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


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 I’d never even heard of until January, even though I was raised with dogs and had been volunteering around them for years.

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.

Review of The Farmer’s Dog: JUNE 2022 UPDATE!

JUNE 24, 2002: After over a year of using The Farmer’s Dog (TFD), these are my experiences, on top of what I said last June, below.

Popeye seems to really like it, and typically gobbles it down…but in the past he gobbled down his kibble, too, as well as the chopped Salisbury steak I put on it at dinnertime when I was still feeding him kibble.  Currently, he gobbles down Blue Buffalo Beef Stew just as happily, which I now sometimes substitute for TFD, and sometimes I mix in, half-and-half. This is an experiment, and it seems to work well.

Irrespective of inflation, TFD is, well, absurdly expensive: about $170 for just three weeks of food, for a 52-pound, very-low-energy senior pup. Yearly, this is about $2,900!  This is more than I spend on food for myself!  And if you have a 70-pound 2 year-old Lab, I can’t even imagine what that will cost you.  For the vast majority of pet-owned humans (he owns me, not the other way around), this is simply impossible. And in this economy, even more so.

The Farmer’s Dog markets itself deceptively as “fresh.” It’s not. The 21 plastic tubes of food arrive frozen, rock solid, and have to be stored in the freezer, meaning the last few have spent the better part of a month frozen. Each day I have to plan ahead to ensure the next tube is thawed in time for my boy’s meals at 8:30 a.m. and 5:30 p.m. Even when thawed, they’re sometimes difficult to get cleanly out of the tube, and even harder to truly portion them at 50%. I do my best, but oftentimes I have to pop them in the microwave, which makes the food slide out easier, but of course you have to be careful not to cook it.

So you ask, quite rationally, why not switch to something else? Well, I looked at five other “fresh” dog food services, including Nom Nom, Ollie, Fresh Pet, Just Food For Dogs, and Pet Plate. They all say they’re designed by veterinarians, and composed of “human grade” ingredients (Nom Nom says “restaurant-quality” whatever that is. But I’ve eaten restaurant food I would never give Popeye).  They all typically offer a discount, often 50-60% of your first order, but many are for only two weeks, and then you zoom right up to full price. I can’t find any that will give you a quote without giving your email. And when I went through the process of checking out three of the others, one was slightly less than TFD, one was the same, and one was even more than $170 for three weeks! And it’s very difficult to find genuinely objective comparisons, especially on price; so many “reviews” are really sponsored by one of them.

And I understand why, but the volumes of the four different Farmer’s Dog recipe are very different, because they’re based on calorie density and not volume. Initially I was getting Popeye the beef, pork, and chicken formulas, but the beef and pork formulas were noticeably and measurably smaller in volume. Even if they provided the same number of calories, the smaller portions weren’t sufficient for two full meals for Popeye, and I had to switch to chicken and turkey only.  And while all the formulas contain a lot of moisture, and once they’re thawed, unlike canned wet food, you’re getting even less.

SO–we ALL adore our dogs and cats (and gerbils, guinea pigs, ferrets, parrots, snakes, turtles…) and want the best for them. And let’s face it, mealtime for animals is often the highlight of their day. IF you can afford one or the other, it might make perfect sense. For the vast majority of American households, though, they’re probably out of reach.


June 16, 2001: After reading Big Kibble, “An inside look at the shocking lack of regulation within the pet food industry, and how readers can dramatically improve the quality of their dogs’ lives through diet,” I decided to look into what options I have for feeding my beloved rescue pittie Popeye, genuine human “food-grade” meals.

I’d seen a cable TV ad recently for The Farmer’s Dog, which promised “Smarter, healthier pet food, real food, made fresh” so I looked into it. Here’s what I found.

The Farmer’s Dog is a subscription service, similar to many meal delivery services going, such as Freshly (as opposed to meal “kits” that require some actual prep, such as Hello Fresh). Its introductory offer was $55, and got me (well actually got Popeye) what was billed as 14 days of food, with enough for two portions a day, each day’s food in a single plastic pouch. If my sweet boy liked it, I could continue the subscription, but for quite a bit more– about $165 for 21 days.  Before the trial subscription, I answered questions online about Popeye, including his age, weight, breed, and activity level, and their system calculated what was supposed to be the “correct” portion size that corresponded to a specific calorie count–but neither was divulged to me at that time. I did get to choose three meal types out of four–beef, chicken, turkey, and pork. I chose the first three.


Five days later the insulated box arrived.  Inside were 14 sealed plastic packages, very cold to the point of being frozen via dry ice in the bottom. Inside the plastic, the meals look like some kind of mushy stew, identical in most ways except for a difference in color based on the different types of meat.  So, I opened a package of the chicken-based meal and squeezed out a bit more than half, the best I could, into his bowl. It’s actually difficult to get the food out unless the package is fairly thawed, but then it comes out easily. And it definitely looks more palatable out of the package.

Over the next couple days as I fed Popeye twice a day, it was apparent to me that the portion size was probably a bit insufficient, and I needed to go partially into a second package for his dinner.  He did seem to love it, and enthusiastically cleaned his bowl down to the metal except once. And I tasted it myself; it both smelled and tasted good, like “people” chicken, which was a welcome change from the canned wet food and dry kibble I’d been feeding him. I’ll taste the beef and turkey this week.  After squeezing it into his bowl, I fluffed it with a fork each time, which increased the volume and improved its appearance (not that my boy cared).

So now I addressed what I felt were probably insufficient meal sizes for a 55-pound dog, and eventually got a response to my email from “Hans.”  I found that they’re slow in responding, and after my email I immediately received an automated reply saying “Thanks for reaching out. We’re currently experiencing a high volume of inquiries.”  I guess that means business is good, but as a customer, it wasn’t thrilling.  I can always get a human at Chewy, by contrast.

The Farmer’s Dog food for Popeye

I eventually had a detailed email exchange with Hans, originally asking him to double the portion size. After reflecting on that, I opted for increasing it instead by 50%, and when the price was recalculated, was notified “Your new 21-day plan averages $59.59 per week or $189.52 (including tax) per delivery.” That’s $9.02 a day including tax, probably more than I spend to feed myself at home.

Now, please follow me here, as this was a learning experience. After another day of seeing how much Popeye would eat, I finally (I hope) opted for just a 15% increase over what their system originally calculated, for his next full, three-week order.  The new price with the 15% increase in food is $172.26, $8.20 per day. Again, probably more than I spend on myself unless I go out to eat. Popeye continues to gobble his meals enthusiastically, and he’s left a little bit in the bowl a couple times.

So, in general, I give TFD a positive review, except for the cost. Of course, nothing is too good for my Popeye, as I was not thrilled about feeding him kibble and canned food, and absolutely determined to find him something better. This certainly is far better. So, if you can “stomach” the price, give it a try!

One caveat, and this was not made clear to me at the time of the order, and not apparent on the Farmer’s Dog website, you must FREEZE, not refrigerate, the meals except perhaps for the next day’s portion.  I’m hoping the pouches that are left, which I just moved hastily to the freezer, are still good. I guess I have to sniff and examine them carefully after they defrost.  I just sniffed and tasted tonight’s dinner and it was fine. And he wolfed it down!