What is mega-esophagus?

While I can't say I am an expert on this condition, I sure have learned a whole lot since that fateful vet visit.  I have to say up front, it was a miracle that our vet identified this condition on the very first day.  Most dogs and owners go through months of tests, and the dogs usually wind up with pneumonia before an accurate diagnosis is made.  I learned a bit later that this doc had dealt with a case of mega-e just a few months prior, so it was still on his radar.  We can't express how grateful we are to have such outstanding professionals helping us care for all of our pets.

So, what is mega-e?  It means, obviously, large esophagus.  The esophagus is made up of muscles, which contract when we swallow, forcing food we have eaten down to the stomach.  We don't think about it, it is an involuntary reflex.  In mega-e dogs the esophagus muscles do not contract.  So, when they eat food, it winds up sitting in pockets.  One way to imagine this is to think about dropping an orange into a leg of a pair of pantyhose.  Sometimes the orange will go all the way down to the toe, other times it will get stuck and hang in a pocket half way down.  That is exactly what happens to the food and water (and grass and dirt and toys) a mega-e dog consumes.  Having this stuff stuck in the esophagus will irritate it, and that's when these dogs throw up.  But, they are actually not throwing up--they are regurgitating.  That's why Hobbes' food was not digested.  It never made it down to his stomach.  For many of these dogs the sphincter between their esophagus and stomach also does not work.  So, even if food makes it to the stomach, it can come right back up when the dog is lying down--exactly like a person with acid reflux. 

This also explains why Hobbes was drinking so much water and making sloshy sounds.  Likely, he was drinking because he could feel something in his esophagus, and was trying to force it down.  The water was getting stuck in pockets, so it would slosh and gurgle when he ran.

The greatest danger for dogs with mega-e is contracting aspiration pneumonia.  This occurs when they regurgitate something and immediately inhale it.  The food/water goes into the lungs and causes an infection, resulting in pneumonia.  If caught early, the infection can be treated, but the lungs are weakened and the dog is more susceptible to a recurrence.

The greatest challenge for me was figuring out how to manage this condition in order to give Hobbes the best chance at survival.  The first thing we were told was to elevate him while he eats, and to feed him a liquid diet.  The latter seemed like a bad idea to me, since we knew Hobbes had a particular problem with liquids.  Thank heavens for the mega-esophagus support group on Yahoo!  Indeed there is such a thing--a place where you can learn all about this horrible condition and how to manage it.  The wonderful people who run this list have a prepared package of information they send to all new subscribers.  Some of the information is related to food.  While a liquid diet is an option, they also suggest some dogs may do better eating "meatballs"  And, for those whose dogs have problems with liquids, they suggest making jello cubes out of Knox and chicken broth--both wonderful ideas!

The other hugely helpful suggestion was the Bailey Chair. 

Named after one of the discussion group founder's dog, the Bailey Chair is a contraption that helps a dog stay upright during feedings, and for a set time afterword to allow the food to get through the esophagus to the stomach.  My husband and I designed our own version of the Bailey Chair, which we call the Hobbes Box (now you know why this blog is called Life Inside the Box!)  Hobbes eats three meals a day consisting of his meatballs and jello cubes, while standing in his box for the duration of the feeding then 20 minutes afterward.  That means that Hobbes spends about 2 and a half hours a day in his box.  So far, so good.  No pneumonia.  And Hobbes has lived beyond his predicted life expectancy.

 

Hobbes in his box.