RawPetMedics FB Live: Mega oesophagus

Dr. Conor Brady, how are you this evening?

Yeah, you can't even remember.

I can't even remember your name. Oh yeah, that's right, isn't it? George. George, how's your week been, George?

Oh, you see, look, there's people coming from Chicago and we can't even remember our own.

We can't remember our own names, Michelle. We are fools.

No, so that it's a busy old week, you know, further veterinary crises of staff. But no, look, it's— look, we've got to appreciate we are in a privileged position somewhat, I guess, and we enjoy seeing our clients. I've seen quite a few actually of our viewers coming for appointments this week and seeing them and saying hi and, you know, doing all of the you know, going through their cases. It's been brilliant. Yeah, so yeah, it's really nice to see you guys in the flesh, you know, sometimes. So that's great stuff.

It's great. I saw somebody today, lovely, lovely lady with just a fantastic Australian Shepherd. I haven't seen many Australian Shepherds. The one I've seen have been, you know, pleasant enough, but this dog, she was just lovely. Just really gentle, but not kind of pathetic. Just, this is me, let's be friends kind of thing, without being too in your face. Just lovely. Really, yeah, she made my day. Absolutely made my day.

Our position of being able to spend a bit longer with these pets and being in the room and sort of like actually being able to appreciate their companionship and allowing them to come over and say hello and not having to be so forced, which I know some of our colleagues in the conventional side, you know, they're limited to, you know, 15, maybe even just 10 minutes of, you know, getting everything down, let alone interacting with your dog or cat. And, you know, so, you know, it is a harder job in those circumstances. But yeah, it's so nice just being able to make a connection with those patients, isn't it?

Yeah, very much so. I've even got— I'll show you. Yeah, I've got a sofa. Dog in my room here, so that they can really sit down. And if they've come from a distance, I'll make them a cup of coffee and we'll sit down, because you can't talk to your clients until they are in a position where they're ready, where they're relaxed and they've, you know, taken in the surroundings and what have you, and they're a little bit calmer. And then when they're calm, the dog is calm, and you can actually see what you're dealing with. You can see the actual nature of the dog, because normally you go to the conventional guy and you've got a thermometer up your bum within 2 minutes, within, you know, 2 minutes walking in the door. And so to just sit and allow the dog to come to you, it's great, isn't it? And to really take your time and to go through the nitty-gritty of, you know, you hear something interesting and you chase it. It's great. I love it, I love it, I love it, I love it. Yeah, yeah. It is. We are lucky. Now, so somebody said Janet Nixon is missing Conor, and I don't know where he is. Do you know where he is?

No, I think he just got really scared that we're going to be talking clinical stuff and he decided that the pub was more attractive. No, no, I don't know, honestly, that's casting aspersions.

I'm sure— I think he's got a bit of a phobia of floppy esophagus.

Esophagi.

Esophagi. Esophagus. Yes, that's what he's got a phobia of. Yeah, so there you go. So we're gonna jump into a bit of clinical stuff because we can, and that's kind of what we like.

But before we do so, I think we just got to say, look, thank you so much to our Patreon guys. You know, it is appreciated that you're giving us the support and one day we'll be able to afford to pay Conor and then he'll show up.

Yeah, that'll be a thing, won't it? Minimum wage, mind. You know, we don't want to get airs and graces. So yeah, definitely. So yeah, thank you to patrons. I've been trying to put up plenty of stuff to keep our Patreon people happy. So I hope that you're enjoying that stuff, guys. If you've got any suggestions for what you want to see, then do shout. And because, you know, I come across, you know, really interesting stuff every single day. And it's, it's a joy actually to share it with people who give a damn, enough of a damn to give a couple of quid or so or more. Thank you for those every month. So really, really thank you for those. Really great.

Oh, somebody else has quickly asked, we mentioned a product which is available in the US. Okay, but they're just trying to work out how on earth they managed to get Eco here in, you know, in this country.

