Wednesday, May 20, 2009
Bad Day
Just a short update. Frustrating day. Came home to find blurps all over the house. Couple looked dry and old - like from early in the morning. A couple were mostly water with some grass. This suggests that he wasn't feeling well. However, when I got home from work he did not act like he was feeling bad. He ate dinner well and looks comfortable. Sure wish we knew what to expect with this disease.
Monday, May 11, 2009
May update
Things have been pretty status quo for about a month now. Back in April we had a very bad stretch of a couple of weeks. One of Roland's back toenails came off. Of course it happened just before bedtime on a Sun evening. It's been so long since a toe nail came off that I couldn't find all the stuff. Finally got the bleeding stopped and got to bed. The nail bled off and on for several days.
That Thurs we had an appointment with our vet. She thought he looked great. His weight is holding steady. We reviewed the dosing of bethanechol and discussed what the projectile blurping might be about. No real resolutions. I think we are all guessing at this point. His toe looked fine when she examined it.
The next day and over the weekend, Roland had a really bad time. He was blurping up almost everything that he ate and he did not look well. We also noticed that his toe was swelling some and bleeding again. We were soaking his foot, but it wasn't getting any better. I called the vet and she agreed to treat his toe with an additional antibiotic, which I picked up on Tues. For the next 10 days he got the antibiotic (cephalosporin) and I stopped his tetracycline. I was worried that his SLO might flare up, but cephalosporins don't work well when given with tetracycline. After a couple of days, the swelling in the toe went down and his blurping reduced in frequency and volume. By the end of the 2 weeks, he was back to his baseline.
The main outcome of this episode is that if Roland blurps more than once a day, I increase his sucralfate to 3 times a day. When he has the episodes of repeated blurping and panting it does appear that he has esophageal irritation and the sucralfate should help with this. We've also increased his bethanechol to a total of 20 mg/day - 5 at breakfast, 5 at dinner and 10 before bed. In the past month, he rarely goes a day without blurping but it is often predictable - when he is either excited or drinks a bunch of water, or gets too hot, etc.
A couple of weeks ago he did have one day when the blurp had a different consistency. Usually it is clear liquid with identifiable undigested food. This one day it was darker brown and more even in consistency - more like stomach contents, but without bile.
In our case, as the saying goes - No news is good news. We cannot believe that we lived with megaesophagus for 17 months, but we'll take every day that we can have.
That Thurs we had an appointment with our vet. She thought he looked great. His weight is holding steady. We reviewed the dosing of bethanechol and discussed what the projectile blurping might be about. No real resolutions. I think we are all guessing at this point. His toe looked fine when she examined it.
The next day and over the weekend, Roland had a really bad time. He was blurping up almost everything that he ate and he did not look well. We also noticed that his toe was swelling some and bleeding again. We were soaking his foot, but it wasn't getting any better. I called the vet and she agreed to treat his toe with an additional antibiotic, which I picked up on Tues. For the next 10 days he got the antibiotic (cephalosporin) and I stopped his tetracycline. I was worried that his SLO might flare up, but cephalosporins don't work well when given with tetracycline. After a couple of days, the swelling in the toe went down and his blurping reduced in frequency and volume. By the end of the 2 weeks, he was back to his baseline.
The main outcome of this episode is that if Roland blurps more than once a day, I increase his sucralfate to 3 times a day. When he has the episodes of repeated blurping and panting it does appear that he has esophageal irritation and the sucralfate should help with this. We've also increased his bethanechol to a total of 20 mg/day - 5 at breakfast, 5 at dinner and 10 before bed. In the past month, he rarely goes a day without blurping but it is often predictable - when he is either excited or drinks a bunch of water, or gets too hot, etc.
A couple of weeks ago he did have one day when the blurp had a different consistency. Usually it is clear liquid with identifiable undigested food. This one day it was darker brown and more even in consistency - more like stomach contents, but without bile.
In our case, as the saying goes - No news is good news. We cannot believe that we lived with megaesophagus for 17 months, but we'll take every day that we can have.
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