Q :My dog was diagnosed recently with a megaesophagus and pneumonia.
With antibiotics and breathing treatments his pneumonia is getting better, but I am having a hard time managing his megaesophagus. Do you have any suggestions for me?
This is a hard one. Megaesophagus has long-term management issues that many, if not all owners and pets struggle with. I will try to lay out a few tips that have worked over the years. The important thing to remember is that not all dogs are the same and what might work for one pet can absolutely be the wrong solution for your pet so trial and error are critical for all cases.
To quickly and briefly go over megaesophagus, it is a hypomobility disorder resulting in a large flaccid esophagus. Food and water is not squeezed down into the stomach and so it is regurgitated out of the mouth often without warning prior to being digested in the stomach. This can be an acquired condition due to neuromuscular abnormalities or a congenital condition that some puppies are born with. Oftentimes it is idiopathic, meaning we are not quite sure why it happens. They lose weight because food never makes it to the stomach resulting in a constant circle of hunger, eating then regurgitation of that food leaving them even hungrier.
The critical consequences of megaesophagus include weight loss and aspiration pneumonia due to constant regurgitation. The pneumonia can be managed medically with one or more antibiotics, breathing treatments and coupage, or percussion of the chest. Treatment should last for four to six weeks and follow-up X-rays need to be performed to ensure all evidence of pneumonia is resolved prior to stopping treatment. Unfortunately, aspiration pneumonia can and will reoccur if the regurgitation is not well controlled. Pneumonia can be a fatal condition if not treated aggressively and quickly.
Now, to manage the regurgitation, that is the tricky part. Medications can be given to promote motility. There are medicines that help the stomach stay empty, such as Reglan and cisapride. Acid neutralizers such as Pepcid, Zantac and Carafate will help to protect the esophagus from acid erosion from the stomach.
Feeding and watering are the pillars of treatment. Food and water only are to be offered when the pet is in a vertical position. This position must be held for a minimum of five minutes after drinking anything. This will promote food falling down into the stomach using gravity instead of muscle contractions in the esophagus.
Water can be supplemented in the solid food of the diet or gelatin blocks can be made and given to the animals if they tolerate a more solid form of intake than liquid. Recipes for these Knox blocks are available online or through the Yahoo megaesophagus support group.
Feeding positions are non-negotiable. These pets must be in a completely vertical position, sitting up in a begging pose for 20 to 30 minutes after feeding solid meals. Some owners can hold their pets up with their backs resting against the owners' legs for this time. There are other devices that have been developed by creative pet owners that are worth taking a look at. One is the Bailey Chair. It supports the pet on three sides with a bar in the front to rest their front paws on. It comes with a training DVD and looks very promising; also available online.
For the actual diet, a low-fat diet that is low in fiber is ideal. Fat and fiber will encourage regurgitation. Rice and raw diets are not encouraged because of the complications with pneumonia. It is always best to contact a veterinary nutritionist to help formulate a diet that will encourage nutritional wellness in these challenged animals. Your veterinarian will help you contact a nutritionist and develop an appropriate diet.
The consistency of the diet can be anywhere from a gruel to actual meatballs of food. This is where experimenting will come into play. Pets are all different, so keep working to find the consistency that results in the least amount of regurgitation. Frequency of feeding is also an experiment. Small frequent meals are ideal to help the stomach empty quicker. Feeding five to six meals a day is not uncommon.
Treats should be avoided. Consider creating a bed where the pet sleeps with his head elevated at an angle. There is a collar called a Procollar that can also help to facilitate him resting with his head higher than his body.
All of these management issues do not happen overnight. Pets and people have to be trained to perform the tasks that work for them. But with time and lots of creativity an animal with megaesophagus can be managed successfully long term.
Send questions for Dr. Allison Dascoli to "Ask the Vet," Charleston Daily Mail, 1001 Virginia St. E., Charleston WV 25301 or e-mail them to askthe...@
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