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Mega E in six month old?

5K views 57 replies 12 participants last post by  SummerGSDLover 
#1 ·
Do regular vets have the capability to diagnose mega E? My puppy has been hacking during eating then regurgitating his meal. It happens without warning, he doesn't have the vomiting sound, it's almost as though he swallows and then it just falls back out. He isnt loosing weight but I don't think this is normal either. I just want to do what's best so I'm making a vet appt for this week.
Is it possible to have some people with ME dogs to PM me some of what they first experienced with their dogs and the dogs age?
Thank you.

*-*Summer*-*
 
#6 ·
And this is why the internet is dangerous. Barium if it gets into the lungs can cause issues. if you read the link I sent it says not to use barium. Mega E shows up on a plan film most of the time. You start with no barium.

What happens is your vulnerability when this strikes. Be careful of the doom and gloomers who will tell you in capital letters you must. It can be very manageable in some dogs like mine. Certain precautions need to be met if it does indeed turn out to be Mega.

If megaesophagus is not obvious on plain films, it is better not to use contrast (Barium) studies if possible. This is because megaesophagus patients have the tendency to inhale or "aspirate" food contents that back up in their throats. This is dangerous enough when the material is simply food but if barium is present and becomes inhaled, the body has great difficulty removing it from the lungs. Still, sometimes this is the only way to see the megaesophagus.
 
#10 ·
yes, that makes sense. They get hiccups a lot as well. The good news is he is six months so he survived past weaning. The water is just sitting in the throat area. You will have to change a few things as to how he eats and drinks water. Buy some GasX the strips they get gassy also.

The Yahoo group is good. Just make a new email just for the site. It gets annoying the format is terrible. I tried to build a forum but they refused. Do not get caught up in the real sick dogs. Yours is not in that category.

https://groups.yahoo.com/neo/groups/megaesophagus/files
 
#14 ·
Sorry. Just had a 3 hour appt at the vet. 5 xrays with and without barium. STILL inconclusive. Started two meds tonight (sucralfate & metoclopramide) to hopefully treat esophogal inflammation he has and take more xrays in a couple of days. Vet said it wasn't an obvious case but it could be secondary mega e caused by a thyroid imbalance. Guess we'll see how he does on the meds...

*-*Summer*-*
 
#16 ·
That is good news. Be careful with metoclopramide it can do the reverse effect and make it worse. They do have success with Mega e dogs on that. That stuff messed my boy up real bad for the 36 hours I had him on it. Keep an eye on him.

The sucralfate needs to be liquid

The thyroid can be a cause they should do a full blood profile on him.



The following will address several questions that new folks have asked, in case
they haven't had a chance to read the wonderful info in the files and database:

Here is a very brief discussion w/ questions that may be helpful to many new
folks:
1) What is megaesophagus, and why are antacids suggested?
***A NORMAL esophagus squeezes the food from the back of the throat, through
the chest, and into the stomach. With megaesophagus, part (focal) or all
(generalized) of the esophagus is paralyzed. It ends up being a flaccid tube
that just allows the food/liquid to sit within the esophagus, and not empty
into the stomach. These dogs usually have to be fed and maintained for 30-45
minutes in a vertical position to allow the food and fluid to "fall" into the
stomach.

Also, the sphincter between the esophagus and stomach in megae dogs is "lazy"
and often allows acidic stomach fluids to reflux (leak back) into the
esophagus. Acid is NOT a friend to the esophagus, and will cause burns or
ulcers. If the stomach fluids can be made LESS acidic, it is less likely to
burn the inside of the esophagus (called esophagitis). In general, every dog
needs to be tried on a variety of "antacids" (see a brief explanation of the
different antacids at the end of this message). The most successful seems to be
Prilosec and Nexium. Chronic decreased acid, however, causes a Vitamin b12
and/or folic acid deficiency, so injectable supplementation may be suggested.

It seems to also be in the best interest of these patients to use a "pro-
motility" drug; ie. one that will help the stomach empty more quickly into the
small intestine, so that the stomach juices have less chance of refluxing back
into the esophagus. Usual promotility drugs are metoclopromide (reglan) or
cisapride (propulsid) or low dose erythromycin.

