Suggestions for your veterinarian

Suggestions for your veterinarian:
a) do not assume gloom and doom. W/ dedication of owner
and dvm, many of these pets can live relatively normal lives.
b) test for Addison's, Myasthenia Gravis, hypothyroidism and
lead toxicity (if lead exposure). Perform a thyroid panel, not just
a T4, as sick euthyroid may erroneously suggest hypothyroidism.
c) 3 view x-rays of chest to r/o pneumonia - if present treat
at LEAST 4 weeks. Do not depend on auscultation, alone, for
diagnosis. Clinical signs of pneumonia may preceed radiographic
signs by 1-3 days. If suspect AP, TREAT. Consider albuterol
nebulizer treatments as adjuntive therapy. If pet has had AP,
consider dispensing a "starter" supply of antibiotics for use
as needed. Owner can purchase additional doses after starting.A nebulizer can
be purchased from some pharmacies, medical supply houses, or ebay. Good brands
of nebulizer are PulmoMate, PulmoNaide, Omron. See "nebulizer" information in
the LINKS at www.morrisvet.com.

Suggestions for YOU:
Here is a "typical" (but, not the ONLY) protocol for megae dogs. It is a place to start:
1) administer a dose of promotility medication (metoclopromide, cisapride, or
other) 15-30 minutes prior to eating
2) Feed 4-5 times daily w/ the dog's body perpendicular to the floor so food
"falls" through the esophagus into the stomach (consider using a Bailey chair
or other method of feeding the dog in a VERTICAL position during and after).
This takes advantage of gravity, allowing the esophagus contents to "fall" into
the stomach. A dvd with building instructions for the Bailey chair can be
ordered by sending $6.60 to Donna at matthew1@earthlink.net. Other suggestions
for vertical feeding can be seen in the "feeding/sleeping..." album in the
Photos section. (see all options for getting a feeding chair, below).
3) administer acid neutralizer w/ the meal (Pepcid AC, Prilosec, etc.)
at night; 2-3 times daily if zantac or pepcid w/ one of the feedings)
4) administer carafate ("bandage" for ulcers or erosions in esophagus or
stomach) 2 hours prior to bedtime; or, if required more often, liquid carafate
can be given 1 hour BEFORE, or 2 hours AFTER any other medication, or
food. (Carafate will bind to anything else, except water, therefore, to allow
the carafate to "bandage" esophagus erosions, it needs NOT to be attached to
food, or anything else).
5) administer antacid right before bed to minimize acid in stomach, so if
reflux from the esophagus occurs from the stomach while the dog is laying down,
it is not as acidic. Acid inhibitors are SUPPOSED to be given on an empty
stomach, but, most owners report help even if given WITH food.
6) attempt to have dog sleep w/ front end elevated, for example in a crate w/
the front end elevated. Using a Procollar to keep the head elevated may also
minimize night-time regurg. There are pictures in the photo section, in the
"feeding/sleeping..." album, as examples.

Bailey chair options:
On the folders board, in the Files section, see "feeding methods...."
Go to photos section and see album titled "feeding/sleeping methods...."
Got to YouTube.com and enter "chair megaesophagus."

A dvd/vhs/cd can be ordered from matthew1@earthlink.net, for $6.60. The fee
does NOT include any profit, but, rather production of copies, mailers, copy
paper & printer ink for insert copies, blank DVDs and cases for DVDs.

Some owners contact boy scouts, high school shop classes, handymen, etc, to
build the chairs if they do not feel they are handy enough.

Neal Moor (thechairbuilder@yahoo.com) will build a chair and charges ONLY for
the cost of materials and shipping (shipping is often more costly than the cost
of supplies). Payment is required before building occurs, as if purchaser
decides they don't want the chair, costs for the materials need to be covered.

Here are sources, on this site, for other information that will be helpful for
you and your veterinarian as you learn how to treat and manage your pet with
megaesophagus:

Megaesophagus Brochure - print off for you and your dvm:
http://tinyurl.com/l8nu5k

Bailey chair pictures:
http://www.geocities.com/bailey_chair/
http://pets.groups.yahoo.com/group/megaesophagus/
http://groups.yahoo.com/group/megaesophagus/photos/album/1082975248/pic/list

Bailey chair HOW TO ORDER::
http://tinyurl.com/l78jd7

Subcutaneous fluids - how to give - how to prevent dehydration:
http://pets.groups.yahoo.com/group/megaesophagus/files/Dehydration%20-%20Knox%20blox%20%26%20subcutaneous%20fluids/

Megaesophagus animation:
http://www.marvistavet.com/html/body_megaesophagus.html

Nebulizer info for aspiration pneumonia:
http://pets.groups.yahoo.com/group/megaesophagus/files/Nebulizer%20for%20AP/

Welcome letter from Dr. Kathy, with note to your veterinarian:
http://pets.groups.yahoo.com/group/megaesophagus/files/aa%20-%20letter%20from%20Dr.%20Kathy%20to%20your%20veterinarian/

Regurgitation FRUSTRATION:
http://tinyurl.com/kvbhcg

Dr.Kathy 8-25-09