Made it through the rough patch

Poor Sidney was throwing up for about a week and sometimes it was multiple times a day. By far the most since we got a handle on the Megaesophagus condition last December.

We decided to stop using the Bethanechol and use up all of the remaining Metachlopromide instead of using them both together. We will then try the Bethanechol by itself and see which seems to work best for him and go with that med. Sidney had horrible retching and regurgitation for a week or so that hopefully ended yesterday. He seemed better, but you never know. We're keeping an eye on him. Hopefully the rough patch is over.

He seemed kind of sluggish, but now has his energy back. I was concerned about him getting pneumonia from all of the RG, but he seems to be doing better. I feel so bad for the little guy when he has his rough days. It may have been some esophagitis from eating stuff off of the ground. He never lost his appetite though, which is good.

Bad Day - Changing Bethanechol Dosage

We started the Bethanechol in 10mg doses, 2x per day, which seemed like it was doing some good. However, yesterday morning Sidney was retching, making some horrible vomit sounds. He then vomited all over his cage. This also happened the previous morning. This is a bit abnormal for an ME dog. Normally the RG just kind of falls out. Especially in mornings where stomach acid found is way into the esophagus and irritated it overnight. This was different, this was a vomiting episode (still looked like stomach acid). Again in the late afternoon he looked like he did it again while I was watching him on his Internet Camera, so I know we have a problem that needs immediate attention.

We are going to try and decrease the dosage to 5mg, 2x per day and see if that was the cause. We did give him an extra dose of Sucralfate last night before bedtime to see if that helps soothe his esophagus. It didn't seem like he regurgitated this morning, so some good news. With ME dogs, you need to keep a log of all changes you make to get the proper routine down. If this doesn't help, I will eliminate the Bethanechol and track his progress then. Problem is that you never know what causes the episodes, just have to do your best to figure it out so he doesn't contract secondary aspiration pneumonia, which is the scariest part of this whole thing.

Introducing a New Med - Bethanchol

This is a photo of Sidney chewing on Michael Vick








After seeing several people speak highly of Bethanechol on the Yahoo group site and doing my own research online, we started the Bethanechol on Friday by giving 10 mg before the morning and evening meals, when he gets his Metachlopromide. Costs were prohibiting it because I was told by my vet that it was about $66 for a month supply. But I found out that Costco has the prescription for $25 for a 12 week supply. Worth the 2 hour round trip for that since Sid has been having episodes every morning.

It was difficult to try and find a way to get it into his tummy, since water usually doesn't stay down too well. First I tried to crush it and mix it with some fish oil, but that didn't stay down too long and I was cleaning it up off of the floor in no time. It needs to be taken on an empty stomach, so I finally ended up hiding it in a Knox Blox (the Jell-O cube that we give him to eat in his chair to keep him hydrated) and that seemed to work. Kind of like a make-shift Pill Pocket. We may need to put him in his Bailey Chair for his pre-meal meds now to get this done correctly.

Bethanechol is used in people to treat urinary retention after surgery. The thought in ME dogs is that it can help with the nerve function in the esophagus, hopefully giving it some of its life back. Here's some medical info I found online. It is a cholinergic agonist, so it binds to cholinergic receptors and causes smooth muscle contraction. For it to work the nerves that connect to the smooth muscle do not have to be functioning. We were really concerned that there would be urinary or intestinal side effects of the Bethanechol, since these tissues are also smooth muscle with the same receptors. Basically we're worried he's going to start peeing all over the place and lose control of his bladder. So, the first morning Sid received 10 mg. He had no bladder accidents, so he received another 10 mg that night. He usually RGs right when he wakes up in the morning, but he didn't this time. Good news. We continued with 10 mg twice a day. He didn't RG again until this morning, all over the bed and carpet. I think it's because I let him sleep in my bed as opposed to his cage we rigged up to keep his head elevated, or he ate something at the dog park or on our hike this weekend. Sorry Sid. We didn't notice a dramatic effect and not sure if this will take more time to do what it is supposed to do, but he did RG much less than normal. Not going to get too excited just yet.

It is still early in this test, but I will continue to try and evaluate if it is making a difference, but you never know if he ate something he shouldn't have behind my back.

There are several believers that the Bethanechol can reduce the symptoms of Congenital Megaesophagus in dogs. But, there is NO cure, so if this helps him RG less then it will be worth it. STAY TUNED.

Keeping an Eye on Sid

Problem with Megaesophagus is that when he regurgitates, he has a chance to contract secondary aspiration pneumonia. The worry is that when he does RG, he eats it back up, then does it again, again and again. Recipe for disaster. I only live about 15 minutes from where I work and usually go home at lunch to check on him and give him his sucralfate. But there were some really bad patches where you could just see all of his blankets stained with RG. Kind of scary knowing the consequences.

