MEGAESOPHAGUS: What Pet Owners Need to Know About This Difficult BUT Treatable Disease

Megaesophagus in Domestic Animals

Megaesophagus (ME) is not typically a single disease. It is generally considered a combination disorder in which the esophagus, the tube that carries food and liquid between the mouth and stomach, dilates and loses its ability to move food into the stomach. When esophageal motility is decreased or absent, food and liquid accumulate in the esophagus and have difficulty getting into the stomach.

ME is a heartbreaking diagnosis, and one not fully understood in the veterinary community. But it is NOT an automatic death sentence. Some ME pets, with treatment, live long and happy lives. Others do not, unfortunately, despite tremendous care from their human parents, competent veterinarians, special diets, and a variety of medications and even supplements. Still others “grow out” of ME for reasons that are unclear. Importantly, in some pets, ME is caused by underlying conditions that are treatable and can completely resolve following treatment. 

Basically, when the animal’s esophagus is functioning normally, food in the mouth stimulates nerves that send signals to the swallowing center in the brainstem, which in turn stimulates the swallow reflex. Along the various nerve pathways, there are several places at which a malfunction can cause megaesophagus. Regurgitation is the most common sign of megaesophagus.

Regurgitation is NOT the same as vomiting, and a dog’s or cat’s regurgitation is often recognized by a thick, white foam. 

There are two types of Megaesophagus:

Congenital megaesophagus (born with the condition) is developmental and causes regurgitation starting at weaning, when puppies and kittens begin eating solid food. 

Acquired megaesophagus occurs later in life, in young adults and middle-aged animals.

Approximately 25% of dogs with acquired megaesophagus have myasthenia gravis. While the symptoms are similar to congenital myasthenia gravis, the cause, testing, and treatment are different. 

Obstructive disorders may cause megaesophagus by physically blocking the esophagus from functioning normally.  In these cases, the muscle and nerves of the esophagus are normal, but chronic distention directly in front of the obstruction causes muscle dysfunction.

Examples of obstructive secondary megaesophagus include:

Foreign bodies stuck in the esophagus can prevent normal swallowing.

Cancer in or around the esophagus can also partially block the esophagus. 

Vascular ring anomalies are caused by abnormal development of vessels near the heart. Fetal vessels that should disappear by birth remain intact, encircling and constricting the esophagus. 

 

Diagnosis

Pets with megaesophagus typically regurgitate food and water. Their food does not get into the stomach to be digested, so they do not get the nutrients they need. If they are young, this lack of nutrients causes poor growth and development.

If they develop acquired megaesophagus as adults, then they will lose weight. They may hyper-salivate and “gurgle” when they swallow. In some individuals, you can actually see a bulging of the esophagus at the base of the neck and touching that area may be painful for the dog. These pets may act hungry but then pick at their food or not eat at all, to avoid the coughing and gagging they associate with eating.

Additional symptoms of Megaesophagus may include:

Bad breath

Signs of pneumonia from aspirating food and/or liquid–fever, rapid breathing, abnormal lung sounds, coughing. This is called AP or Aspiration Pneumonia. It is very important to recognize these symptoms and to seek immediate medical attention for your pet, because while treatable with antibiotics, if untreated, AP can be fatal. And unfortunately, ME pets can often contract AP several times throughout their lives, even if an earlier episode was fully resolved. 

Muscle weakness and wasting from slow starvation

ME can be diagnosed with a simple x-ray but a more thorough one is done by a barium swallow study. If this is a new puppy or a rescue, and you don’t have a complete medical history, PRAA or Persistent Right Aortic Arch should be ruled out. This is a vessel coming from the heart that should have dissolved before the puppy was born but remains to strangle off the esophagus. There is a surgery to correct this anomaly. 

Other test modalities include:

Radiology: Megaesophagus is routinely diagnosed through x-rays. The esophagus is not normally seen on x-rays, but the mass of food and/or air can be detected, which may lead to a diagnosis. X-rays can diagnose megaesophagus but do not always determine the cause. 

Fluoroscopy: This test is similar to an x-ray but is performed in real-time during swallowing to assess the esophagus’ ability to contract. 

Other tests: Esophagoscopy (video scope into the esophagus), blood tests, tests for various neuromuscular and endocrine diseases, and muscle biopsies may all be used to determine the underlying cause of megaesophagus.

