Tieback vs. Typewriter

When unilateral arytenoid lateralization (i.e., tieback surgery) was invented, the gold standard for writing machines was the typewriter. The gold standard for cashless transactions was the checkbook. Smoking was the gold standard for coolness, and the gold standard for Presidents of the United States was Richard M. Nixon — or maybe he had recently resigned. You get the picture.

Everyone is glad we moved on from all that, but some people think we should never, ever move on from tieback surgery because it's the 'gold standard' – the one Universal Constant we must hold dear until the end of time.

I don't hold it dear because the truth about tieback surgery is that it is not and has never been gold. It's institutionalized and entrenched. It's what they teach in vet school and there's an established revenue structure built around it. I'm not saying there's anything wrong with that, it's just the way things work in human society. But gold? That's a stretch — a big one.

Here are the facts about laryngeal paralysis surgery that color it anything but gold:

The high cost puts it way beyond the reach of the average American family

There's a financial limit — the stop-treatment threshold of around $1700 beyond which the average American will decline treatment. That means most LP dogs will never see this so-called 'gold' standard. If the surgery cost is greater than a person's personal stop-treatment threshold, they may try to manage the LP with behavior modification and off-label medications until end-of-life, or they will have the dog euthanized.

There are very real risk factors associated with any LP surgery

Many people, even those for whom the high cost isn’t an issue, question whether surgery is the best course of action for their dog because of the risk factors involved. Some risk factors, specifically aspiration pneumonia, apply equally to stent implants but some are specific to surgery. While most LP surgeries have positive outcomes, a significant percentage end in complications, some fatal, in the short- and long-term. It's a disservice to people as well as their LP companions to deny or understate the risks.

Surgery is a complicated process that depends on a surgical team

Surgery isn't performed by an individual, but by a surgical team, and not all surgical teams are created equal. Some surgeons have more experience and skill than others. Some anesthesiologists conform to current protocols and some don’t. And surgery requires an experienced, dedicated support staff, which is increasingly hard to find and retain considering the current shortage of veterinary professionals.

Don’t get me wrong. In no way am I trying to dissuade anyone from surgery for their LP dog. What I want is for people to make informed decisions and not be swayed by an endlessly-scrolling list of surgery-positive testimonials on Facebook groups. Because that's all you're going to see on Facebook. People who lost their dogs after LP surgery aren't going to return to Facebook week after week to talk about how their dogs suffered and died. People need to put the pain of loss behind them, and re-living that trauma on Facebook groups is the worst thing they could do for themselves and the memory of their companion.

What I’m doing is simply advocating for a laryngeal paralysis treatment whose cost and risk factors color it in a different hue – perhaps not gold but at least not tarnished by exorbitant cost and complexities that put surgery out of reach for so many people. The stent treatment for canine laryngeal paralysis won’t save every LarPar dog. But it is simple, non-surgical, and costs below the stop-treatment threshold. And that alone might be enough for people to choose life instead of euthanasia for their companions.