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Learn about Canine Megaesophagus
What is Canine Megaesophagus?

Megaesophagus is difficult to detect and diagnose, and the medical options are few.
The muscles of the esophagus fail and it cannot propel food or water into the stomach. (Its like a balloon that has been inflated several times and then hangs limp.)
 The result is that ingested food sits in the esophagus within the chest cavity and never makes it to the stomach.
 The most serious complication is that digestive fluid/food will at some point pool in the esophagus which generally results in aspiration of digestive fluid/food, leading to pneumonia. (Aspiration Pneumonia)
 Megaesophagus can occur at any age as a puppy, or as an older dog. If it afflicts a puppy, the cause is usually genetic, or can be due to a surgically repairable condition called PRAA (Persistant Right Aortic Arch). If not secondary to another disorder in adult animals, it is called "idiopathic" (cause unknown).
 Megaesophagus can be secondary to other diseases such as Myasthenia Gravis, Thyroid, Addisons and other Neurological disorders.

 

Symptoms:

Regurgitation of water, mucous or food. (Regurgitation is throwing up without any warning; "vomiting" is associated with retching.)
Loss of appetite or refusal to eat.
Sudden weight loss.
Swallowing difficulty, exaggerated and/or frequent swallowing.
They will also try to clear their throat frequently with a "hacking" sound.
Sour and/or foul smelling breath.
 Many canines may be mis-diagnosed with a gastro-intestinal problem.
 Aspiration pneumonia is a frequent complication.

Management:

Your canine needs to be placed in a vertical feeding position immediately to avoid starvation and/or aspiration pneumonia. (Note: Not an "elevated bowl." Elevating the bowl does not place the esophagus in the proper orientation so that gravity will work.)
 Vertical feeding can be accomplished with the Bailey Chair. The canine must remain in the chair for 20-30 minutes post feeding to allow gravity to work.
    A low-fat or low residue canned food fed either in a milkshake consistency or in "meatballs" works best. (If using the meatball method, they must be swallowed whole.) Each dog is different and experimentation with food consistency is required.
Multiple feedings, 3-4 meals per day, is also suggested.

Fluids must be consumed in the vertical position as well.
Medications may include an acid reducer (like Pepcid-AD or Prilosec) 1 or 2 times per day; motility drugs (metoclopromide/reglan, cisapride/propulsid/, low dose erythromycin) to help empty the stomach to minimize reflux from the stomach into the esophagus; and/or an esophageal "bandage" for esophagitis.

 

 Megaesophagus ManagementSuggestions:

 

a) Do not assume gloom and doom. With dedication of owner and DVM many dogs can live relatively normal lives.

 

b) Test for Addison's, Myasthenia Gravis, hypothyroidism and lead toxicity (if leadexposure). Perform a thyroid panel, not just a T4, as sick euthyroid may erroneouslysuggest hypothyroidism.

 

c) 3 view x-rays of chest to rule out pneumonia - if present treat at LEAST 4 weeks.

Do not depend on auscultation, alone, for diagnosis. Clinical signs of pneumonia may preceed radiographic signs by 1-3 days. If suspect AP, TREAT. Consider albuterolnebulizer treatments as adjuntive therapy. If pet has had AP, consider dispensing a"starter" supply of antibiotics for use as needed. Owner can purchase additional doses after starting.

A nebulizer can be purchased from some pharmacies, medical supplyhouses, or ebay. Good brands of nebulizer are PulmoMate, PulmoNaide, Omron.

Suggestions for YOU:

Here is a "typical" (but, not the ONLY) protocol for Megae dogs. It is a place to start:

 

1) Administer a dose of promotility medication (metoclopromide, cisapride, orother) 15-30 minutes prior to eating.

 

2) Feed 4-5 times daily w/ the dog's body perpendicular to the floor so food"falls" through the esophagus into the stomach. (consider using a Bailey chairor other method of feeding the dog in a VERTICAL position during and after).

This takes advantage of gravity, allowing the esophagus contents to "fall" into the stomach.

 

3) Administer acid neutralizer with the meal (Pepcid AC, Prilosec, etc.) at night; 2-3times daily if Zantac or Pepcid with one of the feedings.

 

4) Administer Carafate (A "bandage" for ulcers or erosions in the esophagus orstomach) 2 hours prior to bedtime; or, if required more often, liquid Carafate can begiven 1 hour BEFORE, or 2 hours AFTER any other medication, or food. (Carafate willbind to anything else, except water, therefore, to allow the Carafate to "bandage"esophagus erosions, it needs NOT to be attached to food, or anything else).

 

5) Administer antacid right before bed to minimize acid in stomach, so if reflux from theesophagus occurs from the stomach while the dog is laying down, it is not as acidic. Acidinhibitors are SUPPOSED to be given on an empty stomach, but, most owners report helpeven if given WITH food.

 

6) Attempt to have dog sleep with front end elevated, for example in a crate with the frontend elevated. Using a Procollar to keep the head elevated may also minimize night-timeregurgitation.

 

PLEASE SCROLL DOWN TO FIND OUR SUPPORT GROUPS AND TAKE A MOMENT TO VISIT THE CANINE MEGAESOPHAGUS WEBSITE WHERE YOU WILL FIND INFORMATION, IDEAS AND INSPIRATION

 

 

PLEASE REMEMBER TO ALWAYS FOLLOW YOUR VETERINARIANS

ORDERS.  EVERY CASE OF MEGAESOPHAGUS IS AS DIFFERENT AS EVERY DOG. ONLY YOU AND YOUR VETERINARIAN KNOW YOUR DOG. CANINE MEGAESOPHAGUS IS VERY MUCH TRIAL AND ERROR.

THERE IS NO "OUR WAY IS THE RIGHT WAY"

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