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I am looking for advice on treating a puppy with Mega Oesophagus

I have a 16 week old Australian Bulldog puppy who was diagnosed with Idiopathic Congenital Mega Oesophagus three weeks ago and, quite frankly, I am a little daunted and overwhelmed! I can find very little definitive advice on managing her condition and very few vets here in Perth seem to have had any experience with this condition. Naturally, I would like to do everything in my control to prevent her from acquiring Aspiration Pneumonia!

There are a few Facebook pages in the US that offer some advice, but from what I have read almost all dogs they discuss are on some form of medication or other. Our vet just sent us home telling us to feed her vertically and look at making a Bailey Chair... (Very busy clinic and you often get a different vet every time you go in ...) I will probably go back in to them in the near future and see if they can supply any more information, but my Dad said "Why don't you ask Dr Chris!!

And I thought that as you are a large, well know, specialist clinic in the much bigger city of Sydney, someone there is more likely to have a little more experience in dealing with this condition.

By all accounts, Harley is the picture of health. Healthy weight, glossy coat, running, playing, barking, digging, destroying furniture and everything left on the floor, but we initially became concerned when she was about 8 weeks of age (we bred her and have her mum and brother also) as she appeared to have a cold. Her Mum had picked up a virus from the vet clinic when we took her in for her ultrasound a week before she whelped and ended up struggling through a caesarean with undiagnosed bronchitis - 3 days early and the biggest Aussie pups the vet had ever seen, so she was huge in that last week and all assumed that it was just the pressure on her diaphragm causing her discomfort. Short version, it was assumed the pup caught the cold from her mum, but 4 courses of antibiotic later and no real improvement, so in for x-rays and endoscopy and that is when we received the diagnosis.

I am currently spoon feeding her four times a day, upright in a home-made, temporary swing chair (until she is big enough to make her a proper Bailey chair - or until she gets too heavy and falls through the bottom of my sewn one, whichever comes first...), and keeping her in there for half an hour afterwards to let her food "gravitate to her stomach". I also have raised all water bowls on top of steps to encourage upright drinking - I can't remove them because of our other two dogs - but she hasn't had too much of a need for extra water as her food is pretty wet and I feed her gelatine stock blocks after every meal to make sure she is hydrated. Luckily I work from home so am able to give her the time and attention that ME demands!

At the moment, she is on Advance Large Breed Puppy biscuits and gets 300gm a day (she is about 11kg now), soaked overnight in 2 cups water, and then pureed with the stick mixer (I add extra water to make it slightly sloppy too), but I am finding that even splitting this up into 4 meals a day, it's a lot of food. She really needs to be increasing her biscuits soon, but I don't think her poor tummy can hold too much more at one time because of the water content - and I don't think her patience (or mine) will hold to any more sessions in the chair! But on the plus, she doesn't regurgitate this paste...

I believe that lots of ME dogs eat Satin Balls, but most people use them for rapid weight gain and Harley doesn't need to gain weight, just maintain where she is (with normal increases for growth, of course) - and I don't know her caloric requirements, so don't know how much to feed her, and if it will even end up being a smaller portion of food than she gets now. Or even if she will tolerate meatballs without regurgitating them! I am also unsure about the amount of grains in them - cornflakes, oatmeal and wheat germ. And I would assume that they take longer to digest in the stomach than the biscuit paste she is getting now too, so the risk of regurgitation would be higher?

Would you know of any other types of food that I could give Harley that would be smaller in volume, but give her the same nutritional requirements that she is currently getting from her biscuits?

I kind of get the impression that Harley's is a relatively mild case as we have hardly had any issues with her regurgitating her food, my main concern is the amount of "moisture' that is constantly in her throat area, even when she has just spent 30 minutes vertical. It sounds like she is breathing through a bucket of mucus. She sometimes coughs it up, then swallows it, but not as often as I'd like, she just stoically breathes through it. And whilst it is not so severe all day, it is a daily occurrence.

She also regularly suffers from a blocked nose and there is often little teeny, tiny "snot bubbles" in the corners of her nostrils too. And her right gland has pretty much never gone down since we first noticed her "cold" at 8 weeks of age, no matter whether she was on or off antibiotics.

I have read that ME can cause excessive salivating and nasal discharge, but could there be another underlying cause? We had assumed not as the antibiotics didn't clear it up, but maybe it is something that antibiotics won't help remedy.

I am very worried about her aspiring all this extra "water" that her body is constantly producing and ending up with AP.

I have considered making her a "neck hug" but at this stage of their lives, Harley and her brother will end up "eating" the neck hug and be hospitalised with intestinal blockages... And apparently this doesn't always alleviate the problem.

Do you have any suggestions, recommended medications that don't have too many side effects, anything that may help clear up her "snotty mucus" long term?

And should she be on some kind of acid inhibitor? Or are the side effects of this not worth it as she doesn't appear to regurgitate much at all?

Is the mucus production (and swollen gland) because her food consistency isn't quite right and she is still holding food in her oesophagus? Endoscopy showed slightly inflamed tonsils and our vet seemed to think that it was because of the ME and the regurgitating, but she never really regurgitated often, just "coughed up mucus" every now and then. It seems a vicious circle - her trying to clear herself of mucus is causing mucus production!

Could her Mega E be because of some other underlying issue - MG or Thyroid or anything else? We haven't had any bloodwork done, it was just assumed to be congenital as she was so young.

Statistically, what are the chances of her growing out of it? How can I give Harley her best chance at regaining Oesophageal muscle tone?

Is it likely that she will have a normal, happy life?

Are you aware of anyone here in Perth that may have had a reasonable amount of experience in this rare condition?

Any information would be so very greatly appreciated!!!

Maybe you should do a story on the show about ME. It is a very little known condition here in Australia that people used to assume to be fatal, when it seems it can be managed - however carefully - with the right advice and care!

Annette Green

annettegreen1

1 Answer

Melissa

Hi Annette,

Thank you for your email. You are certainly well versed on the condition of mega oesophagus and a very dedicated owner. It sounds like your little Bulldog puppy needs to see an Internal Medicine Specialist. They will examine her and possibly perform tests to help confirm the diagnosis. Once confirmed they will be able to tell you exactly how many calories she should be receiving as she grows and the best food to provide these calories based on her needs and body condition score. The good news is that there are several internal medicine specialists in Perth. Your veterinarian will be able to refer you to closest specialist facility in your area.

Melissa

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