So in order to try and see if he is regurgitating while we are at work and to give us a chance to stop him from eating it back up and getting it in his lungs, I bought a wireless camera. So basically what I do is access it from work and keep an eye on him. I can now see if he RG's in his cage and cruise home to try and get it stopped and get him in his chair.

Also - I get to see how much fun he has in his cage with his toys - so it isn't all bad. I also get to see if he is full of energy and will know that he will bother me all night long to play. Puppies!!! Luckily he sleeps with his head at the front of the cage where we have it elevated to stop stomach acid from irritating his esophagus so it is easy to see what he is doing.

Our Routine and Treatment for Megaesophagus

So - what is life like with Sidney the Megaesophagus Puppy?


First, his treatment for Megaesophagus. He gets 3 meals a day. That's the most we could handle with our schedule. My family helped me build a feeding chair named a "Bailey" Chair. This is an invention by a family of a ME dog named, you guessed it, Bailey. They are kind enough to send you an instruction DVD on how to build the chair and what they do to manage their dog's condition. What this does is keep Sidney in the vertical begging position for feeding and his 30 minutes of wait time after his feeding to allow gravity to get the food down into his tummy.

Thirty minutes is a long time, I agree. It took quite a while having to sit with him while he was in the chair and keep him calm. We would smear some honey on the side of the chair for him to lick to get him to always associate good things with his chair. He is pretty good at just chilling out in the chair now without constant supervision, which is a huge burden lifted.

We created a meal that crams as many calories into it as possible. So we add instant oatmeal, fish oil and puppy weaning formula to his food and blend it in our Magic Bullet to milkshake consistency. Looks like barf, but he loves it.

To keep him hydrated, we make Knox Blox - which are basically Jell-O cubes we feed him in his chair after he eats. For treats, we made the Frosty Paws recipe we also let him lick in his chair. Plus there is about a cup or so of water in his food to blend it, which also keeps him hydrated. He cannot drink water like a non-ME dog.

We decided to use a few meds to help him out. First is Metachlopromide, which is to help him digest his food much faster than normal to avoid it sliding back up into his esophagus and eventually onto our carpet or couch. He gets this in liquid form - 2.5ml 30 minutes before every meal. We let him sit next to us on the couch for 5 minutes after he gets it so it finds it's way into his tummy. He's used to sitting upright like a person I guess.

Second is something called Sucralfate, which we use to "coat" his esophagus and kind of act as a coated Band-Aid to help when it is irritated to possibly avoid more RG episodes. We use 1/2 a pill diluted in 6ml of water and feed it to him in a little squeeze syringe. He HATES this one - and I find myself chasing him around the house for 10 minutes before I catch him to deliver the meds.

Then at night with his evening meal he gets a tablet of Prilosec OTC to try and help avoid his stomach acid irritating his esophagus and more RG while he's sleeping at night.

Don't get me wrong - there is no perfect way to avoid RG episodes - in fact it happens more often than not. We have good days and bad days, but most of what he RG's is crap he ate off the ground or stomach acid - most of his food, if not all gets digested!!!

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Here is his daily schedule:

7am - MORNING MEDICINE: Gets 2.5ml of liquid Metachlopromide 30 minutes before his meal – He needs to be held vertical for 5 minutes after he gets it

7:30am - MORNING MEAL: Bailey Chair for 30 minutes
• ½ Cup of Dried Eukanuba Kibble Soaked in ½ cup of HOT water and 1 TBSP of Olive Oil (I soak it in HOT WATER right after he gets his medicine and sometimes you need to add more water – HOT WATER so is softens food)
• ½ Cup of Eukanuba Canned Food – Chicken and Gravy Puppy Food
• 1 TBSP of Oatmeal and 1 TBSP of Eukanuba Puppy Weaning Formula
• ½ - 1 cup of additional water

12pm - AFTERNOON MEDICINE: Gets a half tab of Sucralfate diluted in 6cc of water – shake vigorously and give him small bursts so he swallows without choking
• NEEDS it 2 hours after eating or 1 hour before anything else to ensure it coats the esophagus – only needs held up for 1 – 2 minutes after

5pm - AFTERNOON MEDICINE: Gets 2.5ml of liquid Metachlopromide 30 minutes before his meal – He needs to be held vertical for 5 minutes after he gets it

5:30pm - AFTERNOON MEAL: Bailey Chair for 30 minutes
• ½ Cup of Dried Eukanuba Kibble Soaked in ½ cup of HOT water and 1 TBSP of Olive Oil (I soak it in HOT WATER right after he gets his medicine and sometimes you need to add more water – HOT WATER so is softens food)
• ½ Cup of Eukanuba Canned Food – Chicken and Gravy Puppy Food
• 1 TBSP of Oatmeal and 1 TBSP of Eukanuba Puppy Weaning Formula
• ½ - 1 cup of additional water

