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.
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 [email protected].
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.
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.
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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:
http://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.
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:
http://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 flavor 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
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 unflavored gelatin and it’s much cheaper than buying boxes of Knox envelopes!)
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 flavor 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 unflavored gelatin OR 3 heaping tablespoons of bulk unflavored 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 unflavored 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.
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 colorfast (most are these days). Spray a small amount on the carpet, wait a moment, then blot it with white paper towel. If any color 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 pet anything 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
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 colorfast (most are these days). Spray a small amount on the carpet, wait a moment, then blot it with white paper towel. If any color 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 pet anything 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
Megaesophagus in Dogs
by MeadowsVetClinic
The esophagus is a muscular tube that connects the mouth to the stomach. In the condition known as megaesophagus, the esophagus is enlarged with loss of the normal ability to push food toward the stomach. The diseased esophagus is like a deflated balloon; it passively collects food and water until it can take no more, at which point the pet regurgitates all that was just swallowed.
Megaesophagus is seen most often in dogs, but can occur in cats as well. Some pets are born with this condition while others develop it later in life. Some dog breeds that seem predisposed to megaesophagus include: Miniature Schnauzers, German Shepherds, Dachshunds, Great Danes, Irish Setters, Labrador Retrievers, Pugs, and Shar-peis.
Symptoms of megaesophagus include: regurgitation (the expelling of food/water without retching or abdominal effort), changes in appetite, excessive drooling, nasal discharge, or vomiting (the forceful expulsion of food/water with abdominal effort). Megaesophagus makes pets more prone to aspiration pneumonia which can lead to coughing or harsh breathing sounds.
Causes of megaesophagus can include:
- Idiopathic or congenital disorder
- Neuromuscular disease such as myasthenia gravis, distemper, or myositis
- Tumor or foreign body within the esophagus
- In many cases, the underlying cause is not found
Diagnosis of megaesophagus starts with a thorough medical history and physical examination by your veterinarian. The questions your veterinarian will ask you are aimed at determining if your pet is regurgitating or vomiting (this seems like a small distinction, but is important in ruling out underlying diseases). The shape of expelled material, presence of undigested food, and length of time from ingestion to expulsion are things that you should make note of at home. Routine laboratory tests to evaluate the cells of the blood and organ function are often normal for pets with megaesophagus, but these tests are important to perform to address underlying disease or aspiration pneumonia. Xrays of your pet's chest will often show an enlarged esophagus filled with fluid, air, or food. More advanced imaging with endoscopy is sometimes needed for diagnosis of megaesophagus, removal of foreign bodies within the esophagus, or biopsy of tumors.
The main goal of megaesophagus therapy is to address the underlying cause if there is one. Dogs with megaesophagus often require life-long therapy, commitment, and patience. While some pets can be managed, many carry a poor prognosis depending on severity of symptoms. Some animals may die due to complications such as aspiration pneumonia.
It is important that dogs with compromised feed intake are meeting their daily nutritional requirements. In order to have your pet take in enough calories, work with your vet to find a tasty, high calorie, low volume food (which may need to be blenderized into a slurry or softened to make it easier to keep down). Exactly what to feed is sometimes a matter or trial and error. Each patient seems to have an ideal food consistency, which can vary between individuals.
Your pet will need to remain erect while eating or drinking from a elevated position for 15 to 20 minutes- gravity will help the flow of food from mouth to stomach. This can be accomplished by use of a "Bailey Chair"- this is device that will allow your pet to sit upright during and after a meal. Scroll down to see an example of a pet in a Bailey Chair.
To optimize nutrition, you will likely need to feed your pet multiple, small meals throughout the day. You will need to prevent the pet from having access to food and water outside of monitored feeding times in order to help prevent aspiration pneumonia.
You should weigh your pet routinely to help keep track of body condition.
Aspiration pneumonia is life-threatening and may necessitate hospitalization, oxygen therapy, and/or antibiotics.
