|Swimming Puppy Syndrome, a.k.a. Swimmer
Syndrome, Flat Pup Syndrome, Splay Leg (Paraparesis), Splay Weak
(Tetraparesis), and Myofibrillar Hypoplasia. Sometimes referred to as "Pizza
Pups" or "Frisbee Pups". Pectus Excavatum (funnel chest; severe
deformity resulting from intrusion of the breastbone into the chest cavity)
is an entirely different condition, however it can occur
independently, or simultaneously with Swimming Puppy Syndrome. It is in
my opinion imperative to distinguish Swimming Puppy Syndrome from
Pectus Excavatum, to avoid unnecessary anxiety, as both the different
conditions have different prognoses and different causes.
The genetic issue
A genetic cause is very unlikely considering the spontaneous recovery of many puppies. However, the concepts of Swimming Puppy Syndrome and Pectus Excavatum are often (wrongfully!) used as synonyms, so maybe that's why some people believe that Swimming Puppy Syndrome has a genetic component. This idea came to me when I read that some litters of English Bulldogs, for instance, contained some 80% puppies affected by "Swimming Puppy Syndrome"! I'm sure these people are mixing up Swimming Puppy Syndrome with Pectus Excavatum, in which a genetic predisposition may exist, and has been seen in Welsh Terriers. In people, researchers are currently unsure as to the actual cause of Pectus Excavatum but hypothesize genetic defect. Approximately 37% of individuals with Pectus Excavatum have a first degree family member with the condition.
As a breeder I produced 13 litters of Bouviers des Flandres and 26 litters of Labrador Retrievers in 15 years time. In all these years I only had two puppies (from different litters and different parents) affected by Swimming Puppy Syndrome. Both of them recovered completely within two weeks of physiotherapy. I never had a puppy suffering from Pectus Excavatum, and I never had any proof that the Swimming Puppy Syndrome in my two Labrador puppies, or in any other Labrador puppy, could have a genetic cause.
Early clinical signs
Although present at birth, clinical signs become obvious to the breeder at about the second or third week of age, when puppies learn how to walk. However, by careful observation you will be able to identify the clinical signs in an earlier stage, and prevent development of the symptoms. You will notice that the affected pup is always lying flat on the belly. If you lay it on its side, it will immediately return to lying on its belly. This is what is known as the righting reflex. You can observe this by disturbing a sleeping litter of very young puppies and watching all of them 'right' themselves. They immediately crawl to lie on their stomachs and begin to look for a nipple. The normal neonate has an instinct to get onto its belly and drag itself to a teat. Once there, it may just as easily and happily flop over on its side a little, as long as it does not twist too far in the direction of having its belly side up. After nursing, the normal newborn pup will lie on its side to sleep. As they get a little older, they will be just as comfortable draped over each other, and as they are old enough for the ribcage to have developed strength, they may sleep belly-down for a while, but by then it is not abnormal. Check all the pups right after birth and regularly for the next couple of weeks. If you notice a pup that is always on its belly or beginning to show signs of a flat chest, what you do is lay mom down and put this pup on a good nipple. After it's on, turn it on its side, holding its entire body and making sure it stays on its side. If the pup lets loose start over. Do this several times a day until the pup returns to normal and lays on its side; when that happens you have just cured swimmer puppy syndrome. .
General clinical signs
- Turtle-like type of movements (reptation) or walrus-swimming movements on the belly.
- Extended limbs, especially fore limbs.
- Dorsoventral flattening of chest (pectus excavatus) when only fore limbs are affected.
- Medial patellar luxation.
- Respiratory insufficiency with dyspnoea, mouth continuously open, and bluish mucous membranes.
- Occasional regurgitation of milk.
- Slight increase in CPK (x 1.5) (200 IU/l < N < 300).
- Increase in LDH (x 5-10) (N < 70 IU/l).
- Possible spontaneous electric activity of most striated muscles during electromyography.
