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.