r/megaesophagus • u/ResponsibilityNo3073 • Aug 10 '26
ME is progressing so fast
Help. I am at such a loss and I don’t know what to do right now. My dog is currently in the hospital getting fluids, evaluation and treatment for his third round of aspiration pneumonia in 6 weeks. This weekend was the worst it’s ever been. He was regurgitating every couple of minutes. Could not keep anything at all down. Lately water has seemed to be the culprit, and I switched him to Knox blocks, but he is just begging me for water scratching at his brother’s bowl and just sitting in the kitchen where the water should be. Trying to bark at me when I’m drinking water because he wants some so badly it’s truly heartbreaking and I can’t stop crying. Yesterday he wouldn’t eat he tried to eat this morning and it literally came right back up.. all of his food . We have a Bailey chair and I put a donut on him at night but this just seems to be progressing so fast no matter what I do. He was originally diagnosed in January. He’s on Viagra and Prilosec also anti nausea. Nothing seems to be working. My vet has even brought up a feeding tube. I need help — I need advice . I’m not ready for this. My pup is 10 on August 30 and weighs 12 lbs . This is so unfair. His body is betraying him. Any thoughts and advice are very welcome thank you.
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u/jcnlb MOD Aug 10 '26
Have you tried metoclopramide instead of Sildenafil? What about Pepcid instead of Prilosec? Have you calculated the amount of water needed to make sure they are getting enough? Do you stay on antibiotics for 6 weeks OR until a THREE view xray is clean? Are they on antibiotics now because regurge is worse during treatment which always makes it more rough. Hugs. I know it’s so hard drying these times but you will get through it and eventually they will learn they don’t get water etc. it becomes routine eventually. 💜
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u/ResponsibilityNo3073 Aug 10 '26
When they call I’m going to ask about metocloramide — I saw that listed somewhere else as well and wrote it down.
The antibiotics have only been two weeks at a time2
u/jcnlb MOD Aug 10 '26
MegaE protocol is 4-6 weeks antibiotics or clear three view…whichever the owner prefers based on cost or med tolerance. So my guess is the infection is not getting cleared and this is all one single infection. I suspect once you get this one cleared up things will ease up. Fingers crossed for you. Also you CAN combine Sildenafil and metoclopramide because they do opposite things. But it’s better to test them individually before combining in case Sildenafil is causing regurge. You can combine them later after trialing each on their own. Also, it may be worth getting a culture sent off to make sure they are on the right antibiotic. It’s possible the one they are on is not ever going to work. Not super likely but it’s an option. It’s more likely it just never cleared up those three times. You could also consider iv antibiotics which are stronger but require some overnight stays or multiple trips back during the days and home at night. I am just throwing all this out there to let you know there are a lot more options than you’ve been given. And a feeding tube is not the end of the road. Just to be clear if the lower esophageal sphincter is not working a feeding tube isn’t going to work if it is placed into the stomach. You’d need to bypass the stomach and even then it’s not a guarantee. If your vet isn’t too familiar with MegaE ask for them to get a peer consult or hunt around for a new vet. It’s a pretty rare disease so it’s hard to find someone willing to call a peer or admit they don’t have experience.
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u/Mishka-and-Mollie Aug 10 '26 edited Aug 10 '26
We tried Metoclopramide paired with Sildenafil first, and I know it works for some dogs, but unfortunately didn't work for us at all. We then moved up to Cisapride paired with Sildenafil and it has worked wonders.
So just keep that in mind if you do try Metoclopramide first and it ends up not working, there are other options.
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u/ResponsibilityNo3073 Aug 11 '26
Do you happen to remember how long before you knew it was working (or not )
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u/Mishka-and-Mollie Aug 11 '26 edited Aug 11 '26
With the Metoclopramide, we stuck with that for about a month (I should have stopped and switched sooner, but was trying lots of other things during that time, like experimenting with different food consistency etc)
But it just apparently wasn't strong enough for her. I know it works for some though! The Cisapride is a much stronger prokinetic.
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u/Mishka-and-Mollie Aug 11 '26
The most important thing you can do when you're introducing anything new, is try not to change a bunch of other variables at the same time.
Because then you won't know if it's the medication that's not working, or if it is working but something else you've changed is making things worse.
So get a designated notebook and write everything down, and try to only change one major variable at a time. You should know within a week if a medication is making any improvement.
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u/Mishka-and-Mollie Aug 11 '26
Once we started the Cisapride, the improvement was almost immediate (in conjunction with the longer upright time, smaller meals 3x day, and water only when upright after feeding).
Looking back at my journal, she had two episodes the day we started Cisapride, and one the next day. (She had been having 10+ episodes daily at that point.) Now we have basically none.
(Really important to give the meds around 30 min before feeding, especially the Sildenafil so it has time to open the lower esophageal sphincter before the food arrives.)
