Toby is a happy 10 month old Australian Blue Heeler that was taken in by Taylor T., our new receptionist. He was rescued from another family that was unable to provide for him. The family informed Taylor that Toby could possibly have megaesophagus, which is the loss of tone and motility of the esophagus, often resulting in dilation of the esophagus and clinical signs of regurgitation (like vomiting, but typically without abdominal effort). Toby was regurgitating everything that he ate so that was what they thought was wrong.
Once Taylor took him in, she was doing everything she could for him to stop the regurgitation. This usually consists of feeding the dog upright in order for gravity to help the food to go down. When they noticed that feeding him upright and softening his food was not helping, they knew something else was wrong. Then Taylor brought Toby to see us. Dr. Sappington did an exam on him and decided to do a barium study, which is where they put white liquid barium into some food and have the dog eat it. Then, they take x-rays immediately after intake to see where the food was unable to pass through. The barium shows up bright white on the x-rays. After taking a look at the x-rays, Dr. Sappington confirmed that Toby did not have megaesophagus, but an esophageal dilation due to a constriction on his esophagus. At that point, Dr. Sappington consulted with VIN (Veterinary Information Network), and the consensus was that Toby had a vascular ring anomaly, specifically Persistent Right Aortic Arch. This is a congenital defect, meaning he was born with this. Essentially, the right branch of the aorta forms instead of the left, causing the esophagus to be trapped between the trachea and heart. Solid food can’t get past this pinched area, and collects just in front of it. The food collection causes the esophageal muscles to stretch until they lose their tone, creating the dilation. When caught early enough, prognosis is usually good and most dogs return to almost normal function. However, if put off too long the prognosis worsens and it’s difficult to determine how a patient may recover.
Toby was referred to the University where they did a few tests on him to confirm the diagnosis and determine the next step. He had fluoroscopy done, which is a type of medical imaging that shows a continuous x-ray images, similar to a video. They used barium infused food with different textures and consistencies to see which food passed through and which food could not pass through. He then had a CT scan done, also at the University, to see if they could locate the vessel causing the stricture. Once located, they could plan the surgery. They treated it as an emergency and got him into surgery the next day. They performed a thoracotomy (opened the chest cavity) to remove the fibrous structures that caused the constriction of the esophagus.
Toby is now recovering and on a strict, nearly liquid diet that will gradually be thickened throughout the recovery period (about a month). The goal is to eventually get him onto normal, solid dry food so he can continue to grow like a normal pup! He has now gotten the staples taken out and is doing great at home with no more regurgitation and back to his playful self.