Saturday - September 12, 2009
A Reposting of "A Step by Step Guide to What I Know - Very Long But Informative"
|Several times since Bertie's passing, I have been requested to repost my thoughts on Megaesophagus which Bertie suffered from since birth. We were very successful in treating Bertie's condition, though it was new territory for both Ed & I, and our vet. Obviously we did something right, for Bertie lived to the ripe old age of 8 1/2 years. When Bertie was first diagnosed with this condition, the vets at the college only gave him a life span of 2 years. Obviously, they did not know about the Welshie spirit or our determination.
Here is one of the requests which occurred during a computer melt down, with the original article following:
On Tuesday August 25, 2009, Helena, biped for Killian wrote:
Here's Bill's wonderful Bible on Megaesophagus. It scared the heck out of me when I read it, but we had always thought there was something wrong with Killian since the very day we brought him home. It was a relief to finally get confirmation on it.
OK Helena here it is and I am going to be frank and to the point.
First off from what I understand Killian physical development and energy levels are the norm for his age. And since this condition has only be recently diagnosed (OK there are lots of questions in my mind about that), this probably means that he has been doing pretty well so far. If is weight is good, that means his compromised system is working. It also means you have already won half the battle. and if Killian is a cuddlier, then you just got another 25% in your favour. The other 25% is what we will try to address, and most of that is just plain dumb luck.
As for the condition, it just happens. It is not breed specific and should be detected from birth. That is why I question why it has taken so long to get a diagnosis. OK, so no need to dwell on that for we need to be pro-active and positive. But first lets deal with the hard facts of life.
A dog with Megaesophagus has a life expectancy of 2 years, which means you are half way through. That is really tough to come to terms with. However from now, every day counts, and since you already love the little shit (and boy do I know how feels) we just move forward. There is no cure nor is there a lot you can do about the situation, but you CAN make it better. Remember Bertie lived to be 8 years old and had a great life. We even traveled half way across Canada without problems
Causes of death are not all the pleasant. The dog can aspirate, meaning he inhales food into his lungs. Where the food lands in the lungs, it kills those cells. NO regeneration, that's it. Of course unchecked, the dog can develop pneumonia and die. Therefore, you and your vet have to discuss the signs of what to look for, and be prepared to administer the appropriate drugs at the appropriate time. We actually kept a supply of drugs on hand, and with telephone calls were able to administer the appropriate drugs under the direction of our vet. Not all vets will do that but again we had a very close relationship with our vet. You cannot mess around with this. It will happen. Bertie aspirated three times in his life and made it through every time. It does mean over time his lung capacity does decrease. The lungs become spotted like miner's lung.
Unfortunately, the dog could also choke on his own "vomit". Well as you already know, it is not vomit, but food coming back up that has not reached his stomach. Unfortunately, his esophagus will continue to expand till it becomes the major organ in his body. It will impinge upon his lungs and heart, and there will be other complications. This is what Bertie died - congested heart failure. But back to the point - choking.
This where we get into being pro-active. Every time the dog eats or more importantly drinks, holding the dog in an upright position to stretch out his body will help to deliver the goods to the stomach. For many years, we burped Bertie like a baby, including patting his chest. And Bertie belched like a truck driver, That's when we knew the goods were delivered and we could let him down and he could carry on with his life. Later on in life when we had choking episodes and they are damn scary, let me tell you, I found holding him up in the air with his toes just touching the ground helped. Now he did not like this, but since we had spent so much time with him with the burping etc, he knew to come to me for help when things did not feel right. Now just by accident, and trying to work from home, run the house, as well as take care of him, during a particular bad episode, I had to hold him with one arm and let the rest of his body dangle in mid air, Well what ever I did (his front legs were over my right arm, and I had his body pressed somewhat against my body, the food cleared, and all was fine with the world - Yes dumb luck paid off in that instance and I had another weapon to use in the battle to keep this dog going.
OK so there are the three causes of death. Best to come to terms with right now, becomes it helps you understand what to look for and how to treat it. Again it is another weapon in the arsenal to be used. And it is a battle, but after some adjustment it becomes second nature.
OK here are the simpler things you can do.
Raised Food Bowls
I know are looking into this today. We had Bertie's food bowl raised, but we also had the bowl placed on a step (a shallow cardboard box) which he had to place his front paws on to eat. This placed his entire body about at a 30 degree angle. Remember gravity is your best friend when dealing with Megaesophagus. His water bowl was raised as well but without the step. We had 2 dogs and they both used the same water bowl. We tired separate bowls, but they insisted only one bowl would do. If we only had one dog, raising it onto a step would had not been a problem.
It took Bertie about 30 nano seconds to adjust to the new situation.
Again, after every feeding or drink, it was time to burp.