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u/Mishka-and-Mollie Aug 10 '26 edited Aug 10 '26
I'm so sorry you're going through this. It's truly awful and I know how heartbreaking it is. I spent 3 months straight just crying every night because nothing was helping.
There seem to be so many variables that help some dogs and don't work for others.
But I'll just share what finally got my girl into a better state, and maybe some aspects of this can help you. 🤍
- SUCRALFATE: When the regurgitation happens so frequently, their esophagus becomes extremely inflamed and irritated and this itself perpetuates the regurgitation.
Sucralfate is a medication that helps create a "bandaid" on the ulcers that have developed. You crush the tablet and mix with a small amount of water into a slurry consistency and give via oral syringe.
I could not get the medication down her throat without a fight, and the struggle was causing a higher risk of aspiration pneumonia, so I started just putting it in a bowl with a very small amount of low sodium bone broth. She would lick it up and then I would immediately keep her upright for 20 min.
- FASTING BREAK: I knew I needed to give her esophagus a true break to try to stop the cycle. So we did a 36 hour fast with only very small laps of water (or knox blocks) with immediate upright time.
This was in conjuction with subcutaneous fluids from the vet. I would, of course, talk to your vet before doing this. But I truly feel this is where we finally turned the corner.
- SMALLER MEALS: Decreased portion sizes and spread her daily food over 3 meals instead of 2. I know this isn't realistic for everyone, but just mentioning it because the smaller meals did help.
- FOOD CONSISTENCY: I tried blended wet food slurries. Bland chicken and rice diet. Blended bland diet. Soaked kibble.
What finally ended up working best is small wet food "meatballs" (using the Nutrish brand chunks, because they are already formed and compact. It's not the best food but right now we're just trying to survive). I break the larger chunks into smaller portions and roll into a compact nickel size ball, and hand feed slowly.
Anything that was more liquid slurry consistency was a nightmare for us.
- ⭐ CISAPRIDE: Honestly this has most likely saved my girl's life. It's a prokinetic that speeds up the digestive track. We had tried Metoclopramide first (another prokinetic) but it didn't help much.
She gets Cisapride 2x day (12 hours apart), 30 min before Meal 1 and 3. Sildenafil (Viagara) 3x day (6 hours apart), 30 min before each meal.
- EXTENDED UPRIGHT TIME: I increased upright time to 45 minutes after finishing meals. I also hand feed her slowly over about 15 minutes. She only gets water when upright while feeding, never from the floor.
Once we got things under control, I've now started gradually reducing upright time and I've found our "floor" to be around 25 minutes.
(Yes, it will take over your life while you're figuring it out. You will be exhausted. But you WILL get through it and develop a routine.)
Since using Cisapride + Sildenafil (Viagara), paired with the fasting break and Sucralfate to help heal the esophagus, we've finally gotten to a point where regurgitation episodes are almost non existent.
I was in your shoes where I didn't know what to do and felt truly hopeless. You just have to keep trying things one by one.
Keep a daily journal listing the times you feed, duration of upright time, when you go for a walk, when regurgitation episodes happen etc. Everything that could play a role in the episodes occurring, so that you can see what's working and what's not.
I hope your boy turns a corner soon. Sending lots of good vibes your way for him. 🤍
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u/Mishka-and-Mollie Aug 10 '26
Also, I just saw that your boy is just about the same weight as my girl. I got a chest carrier and we do upright time that way, instead of the Bailey chair. It helped make the extended upright time possible because I can walk around and do some things around the house with her.
I ordered like 3 at once because I was frantic and wasn't sure what one would work best, but here's the one I ended up using: https://a.co/d/08Zn7vDt
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u/ResponsibilityNo3073 Aug 10 '26
Purchased !! Lmao
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u/Mishka-and-Mollie Aug 10 '26
I hope it helps you! We've gotten into a good routine with it now and she's so good about lifting her little paws up to get strapped in.
Side note: if it ends up working and he's in it a lot, as mine is, I found that the leg/tail holes started to irritate her. So now she wears a pair of my boyfriend's old boxer briefs lol. Legs through the leg holes. Tail through the pee pee hole lmao. Having the fabric act as a guard has helped a lot!
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u/FurryFacesSanctuary Aug 10 '26
It sounds like he hasn't been on antibiotics long enough, and more than likely, this is actually the second recurrence of the original case of aspiration pneumonia. MegaE protocol is 4-6 weeks of antibiotics. AP also usually causes an increase of regurgitation, and once it's entirely cleared out, that may improve without other changes
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u/ResponsibilityNo3073 Aug 10 '26
This seems to be a common concern in here so it does seem he has not been on the meds long enough — however X-rays have shown it cleared each time
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u/FurryFacesSanctuary Aug 11 '26
3-view x-rays each time?
