case report

Integrative approaches to megaesophagus – case studies

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Below are details of the summarized case studies featured in the article “Integrative Approaches to Megaesophagus” by Dr. Judith Saik, IVC Journal Volume 8, Issue 3.

Using acupuncture for congenital megaesophagus

Case #1

A four-month-old intact female five-pound Bichon Frise/Havenese crossbreed was presented to the Integrative Medicine Service with a diagnosis of megaesophagus that had not responded to conventional treatment. The puppy had a history of chronic vomiting after eating (one to two times a day) and a failure to gain weight since weaning. Radiographs (no contrast study) assessed by a cardiologist showed idiopathic megaesophagus not associated with vascular ring obstruction.

Treatment for the megaesophagus by the referring veterinarian included Reglan (0.1mg -0.2mg/lb BID), probiotics and small amounts of canned food (Blue Buffalo) three to four time a day.  There was no noticeable improvement with this therapy.

The TCVM examination included a dark pink-purple tongue (Stagnation, Heat), neutral body and paw temperature, sensitivity at CV-12 (Stomach alarm point) and decreased femoral pulse on the right side (Qi Deficiency). Although the puppy had slightly harsh lung sounds, there was no respiratory distress, coughing or nasal discharge. TCVM pattern diagnosis included Spleen Qi Deficiency, Kidney Jing Deficiency (congenital presentation) with Rebellious Stomach Qi (chronic regurgitation).

The puppy was resistant to the application of acupuncture needles, so only five dry needle acupoints placed bilaterally were used: BL-20/21, Shen shu, ST-36 and CV-22. The puppy was started on the Chinese herbal medicine, Happy Earth (modified Wei Chang He), dosed at 0.25g BID to address Stomach Qi Stagnation.

At recheck one week later, the puppy was doing well on the herbal formula and regurgitation was significantly decreased to only several times that week. An exam still found a dark pink-purple tongue with a decreased pulse on the right side, but there was no reaction at CV-12. Only four dry needle acupoints (BL-20/23, ST-36, CV-12), placed bilaterally, were used. A second herbal formula, Four Gentlemen (Si Jun Zi Tang), was dispensed to tonify Qi and to be given along with the other herbal formula at the same dose. Two days after starting the second formula, the puppy had a decreased appetite, so the herbal was stopped and the puppy was maintained on Happy Earth only.

Over two months (with acupuncture treatment once a month), the puppy improved to the point where regurgitation after meals had ceased, with only one severe episode when the owner forgot to give the herbal medicine the day before. Once back on Happy Earth, there were no more episodes. Acupuncture sessions were discontinued after the third session, but the Chinese herbal medicine was continued for six more months, at which time the dose was tapered and then stopped. The dog has continued to do well for four years, with no regurgitation at the time of this publication.

Case # 2

A two-year-old male neutered Siberian Husky crossbreed was presented to the emergency and critical care clinic at the Veterinary Teaching Hospital with a several-week history of vomiting and gagging, along with rapidly deteriorating locomotor activity. The dog had been normal prior to the present clinical signs. He was vaccinated one week prior to the current episode.

The primary veterinarian treated him with metronidazole (10mg/kg BID for five days) and Cerenia (1mg/kg SID as needed) with intravenous fluids. The dog improved initially then began vomiting ten days later.  He was switched to a hypoallergenic diet, but two days after the food change, he developed severe hindquarter weakness and was diagnosed with lower motor neuron disease. He was referred to the teaching hospital.

When presented to the referral facility, the dog was transferred to the neurology service where diagnostic tests (radiographs, neurology work-up, CBC, clinical chemistry) diagnosed ambulatory tetraparesis (localization as diffuse neuromuscular), reduced gag reflex, leukocytosis with aspiration pneumonia and megaesophagus. A Tensilon test and AChRab titer (acetylcholine receptor antibody) were both positive. A presumptive diagnosis of acquired myasthenia gravis2 of undetermined etiology was made. Treatment was started, and included pyridostigmine (90 mg TID), mycophenolate (250mg BID), hyoscyamine (0.125mg TID), prednisone (30 mg given over 24 hours) and Clavamox (500mg BID) given orally.

The dog responded to treatment with gradual improvement of weakness and decreased regurgitation. The owner was instructed at hospital discharge that while this was a treatable condition, most patients require long-term medications and special feeding (upright/vertical in a Bailey chair with food in small meatballs).

