This was an intense and emotional visit to our vet, Dr. Suzanne Fariello. Gus has lost nearly three pounds, a significant loss for a dog that weighted 15 pounds two weeks ago.
This is a serious setback in our efforts to figure out how to treat Gus's megaesophagus because it suggests his body is not processing nutrition.
If it continues, there is nothing we can do for him, even tube feeding wouldn't help, and I would not accept that treatment for him.
Dr. Fariello said she was discouraged, but not yet hopeless and neither are we. Still, we need to reverse it, period malnutrition is one of the fatal symptoms of megeasophagus. We went straight to plan B, re-arranging his diet and medications.
Gus's ribs were showing for the first time today, and he looked almost gaunt. My heart sank at this news, it is not good news.
Gus has been eating 1/3 of a can of Purina Pro Plan EN Gastroenteric Veterinary Diet food, we've shifted to feeding him four times a day (we have to hold him upright for at least 20 minutes after each meal, and now mixing in Royal Canin's high-protein, high-calorie recovery diet.
It's possible the Pro Plan was the cause of the weight loss, even though that is a serious symptom of ME. We'll know in a couple of days. I've already given Gus two of the new feedings (his antacid and anti-nausea medication was also increased.)
I might be imagining things, but I think his belly has filled out a bit already this afternoon. It's really too soon to know.
Dr. Fariello and I talked frankly about the options before us.
She agreed with me that the specialists don't really have anything to offer Gus. Although the much-discussed Bailey Chairs are often cited as the best option for treating ME, we have both seen from our separate research that there are about 50 possible treatments for the disease, none of which are believed to be cures.
We see no further reason to consult specialists, we all agreed, they are expensive and their techniques and diagnostic tools are expensive, and they have no magic procedures or pills for ME. We agreed that we don't need a Bailey Chair right now, and that we are not going to try 50 different remedies or treatments. Our elevated eating benches will arrive shortly.
I will not permit Gus to suffer from malnutrition or a slow starvation and end his days spitting up. Dr. Fariello said she knows how I feel and will respect that, she felt the same way. I will protect you from that, she said, and I wanted to hug her for that. (I did hug her, but it was, she said, quite appropriate.)
Nor am I comfortable with all of us spending our lives and most of our days holding him up or propping him up or making special puree food recipes. We have devoted much of the last two weeks on Gus, and it is not a way we want to live permanently. Maria has lost half of her work week and my own writing schedule has gotten erratic. For me, it's somewhat easier I suppose, because writing about Gus is my work. But that doesn't make it easy.
There are really no end of the things we could try, but we have to have some reason to think they might work. There is no cure of megaesophagus and slow starvation is not acceptable for me, or for Maria, for Gus. We won't be keeping him alive for us, it has to be for him.
The best one can usually hope for is special diets, elaborate stand-up eating arrangements and some "happy years" of life. The term does not bring me comfort. There is no getting rid of ME.
I told Dr. Fariello that Maria and I were in complete accord about what we think is appropriate for Gus.
We went to see if his weight can go back up and determine if we can limit his food regurgitations.
On that score, this was a good day, there was only one spit-up this morning, and none since, even though he has eaten three meals.
His stool was normal just a few minutes ago, which suggests this new food is being digested. Weight grain is critical, because it will tell us if nutrition is being absorbed. It's odd about people who love sick dogs, we become stool scholars.
Maria and I can happily live with an otherwise healthy Gus spitting up his food once in a while, or even once or twice a day. We might get there if we can get some weight back on him. The last two days have not been sustainable, we would have to give up much of our work to maintain this level of maintenance, vigilance and worry. And there are a lot of animals here, and a farm that needs a lot of attention.
I just picked Gus up and it seems to me already looks better. Is it wishful thinking? Dr.Fariello also did some acupuncture with him, she is not sure if it will help or not, but believes it's worth a try. He struggled with it, unlike Red.
This is new terrain from me, and I will learn from it. There is nothing solid to cling to, no technological or surgical marvels or magical pills.
I asked Dr. Fariello what it was we were shooting for, what our goals are.
She said she didn't know, she was quite honest with me. At the moment, we want him to gain weight and regurgitate less. If we can get there, we can build on it. She is talking to her friends and mentors, some of them specialists, and I am doing my homework online.
This was a hard and emotional session, it got serious, the stakes seemed high. Maria cried a bit – for her, crying is a way of talking, her emotions are on the surface. I got angry watching Gus squirm and yelp a bit as he got a shot of vitamin B-12 and some acupuncture needles. They he settled down. He is a good, sweet, boy and now is the time to fight for him.
I felt low in the vet's office, not so much now. He is eating well, keeping his food down, and from his bowel movements, digesting it. If we stay on this track, that will be good news. I feel quite hopeful, and I can't say it's based on one solid thing, but there it is.
Maria and I are cautioning each other to be steady. We go up and down, thinking it hopeless, and then when he looks so alert and affectionate and alive, we feel better. That is where we are now. I'd like to stay there for awhile, but we also need to be armored for tomorrow. There is no way to know.