Oh, I've got a very good contact in the States who runs North Point Pets, Nikki Kamek, who's been on Georgia Raw, who's a fantastic woman, and she— I get her purchasing power to She buys it from there and then sends it over. Because if Eco Ears sent it from the States, it would be even more astronomical than it costs anyway now. So Janice says, when are we getting some Eco Ears? It's on the way within days. Give me an email next week, middle of next week, maybe, Janice, and we can send you as many as you like.

You need to call through for your order. The number of people that have been asking that on Facebook.

Seriously? Oh, shit. I'll make another order now then, if you're gonna wipe me out. Pam Thornton, bless her, she says maybe Nick's vomiting impression last week put Connor off. Yeah, I didn't think anybody saw that. I think that's quite good, isn't it?

Well, we're going to do a bit more of that this week because we're going to be talking about the next step up. Okay, so we want to talk about this this week. So guys, we're going to just kick off with a little bit of the round megaesophagus and what it is. Nick, do you want to give us the sort of insights? Do you want me to raise any images just to help?

Have you got an image there?

Yeah, let's see.

Okay, that's brilliant. Okay, so that's that, guys, is an oesophagus. So going from the basics, Your esophagus is the food tube that goes from the back of your mouth down through your thorax, where you don't want food, obviously, into your stomach. Okay, it just delivers it. It works with peristalsis, and it's in you and me, it's about the size of a maybe slightly big garden hose, and in a dog, it'd be slightly smaller than that. And it can take really quite a lot of food, and it just kind of snakes it down. It pushes down, down, pushes it down with peristalsis, and it's very clever, and it usually doesn't go wrong, and it's, it's marvelous. Sometimes it does go wrong for various different reasons. I'll go into those in a second. I'll— I will let Brendan get an edge— an edge word in sideways. But what, what we do, vets do, to try and make a diagnosis is we'll put some barium, which is radio opaque, down into the throat, into the esophagus. And normally with you and me, it would just go pretty much straight through. You see a few streaks and you you'd see these parallel streaks because the walls of a hose are parallel to each other. Yeah, they're all going in straight lines. Okay, but if you get pouching and pocketing, which is megaesophagus, as the name suggests, big esophagus, you get this more and it's floppy, it stops that ability to be peristaltic. And clinically, Brendan, therefore, what do you see? What are the presenting signs that you see in practice? What are people looking out for, and then I'll tell you about what may cause it, perhaps.

Yeah, so I think the key things that we saw on the X-ray, how flaccid and how large that esophagus can get inside the chest. So often we see dogs that are maybe slightly agitated because it's, you know, it's something— it's almost like swallowing that hard crisp that you've not quite softened enough, and it just feels like there's something stuck in the chest. Okay, but you get this sensation that there's something inside the chest. They may be breathing slightly heavier, they may be getting up and moving around, trying to settle down, getting up, moving around, trying to settle down, maybe even drooling a little bit, looking a bit nauseous. But the key thing, and this is back to what we were talking about last week, is you get this regurgitation. So you'll suddenly get, rather than violent thrusting from the abdominal muscles, you will just get them turning around and just going blah as they contract the chest. Okay, a tube of material.

A tube, yeah, literally like a haggis from the supermarket, you know, a modern haggis, not a proper haggis.

And that can be the start of showing signs that the peristalsis within the oesophagus isn't working to push food through into the stomach. There may be an issue with the sphincter we talked about last week, the cardiac sphincter they call it, that as the tube passes through the diaphragm and then enters into the stomach, that's the cardiac sphincter of the stomach. And if there's an issue around there, maybe some fibrosis, some scarring, anything that's restricting food and keeping it in the esophagus and in the chest, then you can get this stretching. But there's other things that then lead to that causation. And cats, I will talk very briefly about cats. We do see this disease. There is a degeneration of the normal parasympathetic pathways and the peristalsis that occurs within the esophagus that's related to ganglia being feared with. And this can also present in eye issues and further down in the gut issues, something called Key-Gaskell syndrome. So we do know that degeneration of the nerves that feed these can lead to these problems. So give us some other things that you've got on your list of causations.

I've got a mega list of megaesophagus. And here you go, because we're doing a little bit of prep here. And I've put this reference up. If you can't find it, it's canine-megaesophagus. This is the American spelling with an esophagus, megaesophagus.

So they can see that. So that's www.canine-megaesophagus.com.

