WHAT I’VE LEARNED ABOUT CARING FOR THE MEGAESOPHAGUS (ME) DOG
By TA Smiley
Greetings, and I’m sorry that your pup has been diagnosed with Megaesophagus (ME). My pup, Zoey was almost two when she collapsed at home. We rushed Zoey to our local St. Albert vet, who sent us immediately to the Edmonton Guardian hospital, who then had to send us down to Calgary to yet another specialist then back up to Guardian Hospital in Edmonton where she was finally diagnosed: Myasthenia Gravis (MG) and MegaEsophagus (ME). Zoey received a diagnosis, and we received some big bills, but we received very little information about how to look after a dog with ME. I had never heard of MG or ME before and I had no idea what to expect or how to help her at home. I remember being scared for my pup, overwhelmed with all the vets, tests and bills, and having a lot of questions. After doing research on the net and joining some online information/support groups, I started writing down the things I learned, many which I wish someone had told me at the time of Zoey’s diagnosis so I’d have been better prepared. I’ve put this collection together so that I could give it to my vets to share with the next canine ME caregiver they come across. Please understand that this information is provided as a resource only. Please discuss all treatment and feeding plans with your vet to confirm it’s right for your pet. – TA Smiley
WHAT IS MEGAESOPHAGUS (ME)?
First off, I’ve learned this: Megaesophagus is NOT a death sentence. ME simply means that the tube carrying food from mouth to stomach is too big, and doesn’t work properly. A normal esophagus has muscles that move the food into the stomach and help keep it there. A Megaesophagus is floppy, often with folds and pouches that trap and hold food and liquid. The dog will often regurgitate the bits of food and the jelled saliva from the esophagus folds.
There are two types of ME: congenital and acquired. A pup that has congenital ME was born with an esophagus that doesn’t work properly. A dog can also acquire ME as a result of another disease. When a dog has symptoms of ME (such as frequent regurgitation of their undigested food, loss of weight, gagging or coughing after drinking water) a barium swallow X-ray is one test that can confirm diagnosis. The barium coats the esophagus to make it visible on the X-ray. When a grown dog develops ME, they are tested further to determine the cause.
ME is not a common ailment, and as a result, many vets are unfamiliar with the details of caring for a dog with ME. When you find a vet that does know ME well, stick with them! Ask in the support groups (links below) if anyone can recommend an ME-knowledgeable vet in your area. Having a vet that really understands ME is critical for your dog’s long term health. Sadly, many caregivers have shared that their initial vet suggested ending the dog’s life at the time of diagnosis. Knowledgeable vets know that a dog with megaesophagus CAN enjoy life as your companion if you are patient and willing to take some extra steps each day in return for your pup’s loyalty and devotion.
THE FEEDING POSITION IS *CRITICALLY IMPORTANT**
Because the ME dog’s esophagus is unable to move food and liquids from the dog’s mouth to the stomach on its own, it is critical that your dog be fed in an upright position and remain upright after the feeding for 15-45 minutes, depending on the extent of the expansion in the esophagus. This allows time for gravity to pull the food down into the stomach.
It is suggested that you start with 20 minutes of upright time after feeding and if the dog has regurgitation after being released, increase the time at the next feeding. If after a week your dog has no regurgitation for several hours after ending the upright time, you can try reducing the time a few minutes.
Feeding in an upright position can be accomplished in several ways:
1. The most highly recommended way is in a Bailey Chair. Invented by the owner of an ME dog
and named after his pet, the Bailey chair allows the dog to sit comfortably in an upright and supported position.
Many caregivers say their dog adapted very quickly to using the Bailey chair. See a short video of a dog getting into its Bailey chair at: https://www.youtube.com/watch?v=qUcCZTnImCI
To have a Bailey chair for your dog, you can:
a) order one from here:
http://www.baileychairs4dogs.com/prices
b) build one yourself with directions from the creators. They will send you a DVD or video of instructions for building your own Bailey Chair for $6.00 to cover costs. Send email to Matthew1@earthlink.net.
c) if you’re handy in the carpentry shop, follow the directions of Paul Grady at http://cannine- myastheniagravis.blogspot.ca/2010/01/bailey-chair-essential- for-successful.html OR another author’s link:
and you’ll find directions for a chair that comes apart for travel here:
https://drive.google.com/file/d/0Bwb3j6x_KoByaXFPZXNsWHZDVDQ/view
2. Depending on the size and compliance of your pet, you can hold your dog upright or prop your dog up in the corner of a couch to feed him and have him stay there for the required length of time after he is finished eating.
3. Again, depending on the size of your dog, you can seat your pet in a waste basket, bucket or laundry hamper lined with towels or pillows to hold her upright.
