Sunday, October 14, 2012

Endoscopy Consultation: Canine Esophageal Stricture

Before I begin, I just want to say thank you to everyone who reached out to us here and on Facebook and via email. This community never ceases to amaze me, and I'm so thankful to be a part of it. We really appreciate the support, kind words, good vibes, and sweet thoughts. Truly--thank you.

Yesterday's endoscopy consultation at LIVS has left us 99% sure that Desmond does have esophageal stricture.

In case you don't know, a stricture is kind of like a bottleneck traffic jam. Desmond's esophagus gets smaller right before it meets him stomach. So when he eats or drinks, whatever he takes in gets stuck before it gets into his stomach and then slowly filters through. Hence, when he consumes too much, too fast, or too much too fast, it comes right back out. There's nowhere for it to go. It's regurgitation as opposed to vomiting--it never makes it into his stomach; it never gets digested.

He's not at risk for anything more serious, and nothing else was found from the x-rays and physical exams. There's no suspicion that Desmond's condition will worsen.

We've decided, along with the help of the specialist at the vet hospital, that putting Desmond through the endoscopy procedure is not likely to provide us with any information other than a full confirmation of a stricture.

At this point, we're going to hold off on it, particularly because we don't think we'd proceed with the ballooning treatment regardless. It's risky and often doesn't work/isn't permanent. Desmond's general sensitivity makes his recovery from anesthesia a days-long scenario, and we can't imagine forcing him to go through all of this for what can surely turn out to be no reason. That's to say nothing of the medical expenses involved (and I won't even get into the problems we're having with VPI on this), which are significant.

The best option is lifelong management, which is exactly what we suspected.

From this point forward, we have to liquify Desmond's meals as much as possible and get him to eat those meals as slowly as possible in as much of an upright position as possible. This means that we are now pureeing and watering down his already-pretty-mushy food from The Honest Kitchen.

We're on the hunt for a slow-down bowl that won't create a huge mess on our semi-carpeted stairs, where he's eating his meals until we can get him a Bailey chair (it's usually used for megaesophagus--which Desmond definitely does not have--but it is absolutely useful for stricture, and both our regular vet and the specialist agree we should look into it).

Bailey chairs are simultaneously the cutest and most pathetic things ever. Desmond would fit right in. Take a look at these posts about the Bailey chair: one with a video, one with links and info from a support group (yup, that exists), and one with pix from the Pet Project blog.

"Lucy in her Bailey chair" image from flickr
In the meantime, we're packing the bowl with Kongs to block him a bit and we're standing by to pull the bowl away for a minute when he gets overzealous. We're also feeding him three times a day instead of two--and will go to four if we need to. In addition, we're holding him up in a vertical/sitting position on the couch for about 15 minutes after he eats. (And of course we're very careful about exercise in relation to consuming food or water.)

We originally posted this one on Instagram / Facebook, but this is Des not enjoying his after-meal sit.
There really isn't too much else we can do. The pepcid and reglan we were once prescribed for Desmond are both essentially useless for this problem. The reglan helps digestion; the pepcid helps acid reflux. That being said, we do think he has some reflux issues on the side, so we will absolutely keep it around for times when he needs it.

This is mostly a time-consuming inconvenience for us, and we feel terrible for Desmond. He loves food so much, and he must think we're starving him all the time. He also is not a huge fan of the sitting up on the couch thing. Plus, the poor guy is now going to miss out on chews of pretty much all kinds. We don't want to take any more chances, since he's such a gulper.

I do worry about the fact that this may all lead to dental issues--wet food, no more chews, regurgitation. I'm not really sure what to do about that besides brush his teeth more. Maybe we can still give him the edible Nylabones and SmartBones. I should ask the vet for sure.

The last bit of concern comes from pneumonia, which dogs who regurgitate can get when the food/water coming back up catches them by surprise and they wind up taking it back in/gagging on it. The vet said it can get into his lungs this way, and then he can get quite sick. So we're now to be on the lookout for symptoms of pneumonia and take them seriously if we see any.

Basically, though, unless this becomes something that causes him to start losing weight and becoming malnourished, he's fine. A crazy, wonky, odd canine nonetheless, but fine. I really can't complain about that.
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