And it's about as comprehensive. It's not completely comprehensive. We have actually found some chinks in their armor, but by gum, it's comprehensive.

Okay, guys, if you want to find it, just, um, there is the, uh, the website. So have a little look at that. Um, but yeah, I found a lot of these. I, you know, there's— it's, it's that classic thing. If you put 10 vets in a room, you'll come out with 12 opinions. And I think we've got the thing where we look at some of these sites and we say majority of that, absolutely, we agree with. And then there's just a couple of things, isn't there, that you go, did they really mean that? But then, guys, I guess if you look at our stuff and the vets out there that are looking at our stuff, oh yeah, yeah, exactly the same. So we do apologize right now. We mean it in the most constructive manner ever. But have a look at this. It's a great site.

Okay. So on one of their pages, and they've got, they must have 200, you know, homepage, about the author, contact me, guestbook, acid reflux, acronyms, acupressure, blah, blah, blah, blah, blah, A to Z. Amazing. So causes. So causes. So They do a little introduction and then they say, right, congenital, you can get congenital, which is what means that something goes wrong in utero. And what, what you can do is you can get, they say, they call it a persistent right aortic arch where your blood vessels coming out of your heart don't separate and there is a degree of kind of sticking together. And if the oesophagus gets caught there, that can be a constriction. Then they talk about neuromuscular and immune-mediated causes, and they talk about acquired myasthenia gravis, which is basically where you just kind of— everything goes floppy and your eyes go like this and you can't eat very well and what have you. Also, we've got possible neuromuscular and immune-mediated causes, which is very interesting, including Botulism, distemper, glycogen storage disease. I didn't have that on my list. I can tell you that for nothing. Neosporosis and other tetanus infections. Endocrine, these are hormonal causes. Addison's disease, hypothyroidism. Then they go to esophagitis, which is where you've got— we did that a bit last time— where you've got inflammation of your esophagus.

Then you've got that just as the reflux and stuff happening around the cardiac sphincter. So yeah, absolutely see that.

The acid sloshing up from your stomach and making your, your esophagus, especially that lower third, very unhappy. Gastric dilation and volvulus, which is the twist, the classic swelling and then twist of the stomach. A hiatal hernia, where you get the stomach pushing up through the, the, um, the diaphragm. Uh, paraneoplastic causes, um, which is described as a thymoma, a benign tumor of the thymus. Toxins, lead, organophosphorus, snake poisons, And then they have incidental or temporary megaesophagus, uh, and mycotoxins and things like that in there, in that list.

Mycotoxins, those sort of black molds and stuff like that?

No, no, they're not. No, no. Okay, good. There's another one because we're going to talk about that with the Latvian connection. Yeah, that would be nice to share that story. Um, medications, dog food, and we've got the Latvian case and we've got the Australian case, and then idiopathic, meaning we, we are idiots and we don't know what's why your dog has got megaesophagus.

We are going to talk at the end of this as well, don't worry guys. We're going to talk a little bit about management of these cases, a little bit of what we can do to help with these situations. So I've seen a few of the comments going up and we obviously want to make sure that we're addressing some of those bits. So don't worry guys, we'll get to those.

Okay, yeah, yeah, yeah, definitely will. But do keep on throwing it up because it's slightly less frenetic because there's only two of us, not three of us, and so we kind of have times to be a bit more chatty with you, which would be nice.

Nick, did you— we read one of the books, I think it might have been the Benjamin Bikman one, with regards to the influence of insulin and glucose excesses, so insulin resistance, on these effects as well.

Just remind you, that's pretty safe to say because Ben Bikman, with a wonderful book, What Makes Us Sick, he basically says choose any tissue in the body, it is affected by insulin resistance, and thus you can see disease from insulin resistance, which is why you need to really try and avoid high insulin foods.

And, you know, I know a lot of the things that we're talking about with regards to the diseases, from anything from Addison's through to myasthenia gravis you know, all of these are, you know, immune-mediated diseases. And, you know, anything that's going to be pro-inflammatory can lead to and aggravate those. So absolutely, when we're talking about dietary controls, you've got to think about how we can change their diet and their inflammation that's going on in the system.

