On Feb 16 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 pellets." The prescription d/d 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 reduced 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.
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. 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!
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 pharngeal area as the dog used to eat branches and grass for some years. It could be a granulation tissue. See the X-ray.