Thursday, February 19, 2009


Just another update. Roland's had a bad week so far. Came home from work yesterday to find a trail of blurps to the doggy door. They were all small spots, but we haven't seen that since the night we took him to the emergency clinic. However, he didn't seem distressed and slept through the night without blurping. It's so hard to figure this disease out.

Another strange thing has happened lately - 3 times to be exact - in about a 3 week period. He's had episodes of what I would have called projectile vomiting, but it's mostly clear liquid and a little bit of kibble. So, I guess I should call it projectile blurp, but that doesn't make sense. The liquid comes out with force and a clear stream. In fact, it splashed. For a dog that's not supposed to have any motility in his esophagus something sure contracted or spasmed. We've discussed this round and round. Perhaps his dose of bethanechol is too high, maybe he has another condition in addition to the megaesophagus or maybe something that we haven't thought of. The third time this happened it was first thing in the morning and he had not eaten yet - or had his pills. Our conclusion is that it's not caused by too much bethanechol. If so, you would expect the symptom to happen shortly after a dose, not right before the next one. Who knows though? Anybody out there with any experience with this??

Monday, February 16, 2009


Photo is from an agility trial when he was about 5.

It was a holiday weekend, which are often not good around here. However, Roland did quite well this weekend. I thought he'd get through the whole day today without blurping, but had one small blurp this evening. He desperately wanted to play/interact, so I got a handful of training treats. Thought I'd try to train a new behavior. He got so excited that he blurped. Not unusual, that's why we try not to get him too excited. But, he's hard to resist when he wants attention. For an old guy, he's still one cute dude. I'm going to have to figure out how to upload photos to the blog.

Sunday, February 15, 2009

Current Regimen - update

OK. Back to Roland's current treatment. Morning meal between 7:30 and 8:00 am every day - even weekends and holidays. Meal consists of 1 and 1/2 cups of medium sized kibble with several spoonfuls of canned food, plus a long squirt of LipiDerm and one 500 mg capsule of tetracycline. These are for his symmetric lupoid onychodystrophy (SLO). Interestingly, the vet thinks that the chronic tetracycline might have contributed to his longevitiy with the megaesophagus. Don't know how to determine this and we are not going to stop the tetracycline to see if he gets worse. Oops... back to his morning meal. He also gets one sucralfate ground up and suspended in NutriCal, plus 5 mg of bethanechol.

Around 5:30 pm he gets a smaller meal of 1 cup kibble with some canned food, with one tetracyline and some LipiDerm along with 5 mg of bethanechol. Late night meal, around 10 pm, is 1 cup kibble with another 5 mg of bethanechol.

If you read the earlier summary of Roland's treatment regimen, you'll notice one difference. He was getting 10 mg of bethanchol with the latest meal and none at 5 pm. Last week was a rough week with repeated blurping epsiodes in the early evening. We didn't really want to increase to total dose, so tried giving 5 mg as soon as we got home from work. Too soon to really tell if this is helping. Overall, our feeling is that the disease is progressing and this is just breakthrough symptoms. For now, we can tolerate the blurping. Yesterday he blurped twice. Once early in the morning - almost a cough and only a small quantity. Around 5 pm a second blurp of moderate quantity, but fairly dry. He's hungry and eating well. I've also reduced the sucralfate to once a day. Since the blurping is much less frequent, I don't think it's really doing much. I've also reduced the NutriCal for now since he's eating so well. Soon we'll need to get back to the vet so that she can see how well he is doing. She's not seen him since we started the sucralfate and bethanechol.

Sometime along the way, before starting the sucralfate and bethanechol, we had stopped the niacinamide (part of his SLO treatment). Clearly it tasted bad and nutrition was a major concern. We decided that we would tolerate loss of a nail or two in order to have a dog with good nutritional status. He's eating well now, so we'll leave things alone for now. It does take weeks to months to see an effect on his toenails, so we'll wait and see.

Saturday, February 7, 2009

Initiating Bethanechol

We started the bethanechol by giving 5 mg with the morning and evening meals. As previously mentioned, after several days we noted that 3 days in a row Roland blurped at 5 am. So we started a late evening snack and moved the evening dose of bethanechol to between 9 and 10 pm. So, his morning dose was given around 7:30 and the evening dose was 9:30. Not an even 12 hours apart, but it seemed to work.

The blurping was significantly decreased in volume and frequency. The matter in the blurp was grainier - more small pieces like it was partially digested. Not sure the meaning of this, but we noticed this within the first weeks. It was, of course, hard to determine the effectiveness of the bethanechol because of the clustering and inconsistency of the pattern of his blurping. However, I was doing a lot less wash of throws and rugs, etc. We also were buying many fewer rolls of paper towels.

