Blue, and His Many Miracles. His PRAA heart defect, and how his regurgitation identification was the key to his diagnosis.

We met “Blue” four weeks ago when his mom came in to try to understand why he was vomiting so much? It seemed that he was always hungry and would eat voraciously, and then a few minutes later would “vomit” up most of the food he had just eaten.

In the scary Third Year of Vet school we all take “Gastroenterology.” It, (if you go to Virginia-Maryland) is taught by the ever-challenging Dr. Leib. One of the first things he drills into our brains is that you need to distinguish “vomiting,” from “regurgitation.” “Vomiting” means that you are emptying the contents of your stomach through your mouth. This is what most of us have encountered with food poisoning, motion sickness, the "oops, I had too much to drink" episode. “Regurgitation” is expulsion of the contents that haven’t made it to your stomach yet because they are being held in your esophagus. This means the food never gets to your stomach and your stomach isn’t doing its "heave-ho-muscular-squeezing" action to force out the contents it doesn’t want. Regurgitation is a passive looking "food-just –seems-to fall-out of your mouth" action, whereas, vomiting is a muscular contraction of your stomach to expel its contents. Sometimes it takes a lot of explaining and some funny looking demonstrations to identify which of these is happening in a pet. For Blue it was the most important diagnostic key for us to uncover. For Blue it was the difference between “most likely easily treatable” and “really really bad.”

We very quickly learned that Blue was regurgitating. He was having great difficulty getting the food, he so desperately wanted to eat, into his stomach. It is like torture. You eat and eat because you are legitimately starving. But you can’t get the food that you are devouring into your belly so that it can provide you with the nourishment you soo desperately need when you are a very young growing kitten.

At his first appointment it was very clear that he was underweight, undernourished, and desperately hungry. These are all tell-tale signs of a pet with regurgitation issues. Once we classify that you are truly regurgitating and not vomiting we can start to identify what is causing the problem. The big key is that the problem lies in front of, (or towards your mouth), and not from your stomach or below, (towards your tail). In most cases it is a problem in, or around, your esophagus.

Your esophagus is a muscular tube that pushes the food that your mouth swallows into the sac (aka your stomach) so your stomach can then churn and digest your food. If your tube (esophagus) doesn’t squeeze the food to your stomach then it just sits in the tube and the tube responds by getting wider and wider, like an over-inflated bicycle tube. The more air you try to put into your tube the more stretched it gets. This sometimes happens if you have an obstruction in your esophagus, or if something around your esophagus constricts it. This second scenario can happen if your heart doesn’t make the appropriate changes it needs to make after you are born. This is called a congenital (you are born with it) “vascular ring anomaly.” It is a malformation of the hearts vessels that entraps the esophagus and acts like a rubber band around the esophagus. The longer you keep a constrictive band around your highly dynamic muscular tube-like esophagus the more that tube will stretch and dilate in front of the tube. This is called a persistent right aortic arch, or PRAA. This anatomic “ring” occurs at the base of the heart and becomes apparent as babies switch from milk to solid foods. Affected patients become weaker and weaker and more malnourished as time goes on. You will die if it is not corrected surgically.

Back to Blue. Blue’s very unique diagnosis (this is the first any of us have ever seen), also came with a very unique story as to how he got to this point. So all the way back to the beginning we go.

Blue was brought in by his parent-mom after she witnessed his mom being hit and killed by a car. Blue was still in his mother’s mouth when she was hit with his umbilical cord still attached. He was taken home and bottle fed by his new mom. After a few weeks of being bottle fed they started to transition him from the kitten formula to solid food. It was then that he began to regurgitate. This brought him to us.

When he came into JVC we discovered that he most likely had a PRAA. The treatment for this is surgical correction ASAP. This surgery requires that we open the chest and remove the band of tissue acting like a tourniquet around the esophagus. Ok, if that doesn’t sound so incredibly difficult then please remember that Blue’s chest is about 2 inches by 2 inches, that the constrictive band is tiny, and that we have to keep his heart beating and the lungs working even while our fingers fumble around in a chest that is supposed to be a vacuum, (can’t be exposed to air, need a ventilator to do), and NONE of us Vets EVER go in the chest because very bad, scary, life ending things happen there. Without this surgery Blue will not live. Only a few Vets are qualified to perform this surgery, (or have ever done this before), and to have it done costs about $3000.

Blue’s mom realized that she couldn’t afford this and brought Blue in to have him euthanized. It is incredibly difficult, and so far for me impossible, to euthanize a treatable pet. I can’t do it. I always feel like I have to at least try. That day I told her that she could sign him over to us and we would TRY to find someone to do the surgery for him.

Jess my technician has taken over his care, and feeds him with a syringe every 2 hours. They have gotten very attached to each other. And the staff, led by Cindy has raised about $400 for his surgery.

This is an x-ray of Blue. He is lying on his side. We put some dye in his food and then had him eat it. The white is the dye. It stops at the base of the heart. then you can see it again in the stomach.

Blue’s surgery is scheduled for Monday Nov 14, 2011. Three Vets are donating their time and surgical skills to provide this. The very talented, skilled surgeons at VOSM, (Veterinary Orthopedic Sports medicine in Annapolis Junction, MD) will save his life.

It is one of the many cases that have been saved by my devoted, compassionate staff, and a few good friends.

If you would like to help contribute to Blue’s care, or any of the other pets in the care of JVC please see our website www.jarrettsvillevet.com, or call 410-692-6171, ask for Cindy and tell her that she is amazing, Jess, and Dr.H too! And if you REALLY want to make someones day call VOSM and tell them that the world is a better place because of people like them, who give even when they don't have to.

Thank-You for your generosity to those of you who have already donated and Thanks to everyone else for your well wishes.

Here is some information from Tams text book on Gastroenterology