Could they save your dog's life?
Personal experiences with our ME dog and feeding by tube
Scout was a lurcher (a greyhound cross) and a rescue/shelter dog, so we knew little of his history. He was found as a stray and we adopted him 6 years ago. He was around 7 years old we think, when he contracted ME.
In June 2013, after several months of sicking up his dinner immediately after eating it (he would then re-eat it and be fine) he was diagnosed with acquired canine idiopathic (ie no known cause) Megaesophagus (ME), a condition we’d never heard of and my local vet had never treated.
At first, we managed the ME well with upright feeding of sloppy food (no bailey chair) from a bowl, but by October 2013, Scout was visibly losing weight through regurgitation (he was a lean dog anyway, being a greyhound type). We then started using the bailey chair, but we felt we were fighting a losing battle. We had tried wet food, meatballs, nutrient gels, high calorie foods, etc, etc.).
By the end of November, he was very weak, very thin and frail and sad.
We faced a stark decision – either to let him go at the beginning of December or fit him with a feeding
tube to give him a lifeline.
It was the vet who had been treating Scout with acupuncture who asked me if I’d thought of a feeding tube. We thought long and hard – it’s a very big decision, but we were fully supported by both vets who had been treating Scout. We were referred to the vet school in Liverpool (UK) where we saw their top internal/gastric vet. He felt Scout was a good candidate for tubing and he was still just about strong enough to take the operation.
So, Scout had a feeding (peg) tube fitted in December 2013.
Over time, Scout regained all the weight he lost - and virtually reached his full 20kg (he'd gone down to a very, very skinny 15kg).
Sadly Scout died at the end of April after possible complications with his kidneys.
I have written these notes to help other owners of ME dogs who are wondering about the possibility – and reality - of feeding tubes.
Although Scout has passed away, and we are very, very sad,...
the tube did give him a few more months of life with some good days and lovely walks and plenty of affection.
So these are in memory of our beautiful boy, Scout.
Peg Tube notes for ME dogs
(These notes are from my personal experiences, only. Always consult with your vet
in the management of your ME dog. There is also a lot of knowledgeable information
available on the ME Facebook pages - (linked on homepage)).
• There are 2 main types of tube - temporary and permanent. Scout had a temporary tube fitted - ie with a long, dangly hose which goes across the dog’s back. Although it is possible to get a permanent, low-profile (ie with no dangle hose) tube fitted, this needs discussion with your vet, since both types of tube have pros and cons. We elected to stay with the temporary tube. So these notes relate to temporary rather than permanent peg tubes.
• With Scout, the tube was placed endoscopically (ie using a tube passed down his gullet into his tummy). The operation does require a general anaesthetic (GA), which is always a risk factor for ME dogs due to post-operative aspiration pneumonia (AP).
• The tube came out near his last rib. He tolerated it all very well, though was very weak to start having contracted AP for the first time at the vets when having the op.
• ESSENTIAL! Be very, very careful that the tube does not come out (particularly in the first 2 to 3 weeks of insertion, since it can then cause a serious infection/peritonitis). Never allow your dog to chew or lick any part of the tube and put on a belly band or coat/t-shirt so your dog cannot ever get to the peg tube. Clean any/all food spillages off the tube in case it attracts your dog’s attention (this info relates to the temporary tube, not permanent tube which does not have the hose).
• Wound care: Change the bandage/dressing daily to ensure the stoma (tube hole) site keeps clean. Due to the way Scout’s tube was fixed with sutures (stitches), we were not initially able to clean the underside well and he did develop a nasty infection around the stoma site which required a course of antibiotics and a change in the cleaning regime. In order to do this the vets removed the sutures so we could clean under the clamp (the white plastic part that sits over the stoma), and around the site much, much more carefully. His stoma did discharge fluid every day (which apparently is normal), but when the infection started, this discharge really increased in amount and became bloody. So keep a constant check on this (ie daily).
• Feeding frequency: We fed 4 or 5 times/day to start with - and slowly built up the feeds (your vet will give you instructions on this). Scout was a medium sized dog – 20kg ideal weight. We ended up feeding 3 times a day and he received 8-9 syringes of food per feed. Vet told us that 3 x day is probably minimum for tube feeding. Your vet will advise. The idea is to build the dog’s weight up slowly, over time – ie 6-8 weeks or more – if they have got down to a low body weight. We tied Scout up to be fed so he did not wander around. Some people feed from the bailey chair.
• Food type & consistency: We fed Burns 'active dog' (ie higher calorie) kibble soaked
overnight and blended with more water to a smooth, silky ‘soup’ so it went through the syringe nozzle OK. We found if we used recovery food (canned) this was slightly grainy and would sometimes block the syringe nozzle or the peg tube entrance. If the latter, we squirted some warm water in (from another syringe) gently to disperse it, but if that didn’t work, we’d use a tweezer point and gently wiggle it around to unblock the tube entrance. Some people use fizzy drinks (coke) to help disperse/break up blockages, but we never had to do this.
