D. E. Larsen, DVM
I was surprised at how light the pup was when I lifted him onto the exam table.
“Boy, this pup is skin and bones, Robert,” I said.
“Yes, that is why we are here,” Robert said. “He has been vomiting everything he eats for the last month. He was doing fine at first, just as lively as the other pups. But when we started feeding them some dog food, he started vomiting.”
“That’s a little unusual,” I said. “What does the vomitus look like?”
“Looks like dog vomit,” Robert said with a questioning look. “What do you mean.”
“I mean, does it happen an hour after he eats and the food is half-digested? Or is it shortly after he eats and the food looks like it hasn’t been in the stomach?”
“He always acts like he is starving. He gobbles the food faster than the other pups. Then he turns away from the dish and deposits it on the floor. It pretty much looks like it looks in the dish, now that I think about it.”
“Can you leave him with us for a few hours,” I asked? “I think we need to get some x-rays of his chest.”
“I guess so, but why will it take a few hours?”
“We are pretty busy this morning,” I said. “I need to get a plain picture of his chest, and then I probably will need to do a barium swallow. That will take a little time.”
“What are you thinking, Doc,” Robert asked?
“We see an abnormality in the dog where the aorta comes out of the heart and turns the wrong way. It is called a Persistent Right Aortic Arch. The normal aorta turns to the left.”
“What does that mean for the pup,” Robert asked?
“It doesn’t bother the heart, but the little vessel that runs from the aorta to the pulmonary artery traps the esophagus, so solid food doesn’t get through very well. Those pups do well when they are nursing but start having problems when they start eating solid food.”
“Can we fix it?”
“Sort of major Surgery for these hands, but yes, we can fix it. But it is rare. This might not be this pup’s problem at all. That is why we need to get some pictures. This causes a ballooning of the esophagus above that strap, called a mega-esophagus. That is why we need to do a barium swallow.”
“So what is a barium swallow? That sounds a little gruesome,” Robert said.
“We give a small amount of barium and then roll him a few times, so the barium coats the inside of the esophagus. This allows us to evaluate the esophagus, and if there is a mega-esophagus, it shows up well.”
“Okay, I will leave him for a few hours, but when will you do surgery if that is needed?”
“We need to have this guy on a liquid diet for a few weeks and get a little muscle on these bones before we put him through an open chest surgery. I will go over all of that when we have a diagnosis. And just for the record, have you put a name on this guy yet?”
Robert looked at the pup with a softening expression. “We were waiting to see if he was going to make it or not. I guess if he pulls through all of this, he will be a lucky dog. Let’s call him Lucky.”
Robert left Lucky with us for the afternoon. The x-rays showed a massive esophagus with ballooning in front of the heart that nearly filled the thorax’s front end.
“This is a classic picture of a persistent right aortic arch,” I said as I showed Robert the x-rays. “I have a recipe for you for a liquid diet. We need to feed Lucky this diet for 3 weeks. I will recheck him at that time. If he is gaining weight, we will schedule surgery.”
“Do we need to do anything else?” Robert asked.
“Lucky needs to eat in an elevated position, so it is easier for the liquid to flow into his stomach. Otherwise, it will settle into the bottom of this enlarged pocket in the esophagus. You need to rig up a platform for the food dish with a step for Lucky’s front feet, so he is standing almost straight up to eat and drink.”
“Has it been 3 weeks already?” I asked Robert. He was a different puppy. He was bright and alert and wagging his tail.
“Dixie says he has gained almost 5 pounds,” Robert said.
“It is amazing what happens when they stop vomiting everything,” I said. “Do you want to schedule surgery now? You know that it will end up making this guy a valuable pup.”
“We understand that,” Robert said. “We discussed it and decided we couldn’t just put him to sleep. We need another dog around the house, so we will sell the rest of the litter, and that will help reduce the expense of this surgery.”
The surgery went well. It was very similar to a PDA surgery without the stress of possible rupture of the ductus.
After collapsing a couple of lung lobes to all for an adequate working area, I ligated the ductus’ strap and severed it. I could see the esophagus expand at the point of the previous narrowing. Lucky was going to feel much better.
I placed a chest drain, and then, taking care to make sure the lungs were fully expanded, I closed the chest.
Following a couple of nerve blocks to control the pain in the chest wall, we recovered Lucky.
Lucky was up and around and not having any problems. There was no fluid in the chest drain. We should be able to pull it in the morning.
“Surgery went well, Robert. I would expect Lucky to improve every week. We’ll continue to feed him from an elevated position for the next six months, but with any kind of luck, he should be close to normal by then.”
“When can he go home?” Robert asked.
“He needs to stay until we pull his chest drain. Things are looking real good at this point, and that will likely happen in the morning. I would expect him to be ready to go home anytime tomorrow afternoon.”
“I pulled the drain this morning, and he is acting like a new puppy,” I said as I allowed Lucky out of the kennel.
Lucky was dancing around Robert and jumping up. He was ready to go home.
“Besides watching that incision, I want you to continue feeding Lucky from an elevated platform and using the liquid diet until we get the sutures out in two weeks. If he is doing well, we will start blending some canned food in with the liquid. I have it all written out for you. If things are going well, we will change to canned food in a couple of months.”
“When can we start feeding him dry dog food?” Robert asked.
“We will see, maybe never. Maybe after a year if Lucky has no vomiting with canned food. The trouble with dry food is these dogs eat it so fast. It may stress his esophagus too much.”
Lucky continued to grow and caught up with his litter mates in no time. Eventually, he returned to a standard diet that included some dry dog food.
Lucky was indeed a lucky dog.
Photo by Josh Hild on Unsplash