March 2008 Archives
Well, I have to admit that I never, in a million years, thought I would be creating a blog. I have various reasons for feeling this way, although, primarily, I don't tend to be very public about my life. One day last week, however, my husband mentioned that he was being encouraged to blog. How silly! We talked about what we possibly could have to say that anyone would ever care to read. Then we looked toward our dog, Hobbes. Hobbes is unique in so many ways, and his presence has changed our lives, for both good and ill. I thought, perhaps, someone would find our life with Hobbes useful, and maybe even interesting.
So, this first entry is an introduction to Hobbes and his family.
My husband and I live in central PA with our two older cats: Tigger (11) and Clio (16), and our three dogs: Sasha the Samoyed (7), Jada the Samoyed/Finnish Lapphund mix (8), and Hobbes (15 months). Before Hobbes, all of our "children" were either adopted or adopted us After the passing of Kody, our Sammy/Great Pyrenees mix over a year ago, however, we thought about purchasing a puppy. The picture above to the left is of our canine family, pre-Hobbes. Kody is on the left, then Sasha and Jada.
I was about to begin a six-month sabbatical--the perfect opportunity to get a puppy. My husband and I fell in love with the Finnish Lapphund side of Jada (a rescue from a collector in Delaware, where she lived with 65 other dogs and minimal care for the first 5 years of her life), and decided to explore this rare breed. We connected with the person who has taken the lead in bringing Lappies to the US, and were able to purchase a male four-month old from her in February 2007. After a 19 hour drive from Tennessee back to our home in Zion, Hobbes joined our family.
The first two or three months after Hobbes joined the family, all seemed normal, or at least as normal as a war zone can be! Adding a 4-month old boy to a household of 6-year-old adult ladies was quite an experience. Hobbes decided he wanted to be "alpha", much to Sasha's annoyance, although she couldn't decide if she wanted to mother this new puppy, play with him, or dominate him. She chose the middle option, but couldn't (and still hasn't) quite given up on being head of the pack. This continues to make for some very noisy encounters. Through it all, Jada usually stands on the sidelines, refereeing very, very loudly.
We first noticed that Hobbes would run and play, and then just stop and throw up. Not food, but small amounts of liquid and sometimes a treat. Then, back to play-time. My husband and I assumed this was normal--neither of us had ever had a puppy before. We assumed they all threw up like this because they would get so excited. So, we cleaned up the puddles and thought nothing of it.
Hobbes also drank lots of water. Because we were having a hard time house-breaking him, we began to monitor his water consumption, and had to begin limiting his water intake. Again, we thought he drank so much because he was running and playing a lot. We also thought that all this water drinking was causing the odd, sloshing sound he made when he ran. He sounded like he had a gallon of liquid in his tummy that would splash around when he ran.
We were so used to having dogs with weird habits, that we didn't pay much attention to how Hobbes ate, either. Hobbes ate in his crate, to protect him and his food from his very hungry sisters (who really wanted some of the yummy, fatty puppy food)! When we put the bowl in his crate, Hobbes would lay down on his tummy and eat, unlike all other dogs we had who stood up to eat.
So, we just carried on as we had planned. I took Hobbes to puppy training school, where he was very, very obedient, and learned how to sit and stay and lie down. One thing he did not like to do, however, is stand. For the life of me, I couldn't get him to stand on command, or keep him up for more than a minute or so. He would get up, get his reward, and lie right back down on the floor. The class instructor joked with me, saying that I would have to train him to stand if I really wanted to show him. She wasn't kidding.
Only two months after joining our family, Hobbes had his first experience at a dog show. I should clarify--his first and LAST experience as a competitor in a dog show. The Finnish Lapphund national specialty (a dog show whose only contestants are Finnish Lapphunds, unlike those all-breed shows we watch on Animal Planet) was scheduled for April, 2007 in LaPorte Indiana. Since this town, just west of South Bend, is only eight hours away, my husband and I decided to send the girls off to the spa for a few days, pack up Hobbes, and have our first experience in the show ring. Very big mistake.
Lesson One--Do not make your first dog show experience your breed's national specialty. While, at the time, there were only about 250 Finnish Lapphunds in the country, and fewer than 100 at the specialty, the competition was very, very fierce. I thought we would all just hang around, and get to know each other--the new puppy owners and the experienced--and be taught the ways of the show ring. WRONG! I won't go into gory detail, but suffice it to say that I will never, never, ever handle a dog in a show ever again.