The vet had instructed us that the range for the dose was 5 mg twice a day all the way up to 15 mg three times a day, so we were at the low end of the potential dose range. Initially, the 5 mg twice a day worked, but gradually we started seeing more blurping again in the early morning. So after about a month we increased the evening dose to 10 mg. He has done well on this dosing regimen. He still has these episodes of worsening blurping with increased respiratory rate that lasts about a day. He looks, and acts, like he doesn't feel well during these times. Seems to happen about once a month, or maybe every 3-5 weeks. We really should keep track to see if these episodes are happening more often. Occasionally, we increase his dose of bethanechol during these times, but again we're not sure how effective it is in this instance. As opposed to before bethanechol, during these episodes he will eat and never looks as seriously ill as the evening when we took him to the emergency clinic.

We continue to wonder what effect the bethanechol is having on Roland's symptoms. However, one night, just as we're falling asleep, Roland blurped a large quantity several times in a half hour. This hadn't happened for ages. I asked Mr. Whippettx how much bethanechol Roland had received that night and he admitted the Roland had not gotten a dose. This was only 1 trial, but the result was impressive enough that we have no plans to skip another dose. We are believers that the bethanechol is reducing the symptoms of his megaesophagus. But, remember that Roland has idiopathic megaesophagus and clearly has some motility in his esophagus.

Wednesday, February 4, 2009

New Vet and New Treatment

About a week after our trip to the emergency clinic, we finally had a first visit with our new vet. She reviewed his history and agreed that he has megaesophagus. We had blood drawn for testing for myasthenia gravis and hypothyroidism. After the results came back negative, we returned to discuss other options and for her to get to know all of us better. We also reviewed all of the things that we have tried. She said that she would look into some other options and ideas. Several days later she called and said that a friend had suggested sucralfate and bethanechol. Things were getting so bad that we were willing to try just about anything. Just the week before, Roland had had one of his really bad episodes and there were streaks of blood in his blurped material.

I decided to try one new medication at a time, so we started with the sucralfate. Sucralfate is used to protect the lining of the GI tract in people with ulcers. Therefore, it should reduce the irritation in Roland's esophagus. After one week, there was no difference in the frequency of the blurps, but we've continued it and we've not seen blood in the blurp again. The sucralfate is supposed to be given 2 hours before meals, but Roland gets frequent meals and there's never a 2 hour period before a meal. However, since the food he eats sits in his esophagus, we've always assumed that the sucralfate has plenty of time in contact with the lining of his esophagus. Or, it may be doing nothing.

After a week, we started the bethanechol. I waited until a Sat to begin it, so that he could be watched for several hours after the first dose. Bethanechol is used in people to treat urinary retention after surgery. It is a cholinergic agonist, so it binds to cholinergic receptors and causes smooth muscle contraction. For it to work the nerves that connect to the smooth muscle do not have to be functioning. We were really concerned that there would be urinary or intestinal side effects of the bethanechol, since these tissues are also smooth muscle with the same receptors. So, the first morning Roland received 5 mg. He had no obvious effects of this dose, so he received another 5 mg that night. We continued with 5 mg twice a day. We didn't notice a dramatic effect, but towards the end of the week we observed that he was blurping around 5 am every day. Happened 3 days in a row - with no blurping at any other time. So... we tried giving him the evening dose between 9 and 10 pm (from 5-6 pm). It worked. No more 5 am blurps. By the end of the week, we'd gone from blurping daily to rarely blurping. It was a miracle.

Emergency Clinic

Our first (and, hopefully only) visit to the emergency clinic was on the evening of May 1, 2008. We had not yet found a vet, although we had a list of potential vets from other greyhound owners. On May 1st, I came home from work and found Rolland outside the dog door looking quite unhappy. There was a trail of small blurp spots inside the house across the room to the dog door. Clearly he did not want to come in past the mess - he has always been a very clean dog. I let him inside and cleaned up all the messes.

As the evening went on he blurped several more times and refused to eat anything. In the early evening, he started looking very distressed with panting and holding his head up high. He also refused to lie down, preferring to stand. He looked so uncomfortable and we had no vet to call, so off to the emergency clinic we went. There they agreed that they thought he had megaesophagus and they presumed that he had aspiration pneumonia. However, he did not have an elevated temperature or any rales or wheezes. We gave permission for a chest x-ray, knowing that he would need sedation. He was given a single 4 mg dose of oxymorphone and a chest x-ray was obtained. Moderate consolidation was noted in the left lung and he was sent home with Reglan and antibiotics (Baytril and Clavamox). Although he was wobbly from the sedation, we took him home at 1 am.

