Mega Esophagus

Plus, torn anterior cruciate ligament and additional comments on the rabies vaccine.

(Question) About'‚seven days ago my 14-week-old black Lab puppy started throwing up her food. It was slimy and not digested.'‚ She has done this about four times during these'‚seven days, each time the same, until yesterday when she decided to stop eating.

She plays normally'‚but tires quickly.'‚'‚Her stool is on the softer side but not diarrhea.'‚ I took her to the vet today.'‚ They found a high number of white blood cells in her stool and put her on Metronidazole 250mg once daily for seven days.'‚The vet also mentioned mega esophagus'‚as something to consider.'‚They put her on a bland diet and gave her fluids.

Once she was home we did find a small amount of bloody mucus in her stool and she obviously vomited as opposed to just spitting out some dog food.'‚ She weighs 25 pounds, three of which she gained in the last 10 days.'‚ In regard to the mega esophagus,'‚how serious is this condition, what should we be watching for and what are the long-term results?

We are planning to train her for upland and waterfowl hunting; is this still possible? Any information you can give us will be much appreciated. --C

(Answer) Most of the cases of mega esophagus I've seen have been in German shepherds but the disease has also been reported in Labs and Irish setters. The most common clinical sign is regurgitation of undigested food from a few minutes to a few hours after eating.

The disease usually presents when the puppy is weaned and started on solid food, as liquids can pass by gravity down the esophagus and into the stomach. Mega esophagus is diagnosed by a history of regurgitation and barium studies of the esophagus. I've seen some pups that you could just lower their head and fluid would run out their mouths.

Barium studies are used to confirm the diagnosis and to differentiate the disease from persistent right aortic arch. Attempts are made to treat affected pups but are usually not very rewarding. These pups are susceptible to secondary pneumonias from inhalation of regurgitated materials.

Some try liquid diets and feeding dogs from raised pans but most are eventually euthanized. It sounds to me like your dog has a GI upset that should respond to the metranidazole. I would suggest a barium x-ray of the esophagus after the dog feels better to rule mega esophagus in or out.

(Question) What is the truth about rabies shots? I live in a state where you have to give the shot every year. The latest Gun Dog indicates this is too much and could cause numerous side effects. The article states the shot is good for 5-7 years. If so, then why and who--WHY a shot every year and WHO is getting rich and WHO is getting ripped off?

(Answer) In the August, 2008 issue I commented on current studies of long-term immunity studies following rabies vaccination. This study will test dogs at five and seven years following vaccination to see if they are still immune to challenge with rabies virus. We hope that, should the hypothesis prove out, we will someday have laws that recognize rabies vaccination for 5-7 years.

In the meantime as practicing veterinarians we will continue to obey the laws of the governmental regions in which we practice and vaccinate the dogs accordingly. I don't know who is making all the money. What do you think? The ones getting ripped off are the dogs.

(Question) Cedar is my 4-1⁄2-year-old female yellow Lab. I train her year round and we duck hunt all fall and early winter. She is considered by many to be a finished hunting dog.

Cedar was just diagnosed to have a partial tear of the CCL in her right hind leg. The left leg is "rock solid," as my orthopedic vet put it. Cedar was examined by my regular vet last week under anesthesia and then by an ortho surgeon but not under anesthesia.

The surgeon is recommending a TPLO procedure because she is a hunting dog. But he also said it is very common (up to a 60 percent chance) that after the procedure, and during recovery, a dog could do the same thing to the other leg. Then that leg would have to be done which obviously extends recovery and she would also miss the 2009 season. I have had that confirmed by another ortho surgeon and it seems like it could just be a recurring situation and she may not hunt again anyway.

I am having trouble seeing how a dog with plates and screws in even one leg, never mind both legs, could perform in the situations we hunt in. I have only been able to find two similar situations as reference: one is an agility dog who underwent the surgery and year-long recovery and blew the repair out the first time she competed; and the other is a pointer who did the same.

Another distressing factor is the recovery. The dog must be confined in a very small space 24/7 for at least a month, followed by extensive therapy, etc. I had meniscus surgery in January and even with determined rehab I still feel "twinges" and I wonder whether a gun dog might ever return to active hunting. Plus, I am told that if the TPLO breaks it could shatter the bone, which obviously is bad thing.

The other consideration is the lateral suture technique (also called by other names). Recovery is apparently similar but less stressful than the TPLO--but there is still the potential for all the same repercussions.

If we did nothing, the vet felt sooner or later Cedar would blow out the ligament completely and there would be additional complications regarding ineffective scar tissue, arthritis, and greater chance of blowing out the other CCL. Then we would have to get her in quickly and we would be back to square one, so we are opting for surgery. Doing nothing doesn't seem to be an option for me.

I am also considering "facing reality" and getting a puppy for hunting and just keeping Cedar as the loved member of the family she has become.

Any advice or input from you from a future hunting perspective would be extremely helpful and appreciated, especially in regard to keeping the dog restrained for at least a month, and what you think I might expect in recovery and future hunting capability. --FB

(Answer) I don't have a great deal of good news regarding the treatment of anterior cruciate ligament rupture but I do have some new news. Yet another new surgical procedure has come on the scene in an attempt to correct this devastating disease.

The surgical procedure is called a tibial tuberosity advancement. It involves cutting off the tuberosity of the tibia and with the use of metal plates and other hardware,

tilting it forward. Advantages of this surgery over the TPLO are claimed to be quicker recovery, less implant failure, less technically demanding, resulting in better clinical results, good results with chronically arthritic knees, and the ability to operate on both knees at the same time.

I have not had any client dogs referred to surgeons for this operation, as it is only recently that we have had surgeons in my area trained in TTA. There is a website for the surgeon who seems to have a great deal of experience with the surgery; that site is: This website may answer a lot of your questions about TTA surgery as well as post-op considerations for cruciate ligament disease in general.

Most of the cases I see are in Labs but that is not surprising since there are large numbers of Labs in the dog population. I've also seen several cases from certain families of Rottweilers. Some general observations I've made are that if one side blows out you had better be prepared for the other side to go; post-op recovery is long, but dogs do return to limited field work; and over the remaining years of the dog's life you will invest a lot in time, emotion and other resources.

Barium studies are used to confirm the diagnosis and to differentiate the disease from persistent right aortic arch. Attempts are made to treat affected pups but are usually not very rewarding.

On a Different Note'¦

The past few days I have had a "tough" job to do. I have an exercise pen set up next to my desk and I am spending my free time observing a group of four littermate German shorthair puppies, now 4-1/2 weeks old.

My technician hand-raised these pups from day one and now that they are on solid food and "going good" we have brought them back into the clinic and put them in a relatively isolated area by my desk.

I've gone through this process many times over the years and am always amazed at what I learn by just sitting and watching the pups go about their daily activities. What a relaxing exercise for me'¦and what an opportunity to pick out a pup! Contact Tom Holcomb, DVM, at:

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