Lesson Two--Do not stay at a hotel that gets BAD ratings on Hotels.com. I am sure that LaPorte Indiana is a lovely place. The lake looked very pretty, and it is probably terrific in the summer. But, the hotel where we stayed was creepy to say the least. The shower would not drain, the carpet was stained, and there was what appeared to be a bullet hole in the window. Not exactly the Plaza. I was ready to leave the second we checked in, but stuck it out for one night. After the show experience, and seeing the hotel, my husband and I agreed to pack up and go home immediately the following morning.
Lesson Three--Puppies with Myasthenia Gravis do not make good show dogs. Of course we didn't know Hobbes had MG at the time, but should have guessed something was off. While the other dogs stood and waited their turn to be poked, prodded, and patted down by the judges, Hobbes lay on the floor, doing his best imitation of a bear rug. Not even the lure of a hot dog would get him to stand for more than 30 seconds. I had to hold him up like a rag doll just so the judge could get a decent look at him.
The entire trip was not a waste. My husband got to talk to a lot of nice people (while I was trying to make Hobbes appear mildly interested in this showing thing), and saw some really lovely dogs. But, it certainly was not worth 16 hours in a car, the hundred dollars to pay the girls' spa fees, and the gray hairs I sprouted.
Warning--this episode is a little gross, if you don't like to hear about dogs barfing! For us, it is all in a day's work.
After the dog show fiasco, we settled into a relatively quiet life, for a brief time, anyway. I was home working on my sabbatical project, trying to train Hobbes, and keeping the girls entertained as well. I can't say it was terribly exciting. We had gotten a little concerned because Hobbes seemed to be having barfing episodes (that's what we called what he was doing) most frequently at night. He would make a noise that sounded like Tigger coughing up a hairball, and then spit out a little liquid, food, grass--whatever he had been chewing on before bed. Our vet suggested that we give him just a little bit of food after his very last potty break, which was around 11:30 at night, to keep his tummy settled. Seemed to work for about a week.
One night, however, Hobbes made horrible wretching noises. He sounded like he was choking. Then, around 3 in the morning, he coughed up his food. But it wasn't digested--it was swollen! His kibble looked like it had been soaking in water for a couple of hours. He sounded so awful, and the food thing was so weird, that I called the vets' office the next morning. Jada already had an appointment for early afternoon to have her thyroid levels checked (poor girl is hypothyroid), so we asked if we could bring Hobbes along. Our regular vet was out for the week (at a conference, so he claims--I just bet <grin>) so we saw one of his associates--someone we have seen and worked with extensively. Needless to say, we trusted him absolutely. And that trust was rewarded.
After x-raying Hobbes to see if he had any blockages, the dr. suggested a final, non-invasive test. Hobbes would be anesthetized and then given some barium to drink. He would then be rushed to the x-ray machine, allowing the doc to follow the barium through the digestive tract. Sounded fine with me, so I took Jada home (her thyroid meds were working just fine) and waited for the call.
I hadn't been home for half an hour when the phone rang. The vet sounded deeply upset. He was afraid that he had guessed correctly, and that Hobbes has something called mega-esophagus. Of course I had no idea what that meant. He told us that Hobbes was coming out of the anesthetic, and we could pick him up in about an hour. Of course I immediately went to my computer and started searching for this odd condition. I located a bit of information on it, then called my husband. We agreed to meet at the vets, so we could hear the diagnosis and management of this condition together.
At the vets, we were given a handout that talked about mega-e (as we call it now), how to manage it, and what to expect. We were told that Hobbes might live for about 6 months with this condition, and likely would succumb to aspiration pneumonia. We were devastated.
While I can't say I am an expert on this condition, I sure have learned a whole lot since that fateful vet visit. I have to say up front, it was a miracle that our vet identified this condition on the very first day. Most dogs and owners go through months of tests, and the dogs usually wind up with pneumonia before an accurate diagnosis is made. I learned a bit later that this doc had dealt with a case of mega-e just a few months prior, so it was still on his radar. We can't express how grateful we are to have such outstanding professionals helping us care for all of our pets.