Yeah. Yeah.

And Nicola, you can't say that. He knows.

Oh, Nicola, your card is now marked. We're going to tell him of that. Brilliant. Okay, so let's have a look. So we've got reasons why it can go— oh no, the ones that they missed out. What did they miss out? What they missed out was— so they missed out toxins, aflatoxins, which are neuropathogenic. Yeah, they will knock out your nerves. But what he did, the big one was some dogs can get it from trauma to the neck because your neck and your esophagus has got loads of nerves supplying, supplying it to speed it up and slow it down and coordinate the, the peristalsis and all these kind of things. And so any damage to the neck or to the spinal nerves coming out from your vertebrae— he says pointing at the back of his neck while he's on film— which is not very clever. Any damage to any of those, they can have an influence on the structures within the neck. And so that's a really obvious one.

And so we're going to talk about those from about C, which is the cervical vertebrae, I think it's C6, all the way through to about T3, which is the thoracic vertebrae. Those outflows, I think the things to remember with those lower ones is that for wobblers, so for big breeds like the Great Danes, the Dobermans, all of those that can suffer from wobblers, you know, not just affects necessarily what's happening through to the back legs, and that's why it's called wobblers as well, but actually the nerve outflows, if they're impinged, it may also affect those and may give laryngeal paralysis. I've noted somebody said that you know, earlier on. So you may get sort of concurrent disease or symptoms appearing. Something that's really important to mention here is one of the complications with megaesophagus, especially if you're getting laryngeal paralysis, and that's aspiration pneumonias. So this is why some of the treatment and management protocols that we're going to talk about are really important, because actually, if you just leave them and say, well, you know, they've got it, but I can cope with the regurge because they're outside for so much of the time. You've got to remember there are some consequences here. If they can't actively cough because they've got laryngeal issues, and also they've got this material that's resting in the chest and may rise up into the back of the throat unexpectedly, there is a risk that your dog will breathe that in inadvertently and aspirate that and cause themselves a pneumonia. An aspiration pneumonia. So do remember, it's not something that you should just ignore. There are mechanisms to help, and let's go through that.

That's brilliant. So damage to the neck, and the damage to the neck can be, you know, overuse of the chain, dogs pulling you down the street, but also just thinking laterally, damage to the neck could be arthritis, could be the dog gets, you know, significant osteoarthritic changes. In the neck and that impedes the spinal nerves and off you go, you develop megaesophagus. You ever seen that with arthritic-y change?

Well, a lot of spondylosis spondylitis stuff, yeah, they see that. I mean, there's so many other symptoms that are there, but absolutely affects having that increased tone on the parasympathetics on the heart rate Definitely seen that, seen the aggravation of gut symptoms with that. So yeah, these things are important to note. And somebody has mentioned, I think we should start to talk about some of the management techniques because there's so much to talk about.

Yeah, let's jump into that.

Who's touched on chiropractic first? Your experience with chiropractic and this sort of treatment.

Yeah, I've used chiropractors and osteopaths. I just happen to know more osteopaths, and I think that, just as an aside, I think that there's more— it's probably more— and I'll be killed by any chiropractors or osteopaths in the audience, but it's not like that.

Let's not light that fuse, you know.

No, no, but it's just I think they're both great, and you can get great chiropractors and rubbish chiropractors, and you can get great osteopaths and rubbish osteopaths. And I think that there's probably more similarity between a really great osteopath and a really great chiropractor than there is differences. They will talk about differences, but actually I think that they do it by, by just by feel, by judgment. They can feel stuff that you and I really, you know, mere mortals cannot feel. They do a lot of kind of energy work or really subtle pulses of the cerebrospinal fluid. You know, it's, you know, wonderful stuff. So I've spoken to my lovely osteopath who comes to the practice here. He's a guy called Tony Nevin, and he says of laryngeal paralysis, which you could say is, you know, same but different to megaesophagus, he says that he is able to fix about 50% of laryngeal paralysis if they get in early. So I think therefore, and it stands to reason, that if you have the slightest hint of megaesophagus, the first person personally I would see is an osteopath or chiropractor. And if you've got a good acupuncturist, because they're going to be doing quite a lot of similar stuff, reducing inflammation, enhancing neural tone in the area. So that would be, for me, that would be number one kind of intervention, really.

