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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog
Satisfied Customers: 32886
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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Did my dog have megaesophagus and myasthenia gravis

Customer Question

I'm hoping you can help answer some of my questions. Unfortunately I had to put my dog asleep a few days however, im questioning his symptoms and think it may have been something else. The vet believes this was megaesophagus and myasthenia gravis.
He was of mixed breed but very like a kings Charles only bigger and was 9yrs.
It started on a Wednesday when he was playing he went to catch a stick but when he landed he started to walk funny. At first we thought he may have twisted something when landing. By Thursday he became a lot more subdued and didn't even go for the postman (not like him at all) and was walking in a curve like a half circle.
By Friday he got a lot worse he was still curved but walking and slobbering a lot and tongue hanging out and extremely bad breath. He wasn't eating or drinking.
We brought him to the vet that day but while weighing him he struggled when been lifted. once we got him on the ground he suddenly got so much worse to the point where he couldn't use his legs.
At first the vet thought it was something spinal and was now effecting his brain. They took him in for examination and xrays. His blood tests, brain test etc all came back normal but they found what looked like a stick or foreign body of some sort in his esophagus. He was also suffering from pneumonia.
If they could get this foreign body out the prognosis looked good with antibiotics for the pneumonia. But we needed to act fast as he was deteriorating quickly and had a lot of puss coming from his mouth. This was a general practise and he needed to see a specialist. The closest specialist we could find was a 3 hour journey away.
We brought him down the next morning but he hates been in cars and was extremely stressed by this and struggled a bit towards the end of the journey even the food tube (balloon) burst in his stomach.
Once we got him into the vet hospital they gave him air to calm him. They than did more xrays and examinations. The foreign body they thought may have been a stick was actually soft tissue. The vet than went through the xrays and explained to us that it was a lot more complicated than previously thought.
First of all his esophagus was huge and diagnosed as megaesophagus. The vet also pointed out grey/white areas in his lungs and tree like shapes on his kidneys and believed this was myasthenia gravis. Also his pneumonia was very advanced. We were given a treatment option but this included months of handfeeding and special box they have to sit in and that's only if they could treat the pneumonia. We were warned that he was in a very bad way and wouldn't even survive the journey back home.
The months of treatment was not an option as my dog was a farm dog and loved been outside also knowing he was in discomfort I took the very had decision to put him asleep.
Since than I have done more research into megaesophagus and myasthenia gravis and am still not convinced this is what he had. He was extremely able bodied right up until that day he landed badly. He was eating before this no problem at all. There were no signs of this disease.
My questions are:
1. Do you think this sounds like megaesophagus and myasthenia gravis and if so can the symtoms really come through that quickly?
2. Before he went to the specialist should the first vet not have seen this issue with his esophagus,lungs,kidneys on the xrays than we would never have made him make that uncomfortable journey.
3. Is it possible it was just megaesophagus but when he had the second fall in the vets and the journey everything else in his body just started going.

Basically I just don't understand how a disease like this can come over all of a sudden,
Do you think it was possibly caused by something else?

Thank you for help,
Submitted: 3 years ago.
Category: Dog
Expert:  Dr. Michael Salkin replied 3 years ago.
Aloha! You're speaking to Dr. Michael Salkin
My condolences for your loss. I'll answer your questions as you presented them.

1) Yes and yes. The diagnosis is suspected in one four contexts, all characterized by neuromuscular weakness that may (classically) or nmay not (often) resolve with rest. measurement of serum antiacetylcholine-receptor antibody levels should be part of any diagnostic evaluation of such weakness. The contexts are as follows:

Congenital: generalized limb weakness with or without regurgitation/dysphagia, evident at abut 8 weeks of age
Generalized: acquired: generalized limb weakness that may be precipitated by exercise, with or without regurgitation/dysphagia
Focal acquired: dysphagia/regurgitation or facial weakness with no limb weakness
Acute fulminating acquired: acute generalized limb weakness and dyspnea due to respiratory muscle weakness.

The last three contexts can appear suddenly although they would actually be called "acute on chronic" which implies that the disease process had been present for a long time but the current symptoms arose suddenly.

2) Yes, the referring vet should have been able to see a large megaesophagus and evidence of aspiration pneumonia in the cranial lung lobes.

3) No, that's not a reasonable scenario. Note that generalized muscle weakness is exacerbated by exercise in the generalized: acquired: context. He was struggling and stressed.

I, too, would have put myasthenia gravis on the top of my tentative diagnosis list and would have submitted the acetylcholine receptor antibody test. Please continue our conversation if you wish.