So, what is mega-e? It means, obviously, large esophagus. The esophagus is made up of muscles, which contract when we swallow, forcing food we have eaten down to the stomach. We don't think about it, it is an involuntary reflex. In mega-e dogs the esophagus muscles do not contract. So, when they eat food, it winds up sitting in pockets. One way to imagine this is to think about dropping an orange into a leg of a pair of pantyhose. Sometimes the orange will go all the way down to the toe, other times it will get stuck and hang in a pocket half way down. That is exactly what happens to the food and water (and grass and dirt and toys) a mega-e dog consumes. Having this stuff stuck in the esophagus will irritate it, and that's when these dogs throw up. But, they are actually not throwing up--they are regurgitating. That's why Hobbes' food was not digested. It never made it down to his stomach. For many of these dogs the sphincter between their esophagus and stomach also does not work. So, even if food makes it to the stomach, it can come right back up when the dog is lying down--exactly like a person with acid reflux.
This also explains why Hobbes was drinking so much water and making sloshy sounds. Likely, he was drinking because he could feel something in his esophagus, and was trying to force it down. The water was getting stuck in pockets, so it would slosh and gurgle when he ran.
The greatest danger for dogs with mega-e is contracting aspiration pneumonia. This occurs when they regurgitate something and immediately inhale it. The food/water goes into the lungs and causes an infection, resulting in pneumonia. If caught early, the infection can be treated, but the lungs are weakened and the dog is more susceptible to a recurrence.
The greatest challenge for me was figuring out how to manage this condition in order to give Hobbes the best chance at survival. The first thing we were told was to elevate him while he eats, and to feed him a liquid diet. The latter seemed like a bad idea to me, since we knew Hobbes had a particular problem with liquids. Thank heavens for the mega-esophagus support group on Yahoo! Indeed there is such a thing--a place where you can learn all about this horrible condition and how to manage it. The wonderful people who run this list have a prepared package of information they send to all new subscribers. Some of the information is related to food. While a liquid diet is an option, they also suggest some dogs may do better eating "meatballs" And, for those whose dogs have problems with liquids, they suggest making jello cubes out of Knox and chicken broth--both wonderful ideas!
The other hugely helpful suggestion was the Bailey Chair.
Named after one of the discussion group founder's dog, the Bailey Chair is a contraption that helps a dog stay upright during feedings, and for a set time afterword to allow the food to get through the esophagus to the stomach. My husband and I designed our own version of the Bailey Chair, which we call the Hobbes Box (now you know why this blog is called Life Inside the Box!) Hobbes eats three meals a day consisting of his meatballs and jello cubes, while standing in his box for the duration of the feeding then 20 minutes afterward. That means that Hobbes spends about 2 and a half hours a day in his box. So far, so good. No pneumonia. And Hobbes has lived beyond his predicted life expectancy.
Hobbes in his box.
No, I don't mean using him as an ingredient in some kind of stew (although there are times when...never mind). I mean finding out what to feed the little guy. Having gotten his diagnosis of mega-esophagus, I immediately went into "solve the problem" mode. That means freaking out until I come up with a solution that worked.
First, I bought some solid meat stuff, that looked like something we would get from Hickory Farms for Christmas, and cut it into cubes. Hobbes seemed to like it, but this stuff is very expensive, and full of protein, which mega-e dogs are supposed to go easy on (slow to digest, so it hangs around the stomach longer). At the same time I bought canned puppy food, and was trying to roll the stuff into meatballs. It doesn't stay together really well, and was very difficult to batch. So, I pulverized some oatmeal to use as a filler, but all I got was pastey dog food.
After a couple weeks of experimentation, I came up with the following formula, which seems to work really well. The only problem is that this doesn't freeze well, so I can't make a months worth of food at a time. Hobbes probably prefers that his food be fresh anyway!
2 cups pulverized ProPlan kibble (we are currently transitioning from puppy to adult)
1/3 c. instant mashed potato flakes
1/2 cup pumpkin
1/4 c. water
2 cans ProPlan dog food
Mix the dry ingredients, then add pumpkin and water. Add in canned food until thoroughly combined. Press into loaf pan sprayed with Pam or other oil spray, and refrigerate, preferably overnight. Cut loaf into eight sections. Roll meatballs approx. 2/3 in, in diameter (size will vary based on type of dog). Place in eight containers. Once all rolled, remove enough from each container to evenly fill a ninth. Makes 3 days worth of food.