Best to Test: If ME came on suddenly and your dog was not born with it, it is always wise to test for an underlying disease that could have caused the ME. In about 25% of the cases, Acquired Myasthenia Gravis is the culprit. The thyroid should also be tested. Hypothyroidism is common in dogs and can cause ME. Addison Disease is called the Great Pretender and because of that, it is wise to test for it. There are many other diseases that can cause ME but they are the most common. You should blood test for all these conditions, to rule out or in, and there is treatment for each of these disorders. Many times, once the underlying/primary condition is treated, the ME becomes easier to manage and in some cases resolves altogether!

Responses and Therapies

Vertical Feeding: Gravity will be your friend with this disorder. A Bailey Chair is the easiest way to achieve this for many dogs but for some there are alternatives. Pet MD has an informative page on Bailey Chairs.

Baileychairs4dogs.com manufactures quality Bailey Chairs, as well.

Neck Hug: Elevation of the head is important for these dogs. When they lay down often times saliva will collect in the esophagus. It causes a dog to gag, cough and sometimes regurgitate the saliva back up and out. When you keep the dogs head elevated it keeps everything moving in the right direction. There are cloth, polyester filled ones on the market you can purchase. There are inflatable e-collars on Amazon and at your local pet store. Sometimes they are called “recovery collars,” and can work very well. They are not, however, a substitute for a Bailey chair, special diets and supplements as needed, and veterinary care. 

Food: We don’t recommend a specific brand of dog food here. Your vet may recommend a food that is low in fat contents, because fat is more difficult to digest. Your vet may recommend a prescription food depending on your dogs diagnoses. Food consistency is important to get just right, which does takes some trial and error, and perhaps experimentation. Some pets need a slurry (more on the liquid side); others need something thicker with a milkshake-like consistency. Others do well with dog food that is rolled in *small* balls. For this, have your dog point his nose to the ceiling and drop from above their head, one ball at a time. This way, they aren’t chewed but rather swallowed whole. More recipes and a free cookbook on the website: caninemegaesophagusinfo.com under Resources.

Water: Most but not all ME dogs have issues with plain water. But you can always add water to their food and blend it. Knox blocks, gelatin made with chicken or beef broth or other approved fluid, are often tolerated and very helpful to keep your pet hydrated. Another option is to add Thick-It, which you can find in your local pharmacy, and just add the recommend amount to water. Some ME dogs do well with water before or after meals, while they are upright. Others have found that using a hamster-style water bottle, attached high enough that the dog has to reach up to drink, will help. You can also have your vet teach you how to do sub-cutaneous fluids right under the skin. 

Medications: Some ME dogs do not require any medications at all. Here are some of the most common ones:

Metoclopramide, Cisapride and Bethanechol: These pro-motility drugs help stimulate the stomach muscles to move the food and fluid into the intestines faster. Bethanechol may have some effect in the esophagus.

Antacids: If your vet feels an antacid is appropriate, they may prescribe famotidine (Pepcid) or omeprazole (Prilosec) or another common one. Note that you should always speak to your vet about *any* over the counter medication before trying it with your pet.

Sildenafil: Often called “Doggy Viagra,” it’s used to help relax the lower esophageal sphincter (LES) is the muscle ring that leads to the stomach. This will help by allowing food and fluids to easily enter. It’s typically dispensed as a liquid at a certain time before meals. 

Complications:

Aspiration Pneumonia (AP) can occur when a dog inhales food or fluids into the lungs. If you see the signs of AP, it’s vital to act on it quickly. Signs will vary, but most ME animals will be lethargic, have irregular breathing, not eating, a fever, and may present with a cough or runny nose. It is important to get medical attention quickly to avoid a more complicated and costly visit at the vets. Generally, vets will do chest x-rays and blood work, and if AP is diagnosed, antibiotic treatment will begin immediately, meaning 2-4 weeks on one or possibly two antibiotics to completely clear the infection. Three-view x-rays of the lungs and blood work are generally repeated just before, or coming off of antibiotics. 

Esophagitis: Esophagitis can occur from acid reflux or repeat regurgitation or vomiting episodes. Small ulcers can form causing irritation of the esophagus. You might notice your dog gulping more, or refusing food. They might cough up the same telltale foamy substance. In this case, Sucralfate/Carafate is often prescribed to help soothe the esophagus. It should be given alone apart from food or meds, 1 hour before or 2 hours after food and meds, and helps by putting a protective coating on the esophagus. It comes in a soft tablet that can dissolve in a little warm water, and is then syringed gently in the cheek pocket of the mouth. It also comes in liquid form.

