NOTE: This is for long time, experienced ME people and newbies.
When the picture changes, we recommend going “back to square one” and reviewing everything one factor at a time.
I wrote this in response to many posts about frequent regurgitation and questions about feeding amounts. The two are necessarily very connected: Your dog will ultimately tell you how much to feed. Start with a volume that is about 1/4 to 1/3 of what a feeding used to resemble, regardless of type and consistency. PLEASE CONSIDER abandoning the “elevated” feeding and go to vertical feeding and sitting. Every week I hear directly from folks who made this change (if they didn’t already use it from the beginning – many DVMs are becoming familiar with this process and recommending it upon diagnosis) and if gravity is the
problem, they report huge improvement with how much and how often their dogs are regurgitating. A spunky Italian Greyhound may take a bit more patience in training him to accept sitting still for this, so you may have to hold him upright or even use a baby Snuggli for a few weeks before transitioning to the chair, but in the long run, it will pay off.
I know that we are all eager to get a bit of weight on these dogs. However please know that the only “good food” is first and foremost that which stays down. Weight takes a while to put on, unless you are a human female (then it seems to happen automatically-giggle). It takes food, time and exercise. And anything that risks aspiration pneumonia is not a good thing. One thing at a time.
Bailey has regurgitated a bit on more days than not for ten years. And a year or two was actually on a weight loss regime to lose five pounds that crept up on him. We just reduced his five feeding amounts by about 1/5 and added some very low sodium chicken broth. Grandma feeds him during the day, and it was easier to do it that way than to reduce to four feedings. (Dogs and seniors thrive on routine.)
So – regurgitation “happens” and you will soon learn if your dog is one for whom this is normal, and what is normal for her. It should not be a huge portion of the meal,but this does happen occasionally. We’ve had it happen on memorable occasions at hospital therapy dog visits as well. Another story….
Factors to consider for regurgitation issues:
1. Vertical feeding is the mantra. If you think your dog won’t adjust, get over it. Your attitude is key. Failure is not an option. Hire a trainer for one or two home visits if you need to. Arthritis or bad hips are generally NOT much of an obstacle. Adjustments can be made. Size of dog is NOT an obstacle. We could do this with a Clydesdale if need be. I’m serious.
2. Nothing by mouth unless dog is vertical or you get her that way immediately afterward. NO water, pills, treats, food. Only kisses. “Rabbit cage bottles” give me shivers. Risky. If later you find this works for your dog, great. Don’t risk it early on – it is courting danger.
3. Proper food consistency. Trial and error. Liquefied or meatballs swallowed whole? (Some – ONLY A TINY PERCENTAGE) can do okay with other types, but DON’T DO THIS AT FIRST — TOO RISKY! Particles cling to the esophageal walls and irritate – more regurgitation. How is that going to be cleared out of the esophagus if it is not moving down?
4. Too much food at once! Cut the volume down and increase the number of feedings. You’ll eventually figure out how much and how often.
5. If your dog doesn’t handle liquid well, try the Knox blocks or ask your DVM about subcutaneous fluids.
6. Inadequate “vertical” time. 15 – 30 minutes or more should do it. Some need more.
7. Bacterial overgrowth, such as helicobacter pylori, may have a huge effect on regurgitation. If other causes are ruled out by your DVM, ask to put your dog on a course of triple therapy to see if this cuts it back (amoxicillin, metronidazole and carafate, or another accepted protocol for IBD, SIBO, ARG – Antibiotic Responsive Gastritis). It usually will help within about three days if that is the cause. This can be the case with newly diagnosed dogs or much later. We seem to need to do this for Bailey about once a year. There are tests, but not really worth it in my humble opinion, generally. I think it may cost more or as much as the treatment. If the treatment works, you have your answer. If your DVM disagrees with me, follow her or his advice but let him or her know that this has been proved several times with our group and stress that it is a good, noninvasive way to find out. If not, or if other causes are not ruled out, you may need to have an endoscopy done first.
8. Regurgitation increases esophageal irritation, so it may “beget” more regurgitation. Generally our dogs should be kept on medications reducing the production of acid, such as Nexium or Prilosec and/or Pepcid. Reglan and Cisapride helps many, not others. For still others, it may make regurgitation worse, but not often. Motility drugs do not do anything to the esophagus. That is not moving. It helps the stomach empty faster to allow drainage into it from the esophagus.[Note added by Dr. Kathy – esophagitis/gastritis can also cause regurg. Liquid carafate (sucralfate) acts as a bandage to heal these. Must be given 1 hour before or 2 hours after food or medicine. Can only be given w/ water, not broth, etc.)].
9. Do not make changes quickly, without close observation. We find that people who do this can seldom find cause and effect. These dogs have good days and bad days, and you need to study them and keep a diary to see what is really going on. Changes should be made slowly and be circumspect before deciding on cause and effect. Try to change one thing at a time to be sure what is going on. Keep a diary!!!
10. Communicate with your veterinarian! While not all have had much experience with dogs with megaesophagus, that is changing. Most of them are willing to learn along with you and will go with what seems reasonable. He or she can always check online, contact Dr. Kathy, and is always free to call me if they want to. If your DVM is not open to suggestions or seems not to have the time or inclination to do much other than recommend euthanasia, sometime even before your dog is suffering (just pessimism), you may need to look for another DVM. Most are NOT like that! Your DVM is your greatest resource. We (other than Dr. Kathy) are not veterinarians! And even Dr. Kathy cannot treat your dog (unless you are in the Detroit area or close to it).
11. If your dog seems “off” and is refusing food, seeming ill, or you are not comfortable with what you see, go to the DVM or emergency if during off hours. Aspiration pneumonia can kill your dog, especially if you are not “on it” within a few hours.
12. If you are already doing all of this and your dog is STILL having problems, consider a feeding tube. These save lives and are MUCH MORE MANAGEABLE THAN YOU MAY THINK. Some are temporary and can get your dog back on oral feedings. Some may be permanent.
13. Always keep in mind that megaesophagus may be secondary to another disease or disorder, and at times you may need to follow up with this. This is especially important with older dogs, but can be the case with younger ones. Recent surgeries, vaccines, neurological problems autoimmune diseases, cancer, and other diagnoses may be the cause. Sometimes if those are controlled or resolved, the problem may disappear. Not often, but we hear of it regularly. I would not have guessed ten years ago that it happens as often as it appears to, but still the minority.
14. Define what “success” may be in your case. From giving your puppy a near-normal, happy life to helping your older dog with cancer have a more comfortable last few months, and everything in between. Be honest with yourself.
15. Consider whether adding a holistic DVM to your dog’s regime may be helpful. It usually is.
16. “Treats”?! Fuhgeddaboudit! Learn to offer rewards such as a toy, a taste on your finger, but only a smell or a flavor. Not much of a treat if you put your dog in the hospital because it stayed in the esophagus and eventually ended up in a lung. Get creative. Having your dog with you to play, to see that tail wagging – that is both your “treats” and his.