4. Some dog owners with very obedient dogs with very mild Megaesophagus can get away with feeding the dog on the stairs or a short step ladder, placing the bowl high enough so the dog is eating on at least a 45-degree angle. However, several owners of older dogs say their dogs find it more comfortable to be propped up than to stand on their back legs and have that pressure on their back and hips at each meal.
What is important is that your dog remain upright while eating and for the required time afterwards so all the food reaches their stomach. If not, it is very likely that they will regurgitate, putting them at risk of inhaling particles, which could lead to Aspiration Pneumonia, the leading cause of death for ME dogs.
WHAT TYPE OF FOOD?
Reportedly, most ME dogs cannot eat dry kibble because when it is chewed, the dry bits of kibble get stuck in the folds and pouches of the megaesophagus, causing regurgitation and risk of Aspiration Pneumonia. The goal is to have the food fall/roll easily down into their stomach, intact. This is done with varying degrees of moisture in the food.
Some feed their dog a food slurry. The slurries used are made of a variety of ingredients: some are home made from scratch, others use kibbles soaked overnight and pureed in a blender, while others blend canned food with water. However, many caregivers report their dog does well when their food is shaped into meatballs that can be swallowed whole (smaller in diameter than the dog’s throat) allowing them to roll down the esophagus easily. Just as there are a variety of slurry recipes, there are also a variety of meatball recipes. You’ll find some of these recipes at this site:
https://caninemegaesophagusinfo.com/recipes/ Note: this site has a LOT of great info on more than just recipes. It’s the “Go To” place for ME and it is well worth your time to check it out!
Gaining weight is often an important goal for the ME pup. Many dogs with ME are underweight prior to diagnosis due to frequent regurgitation of the food that did not reach their stomachs. Also, finding the right texture of food and the timing of feedings takes some guesswork as no two dogs are alike. Some dogs will continue to regurgitate, even when fed sitting up, if their food consistency, water source or medications aren’t quite right. Many caregivers feed their ME dogs several small meals a day, and others add things like coconut oil to their dog’s meals to increase the calories per serving. Speak to your vet about your dog’s specific nutritional needs.
APPROVED TREATS
Regular treats such as Milk Bone dog biscuits won’t work for your special ME pup. Treats for the ME dog must be ones that won’t stick in the esophagus and cause regurgitation. I learned from Bob and Donna Challender, (the couple that facilitate a couple of the Facebook support groups and run the Canine Megaesophagus Info website), that one of the best treats for ME dogs is actually a baby food! Gerbers makes a product called “Puffs” that are small, tasty, and dissolve in the mouth so there’s nothing to swallow.
Another treat that caregivers of ME dogs recommend is the PetSafe LiketyStik, which provides the dog with some flavour but nothing to swallow.
Small ice cubes or ice chips are yet another suggestion for treats and, surprisingly, my Zoey enjoys them as much as she enjoys the Gerber Puffs!
WATER FOR YOUR ME DOG
My vet informed me that dogs require approximately 1 ounce of water for each pound of body weight (66mL for each kilogram), and more if they are very active or when the temperature is high. Many Megaesophagus (ME) dogs (my Zoey included) cannot tolerate drinking from a bowl of water (or a lake, puddle, etc.) because the water collects in the pouches of their esophagus and quickly causes regurgitation.
Some caregivers use a product called “Thick it” which thickens water and this makes it tolerable for many ME dogs (see http://thickit.com/products/thickeners/).
Other dogs do better with “Knox Blocks” which replace drinking water altogether by providing them with small cubes of gelatin they can swallow whole. The gelatin then melts into liquid in their stomach. We’ve found this to be the best solution for our pup.
Recipe for Knox Blocks
1 cup no-salt chicken or beef broth (cold or room temperature is fine)
4 envelopes of Knox unflavoured gelatin OR 3 heaping tablespoons of bulk unflavoured gelatin powder*
3 cups boiling water
Directions:
Add gelatin to the broth, stir well.
Add the boiling water to the broth mixture and stir well, until all gelatin is dissolved.
Pour into a 9×13 cake dish to make cubes OR pour into a small cookie sheet for gelatin strips. [Tip: put the pan or cookie sheet in the fridge before pouring in the gelatin mixture. Reduces spills!)
Refrigerate until gelatin is firm, approximately 2-3 hours
1 heaping cup of gelatin cubes = approximately 8 ounces of water (250mL)
*(Tip: The Bulk Barn store carries unflavoured gelatin and it’s much cheaper than buying boxes of Knox envelopes!)
