a completely new type of orthodontic device developed in 2000. We suggest that patients should not give up on collapsed trachea as a disease that cannot be cured, but should not remain still until the condition becomes incurable, and should "watch the situation" with full attention from the initial stage of mild coughing, including medical treatment. 

The only one in Japan and the only one in the world.

We aim for radical cure by surgical treatment for tracheal collapse. 

 

The following is a brief explanation of the symptoms of tracheal collapse, which may be difficult to understand even for the general public.

 

Tracheal collapse is a common respiratory disease in dogs, and is generally seen in middle-aged (7-8 years old) small dogs (Pomeranians, Yorkshire Terriers, Maltese, Chihuahuas, and Poodles).

Surprisingly, however, it is also common in pure breeds of Japanese dogs (e.g., Shiba Inu) and mongrels. Large dogs such as Golden Retrievers and Labrador Retrievers, and small dogs such as Pomeranians and Yorkshire Terriers can develop the disease at as young as 1 to 2 years of age.

 

The disease can be summarized simply as "a disease of the collapsed trachea. The trachea is a tube-like structure that enters the chest through the throat and branches off into the bronchi just above the heart. In dogs, most cases begin in the last part of the neck, just before the trachea enters the chest, and in severe cases, the dog is unable to breathe in or out air.

 

The cause of this disease is still unknown. Although some research has been conducted on the underlying causes, morphological changes and changes in the cartilage that makes up the trachea after the tracheal collapse has occurred, and the pathogenesis of the disease, the underlying causes are not yet known. In addition, in breeds that occur at a very young age, genetic predisposition is believed to be the cause. These include Pomeranians, Yorkshire Terriers, Golden Retrievers, Labrador Retrievers, and Boxers.

What does a collapsed trachea actually look like on a tracheoscopy? A tracheoscopy will help you swallow the situation.

 

First, the normal trachea is nicely circular, as shown in Figure 1.
 

 

And in tracheal collapse, this gradually collapses (Figures 2-4).

In the end, they are crushed so that it is a wonder that they are still alive.

The most important thing is that no treatment has yet been established for this disease. Medical therapy can cover up a mild cough, but it cannot fundamentally widen a collapsed trachea. Even without specialized knowledge, it is hard to believe that medicine can widen a collapsed trachea, isn't it?　The simpler answer is that if the trachea is collapsed, it should be surgically widened, but we cannot find the means to do so.

How to widen it?

In the old days, there were methods to suture the trachea, or to cut the mantle of a syringe into a Lassen or C shape, fix it outside the trachea, and suture it (prosthesis method). Textbooks have introduced these methods, but the results have not been as good as expected, and no one currently performs surgery in this way at all.

Also, it should not be done. You should not do it.

 

I have actually experienced failures myself. I have also had the experience of undergoing surgery with this method at another hospital, but breathing difficulties developed six months later, and after a year, I had to have the surgery done again at the behest of the patient, as every day was a succession of suffering. It was a scene that made me want to cover my eyes. The inside of the trachea was barely thick enough to hold the lead of a ballpoint pen, and the syringe mantle wrapped around the trachea was falling apart at the mere touch. It was truly the worst of both worlds.

 

On the other hand, there is the stent method, in which a metal dilator is inserted into the lumen of the trachea under endoscopic or radiographic fluoroscopy. Currently, endotracheal stents for dogs are on the market in the United States and are available in Japan. The procedure is very simple. The stent is automatically expanded in the trachea by pushing the retracted stent out into the trachea under anesthesia, and the procedure can be completed in a very short time. However, several problems have been pointed out.

 

First, the trachea is very sensitive to begin with, and foreign objects are introduced into it. For example, we have all had the experience of accidentally swallowing a grain of rice in the trachea while eating. Just imagining the pain and coughing at that time is enough to make you start coughing. The cough may become worse due to the placement of a long stent in the sensitive tracheal lumen. It is also possible that granulation tissue may enter the trachea after placement, causing further narrowing of the trachea.

 

Second, metal stents can cause metal fracture due to the three-dimensional movement of the neck. And once in place, it is impossible to remove. Also, depending on the shape of the stent, there are drawbacks in the means to stop it in any desired location. In human medicine, stenting is the mainstay of treatment for tracheobronchomalacia and other diseases similar to canine tracheal collapse. A silicone stent called a dynamic stent has already become the gold standard, and it looks ideal because it can be made to the size of each patient using CT and other methods.

However, if you listen to the voices of human physicians in the field, the opinion that they do not want to use them is still very prominent.

It is not a permanently maintainable product, and in fact, there are many problems such as removal of phlegm and problems with granulation tissue growth.

The above is why we are stuck with the "curse" that collapsed trachea cannot be cured.

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For early cases, "let's wait and see while we treat it medically."

(Will the trachea that was collapsed by the medicine return to normal?)

 

"Let him lose weight and he will get better."

(But he is not fat...),

 

(But he's not fat...) "Let's try to make him more medically active" when this progresses to a moderate level

(I wonder how long I won't be able to sleep...),

 

In severe cases, "I can't help you anymore. There is no treatment.