Gastroesophageal intussusception (GEI): This is a very unfortunate complication of ME. It’s important that ME parents are aware of it can have an informed discussion with your vet in the event it occurs. GEI can occur after a dog regurgitates or vomits repeatedly; their stomach telescopes or slides in the esophagus. There may be blood in the vomit, a typical sign that there is trouble brewing, and the dog will look distressed. It is an absolute emergency that requires immediate, emergency veterinary help. If you suspect GEI, call ahead to your vet and relate what you suspect is happening, because they may divert you to a clinic with more advanced equipment or surgical team. GEI can be surgically corrected, and the stomach tacked down at the same time to prevent further incidents.

ACKNOWLEDGEMENTS:  VCA Animal Hospitals, The Upright Canine Brigade, PetMD, The Merck Veterinary Manual online, Popeye Gaier

RESOURCES:

https://vcahospitals.com/know-your-pet/megaesophagus https://caninemegaesophagusinfo.com/    https://www.petmd.com/dog/conditions/digestive/megaesophagus-dogs  https://www.merckvetmanual.com/digestive-system/diseases-of-the-esophagus-in-small-animals/dilatation-of-the-esophagus-in-small-animals

 

 

 

Help Paws of War Save Sweet Troop!

Three courageous female soldiers in the U.S. Army – a Major, a First Lieutenant, and a Lieutenant Colonel, who are deployed in the Middle East found two helpless puppies abandoned outside their base gate. Moments later they knew they had to act fast to save the pups’ lives and reached out to us for help.

The two deeply bonded brothers huddled together scared and starving; all they had in the world was each other. Locals told the soldiers that animal control was coming for them in the morning—and that would seal their fate, but looking into their innocent eyes and adorable faces, our heroes couldn’t let that happen. The pups became known as Tanner and Troop, and they were running out of time.

But something was wrong. We suspected that Tanner was suffering from even more than the effects of being abandoned. Both pups were taken for veterinary assessment where it was confirmed their harsh beginning to life had taken its toll; both were also anemic and suffering with internal infections. Treatment began immediately, but Tanner was still struggling. After further tests he was diagnosed with a debilitating condition affecting him right down to his bones. He was in significant pain and his health was deteriorating rapidly, but despite everything, his little tail wagged his tail whenever he looked at Troop. Tragically, although all efforts were made to save Tanner, the toll on his frail body was too great. He wasn’t responding to treatments, and he couldn’t fight any longer. His young heart stopped beating and he passed away peacefully. Who knows what the outcome would have been if he had been loved and cared for the way he deserved instead of being abandoned.

The soldiers and our team are heartbroken, but no one more than Troop. He is lost without Tanner, and on saying goodbye to his brother, he ran around him, kissing him, not understanding why he wasn’t responding. He has become so sad and quiet, and looks every time a door opens – hoping his best friend is coming back. The news has been hard on everyone, but we must continue with the knowledge that Tanner got the best chance to make it, and he was surrounded by love. Now we must save Troop.

YOU CAN HELP!
Please make Paws of War part of your GivingTuesday donations!

https://www.pawsofwar.org/donate

 

Undercover Investigation: Stressed, Cruelly-Treated Animals Trapped in Mall “Petting Zoos” Including Woodridge, NJ

SeaQuest is the source of hundreds of animal abuse complaints

Keeping wild animals in small, bare cages inside a retail shopping mall is absurd and abhorrently cruel. Yet this is the business model of SeaQuest, a for-profit chain of shopping mall-based wild animal petting zoos that has been plagued with controversies and cited by the U.S. Department of Agriculture more than 110 times for violations of the Animal Welfare Act.  

SeaQuest peddles public interactions with wild animals such as sloths, sugar gliders, capybaras, coatimundis, kinkajous, wallabies and Bengal cats, as well as various fish, reptiles and birds. Customers grab, handle, pet and poke at these animals intermittently all day long. The animals have no access to sunlight or fresh air, no means to escape the loud, chaotic environment created by scores of adults and children coming in and out of SeaQuest facilities throughout the day, and no space or natural habitat in which to express their natural behaviors.  