BURPING & PERCUSSION
Some ME dogs need some hands-on help after eating or when they are gurgling in the throat with liquid that has not gone down to the stomach. Burping helps prevent regurge and percussion helps move food stuck in folds in the ME. You will find helpful videos on how to burp your dog to avoid regurge and how to do throat massage and percussion in the links below:
Note: You need to copy and paste these shortened links into your browser for them to work! goo.gl/dfGGQC <- video showing how to burp your dog after meals
goo.gl/ifqevt <-video of vet demonstrating percussion (aka coupage)
We’ve found that by giving Zoey some burp and percussion pats after each meal, the number of regurgitations dropped dramatically. Combined with the neck pillow = no more middle of the night regurges for Zoey! ☺
KEEP THAT HEAD UP!
Keeping the head elevated is essential for your dog, especially when sleeping, otherwise saliva pools in the upper esophagus folds and lead to regurgitation. It’s advised that you have your dog wear a neck pillow whenever you are not watching closely to ensure they aren’t laying with their head down, lower than the stomach. Many ME dogs learn to use a pillow, and several caregivers have devised ways to put their dog’s bed on a slant and taught their dogs to sleep with their heads on the high end. However, neck pillows are the most popular intervention and it has proven to make a significant difference for ME dogs.
To get neck pillow for your dog you can:
- a) buy these neck pillows (aka “Neck hugs”) at most pet stores. You’ll find them near the “conesof shame” (the plastic collars put on dogs after surgery to prevent them from licking the incision). If you can’t find them, ask where they have “the inflatable ZenCollar or ProCollar”
- b) buy a “King Collar” through Amazon.ca : https://www.amazon.ca/Kong-Cloud-Collar-Collar- Large/dp/B0045Y1JGG (check the size!)
- c) order one custom made for your dog from Wag Tail Farms ($50 for a medium sized dog):http://www.wagtailfarms.com/
d) make your own (instructions available, courtesy of Pam Giles, in the Files section on the Facebook Canine Megaesophagus Support Group). Note: When making or selecting one for your pet, WagTail Farms’ website shares that the width (measuring from inner circle to outer circle) needs to be 1″ to 2″ past the end of your dog’s nose, and the thickness should be 1” or 2” less than the length of your dog’s neck.
CLEANUP TIPS
There’s just no way to put this nicely: regurge1 is a gooey, slimy sometimes stinky mess. Regurge is not vomit. Regurge is the saliva and bits of food (or whatever your pup has eaten) that has been collecting in the folds and sags of your dog’s megaesophagus. It has not yet reached the stomach and comes up almost effortlessly, although your dog might make a gagging sound at the end of it to clear the throat. Vomit comes from the stomach, contains partly digested food and comes up forcefully with the dog heaving as it’s brought up.
Trying to clean up regurge is like trying to pick up partially melted Jell-O. I went through many rolls of paper towels in the first couple weeks until I was given a gem of info from another ME dog caregiver: invest in a small shower squeegee and a dustpan. It makes cleaning up regurge SO much easier!
Also, if you mix a 1/2 tsp of Blue Dawn dish soap, 2 cups of water, and 4 tablespoons of vinegar in a spray bottle, you’ll have a fantastic cleaner to use after picking up the regurge. Before using on your carpet, test your carpet in an unseen place (like a closet corner) to be sure the carpet is colourfast (most are these days). Spray a small amount on the carpet, wait a moment, then blot it with white paper towel. If any colour from the carpet is on the paper, do not use it on your carpet. On solid surfaces, the vinegar disinfects without the use of harsh chemicals that can transfer from the floor to your dog’s paws.
RECOMMENDED ACCESSORIES
In addition to having a neck pillow and bailey chair or upright feeding container for your pet, a few other accessories are recommended. One is a cloth or closed-end muzzle to wear outside to prevent your furry companion from eating or drinking anything that could cause regurgitation. My Zoey requires one because she’s like a young toddler – she puts EVERYTHING in her mouth! Several other caregivers also report using muzzles when going for walks to prevent their ME dog from eating anything found on the ground or taking a drink from a puddle. In addition, a medical alert type of dog tag is recommended; if your pet gets lost, it’s important that the finders know not to give your petanything to eat.
CAREGIVER SUPPORT
As stated above, having an ME dog as a companion requires a commitment on your part. It’s not always easy, but there are many tips available to make your ME dog’s life (and yours) as easy as possible, and you’ll find them in the following online support groups. I highly recommend you join these; even if you do not want to post things, reading the posts of others can provide you with a great deal of info. You can also post questions and get informative and helpful answers from other owners of ME (and MG) dogs who have been through the initial shock and “What now?!” stage that you may be experiencing at this time.