7:30pm - EVENING MEDICINE (as needed): Gets a half tab of Sucralfate diluted in 6cc of water – shake vigorously and give him small bursts so he swallows without choking
• NEEDS it 2 hours after eating or 1 hour before anything else to ensure it coats the esophagus – only needs held up for 1 – 2 minutes after

9pm - EVENING MEDICINE: Gets 2.5ml of liquid Metachlopromide 30 minutes before his meal – He needs to be held vertical for 5 minutes after he gets it

9:30pm - EVENING MEAL: Bailey Chair for 30 minutes
• ½ Cup of Dried Eukanuba Kibble Soaked in ½ cup of HOT water and 1 TBSP of Olive Oil (I soak it in HOT WATER right after he gets his medicine and sometimes you need to add more water – HOT WATER so is softens food)
• ½ Cup of Eukanuba Canned Food – Chicken and Gravy Puppy Food
• 1 TBSP of Oatmeal and 1 TBSP of Eukanuba Puppy Weaning Formula
• ½ - 1 cup of additional water
• 1 tablet of Prilosec with food

What is Megaesophagus?

So what is Congenital Megaesophagus in dogs? Basically, it is loss of motility of the esophagus, which is a tube of smooth muscle that connects the mouth to the stomach. If you are interested in some fancy, medical description - I found the below actual description online:

"The esophagus is the tube connecting the throat to the stomach. When food is perceived in the esophagus, a neurologic reflex causing sequential muscle contraction and relaxation leads to rapid transport of the food into the stomach, like an elevator going down. Other reflexes prevent breathing during this swallowing process to protect the lungs from aspiration. When these reflexes are interrupted such as by disease in the esophageal tissue or nerve disease, the esophagus loses its ability to transport food. Instead the esophagus loses all tone and dilates. Also, the reflex protecting the lung is disrupted and aspiration pneumonia commonly follows."

Sidney has Congenital Megaesophagus. In Sidney's case the condition was present from birth and presumably there is a genetic basis or it is a birth/developmental defect. The other form is called Acquired Megaesophagus, which happens to dogs later in life. I've read there are two treatable conditions that can lead to Acquired Megaesophagus - hypothyroidism and myasthenia gravis, both of which Sid does not have.

There is no answer to why Congenital Megaesophagus exists or what causes it, if so, we don't know what it is. There are some causes such as a Vascular Ring Anomaly, which Sid didn't have so I don't know much about it - but all the info on this is on the Yahoo Support Site.

The main causes of death are malnutrition and aspiration pneumonia. The malnutrition results from the food never getting to the small intestine for absorption. The aspiration pneumonia results from inhaling small amounts of the regurgitated 'stuff.' Sidney had Aspiration Pneumonia once already - but seems to have recovered well. This is the scariest part of the condition for us.

General recommendations are to have the dog sit in a vertical position for 30 minutes after each meal, to feed multiple small meals and make the meals in the consistency of gruel. Some people feed meatballs to their dogs if they aren't chewers, but my lab will chew anything he sees, so we went for the gruel route.

Basically - the disease/condition affects everything he eats. He cannot have any solid food, treats, etc. And what he does have he must stay vertical for 30 minutes. Fun training a lab puppy with no treats and stopping him from eating sticks and mud outside!!

Introduction - Our Puppy with Canine Congenital Megaesophagus

First, let me introduce you to Sidney - our happy little Chocolate Labrador puppy. He was born on 9/26/2009.



Sidney has congenital megaesophagus and has had it since he was born, but we didn't figure out the actual diagnosis until 12/7/2009.
At first, when we brought him home he would regurgitate (for sake of typing throughout the blog I'll just refer to it as RG) his food in big, undigested blobs. He spent several days and nights at the vet while we were trying to figure out what was wrong. He was dehydrated and underweight. One afternoon he must have RG'd at least 10-15 times in one hour - so I rushed him to the vet and they kept him there and did what they call a Barium Swallow test - to see the shape of his esophagus and called me into the room to give me the bad news. The basic diagnosis is that the guy will not live very long and dogs with this condition really don't have a great chance of success.

Unwilling to let Sidney suffer and die, we searched the internet for information about this disorder and luckily found a Yahoo Support Group that, in my opinion, saved his life. So anyone reading this that has a dog diagnosed with megaesophagus, please go to:

http://pets.groups.yahoo.com/group/megaesophagus/

Knowing how panicked, scared and sad we were about losing Sidney, I decided to start this blog about our experiences with this condition to prove to everyone out there that megaesophagus is NOT A DEATH SENTENCE. I read a quote from an ME dog parent that I loved:

"Our dogs do not die from megaesophagus, they die of old age with megaesophagus."

Every dog is different and the routine and food and medicine depends on trial and error for your dog, but I will update his current progress and explain what we do and how we do it. Thanks for reading and we hope this information will help someone else with their pet.

UPDATE: 5/11/2010: It has now been 5 months since the diagnosis and he started at 14 pounds. He now weighs 40 pounds and counting.