Friday, January 30, 2009

Megaesophagus

This is Maiya, shown at 2 years old in these first two pictures, just 2 days after being rescued.
She has Megaesophagus.

Megaesophagus ~ A condition in which the esophagus loses all tone and dilates making swallowing extremely difficult which increases the risk of aspiration pneumonia and malnutrition.
Symptoms are regurgitation of food, weight loss, coughing, aspiration pneumonia.
Comes in three forms ~ Congenital, Secondary, and Idiopathic
Congenital ~ Dog is born with it. Can be caused by a PERSISTENT RIGHT AORTIC ARCH, but most times is just genetically inherited. The link to genetic inheritability is unknown.
Puppies with congenital megaesophagus have the best chance of survival and management. As the pup matures nerve function may increase either curing the disease or making it more manageable. Some puppies never improve.



Secondary MegaE ~ is megaesophagus caused by another disease. This can happen at any age. Thyroid diseases, neurological conditions, Addison's disease and Myasthenia Gravis are a few diseases but not inclusive of all the diseases that may cause megaE. It is reported that Myasthenia Gravis accounts for 25% of secondary Mega cases. Megaesophagus can be cured in this case if the underlying disease is corrected before the esophagus becomes too stretched out in which by that time it may not return to normal function.
Idiopathic ~ Common in dogs 6 years +. It appears for no reason and is the poorest prospect for treatment.
Surgery is usually not an option as not only is this primarily a neurological condition, but the esophagus itself is slow to heal when operated on.
There is no standard treatment for megaE which makes it one of the hardest diseases to manage. Elevated feeding in which the dog sits in a "high chair" or held in the begging position helps use gravity to draw the food down into the stomach. Consistency of food is everything with megaE. The unfortunate part is that you never know what consistency works best with your dog. It's all trial and error. While some dogs require a soupy consistency, others may require a thicker oatmeal like consistency. Some even do very well with canned food rolled into meatballs and then dropped down the throat. Many times dogs are in such poor condition that it does not leave much room for the error part of the trial. It may take a lot of changes before you find something that works, and even then, you may never find something that works.
.
Maiya showing her climbing abilities, letting her mom know she can do the same things dogs without MegaE do.

Medications are virtually useless in MegaE. Vets will often prescribe reglan or cisapride. Neither of which will give the esophagus tone or motility, but may help strengthen the esophageal sphincter if it is having trouble staying closed leading to reflux.
A Histamine-2 blocker such as Zantac, or Proton-Pump Inhibitor such as Prilosec are often standard medications. Again, like the latter, they don't do much for the esophagus itself but can neutralize or even eliminate the stomach acid that is regurgitated up into the throat causing esophagitis.
Carafate can be useful in preventing esophagitis (inflammation of the esophagus). It soothes and creates a coating over the tissue to help prevent burning and irritation of regurgitated stomach acid.
Maiya getting dinner. Look how patient she is.

Gastrostomy tubes are a last resort. Some dogs do not fair well no matter how many different ways you mouth feed. Those dogs are good candidates for a G-tube. G-tubes don't require much more maintenance than the megaE dogs themselves, but can be a scary thought at first. A dog with a G-tube can function in every way as a normal dog except he/she will receive their nutrition directly into the stomach bypassing the useless esophagus.

Sweet and spoiled Maiya has the best spot in the house.

Prognosis is guarded to poor with MegaE dogs. In most cases it boils down to the time and dedication the owner has for the dog. Even then, with the most dedicated owners, and scrupulous treatment the dog still may not respond and need to be euthanized.

Aspiration Pneumonia is the number one cause of death in Mega dogs. Maiya has had it 6 times.
Maiya belongs to a very close friend of mine. She is almost 4 years old now. She was not expected to survive this long. Maiya is a very special girl with an outstanding dog mom that has gone far above and beyond to give Maiya the life she has so deserved.

Thank you my dear friend for being such an inspiration to us all, and doing all you do for Maiya.

Updated November 6, 2009 Maiya and Megaesophagus
Updated November 13, 2009 Maiya Update

24 comments:

Carolina said...

Gosh, how awful for both the dog and for the people who care for her. It's good to see that she is doing so well despite this horrible condition. All the best to her and her human friends. A big hug for you all!

Stacy said...

I LOVE that Maiya's mama takes the time for her! She looks SO sweet!
I love hearing stories like this and also learning.