As I mentioned in the last entry, Hobbes does not get the majority of his liquid in water form, because water seems to cause real problems. Instead, I make him chicken flavored jello. Our other dogs love this as well!
4 pkgs knox gelatin, softened in 2 cups cold water
1 tsp sodium-free chicken boullion, dissolved in 2 cups boiling water.
Mix gelatin into water until dissolved. Stir boullion mixture until thoroughly combined. Pour chicken broth into gelatin, straining it to remove parsley and other small pieces. Stir. Pour into 13x9 in pan which has been sprayed with Pam. Refrigerate until solid. Cut into 48 pieces, and split up into 4 containers. Enough jello for 4 meals.
I admit that this whole process really wigged me out. Whether or not Hobbes survived was in my hands alone! Thank goodness I was on sabbatical during this time--I would have been impossible to work with. I've since gained a bit of perspective on the whole thing, and know that I can only do what I can do. I am pleased to say that Hobbes grew nicely during the past 6 months, so much so that we had to cut back on his meatball intake because he was getting too fat--unheard of for a mega-e dog!
Unfortunately, figuring out how to feed Hobbes wasn't our final challenge, as you will see in the next installment.
Mega-esophagus--what a bummer. My husband and I were looking at a future without vacations (still haven't had one) because who would take care of Hobbes? He needs to be fed three times daily, in his box. What if he came down with AP (aspiration pneumonia)? The liability issues are huge. So, my wonderful six-month sabbatical was turning into a angst-filled period that made me miss work, and the comforts of the daily routine away from the house.
One evening, as we were walking the three dogs, Hobbes seemed to come up lame. He would walk about a block or two, and then just stop. It looked like his back hips were popping out of their sockets. Great--hip dysplasia. So, being the ever vigilant owners, back off to the vets we go for hip x-rays. At this point Hobbes is only about 6 months old. Indeed, the x-rays showed a huge amount of space between his hip joint and socket, and our vet said he could easily pop the legs in and out. Because of the mega-e, our vet suggested giving Hobbes shots of Adequin rather than any kind of oral medication to protect the joints and attempt to prevent arthritis.
First of all, giving a shot to a puppy in the muscle--not fun. My husband had to lie on top of Hobbes while I did the honors. This was very unpleasant. Secondly, Hobbes' breeder went berserk, essentially accusing us of abusing this poor dog. Her claim--Finnish Lapphunds all have loose joints, especially puppies, so Hobbes' condition was not unusual. Huh? All Lappie puppies come up lame when they walk? We couldn't believe her righteous indignation. We knew she wouldn't be happy (Hobbes has 7 siblings, all of whom should be prevented from breeding if he indeed has dysplasia), but thought she would take the diagnosis seriously, rather than accuse us of stupidity and abuse and our vet of incompetence.
After a couple of weeks of administering the shots, we didn't see any improvement in Hobbes. When we took him for a walk, my husband would inevitably have to carry him home. So, the shots stopped. Our vet did one final test--the standard test for myasthenia gravis. (Just a note--Hobbes was tested for MG when he was first diagnosed with ME, because the latter can be symptomatic of the former. The test came back negative). Hobbes was exercised to the point where he stopped, and then given a shot of mestonin--the medication usually prescribed for MG. Unfortunately, Hobbes reaction was not pleasant, although not unusual. He started to drool and vomit. This in addition to the diarrhea he had already. The results of the test were inconclusive. At this point our vet strongly suggested we take Hobbes to see a neurologist, and asked where I would like to go. Without hesitation, (and for no real reason, except that I had no desire to drive to Philadelphia) I said Cornell.
Our vet was able to make an appointment for Hobbes with the neurologist at Cornell's Companion Animal Hospital the very next day. Got directions from Google, packed up Hobbes in his crate, and off we went. After an extensive interview with the doc and his assistants, Hobbes went off with them for some preliminary tests, and I spent a few hours walking around Cornell. I figured they would do whatever they needed to do, give me a diagnosis, and then home we would go.
