DIAGNOSIS
1. History - Other clinical signs, young or older breed,
large breed
2. Physical exam - including full neurological exam,
thorough thoracic auscultation (aspiration pneumonia,
caudal lobes on X-ray)>
THORACIC X-RAY. Needs 3 views. 2 lateral + V/D. Look for
aspiration pneumonia, cranial mediastinal mass, air in
esophagus (one lateral without sedation as drugs can
cause air in esophagus).
Contrast studies. Liquid barium using plain X-rays,
evidence of strictures, vascular ring anomaly (puppies).
Food and barium dynamic studies (fluoroscopy) to assess
motility of esophagus.
Other investigations to identify underlying problems.
TREATMENT depends on causes
Distemper, autonomic drugs, toxicity (lead, thallium,
anti-cholinesterase), Esophagitis, systemic lupus
erythematosus, hypoadrenocorticisum, thyoma,
myasthenia gravis (focal, most common cause,
auto-antibodies produced against Ach receptors),
polymyositis.
1. Vertical feeding - Feed from a height. Bailey's
chair. 1 hour upright feeding.
2. Bethanechol or cisapride for myasthenia gravis
CASE STUDY
Use of barium meal showed esophagus enlarged in two
areas, convincing the owner of the diagnosis. Plain
X-ray not so clear in showing megaesophagus.
2. Dietary - canned food, meat balls. No dry food.
3. If myasthenia gravis, require anti-cholinesterase
drugs and immune suppression.
bethanechol or cisapride
In practice, it will be most expensive for an owner to
get all the tests done to determine the cause and the
surgery. In my case, the owner was not keen on more
tests.
"Vertical feeding," I asked Dr Gladys what it meant as
stated in her University book. I was glad to see her now
graduated and practising as last year, I met her in
Perth and she was in her 5th year, studying very hard.
This was after we had taken the X-ray with barium meal
to show the megaesophagus to the owner as he was not
much convinced with the plain radiograph.
"Feed like a human being, being upright," she said.
"You mean, the dog should stand up and eat and drink?" I
asked. Lucky for me she had the patience.
"Use a Bailey's chair," she replied.
Well, Bailey's chair are mentioned in the internet on
megaesophagus nowadays and therefore is no secret.
It is actually a toddler's dining chair where you
confine the toddler.
"It is not practical," the owner told me when I advised
him to make one Bailey chair. "I don't expect my dog to
sit in it for more than 5 minutes.
The theory is that gravity enables the dog that is fed
soft food seated in a Bailey's chair to get the food
into the stomach. The dog must sit in it for some time
and this may not be to the dog's liking.
The dog had lymphoma and FNA (fine needle aspirate) done
on the popliteal and cervical lymph nodes by Dr Gladys
and Dr Daniel indicated abnormal cells. A lab test was
recommended.
"The owner is more interested in the cure than in
knowing that his dog had what type of lymphoma," I said
to Dr Daniel. "Such test need money and the owner just
wanted to cure the dog of regurgitation and the tongue
ulcer. Will such test help? I will say not. So, in
practice, economics play a big part unlike in the
academic world of the Vet School."
Tips for Dog Owners
The best time to spay your dog is 2 months after the end
of heat
TOA
PAYOH VETS
