The case of the "vomiting" skin-and-bone poodle
Megaoesophagus,
regurgitation & vomiting - earlier case report
On Feb 16, 2011 evening, I phoned the owner of the skin
and bones dogs. I had proposed feeding every hourly from 7.30 am to
midnight with small amounts of food (6 pellets and 1 tablespoonful of
k/d diet) to get the dog to put on more weight and survive. In the
past week, it was two-hourly and there was no more vomiting.
Prior to
consulting me, the lady owner fed small amounts of rice, cereal and
other things like asparagus and multi-vitamin B's were fed by the
husband 3x/day. The dog would "vomit" every day but not all the time.
There was persistence in "vomiting".
This was actually regurgitation
of food eaten some minutes ago and finally, since the dog was
depressed and unable to eat anymore and was tired out, the couple
sought veterinary consultation, thinking the dog was suffering from
stomach cancer.
"Didn't my wife phone you?" the husband said. "No," I said. She passed
the phone to her wife. "My dog vomited at midnight after the last
meal," she said. "I think every 2-hourly feeding would be fine," she
suggested.
"It is a matter of trial and error in this case of megaoesophagus," I
replied. "The gullet can't hold too much a large quantity of food and
water and that is why I asked to feed every hourly to ensure she puts
on weight."
The happy owner reiterated, "Now my dog does not have the pus
discharge in her eyes every day and so I don't need to wipe off the
eye discharge. She does not tire so easily and looked eagerly for her
food when she hears the noise of crunching of her 6 Prescription D/D
pellets." The pellets are crushed into powder and mixed with the
canned K/D diet so that they will not irritate the mucosa of the
gullet and will pass into the stomach. 2.5 mg prednisolone was given
daily too and would be stopped after 3 weeks. It reduces inflammation
and promotes appetite effectively in this case. Trimaxazole
antibiotics had been given and would be stopped after 3 weeks. We
would wait and see.
"Is the dog putting on weight?" I asked.
"I can feel she is heavier when I carry her," the lady owner said.
"She passes well-formed solid stools."
"Is she shivering?"
"No more, but she could be shivering due to your grooming clipping her
bald to de-tick her last time," the lady owner was also getting the
dog clothed and wrapped in a blanket at night in the air-conditioned
room.
So far, no food regurgitation. The diagnosis of megaoesophagus was not
a death sentence and this 8-year-old dog should live to an old age if
there are no other health problems.
The earlier vet report about this "vomiting"
skin-and-bone poodle is at
http://www.toapayohvets.com/web1/20110204megaoesophagus-regurgitation-dog-toapayohvets-singapore.htm
This is NOT an easy case to diagnose as it requires several follow-ups
by the owners. Due to economic reasons, the majority of Singapore
owners seldom come for reviews. It is just not practical for the vet
to phone up as the owner may think he or she is soliciting.
Regurgitation is often confused
with vomiting by the owner and the owner often misled the vet by
giving the incorrect complaint of "vomiting". I visited the apartment
to see the dog in her natural environment and lifestyle. It is a rare
case as most "vomiting" cases are really vomiting dogs and
so the busy vet may mis-treat the case.
P.S
Due to economic reasons, I did not ask the owner to X-ray the distal
oesophagus with contrast medium as X-rays of the neck and abdomen had
cost some money for these senior citizens.
It would be good to do it,
but at the owner's expense. In the X-ray, you can see that the
oesophagus is dilated as gas and liquid filled up the dilated
mid-oesophagus. The diagnosis is still megaoesophagus and the
treatment depends on the cause. Feeding small amounts of food
(powdered pellets and canned food) without regurgitation, the X-ray of
mid-oesophagus and return to normal health supports the diagnosis of
megaoesophagus. There appeared to be an area of granulation in the
pharyngeal area as the dog used to eat branches and grass for some
years. It could be a granulation tissue. See the X-ray. The dog will
now be fed every 1.5 hourly instead of hourly.
UPDATE AS AT MARCH 26, 2011
Chinese New Year had passed and the dog is thriving. No complaint from
the senior citizens to date. This case take up a considerable amount
of time and if a vet is very busy, there will be little time to follow
up on such rare cases. Hence the possible diagnosis of "stomach
tumour" or dog food allergy by Vet 1 some years ago. "The vet asks me
to stop the dog from eating (dry) dog food!" the husband was the type
who had some medical knowledge told me more than once. Obviously, he
did not think that dog food allergy was the cause of this "vomiting".
In this case, the owners did not seek a second opinion, due to reasons
of thrift and frugality. Their children have excellent jobs, being
graduates in professions that pay well. If they ask the children for
veterinary fees to be paid, there would be no hesitation. But they
would not do it.
They could afford more detailed investigation if the husband would do
it. Feeding asparagus and multi-vitamins were his method of
resolving this "vomiting" problem. I was surprised that the dog did
not die from malnutrition as skin-and-bones during old age is not good
for health. I came to know the husband due to a connection of
attending to the terminal gastric cancer of of my first boss when I
worked at the Agri-Food and Veterinary Authority in the late 1970s. It
took him some weeks to be confident in consulting me as he had lived
with this "vomiting" dog for many years. Till the dog stopped eating
before 2011 Chinese New Year. The Chinese do not want the presence of
deaths of the dog or people during Chinese New Year as it would be bad
luck. So, I was consulted.
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PAYOH VETS
