Persistant Right Aortic Arch Diagnosis

We’ve always feared there was more to Gunner’s digestive issues than allergies. Although we’ve seen some real gains from moving him onto the raw diet, we still experience occasional, random vomiting. We’ve tried multiple kibbles, followed the advice of the vets, and still have a sick dog. The vet bills, the smell of vomit, and the simple fact that he’s uncomfortable has been building up. I wish moving him to a raw diet would be the end all, but it just isn’t.

After two months of raw food, he is still hovering at 60 lbs. There is no doubt the raw food has reduced the frequency of the vomiting and improved his energy level and appearance, significantly. However, there is still the occasionally vomiting. The vets have seemed to conclude that “some dogs just vomit”… which I personally feel is a ignorant statement.

So, after gaining a referral from an acquaintance at a doggy daycare, I scheduled an appointment. This Vet is an “internist”… which although I don’t know the precise definition, it appears he will look at your dog, charge you double what a normal vet would, and then send you off to someone else for treatment. Hmmm… he must be good at identifying problems.

We had an appointment with the Internist and after some discussion about Gunners symptoms we agreed it was likely an issue isolated to his esophagus.

According to the Internist this was tell-tale “PRAA [LINK]. “Persistent Right Aortic Arch. See link for a technical description…. But put simply, a tendon from his Aorta had not dissipated during his puppy years and was constricting his esophagus – making it difficult for food to pass. So, he’d eat up two pounds of food, and most of it would bunch up into his esophagus… thus regurgitation (not “vomiting”) would occur. After researching the diagnosis, it seemed like a perfect fit.

 

Xrays followed:

 

 

 

 

 

So, with confidence I scheduled an appointment with the referred Vet for surgery. She examined the x rays, and agreed with the previous diagnosis, but was a bit confused about the image. Nonetheless, she was confident that was the issue, and it could be corrected.

 

We dropped Gunner of the next Wednesday for the surgery.

Around 2 o’clock the surgeon called.  She was obviously distressed and I could immediately tell something was amiss.  She’d cut him open, separated his ribs, inflated the esophagus, and found nothing. No constricting tendons, no dilation, nothing that would appear to be causing a build up in the esophagus. How could this be I thought?!?  Both you and the Internist we’re confident PRAA was the problem. Hell, even I thought the x rays confirmed it.

The surgeon, still emotional herself at the failure, explained there is a remote possibility the constrictor could be on the other side of the esophagus (thus the other side of the dog).  She was truly baffled that there was nothing to fix after opening up Gunner. Needless to say we were very, very disappointed. Gunner was in trama, and wouldn’t be back to normal for 2 or 3 weeks!  (Any idea how hard it is to keep a GSD “calm” and “resting”).

Also, the visit to the internist was $450 with tests and the surgury itself $2500.  $3,000 spent and no fix???  You can imagine my dismay.

The only sliver of a silver lining was that the surgeon had “inflated” the esophagus to identify the constrictor. That in itself is believed to be somewhat thereputic.   Can’t say I’ve confirmed that. All in all the experience was outright disappointing.

 

We learned only after the failed surgery that the internist could have done a Scope to confirm the PRAA diagnosis.  The Surgeon tried to draw the analogy that the x rays were like seeing a broken bone, then going in and not finding one.  Maybe that is so, but it doesn’t remove responsibility from the Internist discussing all options from the onset. I suppose the lesson here is to always get a second opinion.

Although there is plenty blame to go around, the fact is Gunner is a rough case. We won’t be pursuing and more expert opinions for a while.