When I spoke with the neurologist that afternoon, he said that the tests they had run were inconclusive, and so they wanted to do two things--an electrodiagnostic test to check Hobbes' nerve and muscle functions, and if that didn't give a clear answer, then he wanted to do a nerve/muscle biopsy. What to do? I hadn't brought any of Hobbes' food or jello with me, and I wasn't prepared to spend the night. The doc reassured me that they knew how to take care of a dog with mega-e (duh!! This is one of the premier animal hospitals in the country!), and that they would likely want to keep him for two nights, especially if they did the biopsy. So, I left Hobbes in their wonderful hands, and home I drove (another 3 hours or so).
The next evening I spoke with the neurologist, who had conducted both tests, and because they couldn't find anything to contradict the diagnosis, he determined that Hobbes had (and still has) acquired Myasthenia Gravis. That means that Hobbes wasn't born with the condition--he somehow developed it during his very brief life. The next morning I packed up the car again, and off I went to pick up Hobbes. I was thrilled when he recognized me, and ran to me across the waiting room floor! Along with all of the meds Hobbes was taking for the mega-e, he now got to add pyridostigmine to his daily drug cocktail, well disguised in his meatballs. The picture to the left is Hobbes after his visit to Cornell. I call this his centerfold pose.
Just an amusing coincidence, before I talk about MG, and what this diagnosis meant for Hobbes and for us. Today I go to the neurologist for an EMG of my right hand (carpal tunnel syndrome--no longer a work-related injury thanks to Harvard <grrrr>). Anyway, an EMG consists of sticking needles into my hands to test how my nerves respond--just like they did to poor Hobbes at Cornell! I'm sure he is feeling vindicated this morning!
Again, I'm not a doctor, so my take on MG will be simplistic at best. I am obviously more concerned about its impact than I am with the chemical reasons for its occurance. Acquired MG in a dog is an auto-immune condition. His body is making antibodies against a chemical that allows his nerves and muscules to communicate. A dog that is born with MG does not have the necessary receptors that allow this communication to occur. That means that a dog with acquired MG has these receptors, but exhibits all of the physical characteristics of having MG. No one knows how dogs acquire MG. Some believe it has something to do with their innoculations; their bodies have an adverse reaction to their rabies or distemper shots. While Hobbes did react poorly to his rabies vaccination, no one can say definitively that this shot caused his body to attack itself, resulting in the MG.
What are the physical signs of a dog with MG? It will vary from dog to dog, depending on whether the MG is localized or systemmic. For many it manifests in ME only, meaning that the only muscles affected are those in the esophagus. For others, ME may not occur, but the dog may exhaust completely after brief periods of exercise, or they may be completely lethargic. Any muscle group can be affected. Hobbes' MG, for example, initially was localized in his esophagus. This may be why the blood test for MG, which looks for those antibodies in the blood, came back negative. As time passed, however, Hobbes' MG spread to his legs, which is why he would stop walking and had to be carried home. If you watch Hobbes for any period, you will also notice that his facial muscles are also affected--particularly his eyes. He blinks a lot, and his eyelids droop, even when he is clearly wide awake.
What does this mean for Hobbes? As I mentioned earlier, he takes additional medication to manage his MG, administered three times daily, reinforcing the need for Hobbes to have three meals. We can take him for walks now, but we have to be careful because he still tires easily. Hobbes will also never have any vaccinations again. No rabies, bordatella, etc., to prevent further aggravation of the condition. Of course, that also means that no boarding facility will ever take Hobbes--not that they would anyway. Otherwise, his daily life is pretty much normal, well, beyond eating in the box.
Hobbes' prognosis is unknown. Research shows that most dogs with acquired MG will go into remission. That doesn't mean the ME goes away, but the rest of the muscle weakness abates. For those dogs that do not go into remission, the same research shows they likely will get some form of cancer. Hobbes has shown no signs of remission at this point, and he was diagnosed about 6 months ago. We are still hopeful, though, because remission may occur as much as two years after diagnosis. What ever happens, we will continue to take care of the little pest as long as he is with us, because we love him.
One final note. In a previous post I discussed Hobbes hip problems, and our initial concern that he has hip dysplasia. It is possible that the very loose joints are due to the MG, but we really don't know. Whether the looseness is caused by MG or HD, however, we still need to be vigilant, because the same damage to the joints will occur.