Three weeks after the diagnosis, the owner presented her dog to the Integrative Medicine Service for assessment with the goal of decreasing Western medications – which were creating side effects such as ravenous appetite, diarrhea and lethargy – and possibly to improve the megaesophagus. Clinical and TCVM assessment on presentation revealed a lethargic dog with dry mucous membranes, medium pink tongue, severe constant panting, reddened sclera, hot ears/feet, dry warm nose, rough foot pads, muscle wasting along the topline, neutral to slightly cool back, and a forceful pulse that was decreased on the right side, particularly at the Spleen location. There were no positive Back-shu or Front-mu points. Auscultation of the chest revealed harsh lung sounds and there was a decreased gag reflex along with conscious proprioception deficits of both hind legs. The TCVM pattern diagnosis was Qi and Yin Deficiency with Liver Qi Stagnation.

Treatment included dry needle acupuncture at BL-17/18, ST-36, LI-10, BL-20/21, Bai-hui and GV-14 with aqua-acupuncture (B12 vitamin, 0.2cc) at CV-12, CV-17/22/23 and LI-4. Two herbal formulas, Four Gentlemen (to tonify Qi) and concentrated Hindquarter Weakness (to address Qi and Yin deficiency) were prescribed at one gram each twice daily with no change in Western drug doses and continued feeding in the Bailey chair. The protein in the dog’s diet was changed from chicken (Hot) to beef (slight Warm) for a slightly Cooler diet.

Two weeks later at recheck, the lethargy had improved, lungs sounded clear, mucous membranes were moist, ears/feet were neutral to slight warm, the back was slight cool, the pulse was decreased on the right (but improved) and there was a slight deficit at the Lung position. The dog’s appetite was good, there was no regurgitation, and conscious proprioception was now normal in one of the hind legs. TCVM pattern diagnosis was Spleen Qi Deficiency and Wei Syndrome. Acupuncture points included dry needle at Bai-hui, LI-10, CV-12, ST-36/37 and KID-1 and electro-acupuncture at BL-20/21 bilateral (5 min 20Hz, 5 min 80Hz-120Hz). The herbal formulas were continued, the antibiotic was to be finished and stopped, and the prednisone was decreased to 15 mg SID in the morning. Daily massage therapy (Tui-na) and acupressure protocols were started, and the owner was trained how to apply the therapy.

Over the next two months, with acupuncture treatment monthly, all Western medications were tapered and then stopped while the dog returned to normal neurological status and energy levels with no regurgitation. The AChRab titer (acetylcholine receptor antibody) was repeated one month after all Western medications were ceased, and the titer result was negative (normal). One herbal formula (Four Gentlemen) was discontinued at month three, and replaced with Bu Zhong Yi Qi herbal formula (to tonify the Middle and Augment the Qi Decoction). This Chinese herbal medicine has veterinary applications for megaesophagus and myasthenia gravis. In a study involving 100 human patients with myasthenia gravis, there was an efficacy rate of 86% when using this formula with general Kidney tonics.1  The dog continues to do well as of the writing of this paper, seven months since initial clinical signs.

Using homeopathy for megaesophagus

Case #1

From Veterinarian Jimena Beltran de Heredia, Mobile practice, Granada, Spain (jimenavetintegrativa@gmail.es)

A four-year-old female English Setter mix presented for chronic vomiting. She had a history of vomiting either immediately or within minutes of food consumpion since she was eight weeks of age. The vomitus contained undigested food without an acid smell. She was in poor body condition (BCS=3/10). The submaxillary glands were slightly enlarged and she had an inducible cough.  A clinical diagnosis of regurgitation – not vomiting – was made based on undigested food in tubular form which did not have a normal low pH consistent with stomach contents. Based on this, megaesophagus was assumed (the owners refused further disgnostic tests).  Homeopathically significant symptoms included weakness after parturition of the dog’s only litter. She was very emotional, empathetic, and demanded the company of her owner and resident cat. She was worse when left alone or with other people, and displayed a strong fear of fireworks and barking dogs. She was also anxious in the car, very loquacious, and drank a lot of water at home and even more from ditches while on walks. On August 25, 2015, the owners elevated her feeding platform. She started taking homeopathic Phosphorus 30c, diluted and succussed, 2ml per night for five nights. She had an aggravation (a good sign that the vital force is responding) of urinating copiously the second night, then less and less for the next three nights. At the same time, she felt better and drank much less. On days 30 and 31, there was no regurgitation. The diluted Phosphorus 30c was given every 15 days, then occasionally as needed.   Six months later, the owners moved to Portugal as the dog was feeling better. She still regurgitated from time to time but had gained weight and was happy.  She rarely needed more Phosphorus.

