Bear is sitting in a Bailey chair for vertical feeding, to help get food to the stomach. Photo by Dr. Sherri Wilson.
My dog has a problem with his esophagus, the tube that connects the mouth to the stomach. Normally the workings of the esophagus are not even something that you and I or your dog have to think about, as muscle movement in the esophagus is one of those automatic things that is carefully coordinated when we eat or drink. That way, food and liquid go right down to the stomach in less than a few seconds.
But when the motility (muscle movement) in the esophagus is not working correctly, food and water don't make it easily down to the stomach. Instead, they sit in the esophagus, usually for minutes but sometimes it can be for many hours. When the dog changes position, such as just jumping off the couch, the food or liquid comes out.
How it comes out is interesting; well, it’s interesting when it’s not on your carpet! We call it regurgitation, which is different from vomiting. Regurgitation is passive, meaning that the material comes out because of a shift in position, which sends the food/liquid sitting in the esophagus out through the mouth, surprising everyone.
This differs from vomiting, which know is coming because the brain coordinates it: first there is nausea (drooling, hanging of the head, licking the lips), then the abdominal contractions and the retching sound, then the material comes up.
Most of the time, what you see your pets doing when they’re sick is vomiting; they retch first, then bring something up. Maybe one percent of the time what you’re actually seeing is regurgitating: it’s this passive ‘flying out of the mouth’ business with no retching first. It makes a big difference to what we think about where the problem is, so be sure to tell your veterinarian if you see regurgitation and not vomiting so we can focus on the esophagus.
Note that if you just find the puddle of vomit on the ground, you can’t tell how it was brought up. You have to see the dog vomit or regurgitate to know which is which, or you could hear the dog retching, and then you know that you’re hearing vomiting.
When the esophagus has completely lost its motility (its ability to contract its muscles), it widens or dilates with air. We can see this on x-rays, and it’s called megaesophagus.
This is my SECOND dog with megaesophagus. Say what? What did I do in a previous life that prompted this?
The first dog had an underlying disease that caused it, a disease called myasthenia gravis that developed when he was two years old. That is a rare disease where the immune system wipes out the junction between the neurologic system and the muscles.
If the neurologic message (the electrical message in the nerves) is a boat, it needs to dock at its receptor in the muscle to be able to send its message. But the immune system has destroyed a lot of the docks, so the boat circles around trying to find a dock to connect with. When it finds one, the message is given to the muscles, and they move. Myasthenia results in a lot fewer docks (receptors), so the muscles don’t contract well. Sometimes they just contract in the esophagus, sometimes in all the leg muscles as well.
To get the food down to a dog’s stomach, one option is to put a feeding tube in the stomach so we can squirt a liquified canned food directly in there.
Another option is called vertical feeding: taking advantage of gravity to try to move the food from the mouth down to their stomach. If you hold the dog up in a vertical position for 30 minutes after being fed, this helps get the food to the stomach and avoids over-stretching the esophagus.
When food or liquid sits in the esophagus, the dog loses a lot of weight because the esophagus can’t absorb the food to be used for nutrition. In addition, food or liquid sitting in the esophagus will be regurgitated throughout the day, which not only makes a mess in your house, but each time the dog regurgitates he could aspirate (e.g., the food or liquid could slide into their lungs, causing pneumonia).
If we can keep them going, myasthenia gravis will spontaneously stop within several months. That’s what happened with my little dog: after eight months of feeding him through a tube four times a day, he regained the motility in his esophagus. His immune system had stopped its destruction of the neuromuscular docks, and he hadn’t developed permanent over-stretching of his esophagus because he’d been fed through a stomach tube. He never had that disease again for the rest of his life, which was another 11 years.
It was a challenging time. No, that’s an understatement. Squirting a canned food through a small diameter tube tests your patience in ways you have no way of understanding until you do it. You find out what tiny fragments of ‘stuff’ are in canned food that you paid no attention to previously. Despite adding water and putting the food/water in the blender, these little fragments obstruct the syringe/tube and it explodes off the tube as you’re pushing it. About the 500th time that hits you in the face or hits the ceiling above you, you begin to question the choices that led you to this point in your life. So to say it was a MIRACLE when it went away is also an understatement.
Now five years later, we have another little dog with a megaesophagus. Really. My husband and I froze in horror when he regurgitated one day. Seriously, we’re not bad people: did we really deserve this? We’ve been down this road before and this time there was no underlying disease that could be found. This is likely to be his story for the rest of his life. Our shih tzu, Bear, is only seven years old, so we could be doing this for many years.
We first put in a stomach tube that worked well for the first six months, but then it broke and the replacement tube fell out repeatedly, and the tract from his stomach to the body wall sealed up for good; unfortunately that was that. We could have started again with putting in a new tube, but decided to try feeding him vertically in a Bailey chair.
Bailey was the name of a big dog who had developed megaesophagus as a puppy. His devoted owners developed a wooden stand for him to sit in to eat and then rest afterwards, allowing him to be fed vertically for 30 minutes without the owners needing to physically hold him up.
At the time, this challenged the prevailing advice in veterinary medicine, which was to give water and food from an elevated position (e.g. feeding the dog with the bowl on some steps). This elevated position is not NEARLY as effective in moving food/water from the mouth to the stomach as is a vertical position, like in the Bailey chair.
For years, Donna Koch (Bailey’s owner) and her husband have made available advice in measuring and assembling a Bailey chair for individual dogs, all for the price of shipping a DVD or VHS with the instructions. These plans are still available; check out the active Yahoo Megaesophagus Group that is co-moderated by a veterinarian; it is highly recommended. Having a dog with a megaesophagus can be stressful and there’s no need to go it alone. Also, there are now commercial web sites that will assemble a chair for your dog based on measurements you provide, which is what we did. Given the speed at which we were getting around to building one ourselves, it would have never happened, plus it would have splinters.
There are also many creative solutions for vertical feeding, depending on the size of the dog, e.g. putting the dog in a Exersaucer, a baby jumper, a baby backpack, a white construction bucket with towels stuffed around the dog, in a baby Bjorn front baby carrier, etc.
It took a few weeks for Bear to get used to the idea that he needed to stay in the Bailey chair. That required a combination of sitting next to him giving him meaningful looks, followed by quieting him if he was wriggling to get out. It helps to use the beach towel to make him feel more wedged into it.
For the most part we can now walk around in the kitchen while he’s in it, still giving occasional meaningful looks and praising him for being such a good boy to stay there. The other day, I actually forgot him in the Bailey chair and left the room to do something else. After an hour and 15 minutes, I happened to come back and there he was, still sitting in his chair! He got a lot of praise that day.
Our other dog, Buster, is a pit bull. He is highly skeptical of the Bailey chair. It’s fine when it’s empty, but if Bear is in it, Buster acts like it’s the electric chair and will not come in the house even though he would never fit into this tiny chair. He skulks outside the dog door until Bear is out of it.
It may be harder now to explain to a pet sitter what this vertical feeding is all about, but living with a dog with a megaesophagus is very do-able. But please, I don’t need a third one…
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