• Syringes: We used the single use syringes, but managed to get several days’ use out of
them before they’d seize up. We had 8 syringes in use at any one time (much easier than
trying to refill one each time). Syringes were 60ml capacity with a 2.5mm aperture. You get
through a lot of syringes since they seize up after a few days. The syringes are single use
ones (we didn’t find any multiple use syringes). We used to get about 4 or 5 days feeding
from them (around 12 or 15 feeds) at most. Some syringes could be eased a little bit by
washing in vegetable oil. It’s the plungers that seize up I think.
• Nil by mouth: Scout took all medications via tube – antibiotics twice when he acquired
Aspiration Pneumonia. The only other med he took apart from that was Ranitidine x 3 daily. Scout got all his food and water through the tube and officially had nothing by mouth. However, during a very bad bout of regurgitation we did give him sucralfate/antepsin by mouth to help soothe this foodpipe. We did our best to ensure Scout did not get anything by mouth - so did not leave food or water out etc. On walks, he did like eating sheep droppings. For some strange reason these were rarely regurgitated – we have no idea why. If your dog does hoover up food/droppings while out walking, consider using a muzzle with a solid end piece.
• Bailey chair/elevation: Even though Scout was being tube-fed we did put him in his bailey chair after each meal for 15 mins. Not to help the food go down, but to help encourage saliva to drain down. Not sure if it did help that much, but definitely worth doing.
• Teeth care: you still have to clean your dog’s teeth. Tartar builds up more readily than usual since they can't chew on bones or kibble, etc, to clean their teeth.
• Regurge: Scout continued to regurgitate saliva several times a week since this was not
draining down due to his enlarged esophagus. We were warned this might be the case, but to be honest, we did not realise it would be quite so much.
• Weight monitoring: While gaining weight, Scout was weighed once a week at the vets to
monitor progress. If he lost weight we fed him up a bit more; if he was gaining, we kept on
with the same regime.
• Tube protection: You have to be very, very careful that when out and about the tube doesn't get snagged on anything or that your dog doesn't pull it out. Scout pulled his tube out after 6 weeks, so we had to start all over. This was because he was able to get to the tube. After that he wore a stockinette vest and a t-shirt making access much less easy. In the summer use a belly band type covering for the tube and the exit point. This is really important. You really do not want to have to go through the procedure more than once!
• We did not know that the possibilities for Scout to have new tubes fitted were very low. He was a greyhound mix, so had a very large/long rib cage making access his stomach very tricky.
• We thought very long and very hard as to whether this would be a good move for Scout. We got opinions from 2 vets who know Scout. Both said to go for it. Both said if Scout were their dog, they would do it. Scout was a good candidate for tubing, since he's fairly calm and dependable (he's 7), not too dizzy or rough and tumble or nervous, etc. You know your own dog the best. Ask your vet too, if you have a good one.
• If you go for the tube, don't leave it too late - ie your dog needs to be strong enough to
tolerate the operation and recovery. For the first day or two post op they can't be fed very
much until the tube is settled in.
• Beware that at first at least once back home, the management, although far easier than the by mouth method when your dog won't keep anything down, is still quite intensive to start with, especially with 4 feeds/day. We both work full time (though we work from home) and we did find at first that it did take up a lot of time, but gradually it did get a lot better and we got quicker at the feeding and clearing up etc! Three feeds a day is a lot more manageable than 4, we found.
• Aspiration Pneumonia is still a definite risk even though your dog is being fed by tube. In fact Scout had AP 3 times since December - twice at the vets when being tubed and once at home. So you still must beware of this and act accordingly.
• Regurge - doesn't necessarily go 100 percent, but it is reduced (due to food going bypassing the foodpipe). However saliva/mucous still does build up – in our case over every few days – and would come up. Scout did have some bad nights of regurgitation which took him a day or two to fully get over.
• Not being able to eat by mouth – This was a big consideration for us. Dogs love their food and treats and Scout loved his food. However, once peg tube fed, he had a lot more fuss &
affection instead. He was amazingly accepting. We were fascinated to find that Scout was
eager to have all of his meals (unless he was having an off day) and would readily go to his
feeding place to wait for the syringe feed. He would stand pretty still and ‘enjoy’ it. Our vet
said this was because his brain was receiving ‘I am being fed’ information from his stomach – so in fact even a tube feed was likely to be ‘pleasurable’ for him. This was good news.
• Costs - Scout was insured but the overall bill has been high - around £6000 (that is for 2
operations due to the tube being pulled out). There are the ongoing costs of syringes,
dressings etc (covered by insurance if you have it), but again quite costly. We did find a much cheaper source of suitable dressings online – so don’t rely on what the vet supplies, which will be costly. Look around for cheaper alternatives.
• Your time. Peg tube feeding requires a commitment on behalf of the owner that you should not under-estimate – both for feeding and stoma care. We both work from home so could manage them. However holidays/days out/long journeys etc needed to be much more carefully planned than normal. And our visits to the vets increased.
• Apparently peg tube feeding can precipitate kidney issues. We did not know this until Scout became poorly at the end of April 2014. So discuss this issue with your vet.
We were glad overall we took the tube route for Scout. It gave him a few months of life he would not have had.
He didn’t regain his old self 100 percent, but was not too far off on his best days.
To see him up for walks again or doing a little jig and playbiting your hands when it's dinner time or having a run in the field made us feel very proud of him and pleased we took the plunge.
I hope these notes are of help to you if you are considering a tube for your ME dog.