Feeding Tubes

Could they save your dog's life?

 

Scout's Story 

Scout

Personal experiences with our ME dog and feeding by tube 

Sarah Jameson
May 2014 

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.
Scout Running


So these are in memory of our beautiful boy, Scout. 

Scout in field


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)). 

Tube surgery 

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. 

Tube management

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. 

Considerations

• 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. 

Mattie's feeding tube This is Mattie and her feeding tube. (Thanks mom, Racheal)

Mattie's feeding tube

 

A close up of Mattie's tube - a longer feed tube is implanted first in dogs, until the site heals up and a low profile tube can be added. 

 

Mattie's feeding tube

Mattie

Here is Mattie in a dress by "happy go lucky".  Her mom puts a piece of cut pantyhose or sock over her tube and then clothes on top.  These dresses are Velcro so they wrap tight to prevent her from chewing on her tube.  The dress provides has easy access to feed her.  Isn't she adorable?!

Feeding time for "Thando" Instructional video for tube feeders.

This is beautiful SuperNova Cassius. Cassius shows us how tube feeding is done...with a little belly rub! 

Recipe for Tube Feeders

By Debbie
 
4 Cans of Vanilla Ensure Plus (for extra calories)
2 cans of food
2 Tbls of canola oil
 
Blend well! 

10 thoughts on “Feeding Tubes

  1. Please give me some good advices..
    Hello I’m Helen from Hong Kong. I have a 5-months old mongrel. I adopted him 2 months ago, and 2weeks after I brought him home, he was diagnosed with canine distemper.
    Luckily at that time, he went through those difficult times. But as the distemper has left a scar on him- myoclonus occurs( he has involuntary muscle twitching)
    But a week ago, he started regurgitating. And the vet told me my dog has megaoesphagus maybe due to distemper.
    Now his appetite is good, but still regurgitate sometimes even I have hanged him up for at least an hour after feeding. He is losing weight n becomes so skinny that breaks my heart.
    The vet told me if the dog keeps on losing weight, I should let him go . But I really look for an advice . What do you guys think about him his case?
    Megaesophagas dogs in Hk is rare- or usually pts by the owner. So I cannot get a Bailey chair easily .

    1. Hi Helen,
      There are several different things you can use instead of a bailey chair. Some use the back of a chair, the stairs, a step stool, the arm or the back of the couch. If your dog is small enough, you can use a baby hi-chair, a baby walker, a baby swing. Some use a baby bjorn strap on body carrier to carry their pup around while they are digesting their food. Also chairs are not hard to make. They are basically a 3 sided box with a door and tray or a paw bar. If you go to baileychairs4dogs.com you can find out how to measure and put one together for yourself. Honk Kong is not along in their thinking unfortunately. Many vets here still give a gloomy prognosis. It can be managed and there is a chance that your 5 month old may come out of it. Distemper is a pretty severe disease. He sounds like he is fighter!

    2. Let him go when he gets too thin and the quality of his life is dwindling. I loved my dog deeply and was willing to spend a small fortune on a week of intensive care to get him over aspiration pneumonia caused by a sudden megaesophagus. I am a retired nurse and had the time, skill and money enough to be devote every waking minute to him, cooking for him, calorie counting, frequent handfeeding him and giving him round the clock meds. He was a 160 lbs love of a dog who despite everything, lost 30 lbs in 3 weeks. A tube was an iffy option because of the huge volume he would have needed of watered down nutrition. He’d need round the clock continuous feeds, and it would not have stopped the constant copious regurge of oral secretions which lead to another episode of pneumonia within a month. Through out that month, I seldom got a nights sleep as my poor dog spent he night regurgitating foamy phlegm or later, throwing up. Although I tried to his head up on pillows. Each day I washed put towels and blankets soiled from the night before. I live in the US where medical care is obscenely expensive for animals as well as people, and when he developed pneumonia again, I could not afford another $5000 to get him through, just to have him go back to starving and vomiting. I hope this helps you feel better about letting him go.