And there's some of the Western, more westernized things. So that's homeopathy, you know, if you're just talking about nerves and the reaches for things like Hypericum, Opium for a lack of sensation and effect, that can be really useful. Herbal-wise, what's your sort of go-to herbs for support?

Nothing, nothing that really stands out, but I mean, supporting the nerves, supporting the nerves, you'd be wanting to come in with, with the adaptogens. You'd be wanting to come in with the antioxidants, strong antioxidants. You want to improve blood supply to all these areas because if they're, if the nervous tone is poor, then the blood supply, nerves specifically, remedies specifically for nerves, I can't really think of any. Yeah, so there are neuro supports and I'll do a little list for you.

Okay, that's grand. I think the other element to remember about homeopathy is that really those two locals that I mentioned can be useful, but really finding a constitutional, far better. And, you know, look up your vet through BAHVS website. They will often give you a good homeopathic vet to look at some of the other constitutional workups for those, those cases. I definitely have used acupuncture in these cases, definitely. And sort of also, we haven't really mentioned there is a crossover to things like megacolon cases as well with some of these bladder paralysis and paresis sort of comes in and there's quite a crossover I find with those, often very similarly the spinal issues that we've talked about, but it's just where they are down the spine as to when they're affecting them. In these ways. But definitely, I think where there's immune-mediated conditions, all of those other things, the adaptogens and stuff that you've mentioned, are really, really useful. So, so what's your position— pardon the pun— for, you know, your go-to for when people are feeding these cases?

Yeah, well, back when I was first qualified, these things didn't exist, but there's a thing called a Bailey chair. Now, which is basically like a baby chair. You know, the kind of thing that you put your baby in when they're 1 year old in order to bring them up to the height of the table so that you can feed, you know, spoon food into their face, which they then spit and mash all around their face. You know, that's— yeah. So the baby chair. So it's a bit like that, except it's a little bit lower. And it's the sides go up because, because many of these dogs, they're often bigger dogs, by the way. Uh, I'm not sure the stats, but I think it tends to be, you know, the retrievers, the— I've seen it in a greyhound and a lot less in their small dogs. But what have you seen it in small dogs at all?

I think obviously the brachycephalics where there's a degree of, uh, hiatal hernias. So, you know, the pugs, the, um, the bulldogs, those sort of things. I've definitely seen it for some of those. Yeah, I'd agree that generally the sort of, you know, mid to larger dogs, but then again, you're into the wobblers side of things as well, I guess, sort of sways us that way. A few spaniels that I have seen, but then that's the immune-mediated diseases. So I guess it's their predisposition to the type of disease that actually takes you know, which, which of those breeds have got megaesophagus? Because megaesophagus is not a diagnosis in itself, it's a symptom. Yeah, effectively is what we're trying to say here.

Okay, that's it. So the Bailey chair is basically a really quite a deep, long-backed baby chair, and the idea is that you keep the dog upright after you feed it. You tend to— you feed sloppy food that's not going to become particulate so that they can't cough it up and then inhale bits of kibble-y food, for example. Another reason not to feed kibble. And you keep them upright like this so that gravity takes the food which is in the megaesophagus and it just kind of trickles down into the stomach. And that's That's a really good— sort of like that, a Bailey chair. There you go. And there's lots of different types, and you can make them yourself if you like. Back in the old days, people used to make them. So have you used them? Did you want to just take people through?