Case #2

From Ed DeBeukelaer, MVRCS. Author of Homeopathy: What to Expect, including 101 Cured Cases (12edb3@gmail.com)

Two Dalmatian puppies were seen at three weeks of age for milk regurgitation, but were otherwise clinically normal. Since the owner was feeding a lot of milk to the mother, we advised stopping this to see what would happen.

The regurgitation continued and at five weeks it became clear that these two pups (out of five) were not growing as much as the others and had started showing respiratory issues. Conscious chest X-rays of both pups showed bronchia which appeared filled. A diagnosis of megaoesophagus was made carrying an uncertain prognosis suggesting copious aspiration of milk. At the time of the x-rays, the pups were both dyspneic.

The gestation had been normal but delivery had been slow: the mother did not seem to push much and the owner had given a few doses of calcium orally. The two affected pups were very lively and hungry, pushing the others out of the way to get to the nipples to drink.

I started with a quick prescription of Phosphorus 30c in liquid TID while the owner contemplated whether to treat the puppies or put them to sleep. Their breathing improved the next day and treatment was continued. The regurgitation also reduced.

A follow up x-ray three weeks later of the worst of the two pups showed a complete clearing of the bronchia. The owner had started feeding solids while holding the puppies upright and they were doing reasonably well.

One pup made it to the age of eight months, but because of an aggravating situation was then put to sleep. The other one is now two-and-a-half years old and is even taller than the rest of his litter. She does regurgitate small amounts of smelly mucus daily but keeps all her food down most of the time.

Both puppies had received several follow-up prescriptions: the one that was eventually put to sleep only partially responded to further prescriptions. The one that is still alive responded well to Falcon peregrine first, then Ara macau later.

Falcon peregrine (10M) was prescribed based on the fact that this pup was the brightest and fastest of all the pups (at the age of three months). I was told she was fearless. The owner also noticed her abdomen enlarged substantially after each meal. A key to the Falcon prescription was combining the rubrics “fearless” and “abdomen enlarged after eating”.  The dilation of the abdomen stopped and she did well for a year.

One year later, more help was needed: her character had become more pronounced. She turned out to be a naughty but funny pup, smiling at her owners, stealing things for fun, and jumping over any gate or fence. She could jump from a standing position – there was no effort involved. She would not run off but could not be contained. None of the other seven dogs in the house jumped the barriers; they were all well-behaved. This one got away with everything.  She was always on the go – restless, the owners told me. She was also very much a family dog in relation to her attitude to the other dogs and owners.

There was a greyish discharge coming from her ears but she did not like them being touched. Closer examination (which proved very difficult) revealed a very mild ear canal irritation. The Falcon peregrine remedy did not help any further, so Ara Macau was prescribed based on the dog’s conflict with being a well-behaved family member and wanting to keep her freedom. I had another case of the same remedy of laryngeal paralysis which had a very similar dynamic. The ear problem settled and she has since taken this remedy every few months in a 30c upon worsening of the regurgitating.

Using laser for megaesophagus

From Janet Gordon Palm, DVM, CVCP (animobilityvet.com)

An 11-year-old male neutered Collie presented at New Hope Animal Hospital with evidence of aspiration pneumonia secondary to megaesophagus. He had a history of regurgitation and retching multiple times a day for months. The pneumonia had been present for over one week prior to presentation, and was getting worse. Radiographs were taken, and the patient was given appropriate dosing of Clavamox and Baytril upon presentation.

One week later, the owner presented the dog again for a recheck. He had not significantly improved. The owner had an emergency in his home country of Russia where he would be staying for three weeks. His dog sitter refused to take on the dog’s care and the owner was facing a decision to euthanize, or to board him with us for the duration of his trip. I had actually suggested euthanasia as there had been little improvement during the dog’s week on antibiotics, and there was no ICU option for ideal care. After a conversation about  risks, and a discussion of our right to make an executive decision if suffering progressed, it was agreed that we would take on the dog’s care.

