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My five year old labrador retriever has been diagnosed with acquired megaesophagus; we have ruled out Myasthenia Gravis and a thyroid condition. The vet has told me to feed high protein food (puppy food) and to feed from raised bowls and to walk the dog on his hind legs for three to four minutes afterward. I feed in small increments three (3) times a day, he has maintained his weight for the two months we have been having the problem. My question is, is there any unconventional treatments we might try? Does this ever correct itself? What is the likelihood of developing aspiration pneumonia? How does this problem affect the overall lifespan of the dog? Any ideas on how he might have gotten this condition?

Customer (name blocked for privacy)

Status: Closed Value: $50

Thyroid and MG are the two most important things to rule out. Did your vet do lead levels or any contrast swallow radiographs? Are there any other signs in the dog neurologically or muscularly...weakness or so forth?
Has your vet mentioned determining between muscular cause vs. neurological?

Sorry for the questions...but it will help with my response for you.

Dr.Vamvakias

Dr. D.A. Vamvakias
Veterinarian

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Response to DanaDVM's Post: My vet did xrays and had a sonogram done, the sonogram did not indicate any problems, the xray indicated the problem with the esophagus. He did blood work which all came back normal; the thyroid test was done as well as the one for MG, both came back normal. I believe he has ruled out a nuerological cause with the test for MG, I believe that he's not sure what caused this as all the test have come back normal.

Last spring we had a problem with the dog (Gunner) vomiting which cleared up after about three weeks, we had xrays done and barium was used, a sonogram was done and we had him on canine ID food, the condition cleared up with no problems until late August. It was different then as he threw up mostly bile and food. This time it has a lot of mucus and usually happens when he lays down at night (and throws up in my bed!).

Gunner shows no other symtoms, he's active and full of energy, he has maintained a weight of 67lbs for the last 3 weeks despite the vomiting. He has always been on the lean side even though he likes to eat. I hope I clarified things a little better.

I remember your dog now from September...xrays were normal then.

Well, I understood what the vet had done initally, so I guess I will word it differently.
You ask about prognosis and so forth, it depends on the cause.
Your vet has done some of the workup, but not all of it. A sonogram/ultrasound will not show anything...and the thyroid and MG are just 2 possible causes. Now, without further work up like lead levels, ANA titers, Creatine kinase levels and possible ACTH stim test...you can assume it is idiopathic megaesphagus. There is a feeling that 80% are idiopathic, which just means "we don't know why it happens".

The prognosis is different if you happen to go after and find a cause vs. the idiopathic version.
The prognosis is poor for idiopathic megaesophagus. It is a constant battle to maintain the weight of the dog, and aspiration pneumonia is an ongoing risk. Eventually a type of feeding tube is placed to maintain the nutrition of the dog.

I find that the maintenance of these dogs coupled with the constant pneumonia, owners usually give up treatment and put the animal to sleep.

I am sorry I don't have more positive information. If you have further questions, please let me know. I think in your area, there are some specialty clinics that may be able to go the next step with your dog. I have heard of muscular biopsies, and neurological testing...and even an active viewing radiographically of the dog chewing and swallowing to see if there is another problem.
It truly depends on how far you are willing to go.

Dr.V

Edited by DanaDVM on November 15 2004 at 5:59 PM

Dr. D.A. Vamvakias
Veterinarian

Response to DanaDVM's Post: I'm sorry if I misunderstood your question. I guess I should get the names of all the tests he performed to see if I covered everything.

Should I have the lead levels, ANA titers, Creatine kinase levels and ACTH stim test done to narrow down the possible cause?

Is this something you would normally seek a specialists advise on?

Thank you,

Honestly, I am considered a good vet in practice and I can hold my ego intact pretty well. Your vet has done the standard approach, and got a diagnosis of megaesophagus with negative hypothyroidism and M.gravis. If you were the 85% of the clients that have spent their several hundred dollars and are done...than proceed with the treatment as you have.
I have aobut 5-7% of clients which would put the dog to sleep because of other issues. The remainder of clients want to know more and want to make sure they have exhausted options for their animal. At this point, in my clinic...at at most general practice clinics...you have reached an end to what is in our reference range. I don't think your vet would hesitate sending you to an area specialist. The tests I mentioned will probably be performed there.

If it were my dog...I don't know. It is a pretty crappy prognosis if it is idiopathic megaesophagus, so I guess I would want someone else to give me a few more options, I guess that is human nature.

Dr.Vamvakias

Dr. D.A. Vamvakias
Veterinarian

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