We had an eventful night with Hobbes on Sunday, so I thought I would share it with you. When Hobbes eats something he shouldn't, or when enough esophageal fluid builds up, we all get very little sleep. This is because Hobbes' regurgitation is always worse at night, and these two factors exacerbate the situation. If Hobbes eats something (he is partial to grass, dirt, hair) when he is not in his box, it usually gets stuck in one of the pockets in his esophagus. One blade of grass can bring on a blurping episode--it is really amazing. When his esophagus becomes irritated, it tries to get rid of this foreign matter.
Initially, Hobbes will sound like he is having a hair ball--hacking, but not expelling anything. Then, after about 20 minutes, he will finally spew something up. Along with the grass/dirt/fur will come a volume of slimey, cloudy liquid, usually with some foam. That is esophageal fluid. Most of us just swallow the stuff without thought--Hobbes' get stuck, and then comes out the top.
This process can continue for up to an hour, or until Hobbes' gets everything out. As he is blurping, my husband and I are armed with paper towels, sponge, and squeegee and dust pan (yes, squeegee--you ever try to wipe slime up with a paper towel? It just doesn't work!) We wipe up the area inside Hobbes' x-pen; change his pillow if we need to (he has two long pillows so he can sleep with his head up, if he so desires), and try to go back to sleep. Inevitably this will happen at around 3 in the morning.
The goal of any owner with a mega-e dog is to prevent this regurgitation from occurring, because this is what causes aspiration pneumonia. Unfortunately, because Hobbes has acid reflux, there is little we can do to stop it entirely. All we can do is try to prevent them by getting his food and jello down to his tummy, giving him his antacid, and trying to prevent him from ingesting weird things.
Yes, we did wind up taking Hobbes to another dog show, but this time it had absolutely nothing to do with him. His sisters Sasha and Jada were invited to participate in the Samoyed National Specialty dog show rescue parade, held last September (2007) in Lancaster PA. This event, organized by the wonderful ladies from MidAtlantic Samoyed Rescue (the group that rescued both Jada and Kody) celebrates all sammy rescues--giving them their moment in the ring. My husband and I were both really excited to take part (hubby LOVES sammies). Of course, we had to bring Hobbes along, because he would need to be fed during the few hours we were away from home.
We got to Lancaster, and hung out with the parade coordinators for awhile. Unfortunately, we were not allowed to go into the show arena, because our dogs were not officially competing. The person running this show was not very nice, and certainly not fond of "dogs of color" as Jada and Hobbes were known (we thought that was hysterically funny!)
Dinner time rolled around. We set up the x-pen and fed the girls. Then, Tom (my husband) and I took turns holding up Hobbes while the other one fed him. Then, between the two of us, we had to keep him upright for 20 minutes after the feeding. Made us really appreciate the Hobbes Box! Finally, we were ready to give Sasha and Jada their moment in the sun.
Because Tom and I each had to lead one of our dogs in the ring, we recruited some folks to watch Hobbes. At this time he still had his shaved leg, being only one month after his visit to Cornell. We told lots of people his story, and they were fascinated. He got lots and lots of attention, which he, of course, felt was only right! Some folks there knew all about lappies (sammy people tend to be the people who also know about lappies), and one gentleman had owned the first lappies in PA! We also had the opportunity to meet Jada's brother and his owner. He and Jada were by far the most stunning dogs there--the sammie/lappie mix is just amazing. In fact, someone said they had talked to Hobbes' breeder a couple of years prior, and told her that they should create the perfect dog, a new breed which was a mix of the two.
While Tom and I were waiting to go into the ring, the most amazing thing happened. A beautiful male sammy started to sing to Sasha! He was staring at her and making "woo woo" sounds, while Sasha played coy and refused to give him the time of day. It was adorable! Our names were called, and we took our stroll around the ring. Sasha just loved the attention, running from person to person seated around the ring to say hi. Jada, on the other hand, slowly walked around with her head down and tail between her legs-she was so scared, poor baby. As we left the ring, Sasha walked over to her boyfriend to say hi, but he ignored her. Served her right for playing hard to get!
We collected our special ribbons and gift bags for the two girls, and back home we went, tired, but happy about our day spent at the dog show.

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