He slept through the night, but we each woke up repeatedly checking to see if he was still breathing. The next morning I went to work and worried the whole time I was there. I came home just after lunch after my husband went to work. Roland was still completely out of it. He hadn't gotten up all day, hadn't eaten, hadn't urinated, hadn't blurped. We didn't think he would live through the night. That next night, I don't think either of us slept. However, Roland was still with us in the next morning (Sat). He actually looked a little brighter, so we carried him outside and he peed and sniffed. When he tried to eat some grass I ran into the house and got a can of dog food. He ate several spoonfuls of dog food then and again every 2-3 hours through the day. By evening he was looking at 75% of normal energy level. By Sun he was back to baseline. We finally started giving him the antibiotics on Sun since he was now eating.

The clinic had given us some metaclopramide (Reglan). We also gave this a try starting Mon morning. The clustering of his blurping and variability of the episodes makes it hard to determine whether a treatment is really making a difference. But, the metaclopramide made no difference, so we've never tried it again. Within several days of this episode at the emergency clinic, we were back to baseline. We also decided that he will never again get sedatives or go back to the clinic. We are prepared for him to have an acute worsening and understand that he has a terminal condition. We are just not going to put him or us through this again.

Roland has had episodes like the one that sent him to the emergency clinic several times. He blurps repeatedly over a few hours and looks very distressed - panting and holding his head up. After several hours he starts to relax again and by 12 hours he's generally back to normal. In retrospect, the sedative slowed down his recovery from the episode. It seems that the smooth muscle in his esophagus is having repeated spasms during these episodes. We have no way of knowing whether this is the case, but that's what it is like. Seems like it happens about once a month, although again we can't predict when it will happen.

Tuesday, February 3, 2009


Photo by ShotonSite.
I've mentioned a couple of times that we give Roland NutriCal every day. We started using NutriCal years ago with a previous dog. He participated in flyball and lure coursing, but when we traveled he did not eat well. Someone suggested NutriCal. It looks like liquid fat mixed with molasses and comes in a tube. It supplies lots of calories in a small, very tasty, volume. It was great for keeping our earlier dog's energy level up for competition.

So, when we were reading that megaesophagus causes malnutrition, we immediately thought about getting some NutriCal. We buy it by the case from an on-line distributor so that it's about half the price of local stores. We started giving it to Roland in late March of 2008. There is no way to know how effective it is, but we're guessing that it doesn't hurt. Certainly, the blurped material does not appear to have NutriCal in it. Even when he blurps soon after eating, the matter that comes up is clear fluid with undigested kibble. Sometimes it's possible to see some of the canned food, but we've never seen a tetracycline capsule or a fat capsule (back when we were giving the capsules) and we've never seen the NutriCal.

When Roland was started on the sucralfate for his megaesophagus we had a choice of tablet or liquid, but the tablets were much less expensive for the dose needed. We were instructed to break up the tablet and mix it with water, then squirt it into his mouth. I tried this a couple of times with different volumes of water. He was a trooper, but I was a klutz. One time I actually squirted it out the other side of his mouth. I didn't want to mix the powder in his food, since the food is mostly dry and he doesn't lick out his bowl. After a couple of experiments, I discovered that the NutriCal picked up the sucralfate quite easily. Now I crush the tablet into a powder then squirt about 1.5 inches of NutriCal into the plastic cup and mix it around. Then this blob is dropped on top of Roland's food. He generally eats this second after the peanut butter covered pills, so it must not taste bad.

Bad times

Rollie blurped a couple of times last night just after midnight. He was OK this morning, but has blurped again tonight about 6 times. He hasn't been able to keep anything down and is hungry. It's been so long since he's had a bad day, that it's really frustrating. We certainly hadn't forgotten how to clean up blurp while half asleep, but it's been long enough that it has us really worried. We talk alot about what will come with this disease in our dog. Will his underlying disease manifest and be the cause of his death? Will he get aspiration pneumonia and die? Will his megaesophagus progress to the degree that the bethanechol can no longer control the blurping and he is no longer getting sufficient nutrients? We are thankful for every day that we have him, but we'd really love a crystal ball on this.

Sorry about the sidestep from his story. I know we haven't gotten up to present day, but I just wanted to share our worries and frustrations.