2) What is the life expentancy of our dogs?
***Depending on the extent of the megae - is it focal (just part of the
esophagus) or generalized (entire esophagus)? Are there other causes
(hypothyroidism, Myasthenia Gravis (MG), lead toxicity, trauma, chemical
damage, etc.)? Are there other health issues - stomach or bowel disease such as
Helicobacter pylori (HP), inflammatory bowel disease (IBD - can only be
diagnosed via biopsy, but, is often treated successfully with appropriate
antibiotics, etc? How often does the pet develop aspiration pneumonia?
How "intense" the treatment must be - ie. some (RARELY seen on this board) dogs
require only elevated feedings; others require 4-7 small vertical feedings
daily and then require being kept vertical for 30-45 minutes. So, with many of
the dogs, especially those belonging to the owners who frequent this board, it
depends on how much time the pet owner has to devote to the pet's care. Please
remember that the owners of dogs who are EASILY managed, only participate in
this board occasionally, because they don't need as much advise.

You will find dogs on this board who have lived a pretty normal length of
years. Hobbs, a Wire Haired Fox Terrier, was lost at about 15 years old, from a
brain tumor. Bailey, who belongs to Donna and Joe Koch (developers of the
Bailey chair), was diagnosed as a puppy and is now 8 years old, and pretty
much runs the household with the rest of the "herd."

3) Why do symptoms seem to worsen when they sleep? Many occurrences happen at
night. Is there anything we can do to help?
****When the dog is laying down, fluid refluxes back into the esophagus and
then can leak into the trachea, resulting in severe irritation not only of the
esophagus, but of the trachea and/or lungs. This is where treatment w/
antacids, pro-motility drugs, and/or carafate (an esophagus "bandage") is
helpful. Doses can be given during the day, but, most find it best to give a
dose of each prior to bedtime (Carafate must be given an hour prior to, or 2
hours after any other meds or feeding, to be effective). Many on the board
teach their dogs to sleep w/ their front end elevated (again, perusing the
photos can give you some ideas). If the dog sleeps in a crate, one end can be
elevated 6-8 inches, and they can be encouraged to sleep w/ their head at the
elevated end. A Pro-collar (similar to a human cervical collar) can be worn to
keep the head elevated, also.

4) What are the signs of Aspiration Pneumonia (AP), so we know what to watch
for?
****Sometimes the only signs are lethargy and decreased appetite. If one of
these dogs refuses just a FEW meals, or acts lethargic for more than a few
hours, it is very advisable to have them evaluated. Coughing, wheezing,
increased respiratory rate, lethargy, etc. are the more common symptoms.
Sometimes the only symptom is lethargy, increased regurgitation or loss of
appetite. Unfortunately, the only way to CERTAINLY rule AP in or out, is with x-
rays. A dvm cannot always HEAR infection within the lungs. Owners may want to
request at least 3 x-rays of the lungs. If only one view is collected, a minor
lesion can be missed. A lot of dogs w/ pneumonia cough, or, their breathing
sounds "rough," or, gurgly. Nebulizer administration of drugs such as
albuterol, as well as oral antibiotics, etc. are usually used for treatment.
Some of the antibiotics (clavamox, especially) can cause nausea, loss of
appetite, or vomiting. Those dogs with chronic or recurring AP can be treated
using medications administered using a nebulizer.

5) Are there any other complications we should be on the look out for?
****The health of these dogs can be very fragile, so if there are any symptoms
that you see that suggest that the pet isn't acting "quite right," evaluation
by a dvm is strongly urged. It is a good idea to become familiar w/ the
emergency rooms in your area so that you aren't walking in with no knowledge of
the the experience or knowledge of the staff.

Many folks copy info from these boards and ask their veterinarian to take a
look. Some dvm's welcome the info; some may resent it. YOU are your pet's
advocate; the dvm is his quarterback, taking all info and putting it together
for what is best for his/her patient.