Anomaly of puppy motor development (permanent abduction) causing splayed fore limbs (26%) or hind limbs (less frequently, 8%), or tetraparesis (in a sky-diving or tortoise-like position, 50%).
- A dietary cause is excluded since the frequency of onset does not seem to be related to the composition of the mother's diet. However, notable improvement in the condition of some puppies after weaning may reveal an alteration of the mother's milk. Absence of mycotoxins (mainly zeralenone) as well as the concentration of in methionine, vitamin E and selenium in the mother's diet should be closely monitored.
Recent studies relating to the aetiology of the Swimming Puppy Syndrome have investigated all maternal dietary conditions (such as oxidation, lack of taurine, K/Na balance, deficiency in magnesium, vitamins B6, C, E, and L-carnitine, relative excesses in calcium, phosphorus, and levels of zinc, copper and choline) and have not shown any systematic anomaly. Taurine synthesis might be insufficient in diseased puppies due to either deficient synthesis, or increased urine loss, or increased tissue needs.
- Environmental factors (slippery floor).
- Small breeds (Dachshund, York-shire, West Highland White Terrier, English Cocker Spaniel).
- Breeds with large thorax and short limbs (Pekinese, Cavalier King Charles, Basset Hound, French and English bulldogs).
- The swimming puppy syndrome has however been described in many other breeds (Belgian cattle dog, German Shepherd, Labrador Retriever).
- There is no gender-related predisposition.
- Puppies of normal size at birth but with faster growth than the rest of the litter.
- Runt of litter, occasionally.
- Normal neurological examination.
- Few modifications of additional examinations.
- Few changes are observed in additional examinations.
- Examination for potential metabolic deficiencies (e.g. taurine level in the mother).
- Histological examinations of brain tissue from seriously diseased or dead puppies.
- Canine distemper.
- Toxoplasmosis (maternal IgG serology).
- Neosporosis (histology, serology).
- All causes for encephalomeningitis (especially systemic mycosis).
- Spina bifida (radiological diagnosis in breeds at risk: English Bulldog and Beagle).
- Degenerative or overload diseases (histological diagnosis): see breed predispositions.
- Myopathies (electromyographic, histological and biochemical diagnosis).
- The condition could be related to delayed myelination of the peripheral motor neurons.
- Ninety percent (90%) of puppies recover without after-effects (based on a study of 60 cases), and even in the absence of treatment (10%)
- The prognosis is poorer as puppies age, even if the condition of 2-month-old puppies proved to improved rapidly and spectacularly within three days.
- The prognosis is even poorer if all four limbs are affected.
- Bronchopneumonia complications due to improper swallowing may occur.
- Functional rehabilitation of the four limbs affected (physiotherapy for 10 minutes, 4-5 times daily) or balneotherapy (treatment by bathing - let the swimmer swim!). Hold the puppy in your hand or a sling, with support to keep his head up out of the water, and let him paddle for a while in warm water (probably around 75 to 80 degrees F to prevent chilling), but take him out and dry him thoroughly if he tires. As many of these sessions as you can manage should help the pup to develop coordination, muscle development, and better circulation while putting much less weight on his body. Your hand or makeshift sling plus the buoyancy of the water will take the weight off the chest. Finger manipulation of his limbs would be a good idea, too, while he's in the water, but also when he's out.
- Treatment using a simple restraint device. This device can be made by the breeder at a very low cost. (See Labmama's Lab Blog.)
- Early placement (from 2-3 weeks of age) of puppies on rough surfaces (e.g. egg cartons or grass).
- Stimulation of paw pads with a toothbrush.
- Use of flexible plastic handcuffs on affected limbs to limit splaying.
- Dietary rationing to limit weight gain in diseased puppies.
- Making sure that diseased puppies sleep on the side to prevent further thorax flattening.
- There's no way to prevent Swimming Puppy Syndrome.
-"Swimming Puppy Syndrome", by Royal Canin
- "Swimmers", by Fred Lanting