Megaesophagus

By Dave Kay and Katy Weeks, in memory of Rusty. Please see our Rusty page.

Megaesophagus is a little known disease that more commonly afflicts larger dogs: an esophogeal enlargement and weakness in the muscles of the esophagus that causes the dog to have difficulty swallowing. The most serious complication is that digestive fluid will at some point pool in the esophagus. Since a dog's trachea connect to the esophagus from the underside, this pooling generally results in aspiration of digestive fluid, leading to pneumonia.

Megaesophagus is difficult to detect and diagnose, and the medical options are few. We lost our Rusty, a wonderful, athletic, and otherwise very healthy Golden Retriever to megaesophagus. Although Rusty was 11 years old, his apparent robust health led us to believe we would enjoy several more years of his company. We loved him very dearly.

Megaesophagus arises at either of two stages in a dog's life: as a puppy, or as an older dog. If it afflicts a puppy, the cause is usually genetic. The cause in older animals is unknown (idiopathic). The condition can sometimes be managed, if caught sufficiently early, by changes in how the dog is fed (standing on hind legs, with "dancing" to help the swallowing). Otherwise, the prognosis is not good. Surgery is not an option at the current state of the art.

Because megaesophagus is subtle, and can sometimes be managed if caught early, we would like to describe the progress of our Rusty's disease, as best as we can reconstruct it. Perhaps our experience can help another family extend their dog's life.

Our dog, Rusty, was 11 when diagnosed, and because the condition was at that point acute enough to cause pneumonia, he died not long after diagnosis. The first symptom Rusty exhibited, starting perhaps a year before any serious difficulty, was so subtle that we did not realize it was a symptom. He occasionally had increasing difficulty in swallowing all the kibble of a mouthful, and would drop kibble from his mouth after trying to swallow. We were already feeding him with his bowl elevated onto a chair, as we had heard that it helped prevent gastric bloat. (A problem that never arose in Rusty.) This additional assist in swallowing may have even masked the symptoms.

In retrospect, during the same period, he also slowed down a bit; nothing you wouldn't expect from an aging dog, but still perhaps a symptom. He became reluctant to leave his "spot" under the rhododendron, and occasionally would turn down a walk. We were puzzled, but attributed the behavior to age and to an episodic joint stiffness that would occasionally give him trouble.

It is possible that another behavior he had exhibited all his life was also a symptom, or even possibly a contributing factor. When fed a rawhide chew, he would chew it the bare minimum necessary to swallow it, and often regurgitate it with a loud retching noise!

The symptoms that were sufficiently acute to cause us to take action were regurgitation and a lack of interest in food in a dog usually very interested in food. These symptoms developed while we were on vacation at the seaside, where Rusty would in previous years occasionally get into something disgusting, and sneak a bite of very raspy beach grass to make himself vomit. We attributed his problems to a bout of beach grass.

Rusty had problems off and on for weeks afterward, raising our concerns enough to take him to the vet. An x-ray revealed nothing useful, and we were scheduling a visit to a veterinary gastroenterologist when Rusty's condition turned acute. He could no longer swallow even water. On a referral from our vet, we took him to Tufts University School of Veterinary Medicine, in North Grafton Massachusetts. X-rays there, of only a slightly different exposure, confirmed a diagnosis of megaesophagus.

It did not sound serious to us, but the vet there (Dr. Proulx) gently put us straight that Rusty's chances were not good. Rusty had in fact aspirated some fluid and had pneumonia. Even if cured of the pneumonia, the vet told us that there was a good chance Rusty would have to return, because the aspiration problem remains. Only about 35% of the patients recover from the aspiration pneumonia, and of those, many return later.

Because of the suddenness of this terrible diagnosis, and Rusty's otherwise robust health, we opted to put him in the ICU. (Rusty was an athlete and enjoyed daily walks of several miles.) We hoped that, once out of danger, changing his feeding behavior and monitoring him closely would allow us to keep him a while longer. We were even willing to live with a feeding tube, which allows you to pump a food slurry in from the dog's side. He was put in an oxygen cage because of his pneumonia. Despite an initial rally from the pneumonia that the vet found nothing less than amazing, soon after Rusty was given a feeding tube he went downhill and eventually into sepsis. He had become quite a pet of the ICU, and the staff was, we think, as grieved as we were. He hated the oxygen cage, and had we known the eventual outcome, would never have subjected him to it. We visited him as often and for as long as the staff would allow, or as long as he could tolerate outside the cage. I personally think the cage contributed to his depression, despite personal attention and the best efforts of the staff. There was, however, no alternative that offered hope. An ICU stay is quite expensive; though we are not particularly rich, we willingly spent over $2000 trying to save Rusty, and we would have paid more if we could have saved him.

Dr.'s Proulx and Wright and the rest of the staff at Tufts were wonderful throughout, and despite their knowledge of Rusty's poor prognosis, gave him every chance. In the end, we were allowed to take Rusty outside, which he loved, and in the bright sun and cool breeze, on a grassy lawn, we were allowed to take as long as we needed to say goodbye. We petted him and sang our special song for him for nearly an hour, then held him as Dr. Proulx put an end to his suffering.

Our suffering lasted quite a bit longer. We found help in several resources, which you can find on Rusty's page. Please visit his page.

We have heard from so many pet lovers that, unfortunately, we can no longer respond personally to emails. Also, our experience is now several years old, so we are not up-to-date on treatments, although we have heard of no breakthroughs. Accordingly, we have now established a support group on Yahoo. Please see http://groups.yahoo.com/group/megaesophagus/

To join, put your email address in the space below and click the button.