One of our cats, Zeus, has congestive heart failure. The vet didn't think he'd do too well...he said "he'll probably be around for a few more months to a year"...
That was five years ago.
Apparently we have the exact right combination of prednisone, aminophyline, and furosemide. He gets at least one pill twice a day, up to three pills in one sitting. Needless to say he's gotten used to it.
Even the vet is surprised.

Suldog said...

Wow, that's love for your friend. Lots of patience, on both ends of the equation.

Betty said...

Very interesting information and Maiya is gorgeous. She looks so sweet on the couch. Her guardian is another one of those 'angels on earth'...taking such wonderful care of her.

Thanks for an uplifting story about a terrible condition.

Mrs.Ruiz said...

She is beautiful, thanks for sharing and boy that was a tall fence she can climb

caroline said...

such a sad, but sweet story. thanks for sharing it.

Dog_geek said...

Poor Maiya, but she looks like a beautiful, sweet, happy girl. I'm glad that she found that special someone to take care of her, for better or for worse. I'm sure that Maiya doesn't spend much time dwelling on her disability!

Jan said...

Wow that is one special owner and one special dog. Glad they found each other.

troutbirder said...

and still such a beautiful shepard. Strong devotion on both sides I'm sure

elsie said...

t, thanks for (re)introducing us to maiya, and for your excellent reporting of the disease. she's such a beautiful girl.

Daniela said...

What a sweet baby! I wish her the absolute best. Her and her mommy deserve it.

las794 said...

Poor skinny thing...but she looks so lively, too! I don't know who is the bigger angel, Maiya or her pet-parent.

Jane said...

What a beautiful dog! I hope she fairs well.

Jane

RDSGHG said...

Your blog about Maiya & her Mums came to me as a Godsend while I sat in my office late one Friday night recently. I've been waiting 'til now to send my heartfelt appreciation to you for "It Matters to Me" - and it does quite deeply, for I was the "Mom" of E, a congenital megaesophagus, hiatal & diaphragmatic herniation pup. After 2 decades of rescue, and multiples of challenges with various disorders & special needs, I don't think any one of them touched me quite the way this disroder does - it can be mind boggling at times & anyone who has experienced the learning curve first-hand undoubtedly feels the very same way. One day there will be better knowledge & with that scientific research will come... better answers. That is my deepest wish.

So, thank YOU for your blog to share about Maiya. I needed it that night - for Draco as I had become his facilitator of improved care & life-altering decisions. By the day you released "It Matters To Me," we were on day eight post-operatively in Draco's case. That night we were just starting to converse about the need for surgery no. 2 - in which a PEG tube could be inserted. They also were concerned that either his first surgery (manual reduction of hiatus plus double pexy) had come undone or that slightly down the GI tract, there was another problem. It ended up being the later - the upper portion of his intestines had migrated underneath the stomach; his was a 'slider', meaning that the stomach was high up in the chest cavity. There were quite a few uneasy hours of worry & tears, but let me cut to the happy part of the story. Draco had that second surgery, and was able to come home to his loving family the eve of Valentine's Day. They are thrilled beyond words, and Draco has taken to his feedings and the tube like the little trooper that he is. This little boy now has his first chances to heal so that he can have a (near) normal life like every pup should have.

His page, "Draco Comes Home" can be found @:
http://www.caninemegaesophagus.org/Draco_Comes_Home.html

Heartfelt appreciation, for "It Matters To Me" was a Godsend 30 Jan. for me.

Peg M.
Founder, cmERp
canine megaesophagus Education & Research project
http://www.caninemegaesophagus.org/

T said...

RDSGAG,

Hi Peg,
Heart warming thanks to you for the very nice comment.
I just read Draco's page. What a beautiful pup, with very special parents to help give him a wonderful chance at life. Kudo's to you for all your work, dedication, and commitment to the ongoing research of MEGA E. People need educated, and the only to do that is through research.

Maiya's mom read your comment too, and it brought tears to her eyes as well as mine.

I bookmarked your site for future reference.

Many best wishes for Draco and his family.

Anonymous said...

I've been surprised at just how many folks are dealing with mega-E -- my dog was diagnosed in April 2008.

She's on Cisapride, pepcid a/c and fed vertical in her Bailey chair and stays vertical for up to 30 minutes after feeding.

She still has the occasional regurg, but she's doing great.