So what's mine, my go-to, because I'm a cheap Yorkshireman, okay, is for most people, if you've got stairs within the house, okay, put the bowl on at least the third or fourth step depending on the size of your dog, and their feet are on the step below that, and their back feet are on the ground. Okay, you know, for many people that have steps up into the house where it's 2 or 3 steps, then again, you know, you can feed them on the back doorstep depending on the weather. You know, we're hard up north, so we let them out in all weathers. And again, you can just feed them so that their bowl is inside the back door, feet is on the top step and their back feet are as low down as possible. Just keep that for the smaller dogs. So certainly for those brachycephalics, I've then— and the small sort of cockers that have been affected— I've then advocated, you know, doing the whole baby burp thing of actually, if you just hold them with their paws over your shoulder, you've got their bum on your hand, and literally just walk, you know, around them. If they're too heavy to do that, then sit on the sofa. And I can just imagine the people laughing that have got a Great Dane with this, trying to achieve that with its back legs over the back of the sofa whilst they're trying to pat. But just keep them in that position 5 or 10 minutes. I've had people that have managed these cases. Liquifying the food is the other thing. So adding bone broth into your raw, guys, okay? So that you create that more of a soup. Is a way of really softening that food down so that they can still take all of that. And yeah, I get that you're going to be losing that bone material side of things, so that everything from the wings and the carcasses and stuff like that as a benefit for your dog. But at least if you can create that soup in this interim time to manage the symptom and just burp them down, they'll often clear that and they have so much more of a comfortable life. I've had dogs that owners that have reported that their dogs have gone from regurgitating every day to, you know, as soon as they've tried this mechanism of feeding them, zero, just absolutely fine. They start putting weight on, they start managing things. It's a symptom I didn't mention early on is actually the lack of weight gain because often they're regurgitating so much of their food. But, you know, just seeing them dogs put weight back on, you know, and actually being able to keep the food down is so rewarding. And obviously we're all the time doing that, reducing the risk of them aspirating that food.

For sure. Sarah is saying that her dog has 45 minutes upright after feeding 3 times a day. Wow. And then Claire comes in and says her dog has 30 minutes upright in the Bailey chair after food. Somebody very wisely says make sure if you're using a Bailey chair that's very well padded because dogs sitting there, they're not meant to sit upright like a human.

Yeah, and those that have other back issues and pain and things like that, you need to be aware of that. I would always adapt your individual case. So, you know, we've had these 40 minutes, we've had the, you know, the 30 minutes. I've said about at least 10 minutes I think adapt it to your dog's needs, because if you can keep that time shorter, yes, then obviously they— and they, they do cope, then great. If they need that bit longer, absolutely, it's right for your dog, please allow that. And cats too, you can do exactly this with your cats. I know loads of cats that, you know, I've got one in the other room who are huggers that love, you know, a little bit of affection and attention and will cling to your shoulder. I also have another cat who absolutely would not want to sit still for a moment if you restrict her. So, you know, again, adapt to your individual pet's needs.

Really, really good. Michelle Wallace is saying liquid is a problem with her dog and she's using a slow water feeder. I don't even know what a slow water feeder is. I presume it just lets out a small amount of water in, you know, every 10 seconds or something like that.

One of those rabbit water bottles that has a little— but instead of it being a really tiny little ball, it's a larger ball that allows them to lick that.

And if that was up, that would be good because then that would have a better angle. So if it was the highest that the dog could realistically reach, or you had it on a step, that would be good because then you get the angle on the esophagus. Because the water is going to go through quicker than food. So that sounds good. I'd have that up as high as you can.

Yeah, absolutely. So, you know, and reiterating, bone broths are really good just to help.

Yeah, well done, Karen.

Okay, so I think you mentioned it's further down. Honey's Dog, Real Dog Food, make some of these bone broths. There's quite a lot of raw companies out there if you look on their sites, and even Bella and Duke, and there's I think quite a number of others that actually will do bone broths as the add-ons. So do remember to have a look at that. I know there's quite a few raw food shops that follow us on here, and I know a lot of you guys also stock those products. So for you who are going to those stores, ask them. There may be some bone broths that you can purchase rather than having to make it yourself, but it is relatively easy. There is a previous one that I've sort of outlined on how to make bone broths on one of these videos. So do have a little look back at those and we can talk a bit more about that going forwards. Maybe we'll put another recipe up.

Cool. Audrey Henniger says that any high-calorie additions to add to the diet to help keep the weight on. So she's obviously— well, it sounds like she's got a, a skinny mega esophagus dog, and I would say coconut oil or unsalted butter. A bit of salt won't hurt the dog, but those kind of fats, maybe a bit of goose fat, things like that is really good. But if you want the really easy one, that's that, you know, you might be vegetarian. Coconut oil is just, is God's gift to calories. It turns into liquid at body temperature, and so it'll go through really quickly, and that might help to kind of lubricate things through as well. Don't introduce fats quickly, just build them up, build them up slowly. Because if the dog's pancreas— we've done a show on pancreas about when?

