Homer came to us after he became literally unable to eat any food without it coming immediately back up. He would try his best, even making repeated attempts to eat what came back up until some of the mush eventually remained in his stomach. Despite his best efforts to nourish himself, his body could not disguise the evidence of weakness, muscle wasting, and overall depression.
On physical exam, it was as if his insides were completely filled with air. He was bloated, and he was almost involuntarily expelling air from both ends. Homer may not have had a bowel movement in several days. I was immediately concerned that he had a gastric dilatation volvulus, where a dog's stomach can fill with air and twist, cutting off the passage of food into and out of the stomach, and more critically, cutting off the blood supply to the stomach itself. In many cases, it's fatal. At first glance, the radiographs seemed to confirm the suspicion ... a stomach fully distended with gas in an abnormal position. But upon further study, the entire gastrointestinal tract from the esophagus to the colon was full of gas as well, seeming to be paralyzed, unable to contract and move ingested food from the mouth all the way through the digestive tract.
Reading up on this fairly uncommon condition known as myasthenia gravis, all of Homer's symptoms could be attributed to the disease, where there is a dysfunction of the neuromuscular junctions along the gastrointestinal tract. With a leap of faith, knowing that the cure for the twisted stomach condition was emergency surgery while the cure for myasthenia gravis was a medication, we decided to begin medical treatment for myasthenia gravis.
The next day, Homer's owners called and said they had given a couple doses of the medication, but he wasn't looking very good. In one conversation, his owner said she thought he looked like he might not live long enough to make it back into the vet clinic. Disappointed and hoping I had not made the wrong diagnosis, I decided we should try to increase Homer's dose in one last effort to reverse the paralysis of his digestive system.
I hadn't heard anything about Homer for a week or so, and I suspected the worst. That was until one fine day, when his owners called to see if I could call in a refill of his medication! He was apparently doing much better, keeping his food down, and even having normal bowel movements! Homer was in for a recheck this week, he has already gained some of his weight back, and everything is on the up-and-up. I never thought I would find myself becoming overjoyed upon hearing about a dog having a bowel movement! It's the simple things in life, I guess.