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Dr. Karing
Dr. Karing, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 429
Experience:  General veterinarian with a special interest in internal medicine and emphasis on individualized care.
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R***. My dog will be 4 years old in February and she has

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My name is********. My dog will be 4 years old in February and she has been diagnosed with Megaesophogus, Myasthenia Gravis and pancreatitis. We feed her in an elevated position and she sits in a Bailey chair for 20-25 minutes after eating and drinking. She eats soft canned food. I am currently mixing Hills Prespription ID with the WD. She needs something high in protein but low in fat. She throws up about 20 times a day and just can't keep her food down. I am trying to find a food that is good for her to be able to keep down with the pancreatitis. The vets that I have visted here don't seem to know much about nutrition with this condition. Can you please help me??
Assistant: Thanks. Can you give me any more details about your issue?
Customer: trying to find a food that is high in protein so she can gain weight back and low in fat for the pancreatitis. Something that is mild on the stomach so that she quits throwing up.

Hi there,

I'm Dr. Karing and I would be glad to help with your question. I would suggest one of the canned forumulas listed below for your dog.

Hill's i/d Low Fat: http://www.hillspet.com/en/us/products/pd-canine-id-low-fat-canned

Royal Canin Gastrointestinal Low Fat: https://www.royalcanin.com/products/royal-canin-veterinary-diet-canine-gastrointestinal-low-fat-canned-dog-food-13.6-oz-24-cans-case-/47071

Purina EN Gastroenteric Low Fat: https://www.proplanveterinarydiets.com/products/en-gastroenteric-low-fat-dog/

If your vet doesn't stock these, then request a written prescription which can be used either at another local vet (if they cooperate) or at an online retailer such as Chewy.com

If you prefer something even more specific for your dog, then BalanceIT.com will take information from your veterinarian and formulate a recipe to be used along with their supplements. https://secure.balanceit.com/

Make sure your dog is on a potent anti-emetic to help reduce vomiting. Discuss Cerenia, ondansetron and metoclopramide with your vet. These can all be used together for vomiting that it difficult to control. In addition, an antacid such as famotidine and Carafate (coating agent) should help with esophagitis that is going to occur secondary to frequent vomiting/regurgitation and will further aggravate megaesophagus. All the medications listed here are commonly utilized for dogs with pancreatitis and are definitely worth considering if your dog with pancreatitis and megaesophagus is still vomiting 20 times per day.

I hope that the information I provided has been helpful. Please remember to select REPLY TO EXPERT if you have more questions or would like additional information. It is my goal to provide you with the most complete information possible prior to you leaving a feedback rating. If you received all the information you needed, then kindly submit a rating.

Thanks,

Dr. Karing

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Customer: replied 7 months ago.
I will definitely talk to the vets regarding the medication you listed. They had her on one medication and took her off because it was not working and making her sick. They have not recommended any other medication. As far as the food, I have the Royal Caninie GI low fat at home and the ID low fat at home. I introduced both of them in a small amount a week apart for one day only and she continued to throw up. Just wondering which food you feel is better. The Royal Canine listed ingredients as meat by products which I had always heard was not as good at real meat. What are your thoughts on which one is best to give her? Any recommendations on how to introduce it with the ID and WD until I can ween her off of those foods?

Fat content (lowest to highest) Hill's (8.3%) < Royal Canin (10.4%) < Purina (16.6%)

Calorie content difference is negligible: Hill's 349/ 13 oz can, Royal Canin 345/ 13.6oz can, Purina 364/can

I guess I would give the edge to the Hill's i/d Low Fat for pancreatitis patients since it is the lowest in fat. As far as quality of ingredients, all three are comparable. They all contain by products which are simply organ meat rather than just muscle. It's digusting to humans but cost effective and may lead to a more balanced diet for cats and dogs. As far as her pancreatitis is concerned, you can change her diet to any one listed above without a transition period. As far as megaesophagus is concerned, I would not expect one of these canned diets to be tolerated better than another but use your judgement in transitioning based on your experience with other diets you've tried. I know a few dogs with megaesophagus don't do as well on some canned diets as others: it is simply trial and error

Is your dog vomiting (active retching) or regurgitating (passive)?

Customer: replied 7 months ago.
she is regurgitating. I was told that she can't do hard food and had to do soft canned food. So would it work to transition her to the ID low fat and just mix it with the WD and stop the ID right away? Then stop the WD in a couple of days?

If she is regurgitating, then the medications that might help most are metoclopramide, carafate and an antacid such as Pepcid or omeprazole. Except metoclopramide, these are all aimed at reducing esophagitis that occurs when the stomach acid repeated comes in contact with the espohagus during regurgitation. The esophagitis just aggravates megaesophagus further (i.e. in fact it is a cause of acquired and transient megaesophagus in some dogs).

Drugs like Cerenia and ondansetron are for nausea that can occur with pancreatitis. They can be helpful to prevent vomiting and increase appetite in dogs with pancreatitis.

Canned foods work better for most dogs with megaesophagus. If you use kibble, then you would need to blenderize it and make it into meatballs that way. I think it is fine to stop the regular i/d right away and start mixing in the i/d low fat. If that seems to go well, then stopping the w/d in a couple of days is completely reasonable.

Is your dog's myasthenia gravis congenital? If so, has she been on pyridostigmine bromide (brand Mestinon) to see if that helps?

Customer: replied 7 months ago.
I don't know if it is congenital. How would I find that out?

Most dogs with congenital myasthenia gravis (MG) exhibit muscle weakness from about 6-8 weeks of age: note this disease is rare and often fatal.

Most dogs that develop MG symptoms as adults have acquired myasthenia gravis. The gold standard of testing to diagnosis acquired myasthenia gravis is an antibody test (acetylcholine receptor antibody titer). Other methods of diagnosis are less reliable: muscle biopsy, genetic testing and neuroconduction testing

. Mestinon, or a similar drug, still might help your dog even if she has acquired myasthenia gravis. In one study, the vast majority (47 of 53) dogs went into remission after 6 months of treatment with such drugs.

There is an online support group for dogs with megaesophagus that you might be interested in too:

https://groups.yahoo.com/neo/groups/megaesophagus/info

It requires a yahoo user ID but that is easy enough.

If you think your dog's diagnosis of MG may be in question or all of the diagnostic/treatment options have not been explained to you, then I would suggest you schedule a consult with a veterinary internal medicine specialist and bring along all of your dog's medical records.

Customer: replied 7 months ago.
Thank you so much for all of this information. I have received more information from you than I have from my vets in months. Really appreciate your time and the information sent.

I'm happy to help. I hope your dog feels better soon.

Hi Kelly,

I hope things are going better with your dog. I noticed you have not accepted my answer or provided a feedback rating and wanted to make sure you were satisifed with my service. Please let me know if you require additional information. If you are satisfied, then the kindness of a positive feedback rating and accept of my answer w ould be much appreciated.

Thank you,

Dr. Karing

Customer: replied 7 months ago.
I was so happy with the feedback. It was quick and gave me a lot of information to go back and talk with my vet about. This is a great service and all of my questions were answered. I would highly recommend this service and will use it again if needed.

Hi Kelly,

Thanks for your kind words. I'll let customer service know you are satisfied.

Have a great week,

Dr. Karing

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