Friday, January 30, 2009

Disease Progression

Roland starting blurping in Dec. 2007. At first it was quite rare - a couple of times in 2-3 weeks. It was always episodic. In other words, it would come in clusters. He'd not blurp for a week or more and then blurp 4-5 times over a 2 day period. This made it quite difficult to determine whether the food (size, dry vs wet, etc) made any difference. Also in early 2008, we were preparing to move to another state. We finally moved the dogs - a 2 day drive across the western US. Roland did not blurp once on the trip. We were so afraid that we'd be cleaning up a hotel room or the car, but we made it safely. However, now we have a sick dog in a new city with no vet. Plus, trying to unpack, start new jobs, get the dogs settled, etc. Life was quite hectic. However, Roland was reasonable stable and not losing weight.

The blurping was gradually increasing in frequency. Early on it was days between blurps, sometimes a week or two. Then he might go a few days without blurping. Then he might skip a day. Then it was nearly every day. We did notice that he was more likely to blurp on weekends. Took a while to figure out, but it seems that he is more active when are around and clearly increased activity increased the likelihood that he'd blurp. When we're at work, he sleeps all day.

We also noticed during this same time period that he was getting weaker in his rear. The new house had 2 steps up to the backdoor and he was clearly not as strong as when he was younger (but who is?). He was also losing muscle mass, mostly, in his rear. We consulted with a veterinary internal medicine specialist, who also happens to be a greyhound breeder, and she told us that this a fairly common in older, large male greyhounds. We don't think this weakness is related to his megaesophagus, but it has clearly affected his treatment. He is too weak to sit for more than a few seconds. Greyhounds are not big sitters anyway - prefering to lie down or stand. Early in 2008, we tried having Roland sit for a few minutes after eating, to improve esophageal emptying, but his rear quivered so much we gave up on that approach.

Monday, January 26, 2009

Past Medical History

Roland was born in March 1998. His whole litter was sick at about 9 weeks, but recovered nicely. We picked out Roland at 10 weeks and brought him home at 12 weeks of age. He was a wonderful puppy -easy to train, housebroken in 1 trial, and generally a really good guy. We began training him for the breed ring, for flyball, for agility and for lure coursing. He grew to be 29.5 inches tall at the withers and weigh between 92-95 lbs.

In Jan of 2000, I came home from work to find him quite ill. He was vomiting bloody stuff and having bloody diarrhea. We rushed him to the emergency clinic where hemorrhagic gastroenteritits was diagnosed. He was treated and released. The bleeding seemed to stop, but he was not better the next day. So, off we went to our regular vet. Our vet was afraid that Roland had an obstruction in his bowel. So after more than 2 liters of fluids, Roland had surgery for a potential bowel obstruction. The vet was able to reduce an obstruction in his colon without opening up the bowel. Roland recovered well from the episode, although it did take quite a while to gain back the weight that he had lost. He had to be on an "intestinal diet" for more than a week and it was hard to give him enough cans of the stuff for a dog of his size (about 75 lbs at the time). The whole episode did give him a real preference for chicken and rice canned food. It also gave him an aversion to pills or the threat of a pill. This is presumably related to the awful taste of the Flagyl (metronidazole) that he was given.

Roland grew into a handsome and healthy greyhound. He finished his championship in the breed ring and became an outstanding lure courser. He won the lure coursing competition at the national specialty one year - the same year his father won the breed competition. Later that year he finished his AKC lure coursing championship. He also earned enough points to become a flyball dog champion and was chosen for a spotlight on Animal Planet as a breed champion that plays flyball. He was such a trooper during the filming of the flyball runs with cameras all over the place. He was not so good at agility because he was too easily distracted, but he did love to run and jump. He finished his novice agility standard title and also his open jumpers title. He was oh so close to excellent jumpers legs on several occasions, but never quite got there.

Then, on Oct. 28, 2005 2 of his toenails fell off. The next day 2 more fell off. He had symmetric lupoid onychodystrophy (SLO). Over the next 2 months, he lost all of his nails. SLO is not an uncommon disorder that affects all breeds of dogs. It is thought to be due to an immune reaction to a protein in the nail bed. The nail comes loose and then separates from the quick. It is quite painful and frequently bleeds as it separates. Until all of his nails had fallen off, Roland hated to walk in the grass or on any uneven surface. We became quite adept at soaking his feet in cold water to stop the bleeding and to numb the toes a little and then wrapping his foot until the nail came off. It was a challenge to keep him comfortable and to keep the blood stains to a minimum.

Treatment for SLO is to start with high doses of tetracycline, niacinamide and lipids (fat). If this doesn't control the disease, then steroids can be used. The disease will never be cured and the nails will always be soft and misshapen. Untreated, the nails will grow in and then fall off again. Roland was started on tetracycline 500 mg 4 times a day, niacinamide 500 mg 4 times a day, DermCaps at 3 times the dose used to treat skin conditions and 1 scoop of unflavored gelatin. We keep that up until all of his nails had fallen out. However, it was difficult to maintain a treatment 4 times a day when both of us work full-time day jobs. So by the end of 2005, this regimen had been tapered to tetracycline and niacinamide twice a day. After about 6 months we tapered the niacinamide to once a day. It was the only pill that was not available in capsule form and it must have tasted awful, because it was difficult to get Roland to eat it. The tetracycline capsules were, and still are, covered in peanut butter. For the lipids, we used a combination of DermCaps (capsules) and the liquid formulation. On this regimen, Roland's nails grew back with only one really deformed. The SLO forced his retirement from doggy activities.