6) What should we consider an emergency or urgent?
- bloody or persistent vomit or diarrhea
- pale or blue-tinged gums or conjunctiva (eye membranes - should be pink)
- stumbling, incoordination, weakness
- continuous coughing for more than 1/2 hour, or breathing with head
extended (hard time getting oxygen)
- foam coming from mouth or nose

IF FOR ANY REASON YOU ARE CONCERNED ABOUT ANY SYMPTOMS THAT YOUR DOG IS
SHOWING, PLEASE RUSH TO YOUR DVM OR TO AN EMERGENCY ROOM. THE HEALTH OF THESE
DOGS IS VERY FRAGILE. THE SOONER TREATMENT COMMENCES, THE BETTER. BETTER A
WASTED TRIP, THAN A SEVERELY ILL DOG. Once you become familiar w/ the symptoms
of AP, you may ask you dvm for a supple of antibiotics to start w/ the first
signs. They mustn't be given for only for a few days, but, usually for 4-6
weeks. Giving them for too short of a time may result in resistance.

7) What are some medications that are used for treatment?
i. Sulcrate (carafate) - liquid or tabs - "bandage" for ulcers/erosions in
esophagus/stomach
ii. Tagamet (cimetidine) - this is pretty useless, Zantac (ranitidine),
Pecid (famotidine ), Prilosec (omeprazole), Nexium (esomeprazole) - Prilosec
and Nexium work best if NOT sprinkled on the food, but, given in the capsule
(most listers have found it to work either way). All but Nexium are available
OTC - need to experiment w/ what works best for your dog
iii. Pro-motility drugs (help open up the sphincter between the stomach and
small intestines, allowing stomach contents to more quickly enter the small
intestines, so that it is less likely to reflux back up into the esophagus:
a. reglan (metoclopromide) - oral tabs & liquid - helps w/ nausea;
helps stomach empty - some megae dogs seem to be very sensitive to the
neurologic side effects (restlessness, panting, nervousness)
b. Cisapride (Propulsid) - helps with reflux (most specialists do
not feel it works/experience suggests that it does in many mega-e pets).
Currently only available through compound pharmacies
c. low-dose erythromycin - NOT used as an antibiotic

Antibiotics frequently used for aspiration pneumonia (AP) -
a. Baytril and/or amoxicillin - Baytril can be given via injection
b. Clavamox - pills and oral liquid (frequently cause nausea) - can give
metoclopromide one half hour prior, to "settle stomach"
c. Azithromycin (Zithromax) - capsules and oral liquid. Usually give for 5-
10 days, but, has activity for 10-14 additional days.
d. cephalexin (Keflex)
e. Sulfa Trimethoprim - must watch for development of dry eye w/ Schirmer
tear tests
f. amikacin or gentocin can be administered via nebulizer
g. there are other appropriate antibiotics, and to find the ideal
antibiotic a culture of the debris within the lungs may need to be collecte
via transtracheal wash or bronchoalveolar lavage

Here is a "sample" protocol for megae dogs, but, some experimentation should be
expected:
1) Feed 4-5 times daily w/ the dog's body perpendicular to the floor so
food "falls" through the esophagus into the stomach
2) administer a dose of metoclopromide (or, cisapride) 15-30minutes hour prior
to eating
3) administer antacid w/ the meal (once daily if prilosec or nexium - at night;
2-3 times daily if zantac or pepcid w/ one of the feedings)
4) administer carafate ("bandage" for ulcers or erosions in esophagus or
stomach) 2 hours prior to bedtime
5) administer antacid right before bed to minimize acid in stomach, so if
reflux from the esophagus occurs from the stomach while the dog is laying down,
it is not as acid. Antacids are SUPPOSED to be given on an empty stomach, but,
most owners report help even if given WITH food.
6) have dog sleep w/ front end elevated and/or wearing a Pro-collar to
minimize "micro-aspiration"
 
#19 ·
And don't freak out if it is mega, I've had 2 pups with it and they had (have?) long healthy lives.

The dogs with the best prognosis are those that are normal healthy weight and size, cause clearly that means the food is getting to the stomach. Additionally many dogs like this actually appear to grow out of the condition by around a year, which may be what's happening with your dog and why the x-rays are confusing.