Such an environment—at SeaQuest and other facilities like it—doesn’t teach people to respect and admire animals. It teaches them that wild animals are playthings to be toyed with for amusement. The Humane Society of the United States sent an undercover investigator to two SeaQuest locations to shine a spotlight on this cruelty and strengthen our broader push for an end to it. 

There is a an abusive #SeaQuest “zoo” in #Woodridge, New Jersey in addition to other locales 

Local animal activists are fighting to have this abomination CLOSED. We wish them luck!

PIXIES AND PAWS “RESCUE” IS JUST AN EXTENSION OF CRUEL PUPPY MILLS

Pixies & Paws, which sells animals from cruel breeders

FROM NEWS 12 NJ AND LONG ISLAND

Documents provided to Kane In Your Corner News 12 Investigative unit show Pixies and Paws, a self-proclaimed “animal rescue” based in New Jersey and serving the tristate area, purchased more than 160 dogs from commercial breeders in Ohio. The purchases were made during a three-month period alone. It’s an arrangement some consumer groups say means Pixies and Paws is acting less like a rescue and more like an online pet store.
In an investigation in May, Kane In Your Corner spoke to Jonisha Lewis about her experience adopting a dog from Pixies and Paws. She said the dog had such significant health problems that her veterinarian deemed it “unfit for sale”. “My son was crying,” Lewis said. “And he was just like, ‘Why? Why Is this happening? Like, why is he sick’?” Then there was the adoption fee – a whopping $1,500… which at first, Pixies and Paws refused to refund, although it eventually relented after Kane In Your Corner began investigating.
PLEASE DO YOUR RESEARCH BEFORE ADOPTING. NO REPUTABLE SHELTER OR RESCUE WOULD ASK FOR $1500, FOR STARTERS!

Help Smokey Make it to Stateside Safety — With the Help of Paws of War!

SMOKEY!

Saved overseas as a helpless two-week old kitten, Smokey wouldn’t have survived without US Army Sergeant Avery. With nothing overseas for Smokey when he returns from deployment, he can’t bear the thought of leaving sweet baby Smokey alone to suffer. With your help we can get this vulnerable girl safely to America where she can have a happy future with her hero and his family!

Our War-Torn rescue team is in action to rescue Smokey and bring her to safety in America, and we need your help.

A kind donation today will help us get Smokey closer to her safe happy life with her hero and his family, where she will never have to suffer again.

Help Smokey make it to Stateside safety!

https://www.pawsofwar.org/?form=SmokeysRescueMission

Rhett! Playful and Affectionate Golden Doodle Looking for his Forever Family!

Meet Rhett, a playful and affectionate 2-year-old Golden doodle looking for his forever family! ❤️🐾
Rhett is big-hearted, full of energy and needs a home where he’ll get plenty of time, attention, and love. Rhett would thrive with an experienced handler and in a household with children 16 and older, as he’s strong, smart, and always up for adventure. His favorite activities? Long walks, playing ball, and soaking up the outdoors. Treat-motivated and quick to learn, Rhett will make an amazing companion for someone ready to embrace his joyful spirit.
Rhett is available to veterans, first responders, and Gold Star families and is waiting to bring endless fun and loyalty to the perfect home.
If you’re interested in adopting Rhett, click the link below!

Help Paws of War and Staff Sergeant Hope Save Sweet Gizmo!!

