Quality ofLife
The overall reported death due to elective euthanasia is 40% and because of a complication is 34% (Harvey et al. 1974). Myasthenia gravis is associated with a high rate (58%) of euthanasia in cats and thus mega-esophagus diagnosed in this species has an inherent poor prognosis as MG is highly associated with a diagnosis of a cranial mediastinal mass in this species (Hague et al.
2015). Reasons for electing euthanasia are reluctance of owners to pursue surgical removal of the thymoma and/or the difficulty in administering treatment. The knowledge of low rates of spontaneous remission and the continued need to medically manage cats after thymectomy make owners reluctant to consider invasive procedures.The main considerations for humane euthanasia are assessed by the owner and should specifically consider the dog or cat's pain, appetite, behavior, and ambulatory status. The client needs to be educated to detect signs of aspiration pneumonia. Many conditions associated with mega-esophagus, specifically neuromuscular diseases, inflammatory myopathies are responsible for generalized deterioration and weakness, and the underlying disease very often will cause progressive disease. Other quality-of-life aspects to consider are those that pertain to the person providing care for the dog or cat. Managing a pet with mega-esophagus requires a large amount of contact time for feeding, whether it is with the aid of a “Bailey chair” feeding-platform or via a low-profile gastrostomy tube. Constant worry develops as a result of the strict regime for feeding schedules, concern about travel and leaving the dog under the care of a pet sitter, and the high frequency of veterinary visits for monitoring or treating complications.
Of dogs with mega-esophagus, 26% do not survive discharge from hospital with the most important risk factor identified in all non-survivors being aspiration pneumonia, but large body size and adult age group (>13 months) were also significant, indicative of the poor prognosis of idiopathic acquired mega-esophagus (McBrearty et al. 2011). Of patients that did not survive, 42% were euthanized, with 81% of euthanasia cases due to