Oh, that was April. Yeah, I think.

Yeah. So we've done one on pancreas and we've got through a lot of stuff. So do go back and see.

And I think Karen sort of outlined here, you know, can I use bone broth? With IBD and the same with fats, really. You know, you've got to think about any of those inflammatory diseases, including pancreatitis, hepatitis, IBD, you know. Yeah, absolutely. You need to just be a little bit cautious and maybe ease them into it. There should be no reason why bone broth— let's go back to bone broth for a moment. You can skim the fat off and actually it's really good for healing the gut in some of these inflammatory diseases. And it benefits supporting good gut flora as well. So a really good prebiotic, I would say, for the canine and feline gut. So there is no reason why you shouldn't be able to ease them in there. We come back to our discussion about the relative histamine release and how you manage that. But many of these products, if made properly, will contain the right enzymes to stop the histamine becoming cysteine systemic and provoking effectively a mast cell dehiscence in response to the foods, etc.

But if you feed a bone broth and dog doesn't itch, then chances are you're not in a histamine type scenario. Also, one of the easy mistakes to make is if your dog has chicken sensitivity, say, you don't want to be making bone broths from chicken carcasses. Okay, sounds obvious, but sometimes it's just nice to have it on the table so that you can avoid that. So whatever sensitivities, good idea to avoid that. Somebody else mentioned about suet. Yeah, any of these things— lard, suet, in the States they call it tallow, over here we'd call it dripping— from beef animals you can, but go gently to start with because pancreas may not be very strong. It may be stressed for some other reason, and if you come along with a great, you know, half a pound of beef dripping, you will send them into pancreatitis. But if you just do it gradually, then you're much less likely to.

I was chatting to a client who discovered that actually there's a little bit of a cheat there, because if you look at pancreas, especially pig pancreas, it often comes with quite a lot of fat with it. And the benefit of using some of these pancreases that you've effectively either coarse chopped or even blended slightly. Don't go too overboard. You're giving them the enzymes to help them digest the fat that you're also giving them, and the weight improvement you can get with those can be really, really good.

So fantastic. Yeah, so definitely look at those. That's really good, really good. So any other thoughts, guys? We've got 5 minutes, so please, if you've asked a question, we haven't answered it, please do pop it up again and we can just have maybe 5 minutes questions and anything else we need to cover, Brendan, that you can see.

No, I think, you know, there's a lot of stuff in there. We, you know, have been talking about the positioning because that's really important, the recognizing, you know, that discomfort signs. I would definitely say be cautious about late night feeds if you've got a dog with megaesophagus because that obviously they're not necessarily going to be up and mobile and moving the gut because actually gut movement can be improved through them with gentle exercise. So we see this if you've got megacolon or you've got issues with paresis in horses. I also advocate this too. We're just expanding our species stuff here, actually giving them a a good walk is a really good way. And this is constipation in people. We talk about this, that actually a really good way of getting gut movement is to just decide, go for a gentle walk. Okay. And that can actually improve things for movement. And I think it also is the same when we're dealing with the oesophagus. So think about that gentle exercise. Oh, definitely change them to a harness. Rather than a collar.

Oh yeah, to protect their necks.

To protect their necks. So look at your harness types that is there. So I quite like a number of the harnesses. There's a debate out there about whether McCutty harnesses, which are these ones which stop your dog pulling by putting a link across the front of their chest to attach and also to click in the middle of their backs, are useful. If your dog's not pulling, great, but if they do pull with that on, there's this discussion as to whether you're twisting their spine as they pull, and I think that was the debate as to whether there's a risk in that circumstances. People will run, look, you know, just if you're on an endorphin thing about running, you know, that's a different matter. Gentle walks, please, not running and jiggling food in their chest up and down.