As a violent storm battered an American base in a desolate part of Africa, U.S. Army Staff Sergeant Hope heard a desperate cry outside her door and when she looked out to investigate, a terrified kitten – Gizmo – rushed in and went into hiding. That was the moment she knew she had to act to save the vulnerable cat and reached out to Paws of War for help. Gizmo was abandoned near the base and with nothing around to survive on, her condition rapidly deteriorated. Staff Sergeant Hope and some other soldiers had been doing what they could – making a tiny lean-to for shelter, and sharing their food, but in a very remote area there wasn’t much available to them to help a struggling cat. Gizmo cowered in the makeshift shelter – afraid of the many predators lurking, and would only come out when she heard SSG Hope who she chose as her person. The sweet cat was so thankful to have someone be kind to her that she would bring gifts of bugs, leaves, and pieces of trash – all she could find to say “I love you” to brighten her hero’s day. In turn SSG Hope found comfort in having the little cat around but while she makes her smile, she can’t take her mind off the worry of knowing Gizmo can’t make it on her own when she returns Stateside and the fear in the young cat during the storm served as a reminder.
Aside from predators, other starving animals, the daily activities of an active military base and constant moving of heavy vehicles, the brutal weather conditions claim the lives of animals daily. Temperatures routinely reach more than 100 degrees through the day and torrential rains during storm season cause severe flooding and life-threatening destruction. There is nothing for homeless animals, and no way to keep them safe. Staff Sergeant Hope is a hero who has selflessly served our country for over a decade; spending many months at a time away from her family and she has never asked for anything, until now. All she is pleading for is help to save the life of the loving cat who became her best friend and a source of joy so far from home.
Our War-Torn Pups and Cats rescue team is in action as we speak – handling the complex logistics of a rescue mission to such a remote location, alongside complying with extensive CDC import requirements, but to save any of the animals who need our help, we need you beside us. Together we can get Gizmo out of harm’s way.. A kind donation of even just a few dollars today will make it possible to get her to the love and safety waiting for her with SSG Hope here in America.

New Jersey Politicians Kill Another Good Animal Shelter – and Lots of Animals

MOST ANIMAL SHELTERS IN THIS COUNTRY ARE PART OF A BROKEN SYSTEM, ONE THAT HURTS INNOCENT, HOMELESS ANIMALS MOST OF ALL. BUT IT ALSO HARMS HEROIC STAFF AND VOLUNTEERS.

NEW JERSEY IS ONE OF THE WORST OFFENDERS.

Last year, the genius politicians of JerseyCity suddenly ended the contract with @LibertyHumaneSociety, and its team that many other shelters and rescues have very happily worked with for years. Still, the hiring of a new director, staff, and new procedures designed for the animals’ benefit heralded the possibility that things would actually work out. It wasn’t to be. When a dog attacked and seriously injured the new boss, bureaucrats who know nothing about a shelter or animal welfare, and even less about leadership and common decency emerged, once again throwing a promising start into turmoil.

https://jcitytimes.com/animal-shelter-morale-sinks-after-manager-is-bitten-hospitalized-fired/

Help Get Justice for Starved Doggy!

Sweet Elmer, Starved to Death in Tennessee

In February of this year, a Selmer City, TN woman brought a horribly emaciated dog to a rescue group, claiming that the dog had been abandoned at her house. The rescue immediately rushed the dog, which they renamed Elmer, to an emergency veterinary clinic.  Sadly, despite all their efforts, this poor, sweet Great Dane died.

The Guardians of Rescue sent Elmer’s remains to a pathology lab to determine an exact cause of death. The results of Elmer’s necropsy were shocking and heartbreaking. While Elmer suffered from intestinal parasites and heartworm disease, the official cause of death was starvation–a painful, excruciating way to die. It was later determined that Elmer had, in fact, been living with this terribly cruel and heartless woman since 2020.

The Guardians of Rescue’s investigation showed that this lady was the owner of Elmer, and responsible for his gruesome death; in response, the Selmer City Police Department charged her with one count of animal cruelty and ordered her to rehome any animals in her custody.  Based on her history of breeding Great Danes, the presence of a heavy intestinal parasite load, heartworm disease and the intestinal obstruction that caused Elmer to die a slow, agonizing death by starvation, we believe she should be prosecuted to the fullest extent of the law.

No matter where you live or whether or not you own a pet, we ask and encourage you to SIGN THE PETITION TO GET JUSTICE FOR ELMER – PLEASE!  The only deterrent we have to these horrible, cruel crimes is to hold the criminals accountable!

(The Guardians of Rescue is a registered 501(c)3, not for profit organization whose members work tirelessly to work to protect the wellbeing of all animals and come to the aid of those in distress. We are all about People Helping Animals and Animals Helping People.)

Megaesophagus: Deadly Doggy Illness the AVMA Needs to Do Better On

MY BABY POPEYE

On February 13, 2023, I said goodbye to my Popeye, the most loving, gentle, and sweet doggy I’ve ever known. I had to help him across the rainbow bridge that day, with the aid of Dr. Sara from Lap of Love, because he was suffering terribly from a disease that is woefully under-studied (is that a word?) in the veterinary medical community.