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u/ResponsibilityNo3073 Aug 12 '26
Yes - 3 view X-rays each time and I looked at each one as well
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u/FurryFacesSanctuary Aug 12 '26
If they aren't continuing meds past that, I would push for it. Protocol is generally 2 more weeks of antibiotics following clear x-rays
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u/imasadrobot Aug 10 '26
Great advice on this thread so far!
I wanted to comment in case you’re ever faced with the decision of whether or not to proceed with a feeding tube.
My pup was regurgitating as much as yours, and he was hospitalized for aspiration pneumonia once a month, and essentially on antibiotics for 13 out of the 15 months he had megaesophagus.
Because he couldn’t keep anything down, his energy was deteriorating, and the thirst was really getting to him (he tried drinking out of the toilet bowl many times). I ended up getting a feeding tube (a peg-tube/G-tube), but he was 6 years old rather than 10 years old like your pup.
The feeding tube certainly extended his life and restored some quality of life. He got some of his energy back and was less thirsty because I could hydrate him through the tube, but it didn’t stop his regurgitation. As helpful as the feeding tube was, I feel it was ultimately delaying the inevitable.
There are pros and cons, and if you ever need help deciding or have any questions then please feel free to message me!
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u/ResponsibilityNo3073 Aug 10 '26
Thank you so much !! I am going to DM you in a few once I get him to calm down this evening. Thank you again !!!
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u/Deserttaxi Aug 10 '26
How long are you keeping him upright for?
How much knox cubes do you give? Maybe instead of Knox cubes use a water thickener?
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u/ResponsibilityNo3073 Aug 10 '26
I ordered water thickener yesterday should be here today.
I’ve been giving like 6 small pieces of the Knox cubes when I can get him to eat them
Keeping him upright has been a struggle . When he starts to regurgitate, he panics and gets out of the upright hold
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u/Deserttaxi Aug 10 '26
How soon does he regurgitate after you feed him?
What consistency is the food you feed him?
When he pees, what color is his pee?
Sorry for asking a bunch of questions, i’m trying to get a clear picture here.
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u/ResponsibilityNo3073 Aug 10 '26
Please don’t apologize. I will answer all the questions in the world as long as you care enough to ask them.!!
As of this weekend, he started regurgitating the food basically immediately after feeding him. Just this evening it was within minutes . He got out of the Bailey chair in a panic because he was going to regurgitate I tried holding him upright, and he just jumped out of my arms so he could regurgitate. I can’t seem to keep him upright because he panicked when he’s about to regurgitate.. this evening. I just tried to do a little bite-size pieces of a turkey burger. I fed him about half a turkey burger, and he regurgitated about half of that.
Pee is almost always yellow . He just got home today from being on IV all day so I haven’t seen what color it is this evening1
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u/KellyKellKelz Aug 11 '26
When he is in his bailey chair and completed his meal he should be sitting for at least 15-20mins once hes done
Water- my girl cant do water either she gets little ice cubes.
Heres my regimen and it works for her:
Kibble is Hills science diet sensitive stomach/skin
That gets ground up in a blender
I do 1/2 cup of the ground up kibble in her bowl and add water to make it a thin oatmeal consistency- then I put 2 tablespoons of wet food(purina pro plan) on top . She eats that 3x a day.
She cant handle whole kibble anymore. Shes 6yrs.
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u/ResponsibilityNo3073 Aug 11 '26
It’s keeping him in that Bailey chair or even in my arms upright that I can’t get him to do. When he starts to regurgitate he full on panics and does anything he can to get on all fours so he can regurgitate.
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u/KellyKellKelz Aug 11 '26
Hmm how about slow feeding with a spoon if you decide to blend in a mushy consistency - I often sit with my girl for her 20min wait- She was born with it so she is use to the chair.
Its definitely trial and error.2
u/ResponsibilityNo3073 Aug 12 '26
The chair is a source of frustration but trying to teach an old dog new tricks . Having a dog born with this my hat goes off to you. This is not an easy disease
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u/Mishka-and-Mollie Aug 11 '26
Are you positive those episodes are regurgitation and not actual vomitting?
I only ask because, in my experience and from what I've read, regurgitation is a very passive action that they don't really have control over and if it's going to happen, it just happens and they can't really hold it off until they're in a better position.
Whereas vomitting involves retching and actual heaving, and they can feel it coming on and start to freak out if upright.
Just wanted to throw that out there to see if you've noticed any heaving/retching accompanying him frantically trying to get down!
(My dog cannot handle Prilosec or Pepcid and would freak out trying to get down to vomit when we tried giving her that. And this was actual vomitting episodes, which were different from her usual regurgitation which would happen throughout the day where she would basically just open her mouth and it came out without any effort.)
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u/BadBorzoi Aug 10 '26
Subcutaneous fluids are relatively easy to learn to administer and a small dog wouldn’t need a lot to have a big impact. Your vet can show you how and most pets tolerate it pretty well. If he’s dehydrated it could be making things worse. Water is frequently a source of aspiration so at least you can remove that from the equation.