The following procedures are now routinely recommended on all GOLPP dogs at the MSU Veterinary Medical Center:

• Standardized thorough history questionnaire: This questionnaire is designed so that all relevant questions pertaining to clinical signs known to be associated with GOLPP will be asked in a standardized manner and responses scored.
• Neurologic examination; Ophthalmic examination; Orthopedic examination: It is clear that neurologic issues need to be discerned from orthopedic issues, and a dedicated GOLPP Neurologic Exam form has been developed to record responses to the careful and complete neurologic exam. We have additionally seen some ocular changes in these dogs and are now completing full ophthalmic examinations by one of our veterinary ophthalmologists.
• Pre-operative standing esophagram: Evaluation of esophageal function in all phases of swallowing is performed fluoroscopically, in standing positions. We have designed and built an esophageal stanchion, so that dogs can eat in a natural body position. Esophageal function is scored, esophageal transit times recorded, gastro-esophageal reflux scored, and hiatal herniation noted. If a dog has very poor esophageal function, we discuss this finding with the owners in depth, and in consideration of the dog’s respiratory compromise.
• Laryngoscopy: Laryngeal function is recorded on induction with a digital video-otoscope with a standard induction protocol, including 1 mg/kg doxapram IV to enhance respiratory excursions when needed.
• Unilateral cricoarytenoid laryngoplasty: Standardized left lateral approach is performed with disarticulation of the cricoarytenoid joint, no cricothyroid disarticulation, no interarytenoid band transection, two 0-polypropylene sutures passed around the caudal edge of cricoid and through articular facet of the muscular process of the arytenoid. Sutures are pulled snug, but not over-tightened. Abduction is confirmed on extubation and recorded with digital still images.
• Muscle and nerve biopsies: At time of laryngeal surgery, the dorsal cricoarytenoideus muscle is biopsied. Left sided cranial tibialis muscle and peroneal nerve biopsies are performed in a standardized manner.
• Anesthesia protocol: In all cases, even if esophageal function is normal on esophagram, the esophagus is suctioned immediately following induction, intraoperatively and immediately post-operatively, before recovery. Additionally, all dogs are placed on a metoclopramide CRI before surgery (1-2 mg/kg/day) and continued into the next day. Hydromorphone is avoided as a premedicating agent.
• Electrodiagnostics: Under anesthesia, electromyography is performed in the tongue, palatinus, esophageal, cricoarytenoideus dorsalis, cricothyroideus, superficial digital flexor, extensor carpi radialis, triceps, biceps, gastrocnemius, cranial tibialis, semimembranosus, semitendinosus, and quadriceps femoris muscles. Motor NCS are performed in the right sciatic-tibial and left ulnar nerves. Typical time for electrodiagnostics is currently 45-60 minutes.
• Management of esophageal dysfunction: Based on preliminary results from a positional esophagram study just completed, we recommend feeding at a 30 degree incline plane with head up, and maintaining the dog in sitting position for 10 minutes post prandially. We also prescribe metoclopramide in dogs with moderate esophageal dysfunction, and add cisapride in dogs with severe dysfunction. We do not have reliable results for the effects of cisapride, but most owners feel that metoclopramide is helpful when given before feeding and before bedtime.
• Physical therapy: Water treadmill physiotherapy and other balancing and coordination exercises are recommended for all dogs long-term into the post-operative period. The aim is to maintain muscle mass and control as long as possible in the face of neurogenic atrophy. Home exercise is also encouraged, with daily long, slow walks.
• Owner education: We have developed owner handouts and updated our website to inform owners of GOLPP dogs on this disease and its progression. Owners are educated to identify early signs of aspiration pneumonia (inappetance, lethargy, fever), as we have good success with treatment when caught early. As the condition progresses relentlessly over months to several years, euthanasia is typically requested by owners when their pet becomes non-ambulatory, or experiences repeated episodes of aspiration pneumonia from regurgitation, gagging, and/or dysphagia. Occasionally dogs will go into a cart for several months.
• Follow up: It is vital for us to follow affected dogs out for the remainder of their life in order for us to understand the natural history of this disease. We now follow our GOLPP dogs out every three months until their demise. It is already clear that most dogs will progress at a fairly steady rate, with euthanasia requested within 2-3 years. However, some dogs will progress at remarkably rapid rate. There is also a small group of dogs in which we have noted a surprisingly slow rate of neurologic deterioration.