 

This was the reality. Even today, it is still one of the most common intractable diseases that do not respond significantly to medical treatment and do not respond well to surgical treatment.

So let's go back to the starting point. Why can't we simply widen a collapsed trachea? If we can't dilate from the inside with a stent, why can't we do it from the outside?

The reason for the failure of the stent method was the lack of sufficient development of the stent itself. Similarly, the reason why the prosthesis method is not widely used is that the prosthesis itself has not been developed sufficiently to meet various requirements.

 

Again, the initial lesion of a collapsed trachea in a dog is, except in very exceptional cases, the last neck. This is the area where the collar is placed, as we often see medium-sized dogs pulling hard on walks. As you can imagine, this part of the body can move freely in three dimensions: up, down, left and right, looking up and down at the owner, looking sideways and backward, and even licking the buttocks. The trachea is flexible enough to follow these movements.

Therefore, the prosthesis placed in this area must also be flexible enough. The prosthesis must also be flexible enough to expand the collapsed trachea while maintaining its ability to expand. Is there a prosthesis that meets all of these strict requirements: not too rigid, not too soft, no tissue reaction after placement, and a size that can be selected to accommodate various breeds of dogs?

 

In Japan, there is the Flexible Spiral Line Prostheses (FSLP), which was invented by Dr. Kogi in 1990 (I named it and Dr. Kogi approved it). The FSLP is made of fiber-optic acrylic material, which is processed into a lacunar shape.

However, there are objections that the material is not for medical use, and there are no published papers by the originators or other researchers. In my experience, it also had the disadvantages of being time-consuming during surgery and, depending on the situation, being slightly dangerous in the middle of the operation.

 

In 2000, I created an ideal prosthesis using the same material, "acrylic material for optical fiber," that satisfied all of the aforementioned conditions and was also easier and safer to operate. I named it Parallel Loop Line Prostheses (PLLP).

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The material, like FSLP, was not developed for medical use. However, we investigated this material because FSLP and PLLP have shown excellent results over the years of actual use. PMMA is the material used for intraocular lenses (the lens placed after the lens removed during cataract surgery), and fluoropolymers are also unique in their low reactivity to living organisms. Fluoropolymers are also unique in their low reactivity to living organisms and have recently been used in bile duct catheters and vascular sutures. Although not developed for medical use, the material was found to be used for medical purposes. There have been cases of experimental implantation and actual cases where postmortem autopsies were possible. Pathological tests were performed at the same time, and it was determined that even after a long period of time, up to nine years, there was almost no foreign body reaction, and implantation in vivo was deemed to be sufficiently feasible.

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Figure 5 is a postoperative endoscopic photograph. Compared to the preoperative crushed one on the previous page, you can see that it has been clearly corrected to a cylindrical shape. The tracheal lumen shows the nylon thread that was used for traction suture. This nylon thread is covered by the tracheal mucosa a few weeks after surgery.

 

As of 2023, 23 years have passed since the development of PLLP, and 1,270 cases have been operated on using PLLP. As a result, I have come to the conclusion that "collapsed trachea can be cured. It is not a disease that cannot be cured or should not be treated. The longest postoperative course of a child is 16 years. Immediately after the surgery, some children have a cough. This is due to the placement of the prosthesis around the trachea and the sutures inserted into the trachea. However, in more than 80% of cases, the coughing is minimal or slight, and no medication is needed.

 

However, there are certainly cases that cannot be cured. There are still cases that we have tried everything we can do, and there are still cases that are already out of our control. Since it is an essential organ for breathing that cannot be replaced, some kind of trouble is not zero. They range from sudden death of unknown cause, tracheal detachment, collapsed bronchi, inflammation of the trachea, and complications of other respiratory diseases. If the reason is severe, there is a good risk of death. Although the overall success rate is about 95%, a few percent of patients still die postoperatively.

And many of the reasons for this are "too late. The disease has a "latent and progressive" nature. It starts out as a mild cough, but in reality, it is often more advanced than thought. The degree and frequency of coughing seems to have increased somewhat. However, it was not that severe. However, when the prominent cough finally begins to appear, you go to the hospital for X-rays and find that you are in the final stages of a collapsed trachea. In such a case, it is not only the trachea, but also the entire respiratory system, heart, liver, and various other organs that are affected, and surgery is not an option.

 

It is also true that the boundary line between "too late" and "too far gone" is very indefinite. The disease can also deteriorate rapidly due to heat and humidity.

The disease can be cured if the patient is properly diagnosed and operated on as soon as possible, taking into account the progress of the disease, before it becomes terminal and unmanageable. Although there are risks involved, even in severe cases, it may be possible to treat the disease after assessing the patient's age, length of time, and condition of various organs, including cardiac function. The major criterion is not the severity of the collapse. It is a question of where the site of collapse is located.

 

The collapse must be in the trachea only. If the collapse extends to the bronchi, surgery is not possible.

 

If you have a child suffering from a collapsed trachea, please think twice before assuming that it cannot be cured, and if you have a child with a cough that has not been so diagnosed, please do not simply dismiss it as a cough. There is nothing to be pessimistic about.

 

Collapsed trachea can be cured.

​tracheal collapse​

Tracheal collapse

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