Break up the food into small portions and feed more often as in breakfast, lunch and dinner. Limiting water intake is good. Interrupt long drinks with a quick pick me ups and burp, and place back at the water bowl. Long drinks should be avoided because you know what will happen and you will be on your knees cleaning up. Yes I know we are dealing with a Welshie, and he will do damn well what he wants to do. But what we are trying to achieve here for him to actually get the water when he needs it in a way that works. We not not trying to limit his water intake, just the delivery method. You may find other methods that work for you.
We switched Bertie to a raw food diet which we bought frozen at the specialty pet store. The advantages were it contained water. Water delivery is the most difficult task with this condition. The food was slippery and would travel down easier. And there was less a choking hazard.
Large chewing treats are now out of the question - too much of a choking hazard. Small soft treat are in, as are fruits. Small pieces of banana are good - soft, watery and add essential vitamins and minerals to a dog that is prone to throw up. And was highly recommended by out vet later on in life when the throw ups became the norm. He wondered how we would get Bertie to even eat bananas (This is where Bill and Ed laugh hysterically) . We could not break off a banana from the bunch without 2 little munchkins at our feet, demanding some.
Take every opportunity to place you dog in an upright position. Less throw ups and more food delivery. OK easier on clean ups as well. Bertie's favourite position was laying against me with his head tucked under my chin. Unfortunately laying on his back, and especially hanging his head over the edge of couch while on his back is STRICTLY forbidden. We were constantly re-arranging the boy because he would start to choked. Every bit counts. It is time consuming but the bonding between you and your dog is amazing.
Well here you are very limited. The only drug that works for this condition is sisapride (cysipride). God I never learned to spell it correctly. Now this drug was taken off the market about 8 years ago for it was highly effective, too effective and interacted with other drugs. Many people died from using it. It was over prescribed, and to many people were taking a complicated combinations of drugs, and their health was already compromised. Out vet had to apply for permission to prescribe this drug from the national gov't. It was given to him since it was the only drug that addressed the condition.
Now this drug does not work for all dogs, but it was the only drug that might works. And it does have side affects when taken over the long turn. But since we were not dealing with the long term, we decided to hell with it. Lets do it. Fortunately we stocked piled the drug when we knew it was being withdrawn from the market, and then the boutique pharmacies started making it, and all was right with the world.
We started on the maximum dose and slowly weaned him down to a minimum dose. At times we had to increase to adjust to his constantly deteriating condition. BUT, and this is an important BUT, we had several years with Bertie where was stabilized. We did not even have to burp. He had an absolutely normal life. Who would believe it!!!! We did good.
Of course all good things come to an end, and as he got older, and his esophagus got larger, problems arose. But Bertie had a whole lot of other things wrong so we were fighting on many fronts.
If you follow the drug routine, then be aware every new drug you may have to give must be checked to see if it is compatible with this drug. Of course those drugs have to be administered at least four hours after the sisipride. We had to give the sisipride in the morning and at dinner. Other drugs were given at lunch of just before bedtime. It is a bit of a juggling act.
The other drug was a Geri Tab - multi vitamin with some steroid in it. I think that is right. I got asked this a few weeks ago and got the fatty acid pill name and the vitamin pill names mixed up. There were a whole lot of meds that we had to admin so please forgive me. This pill just helped balance out his diet given his sporadic nature of his food delivery.
Clean Up On Aisle Four
We found that paper towels and a solution of water and AMAZE (yes the detergent used to wash diapers) in a bottle worked best to clean up all those throw ups. We also had carpets that absorbed things and we threw them out every several months. They were bought from Home Depot and were cheap.
Well there you are. I think that's about it. As I said previously, I worked from home and that made this all possible. It was a little daunting at the beginning but once Ed and I established a pattern, it became easier. And of course the last year of his life, was not easy. At times all I did was look after Bertie. I had several bouts where I was stretched beyond all limits, and decided I cold not carry on. I had several conversations with our vet about putting Bertie down because it was overwhelming my life as well as my relationship with Ed. He agreed and then Bertie would rally, and we would carry on.
There was another member on the list who faced the same circumstances and found she could not do it. I fully understood that, having been there too many times. Sometimes you just cannot do it. No-one on this list will fault you no matter what your decision is on this matter. IT IS A BITCH to get thru - great highs and horrible lows. And as I have talked on about the last few months of recovery from such an ordeal, it does take its toll.
So was it worth it - damn right it was. I loved that little shit but it was always tempered with the reality of the situation. Loosing him was a relief. It had taken over our lives. We were committed and saw it to the end. We impressed the hell out our vet as well and the members on the list, and the breeders here in Canada. It was not easy, it was time consuming, and expensive. But we did it, and it was worth while. It also took its toll on us a huge toll. And we will probably never have another rescue dog. I DID SAY RESCUE DOG - not a dog. We still would like to have dogs, just not special needs dog.
Well there are the hard facts. I hope it helps.
Bill (and Ed) dogless in hot sticky humid Toronto
On Saturday September 12, 2009, W.F. Heartwell wrote:
Well Helena - didn't that email bring back memories. I really was moving when I wrote that email, but I am happy that it assisted you. It is a tough thing to deal with and you have done so well.