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.

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