The next day, seeing the dog deteriorating, I decided to try my new-found complementary therapy in the form of VOM neuronal adjustment, and Erchonia Freqiency Specific Low Power Laser (VOMtech.com, Wm Inman, DVM).

I performed three passes using a human Chiropractic Activator starting at the right and left Atlanta-occipital area, and proceeding along the dorsal spinous processes from C1 to S3, on each side of the sacrum, as well as both ischiums. There were “reads” along C2-T2; T8-S3. A Somato-Visceral Release was performed afterwards using the same Activator along the Paralumbar muscles from T1-L4.

I followed this with LLLT using the Erchonia PL5 (5mW; 635nm) There are two heads each with diodes per head. Line generated beams allow a larger surface area to be treated. Frequency specificity allows for programming specific frequencies obtained from Rife, Nogier, and others to fine tune specific treatment areas.

The Preset Head has frequency settings of 4/9/33/60. This was placed at the Foramen Magnum for all of the following treatment modules.

  1. The Programmable Head was placed over the entire dorsal spine, in particular, T1-L4 where the sympathetic ganglia are located. A Sympathetic Overstimulation was performed. These settings were 216/16/83/66. The time of this simultaneous stimulation of the brain and nervous system was 180 seconds. The concept is that once the absorption and ultimate stimulation of the light energy from the cell to cell response subsides as stimulation has stopped, the sympathetic tone plummets, and the parasympathetics can now rise. This was followed by a treatment further enhancing the parasympathetics.
  2. This time, the Programmable is set for the parasympathetic, colon, endocrine 240/20/73/147. The beam is shone over the cranial and sacral areas, stimulating the Vagus nerve and colon. This is also for 180 seconds.
  3. Following that was Pain/Inflammation/Lymphatic drainage/circulation/liver 9/16/42/53 and this was shone over the entire spine, neck, chest, abdomen
  4. Settings 2949/676/690/728 and 465/72/9/53 was shone sequentially over the entire dorsal spine and abdomen using the Programmable head. Preset was at the Thoracic Inlet for the first set, and at the Foramen Magnum for the second set. Again 180 seconds each.
  5. Lastly, Immune System settings with Preset at the Thoracic Inlet, and the Programmable over the chest and abdomen (especially over the spleen). 10,000/5000/777/240. This is intended to increase lymphatic production of macrophages, Killer T lymphocytes.

Two sessions each day at a minimum of two hours apart for three days were performed. The Sympathetic and Parasympathetic treatments only needed to be performed once each day as the effects last several hours. After the second day of the two treatments a day, the kennel assistant ran out to meet me coming in from the parking lot exclaiming that he was jumping up on things, which he had never done before. He was more vibrant and happy, had eaten his food without retching, and seemed overall brighter. I performed another two treatments separated by one to two days for a total of six treatments within a one week time period. The pneumonia resolved quickly once the LLLT started. A second VOM treatment was performed one week after the initial treatment.

He was relatively cough- and regurgitation-free through the rest of the time he was boarding.

Since we could not reach the owner by phone to obtain approval, I chose not to charge him for what was performed. He was appreciative, but could not invest in the remainder of my recommended 12 total treatments (continuing with two a week for two weeks, then one per week for the remainder.

He decided to monitor for recurrence of symptoms. The dog was discharged, and was symptom-free for over five weeks. He then presented with a recurrence of occasional regurgitation, but no further aspiration. We began treatments as he could afford them and were able to manage him until his eventual euthanasia from age-related quality of life issues.

That was over seven years ago. I have had several Laryngeal Paralysis dogs and two other megaesophagus dogs that have responded favorably, as well as feline and canine constipations, equine colics, etc.

The key is re-establishing nerve communication and circulation to the area. You cannot use a heat producing laser as it has been found that over 15mW/cm2 can alter osteoblast function, and I would be concerned about other cells, as well as DNA impact. The ability to vary the vibration of the light energy in frequencies found by Rife, Nogier, etc. to correspond with different tissue resonance is also key.

References

1Clemmons R. Megaesophagus and megacolon. Web access 15Jan2018; dog2doc.com/chi-files/TCVM_Herbs/August_Chi/Megaesophagus_Megacolon.ppt

2Beebe S, Salewski M, Chen J et al. Tonic Formulas. In: Chinese Herbal Formulas For Veterinarians, City of Industry, CA; Art of Medicine Press Inc 2012:423-431.