      1. I’m so sorry Jane. Only you know what is best for your dog and you. Such a tough decision but one made out of love. Big hugs and love being sent.

  2. Hi Trudy – so sorry you lost your boy, so young too – that’s so unfair 🙁

    It’s a really difficult call. Dogs are different and in some ways you don’t know how they’re going to react until you’ve done the procedure. We did not find that Scout lost interest in everything and did seem to ‘enjoy’ his feeds, as the vet predicted he might – as I mention above. But you are right that food and feeding is a huge part of a dog’s life and this must be a big part of whether you decide to go for a tube or not. We did not find that Scout regurgitated food with the tube (like your pup did), but he did bring up mucous a lot and we were really surprised by the amount. So he gained back his weight, but continued to regurgitate saliva etc. Vet said this might happen but again until you have tried you do not know. I do question now whether we should have gone the tube route (in the very cold light of day), but at the time and with the support of 3 vets we thought we would throw him a lifeline. One of the most difficult things I’ve ever had to decide. But yes there is no doubt it is a very big decision and one no one could ever take lightly and each case is probably different – different dogs, different owners, different circumstances. Maybe one day there will be a better solution for dogs with this condition?

  3. We had a German Shepherd, Ebonwolf, who at 9 mos. was diagnosed with ME, as the months progressed his esophagus kept enlarging. We used a Bailey Chair for all his meals and still he kept regurgitating his food. In May of 2014 he had emergency surgery as his stomach and spleen had herniated up into his esophagus. Every specialist we saw stated his ME was the most impressive they had seen, ( read: the worst, the largest they had seen). Within 2 months he was regurgitating every meal and losing weight, after talking with a GI specialist we had a PEG tube placed as it was our last resort to keep Ebon fed and healthy. If I had the knowledge I have now, I would have never done this. To eat, to drink, it is so important to a dog. We watched our beloved puppy lose interest in everything. We allowed him to eat ice cubes in hope that it would help. As the Vet said, regurgitating water is far less likely to cause AP, (aspiration pneumonia). It helped a little, but not enough. By the end of July his was regurgitating almost everything we fed him by tube. By then he had lost 30 lbs. from when he was at his healthiest and we could see he had given up. So on July 31, 2014 at 4 am he was put to sleep, he was only 20 months old. All I can say is, think it through before having a feeding tube placed as it takes away one of the most important parts of their life, to taste, to chew, it’s an integral part of them. If it’s temporary, no problem, I would do it again, but if it’s to be the way to feed them the rest of their life, then no, I would never ever do it again.

    1. Trudy,
      I am so sorry to hear about Ebonwolf. I understand your feelings completely. It is such a difficult decision on the part of the owner. I am truly sorry for your loss and value your input here. Thank you for taking the time to tell your story.

  4. You may want to post this useful tidbit of information. Our Ridgeback, Buddy, contracted the same ME condition as Scout, and at about the same age (I believe it was in 2011). We found that dosing him with Hydroxyzine every day (an anti-histamine) reduced his mucus production and he never got AP. I credit the Hydroxyzine to both the avoidance of AS and his longevity with this condition. Buddy is still alive but is eleven years old now and has gone downhill in the past 6 months. He was 135 lbs in his prime. Now he is in the 70-80 lbs range. The trouble at this moment is that it seems food is not making it into his stomach, even when in our Bailey Chair for 30 minutes. We are getting this looked into tomorrow.
    I guess I also have a question: Have you run into a situation where the food just wasn’t getting from the esophagus into the stomach no matter what?

    1. That is very interesting about the Hydroxyzine. I know some have used Mucinex and Benadryl to control secretions. Usually an xray will tell you if the esophagus has become so large and flacid, with pockets where the food is getting caught up. You can try throat massage to help the food down the esophagus. Here is a great youtube video of how to do it. https://www.youtube.com/watch?v=A-0Q8_9_07k Thank you for reading and commenting! If you haven’t yet, please join us on our faceBook links!

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