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"