Yeah, for sure. Sarah Bush has said, why do dogs with mega bullfrog from their neck? So Sarah, you might want to have another go at that one. Sorry, not quite sure. Katie, Katie Isaac says, are dogs born with this? Yes, they can be, but not necessarily. They usually acquire it in mid or later life, but they can be born with it if they've got a constriction from the heart, for example.

Oh, I see. So I think what you mean when she barks, if your dog has got a megaesophagus, basically that also can extend up to the pharynx. So if they're creating a pressure when they're barking, because that's effectively the vocal cords of the larynx effectively restricting airflow out of the lungs. But when they release that to give the proper pronunciation of the woof and you've got the soft palate not necessarily being in the right place, I can imagine that then restricts air into the pharynx and then that can swell up. That just means they've not got good airflow out of the nose. There's a couple of things there that may be the reason why they blow out like a bullfrog. I think that's what he's meaning.

That's good. Yeah, yeah, good. That's really good. Okay. Problem feeding raw food, any suggestions? Positioning not possible due to amputation and other congenital issues. Okay, so you're saying problems feeding raw food. I just thought raw food would be one of the easiest because it can be, depending on what the manufacturer, can be very sloppy. Say Natural Instinct, they do quite a fine mix, for example, whereas Cotswold Raw or Benefit or Paleo, they tend to be a bit more chunky. So you might want to just change your manufacturer to something a little bit more smoother. And with regard to positioning, if you've got a small dog, just, you know, as Brendan says, just put the dog on your— on your— on, you know, hold the dog like that. What you can do is actually, when we, when we had kids, you can get kind of a papoose for the front and you just put the dog in the papoose and get on with making your own tea.

A papoose, they're called?

Papoose. Yeah, from the—

Oh, for puppies? A puppy? For puppies? You can get them for puppies.

Yeah. Oh, can you? There you go. A papoose. So if you've got an English Mastiff, you probably won't get one for those. Probably. Probably. But, um, a pup, you know, if you've got a smallish dog up to about, I don't know, 20 kilos, that would be perhaps doable. 20 kilos is pushing it, perhaps. Um, cool. Uh, let's have a look. Uh, Michelle Barg says, I'm in America, have a few great raw companies with lots of very interesting organs. Fabulous, that's really, really good, especially if they don't hide pressure process their foods. Really, really good. There you go. I think we're doing pretty well.

Yeah, Brendan.

Well, we are.

We're there. We're at 45 minutes, guys. We've got to think about next week. We've got Q&A at the end of the month. Okay, so that's going to be regular. So think of your questions. If you've got stuff that you want to you know, help decide or ask about them, please, you know, we're here to try and develop that and make sure we're dealing with your stuff. Um, for all of you guys, you know, please keep supporting through the Patreon page. It really helps, and it's, it's really great to see you guys there. We're gonna, um, put up the link. Oh, we didn't talk about the Latvian, uh, case.

Oh bugger.

But there is a great YouTube um, from— it was a TED Talk actually.

I put it up, I've put it up, yeah, put it up on Patreon. So jump in there and have a look. She just explains the situation.

Really interesting that there are some scandals out there on proprietary foods, um, and it takes a lot of, you know, shouting to, to actually get some of these guys to take notice and take their foods down, uh, when they cause problems. So, you know, if you notice some issues about what your dog's fed, even if it's raw food, guys, you know, we should be questioning everything. I'm making sure that we're on board here. So, you know, don't be shy just because we promote and say that giving a good biologically appropriate raw food is great on this site. You know, if you have a problem, please, you should, you know, raise it with us and try and investigate it. That's what it's all about.

Definitely. How about this for a topic for next week? Because Conor was really keen to talk about the scandal. Why don't we do pet food scandals? I think that'd be really juicy.

Oh, go on then. Let's do that. It might attract him back, you think, out of the undergrowth?

Maybe. It will smoke him out. Yeah. We'll offer him minimum wage as well.

How about that? Yeah, it's higher than our minimum wage. I don't know what it is.

Yeah, sub-minimum wage. Yeah, for sure. Well, brilliant. Um, there you go. Do you— I introduced— do you want to, do you want to count us out?

Yeah, no, look, guys, thank you so much. Um, it's been