Popeye’s downward spiral began last October, when he started coughing for no apparent reason. He was diagnosed then by his regular vet with “simple” lung inflammation, and treated with antibiotics and steroids. But he didn’t get well, so we went back, and upon re-examination and more X-Rays, he was diagnosed with full-blown pneumonia, and put back on a course of stronger antibiotics. He seemed to get better, and I was relieved.  Sadly, on December 2 he had a terrible fit of coughing and threw up a strange white foam. Unlike vomit, it contained no food residue, was bright white, and so thick that paper towels couldn’t mop it up. But he was diagnosed again with pneumonia, probably “aspiration pneumonia” which results when food particles get into the lungs. After spending a very difficult day in the ER, the vet there said he needed hospitalization, and off we went. He spent two nights and two days there on IV antibiotics and fluids. Happily, the hospital called, said he was eating small amounts of food and keeping it down, and was cleared to go home. I picked him up, his tail was wagging, and once again I was relieved…and exhausted.

But I still had no diagnosis as to what had caused his newest symptoms. Fast forward to early January, and Popeye was once again retching up that white foam at least every other day, and went back to the ER. There we saw a different vet, who ordered yet another (now the 3rd) set of chest X-Rays; she told me he had AP pneumonia again, and was put on antibiotics.  She also said she was referring us to an internal medicine specialist, who actually wouldn’t join the practice until the following week.  So nine days later, my baby and I went back…again. After several hours including an examination and a review of his previous X-Rays, the Internist told me that Popeye had Megaesophagus (ME), a disease that can be very hard to treat and often has poor outcomes especially in a senior, as Popeye was. I was gobsmacked. The doctor strongly suggested we test my boy for Myasthenia Gravis (MG), which can cause ME, but two weeks later–the blood sample had to go all the way to the west coast (honestly, no other lab?)–the results were negative. That was actually a letdown, because MG is evidently more treatable. And the blood tests also showed no thyroid problems, which can also cause ME. His illness was “idiopathic”– no known cause.

I was despondent but determined to do everything I could to manage this thing and keep him with me. The vet had recommended giving him liquid Sildenafil, literally doggy Viagra, before meals, which in some pups is thought to help manage ME.  I tried giving it 30, 15, 10, and 5 minutes before, but in almost every case he still regurgitated, sometime as much as 2-3 hours after eating. Another recommendation from the Internist was a “Bailey Chair” which I bought online, and assembled using my very meager mechanical skills. Bailey chairs keep the pup sitting upright while they eat and for some time after, allowing gravity to do its work moving the food through the esophagus into the stomach. But I just couldn’t get my stubborn boy Popeye to sit in it without forcing him, which I could never do.  One other thing I noted in my research was that some ME pups have Persistent Right Aortic Arch (PRAA), but that’s a congenital problem that would have showed up years earlier, and he wasn’t a candidate for surgery in any event.  

In the end, my sweet boy couldn’t keep anything down–he started regurgitating every single meal. He’d always loved to eat, but now wouldn’t even approach his food bowl. Then he even stopped drinking water. He wouldn’t leave the apartment, which he’d always loved, too, and just splayed himself on the couch, sleeping and exhausted. Not knowing what to do, I arranged a video call with a Hospice Veterinarian, also through Lap of Love, and after an hour conversation and a 35-question evaluation, we decided that his quality of life was very poor and it was all but impossible that it would improve. Popeye was at least 13, and had other health problems when I adopted him, including Horner’s Syndrome on the left side of his face, which already made eating more difficult. And now he was just worn out, and his body had given up, though I’m sure his spirit was intact. I knew I had to let him go.

It was the most painful decision of my life. And it still hurts. I hate this damn disease. And I am angry that he presented with symptoms, including loud, retching regurgitation of the telltale white foam of Megaesophagus right in front of three different vets, two of whom were happy to take thousands of dollars in treatments from me but with no diagnosis. Not even a mention of the word, which is also indicated by the aspiration pneumonia he had three times.  Even the internal medicine specialist who finally diagnosed him never mentioned a half-dozen drugs and supplements other humans are giving their ME pups with often good results.

I don’t want to be harsh but I think the veterinary medicine community needs to get its act together far more on this terrible disease, which is suddenly and mercilessly taking the lives of otherwise healthy pups, young and old alike.

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If you want more information about ME:

There is a wonderful support group on Facebook with kind, knowledgeable people who have ME pups or have lost them; more information here from PetMD.