It was a delicious ham. It debuted on Christmas Eve, and although all partook, it survived largely intact. Through the following week, and into the early part of the new year, the family fed upon it. A ham sandwich here, ham on pizza there, but apart from an occasional morsel, there was one family member who was largely excluded from the feast: Muggs, the family bulldog.
He watched as the rest of the family consumed ham-based treats, only grudgingly sharing a piece with him.
As they ate, he stood watch, ready, should the opportunity present. After the last piece of ham was excised from the bone, the family slipped up. The bone was thrown into an open garbage can. Muggs saw it and knew it was his.
From the television room, they heard the can topple over, they ran into the kitchen and saw some garbage strewn on the floor but didn’t notice that the bone was gone.
Two days later, Muggs was definitely off. He had stopped eating and drinking, and now was salivating and vomiting. He was presented to our Mount Pleasant Emergency Clinic, and after a brief exam, an X-ray told the story. It was the ham bone.
It was lodged in his esophagus between his heart and stomach. It looked enormous relative to its surroundings, and it definitely was not going anywhere on its own.
The owners were suddenly facing a life-and-death situation for Muggs. He cannot live with that thing in there, and the choice of how to remove it, what it will actually take to get it out, and even the prognosis, were not immediately clear. This uncertainty translated to an unusually wide estimate of costs.
The first, and probably best, first step would be an endoscope passed down the esophagus. This would be used to try and push the bone into the stomach, where it can be harmlessly dissolved by gastric acids. An added benefit of this approach is that it allows us to visualize the esophagus and assess the damage that the bone has caused.
The problem is that if the scope cannot dislodge the bone, surgery is required, which amounts to an additional expense on top of the endoscopy.
Surgery will result in the removal of the bone, but it is an invasive step, and even this step is fraught with risk. We can try and open the stomach and pull the bone into it, but if this fails, we are forced into a riskier surgery in which we have to open the thorax and cut into the esophagus. This is a concern because the esophagus is a sensitive structure, and with poor healing qualities. This means an increased risk of complications. It also means that we are opening the chest and working around the lungs. This requires a temporary chest tube to be placed after surgery. It also means that we have to feed through a stomach tube, for a while, as the esophagus heals.
So, it could be as simple as a scope removal, or as complicated as an unsuccessful scope, followed by two different surgical approaches, a chest tube, a feeding tube and hopefully no further problems, but you can’t even be sure of that. Depending on the degree of damage the bone has caused, this case could deteriorate rapidly, or be plagued with long-term esophageal problems.
In Muggs’ case, we decided to forego the scope in favor of a direct surgical approach. The stomach was opened and I reached a finger up the esophagus to the bone. I applied a clamp to it and applied traction, but it soon became clear, the bone was lodged so tightly, it could not be pulled out intact. A bone cutting instrument was deployed blindly. Using touch alone, the blades were directed through the stomach, up the esophagus and onto the bone. Luck prevailed, and the bone was sectioned without damaging the esophagus The bone was removed completely in pieces.
Muggs was lucky, but many dogs are not. Some owners choose not to pursue treatment due to expense, and sometimes the damage is so severe that even aggressive treatment is not enough to save them.
The message is that it is not OK to allow dogs to have access to a bone they can swallow.
I (Dr. Henri Bianucci) hear people say, “I’ve always given my dog bones and have never had a problem.”
It’s like saying you have driven without seat belts and never had a problem. The only difference is that it is your dog’s life you are risking.