Thanks for spreading the word that this is not necessarily fatal.

Leanna & Susie

RDSGHG said...

Leanna, I've been surprised, too. I started my web project @ the beginning of July 2006. The searches and visitor count to E's site have increased beyond my wildest imagination. Sometimes responding to emails has been very difficult. The most difficult come from those who find the site after being told the only thing they can do is euthanize their pup. I revel in those who write to ask for help finding a vet who is experienced, and typically will talk them through that and answer any questions they have - the whole process usually takes about an hour. They then often set about bringing information back to their vet along with a new lease on how to approach the symptoms & share that excitement (and progress report) with their veterinarians. I deeply sympahtize with the vets - as most received minimal education pertaining to this disorder while they were in vet school, so when a case is presented to them, they can only rely on what their knowledge base is. A few, *few* have seen a few cases in their years of practice, but most do not know how to better advise. I too experienced all of this way back when. I will never be a vet - I don't want to be a vet - but what I've learned over the years almost qualifies me to impart improved knowledge- for it is through daily experiences of living with more than one mega pup that has brought increased knowledge and increasing thirst for knowledge. I consider myself fortunate in that I've met with measurable success with each of them. But I realize that it won't always be that way. A very kind specialist reminds me every-once-in-awhile that no matter what is tried, they can't all be saved. The point of my writing in reply is to share that, by sharing of our experiences, and encouraging others to share - more veterinarians and specialists can approach how they view "megaesophagus" - and if their minds are opened to the possibilities -- they too can learn right along with the rest of us. There will be renewed interest in the disorder for which 'very little' (with the exception of kind euth.) can be done. We just need help getting the word out.

The current visitor (unique visitor) count to this one website *daily* is avg'd currently @ 178 to 200 visitors per day. It's not just the puppy people, interested friends helping to dx the pup on a web board (and get your pup to the vet pronto!), the newly dx'd senior, but also the veterinarians as well as the teaching universities and other institutions (studying other similar disorders) that drive the traffic. This is only the beginning of the better day (better science) to come. Megaesophagus, in my humble opinion, is one disorder that veterinary science seems to have stepped over and around in the past. I hope to see that change -- and it is, slowly but very gradually - I am hoping for consistently!

The saddest fact is that many breeders, if they realize they are looking at a megaesophagus litter, will 'cull' the one (or more), and sell the remainder of the litter, believing that the remaining are unaffected - when in fact it is highly possible they are (currently) sub-clinical. Some don't believe the possibility and repeat the breeding, or continually breed on the same line(S), still believing they'll never see it again. Needless to say, "they" aren't necessarily talking about this with fellow breeders or their puppy people for the most part. In conclusion, there is absolutely no way of knowing just how 'rampant' metamorphous might truly be. It is only by sharing what is known that we can strive for healthier puppies and breed lineage for the future of all affected breeds. Each of us - the puppy person, the veterinarian, the vet tech, the specialist, the research specialist, and the breeder - all need to work cooperatively if there is ever to be a reduction in the (unknown) numbers of megaesophagus puppies (and idiopathic, later onset - adult dogs when poisoning, other clinical conditions, or anesthesia or other meds are not the causative factor).

Sending hugs for Susie and you, Leanna. Do you know about the Support Group @ Yahoo?

My best to each of you,

Peg

PS) Semi-funny story. One of my vets was excited when I came in one day & wanted to shaer - "Geuss what, we adopted a kitten. Guess what - the kitten has megaesophagus." Now guess what... the kitten has "grown out" of the disorder :-) Knowledge (and the sharing of knowledge) is power...

Crazy World News said...

Dear T well done for all your efforts.

You are a great example for people feeling desperate about their dog suffering mega-e.

I didn't know about the feeder that bypasses the esophagus. I'm really happy it works so well.

My cocker spaniel was diagnosed with mega-e approx. 9 months ago. After lots of effort and trial I managed to stabilize his weight and now he's feeling great! You can see his Megaesophagus video and x-rays in my blog (http://www.crazyworldnews.com/407/animals/megaesophagus-video.html).

Well done for all your efforts, keep going.

And for anyone facing the same problem, one word:
DON'T QUIT. DON'T EVER QUIT.

troutbirder said...