Between Oct. 2005 and Dec 2007, Roland lost only 3 toenails and these happened with minimal distress. Therefore, he was maintained on tetracycline 500 mg twice a day, niacinamide 500 mg once a day, DermCaps (total of capsules and liquid = 3 times the dose recommended for skin conditions) and 1 scoop of unflavored gelatin with his evening meal. Because of the pills, he was being fed twice a day. Because of his height, he was always fed with his dish on a chair or table.

In Dec. 2007, he regurgitated clear liquid and mucus two or three times. There was no food or bile in these 'blurps', and he did not retch when it happened. The first time was odd. Neither he nor I could figure out what happened. The second time he was trotting across the backyard and barely hesitated when it happened. Over the Christmas and New Year's holidays, we spent alot of time on the internet and discovered megaesophagus. The description matched exactly.

Wednesday, January 21, 2009

Current Protocol

So, what is life currently like with Roland - our greyhound with megaesophagus? First, his treatment. He gets 3 meals a day. That's the most we could handle with both of us working full-time. He's fed from an elevated level, a kitchen chair. His water bowl is elevated and is taken away after his late evening meal. As others before us, we have experimented with different foods - kibble versus canned versus moist versus dry, etc. Currently for the morning meal he gets medium sized kibble with some spoonfuls of canned food, a squirt of LipiDerm, plus one 1 gm pill of sucralfate ground up and mixed with NutriCal. The NutriCal is a high calorie food supplement, which we were giving anyway, and it conveniently holds the sucralfate. Then he also gets one 5 mg tablet of bethanechol and one 500 mg capsule of tetracycline, both covered in peanut butter. For his 5 pm meal, he gets another 500 mg capsule of tetracycline and another gm of sucralfate. At his 10 pm meal he gets 10 mg of bethanechol with about a half a cup of kibble. He has been on this regimen for about a month now and only regurgitates a few times a week, mostly when he gets excited or drinks alot of water all at once. He's also more likely to regurgitate early in the morning. He's maintaining his weight and has not had pneumonia.

As an aside, we call his regurgitation 'blurping' and I'll use that word from now on. That is what is sounds like. There's no retching, like there would be if he was vomiting. Also as an aside, I once checked the pH of the regurgitated stuff and it was right between 5-6 (using pH strips), suggestive of saliva and not stomach acid.

Tuesday, January 20, 2009


So what is mega-esophagus? If you are reading this you have probably already done a fair amount of research, so I won't bore you with all of the details. Basically, it is loss of motility of the esophagus, which is a tube of smooth muscle that connects the mouth to the stomach. There is a similar disease in humans, but since we have gravity to assist, the disease is quite different.

There is a congenital form of mega-esophagus. In this case the condition is present from birth and presumably there is a genetic basis or it is a birth/developmental defect. The other form is called acquired and this is the form that our dog has. There are two treatable conditions that can lead to acquired megaesophagus - hypothyroidism and myasthenia gravis. Our dog was tested for both and found not to have either one. There may be some other disease that our dog has that has resulted in the megaesophagus, but, if so, we don't know what it is. The only way to halt the progression of the megaesophagus is to identify the underlying disease and treat it early. Generally, dogs diagnosed with secondary acquired megaesophagus live about 6 months from the time of diagnosis. 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.'

General recommendations are to have the dog sit for 15 minutes after each meal, to feed multiple small meals and to feed in small balls. We tried most of these with varied success. Since, it's now been over a year since his first symptoms appeared, I guess that we are doing something right. In our on-line searches most of the success stories have been about dogs with congential megaesophagus or dogs with myasthenia gravis. Rarely do you see a story about secondary acquired megaesophagus, especially a story with an effective treatment.

Monday, January 19, 2009


Our 11 year-old greyhound dog has mega-esophagus and has had it for a year now. When he first had symptoms we searched the internet for information about this disorder. We found it somewhat limited, so have decided to start this blog about our experiences with this condition.

DC Gerico's Wild Goose Chase, SC, FDCh, OAJ, NAJ, VC..... AKA Roland is now 11 years old. He first had symptoms of mega-esophagus in Dec of 2007. He is currently on sucralfate (1 gm twice a day) and bethanechol (5 mg in the morning and 10 mg at night) for his mega-esophagus. It is now Jan. of 2009.

We don't know what in his history is important to the story, so over the next few weeks or months we'll record his medical history and update his current progress. Thanks for reading and we hope this information will help someone else with their pet.

UPDATE: 12/29/09: It has now been 2 years since the first symptom.