Sounds like you have a good vet and are working on it. I just wanted to calm you if you've been reading all the doom and gloom on the internet about the condition. It CAN be bad and those are the posts/readers you are seeing from frantic owners. The rest of us who have dogs doing fine aren't posting at all so you don't get a balance.

The MOST important thing is......

MAKE SURE YOU CONTACT YOUR BREEDER!!!! the condition is GENETIC so they need to check up on littermates, and not re-breed the parent dogs.

:)
 
#22 ·
“The rest of us who have dogs doing fine aren't posting at all so you don't get a balance.” I am one of those people that MaggieRoseLee refers to.

I have two ME dogs, both GSD. Diva turned 5 at the beginning of December & Jersey will turn 9 in April. Both were diagnosed at a young age. It is manageable. There are things that you will have to do different with these dogs but I found you just fall into a pattern after a while & it’s just the norm.

And to look at the bright side of things, you will save a lot of money not buying treats & chew sticks...... downside is that you will spend your time scouring for deals on paper towels, just in case! :)
 
#24 ·
Maggies dogs I believe did lots of intense sport work.

The only issue is proper hydration. Dehydration, especially in Florida is a killer, make sure he gets enough water. Not sure if he can free drink. Water control is really important.

Try to make a chart with how many ounces he gets including what you give with food each day.

I would monitor the water very closely until you get it under control. Take his temperature a lot, high temps can show dehydration and possible AP.
 
#25 ·
He's free watered. He goes through a cooking pot a day. (the big roasting pots). I'm taking him back in today. Ever since he started the meds, he can't pee very well and has horrible diahharea. I'm limiting his water so his bladder doesn't get distended. Good thing our pocketbook is padded a little from taxes because $300 on Friday and another god knows how much today... *sigh* Keep your fingers crossed for him, will you?

*-*Summer*-*
 
#31 ·
I am 26.5 years old, 4'11, 95lbs and have size 5.5 feet.
Yogi is 6.5 months old, 60 lbs, with 5.5" ears.
He is the peanut butter to my jelly. ;) I figure by the time I'm 28, we'll be roughly the same weight. Haha.

I'll update everyone on what happened tonight when I get up. It's 1:00am my time. For a mom of three boys, that's late for me.

Talk to you soon.

*-*Summer*-*
 
#32 ·
Hope your boy is doing better today.
Depending on the sport and the severity of the ME a dog can do any sport, you just might have to train differently (instead of treats use a toy).
Titan can take treats. We are in the beginnings of schutzhund training. As long as I break up the hotdog into small bits, he's learning to track and no regurge.
I carry a water bottle with a nozzle and get him vertical for water while at training.
 
#36 ·
You would have to have your vet on board and provide past history showing nothing. Also all of them have waiting periods for sickness.

Did they xray his lungs last night to rule out AP? The blood results will show dehydration or high white blood cells. You should have those back already.

Also an inflamed esophagus is really painful. Get some slippery elm and the Carafete needs to be liquid to help bandage anything in the throat.
 
#37 ·
Yes. No AP. Would this cause diaharrea though? He had to get fluids last night and he's just really sleepy today. Last night he perked up but won't come out of his crate. His ears are half down today. He's definitely not feeling well. This vet is really missing me off. The blood work came back but the vet tech said, "I'll have to let the vet call you. He's in a meeting." Whenever my other dog had test results done, the vet tech was always able to tell me everything was good. I'm trying not to panic but he's my baby.

*-*Summer*-*
 
#39 ·
ask them to fax you a copy or email you one. You need to see it.

This is common signs of dehydration as well as side effects of Reglan.

Reglan is used to treat nausea, vomiting, loss of appetite, heartburn and early satiety (feeling of fullness). Common side effects are decreased energy, diarrhea, dizziness, drowsiness, headache, nausea, restlessness, malaise and trouble sleeping.

When he gets better you have to start monitoring the water religiously until you have a great system that works. Water will be a huge challenge. It all gets better as you get a daily routine. You should not let him have access to water unless you see it. Its challenging but easy after a while.
 
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