How sad. My muffy had an incurable urinary blockage. I had a hard time figuring out when enough was enough for her. If only they could talk.

alisha said...

i second the idea of never quitting! my pet, olive, had congenital megaesophagus. with time and care, i found a way to feed her so that she grew and grew...growing out of the condition completely!

never give up!

you can find olive's story here:
www.littlemissolive.com

Forgotten Pets of Spring Branch, Texas said...

Are you on FB? If so, by special invite:
http://www.facebook.com/pages/CmERp-canine-megaesophagus-Education-Research-project/150359048354850

Also, please help to spread the word? Please share the following:
I am hoping you will help spread the word amongst your peers. Please let me know if you have any questions. If you have suggestions on other ways in which we can get the word out about this research study, I will be very

appreciative. We know that still, all-too-often, the DVM diagnostician s still operating under "old school edu." and frequently recommends euth. to the client. It would be wonderful if we could get this into the hands of as many private practitioners as possible, as rapidly as possible.

----------

Leigh Anne Clark, Ph.D.

Assistant Professor

100 Jordan Hall

Clemson University

Clemson, SC 29634-0318

The above is important for the following reasons:

1) Request for cheek swabs -- more samples needed/requested. Following

parameters only apply: the dog must have been diagnosed at the age of

one or before.

2) ANY BREED may be submitted. Focus is still on GSD as that is the

initial grant parameter. IE more GSD samples are still needed.

HOWEVER, "we" are going to start looking at the other breeds.

3) The coffers have run dry. SNP research is expensive. I am

reqeusting donations be sent to Dr. Clarke so that this very importat

research can continue. I will be sending a nominal monthly donation.

It will take all of us working together to move forward. Stop-starts

due to coffers running dry are to be avoided ... even if you can only

spare a one time small donation, please do it today.

Why This Is Important:

Being able to map the genes involved will ultimately lead to the

ability to develop a test so that breeders can know before breeding

which sire and dams are carriers or if they are in fact clear.

Please Note: Leigh Anne runs a tight ship out of necessity (expense).

Thus, please know that no direct results will be made available. Your

affected dog,,, and you,,, can play a huge part in the advancement of

this scientific endeavor to (eventually) eliminate this insideous

disorder. That's a feel good for you and a win-win-win for everyONE!

Should you have any questions, please contact me. Anyone can donate. A

thank you note to Leigh Anne along with your check will make her day.

I highly respect and appreciate all that she has endeavored thus far

and bet you do as well.

Please also share with your breeders in case they too know of other

affecteds in their line to which you may not have knowledge. If you

can print off a copy and take it to your individual DVMs, that will be

greatly appreciated. Pups are being diagnosed daily and delivering

info to each individual DVM is time consuming. Thanks so much if you

are able to do this!

HOW TO SUBMIT:

1) Send a request via email to: LCLARK4@clemson.edu

-- include your name, your ship to address, your dog's age, &

breed, age of onset of symptoms & age @ dx.

2) Dr. Clarke's Genetics Lab staff will mail a kit out to you via

snail mail, to be returned by you via snail mail. You will not need to

go to your DVM.

3) Because the samples for this ongoing study are cheek swabs, samples

can be submitted from anywhere in the world!



Sincerely,

Peg McIntyre

Founder, cmERp (canine megaesophagus Education & Research project)

T said...

Hi Peg. I apologize for my delay in replying. I fell back at xmas time and broke my shoulder, which has resulted in a couple of surgeries, no use in my arm and nerve damage. Sadly, my time has been limited to just physical therapy. I just found your FB page and liked it. Thanks for the heads up.

Will catch up soon. Maiya is doing fantastic and thriving, and gaining weight, without the tube! Amazing!

Forgotten Pets of Spring Branch, Texas said...

It's wonderful to hear that Maiya is doing so well -- yea!!! I hope life is treating you better each passing day, too! Thanks for all!

Peg

Anonymous said...

Sucha wonderful and inspiring story, thank so much forposting all the info too. We have just Lost our beloved Jack to this awful condition, he was just 5yrs old but we are told that we are lucky to have had him that long...he went undiagnosed for three years, despite extensive examinations and investigations but thanks to one dedicated comsultant we finally got the right diagnosis and could begin correct feeding regime. He was a fabulous boy, full of fun when he was well and we miss him every day, he died two weeks ago. I only hope that someday they will find and answer for these poor dogs.Our breeder by the way, when we told her the diagnosis suggested euthanasia....you can imagine my reply.......Chris Pullen