1. Canine Megaesophagus Support Group: https://www.facebook.com/groups/4329632343/?ref=bookmarks
2. The Upright Canine Brigade:
https://www.facebook.com/groups/uprightcaninebrigade/?ref=bookmarks
1 The product of regurgitation is referred to as “regurge”.
3. Canine Myasthenia Gravis Support Group
https://www.facebook.com/groups/1562952957331501/?ref=bookmarks
More info on MegaEsophagus:
https://youtu.be/3riLt6CscP0 <- Excellent video by a vet
*** https://caninemegaesophagusinfo.com *** THE place to go for info, recipes, resources!https://vcahospitals.com/know-your-pet/megaesophagus
In addition to gaining info by joining the support groups, you can develop online friendships with other caregivers of ME dogs. Those friendships can help you through the difficult times and, unfortunately, ME dogs are prone to difficult times which can be both stressful and inconvenient for you.
For example, despite all your efforts, there will likely be days when your ME dog experiences regurgitation several times a day with no explanation. Having to deal with these issues can be frustrating, and having a place to vent, where others understand and have experienced the same, can be very therapeutic.
THE COMMITMENT
It’s very important that you understand that caring for a dog with ME is not the same as caring for Non-ME dogs. Your ME dog is not the type of dog that can lay beside your chair as you eat dinner, passing it a few bites here and there. This is not the type of dog that you can call to clean up the mess on the floor under a baby’s high chair, either. Nor is this the type of dog that you can leave in the back yard with a water dish and a bucket of kibble while you’re at work.
Caring for an ME dog means making a commitment to a daily routine that involves preparing his/her meals in advance, allowing a minimum of 30 minutes per feeding, giving throat and neck massages after meals, being okay with having to wash blankets mid-week (if your pup is allowed on the bed) because of regurge, ensuring everyone in the house understands not to give your pet snacks that aren’t on the Approved Treats list, and making sure your pet sleeps with its head elevated to avoid morning regurgitations. Doing what you can to prevent your dog from regurgitating is not just so you can avoid having to clean it up; regurgitation drastically increases likelihood of Aspiration Pneumonia. As noted above, Aspiration Pneumonia is the leading cause of death for dogs with a megaesophagus.
ASPIRATION PNEUMONIA (AP)
When food particles are inhaled into the lungs, AP can develop, and quickly, so it’s important to know the symptoms:
“Symptoms of aspiration pneumonia include breathing difficulties, swallowing difficulties, coughing, fever, discharge from the nasal passages, rapid breathing, increased heart rate, a bluish tinge to the skin (cyanosis), and a possible intolerance to exercise due to weakness. An altered mood, vomiting, loss of appetite, and regurgitation may also be present…”2
Watching your pet struggling through AP is difficult. While some ME dogs may have AP three or four times in their lives, the possibility of your pet dying as a result of AP is very real. This is why it is so important to do everything you can to eliminate risk of regurgitation.
If you determine that you cannot make the commitment your special dog requires, PLEASE do not have your dog put down. There ARE people who are willing to make the commitment your dog needs, and there are groups willing to help you connect with those people. To get assistance in finding a suitable home for your special needs dog, please contact your veterinarian, or local animal shelter and ask them for rehoming assistance. Posting in the Canine Megaesophagus Support page on Facebook is another great way to find a suitable home for your special dog.
However, if you are able to make the commitment to care for your ME dog, in return, you’ll experience a dog-caregiver relationship that is unlike any other. Now close to retirement, my husband and I have had the honour of having several rescue dogs spend the majority of their lives with us, and we were attached to each one of them. But our relationship with Zoey is so unique. Other ME dog caregivers have also shared that the relationship they have with their ME dogs are unlike any they’ve had before. Perhaps it’s because of the amount of time spent together with feeding and burping sessions, but many of the ME dog owners active in the support groups have described how their ME dog is a close companion, and is more affectionate and more in tune with them emotionally than any pet they’veever had before.
Please remember: You’re not in this alone – there’s a group of amazing people willing to help make your life with your ME dog enjoyable. I can tell you from personal experience that once you get over the initial shock and “What now?” period, and you look into the loving eyes of your ME pet, the commitment and time invested will be well worth it!
I hope this information helps you get started with your special needs pet, and I look forward to meeting you online!
-TA Smiley (“SmileyCrafts” online)
Credit for this information belongs primarily to the online members of Facebook’s Canine Megaesophagus Support Group and the online members of the Upright Canine Brigade, without whom I would not have the privilege of still having Zoey at my side as I write this.
Permission is granted to make copies and distribute this document in its entirety provided it is done so without profit.
