PEG tube for megaoesophagus lab

Re: PEG tube for megaoesophagus lab

Virginia Campbell — Thu, 23 May 2013 12:24:11 GMT

[quote user="Virginia Campbell"] it may be PEG tube or euth.[/quote]

Euth is still on the table by the way. I don't mind the comments about ethics, especially those from people who have actually seen PEG tubes used such as Hanna's comments on her experiences. It's an especially sobering thought that even though the long term outcome was good in the case she dealt with, the QOL problems in the interim were severe. Even though David's comments were the most forceful, he did answer one of my initial questions at the end - about brands of tubes- and this suggests that his previous comments about QOL are based on personal experience. I've definitely been guilty in the past of letting rip in posts about certain things to which I just have a visceral "this is wrong" reaction rather than actually having seen the procedures done and how the animal has managed afterwards.

When I started in practice, I was pretty much against carts, CRF buttons, chemo and any heroic surgery involving prolonged aftercare. I even thought that treating diabetics was verging on over-the-top. My views are more grey than black and white now. I still think most of these things are wrong in a lot of cases - I would try hard to talk an owner out of chemo or spinal surgery if their animal hated the vet clinic, for example; and my vet-hating diabetic management relies a lot on urine dipsticks.

I'll try to find out more about this case. I don't know if it will be a goer. According to out notes on initial presentation, both of the owners work so tube management may not be possible...he's a young bouncy dog and I wouldn't be surprised if they keep coming home to find another tube on the floor. Also, although I know some of these cases can resolve, I can't really see his monster oesophagus magically shrinking back to normal, so he may be stuck with a tube for life. Has anyone here used the low profile tubes long term? Are the dogs able to roll in mud and charge through the bracken with these in place?

Re: PEG tube for megaoesophagus lab

Bob Russell — Thu, 23 May 2013 11:31:15 GMT

[quote user="Andrew Kent"][quote user="David Mills"]

[/quote]

whilst I and many other may share some of these sentiments this is another example on this forum of somebody asking for a specific piece of advice and getting an earful. We don't know the full details of this case, we don't know the owner and we don't know the situation. So these comments are nothing but unhelpful in answer to the initial question.

[/quote]

It is entirely appropriate to discuss the ethical issues regarding any cases but I have to admit there is a degree of implied criticism of the case handling that is unhelpful. 'Whimsical human benefit'??

I would suggest that lack of hunger is a pretty important part of life, more than the eating itself. Most labs I know are looking for food most of the time and not finding it!

The OP is asking for advice that may lead to the dog getting adequate nutrition so that it can live a full life. This is a judgement that is best made by someone who knows the patient and owner.

The points made regarding welfare are absolutely valid and I am sure have already been considered and will continue to be!

Re: PEG tube for megaoesophagus lab

Andrew Kent — Thu, 23 May 2013 09:55:34 GMT

[quote user="David Mills"]

[quote user="Hanna Bennett"]

we had a case which was PRAA which had persistent megaoesaphagus post op, had PEG tube which kept the dog alive but it still ended up needing surgery to resolve an oesophageal stricture. i had real issues personally with the case even though the long term outcome (at 7mo) was good - feel that eating is a big part of a dog's qol, esp in a lab - be warned that if it feels better and tries to do the usual scavenging it will proobably vomit it all back and risk aspiration pneumonia. need really good owner compliance.

[/quote]

I would go further than this and say the welfare is compromised so severely by this that it is cruel to keep the dog alive in these circumstances - any dog, but even more so a lab with their appetite. Partly there is a question of whether an animal that cannot carry out some of its basic functions for the rest of its life is not better off dead (skin buttons for crf, carts for dogs fall into this category imo) - we are all horrified by battery cages, for instance - and partly because eating, for most animals, is a fundamentally pleasurable experience, as is drinking water when thirsty - anything per os in this dog would carry huge risks. Additionally, what about the effect on other parts of its life? It can't go swimming, roll around in mud, jump around in snow.

I'm sorry - and I don't know the whole case - but from the limited info that has been given, this appears to be being done for a whimsical human benefit and the dog's welfare is going to suffer.

FWIW, yes, Vygon are by far the best IME.

[/quote]

Re: PEG tube for megaoesophagus lab

David Mills — Wed, 22 May 2013 22:59:04 GMT

[quote user="Hanna Bennett"]

[/quote]

I'm sorry - and I don't know the whole case - but from the limited info that has been given, this appears to be being done for a whimsical human benefit and the dog's welfare is going to suffer.

FWIW, yes, Vygon are by far the best IME.

Re: PEG tube for megaoesophagus lab

Hanna Bennett — Wed, 22 May 2013 21:52:24 GMT

and the feeding tube needed replacing on multiple occasions which i also adversely affected qol.

Re: PEG tube for megaoesophagus lab

Hanna Bennett — Wed, 22 May 2013 21:51:21 GMT

Re: PEG tube for megaoesophagus lab

Andrew Kent — Wed, 22 May 2013 09:18:26 GMT

Hi Virginia,

I have used quite a few brands of PEG tube but I think the kits from Vygon are the most complete and useful.

I would, however, urge some caution if neither of you have any experience of placing them. We have seen a number of dogs with complications (even death) following PEG tube placement, usually related to how much tension is put on the tube following placement. They are relatively straight forward but not completely benign!

I assume that 'treatable' causes of oesophageal dysfunction have been excluded?

Andy