For some people with swallowing difficulties, hope is a wagging tail. By Bryn Nelson.
Few dogs can claim a Facebook following of over a thousand people. Then again, few dogs are like Bean. In 2012, the Humane Society of Silicon Valley brought the pit bull, then just a five-month-old puppy, to the University of California at Davis Veterinary Medical Teaching Hospital for an evaluation. Bean had been walking oddly and the charity’s volunteers reasoned that an MRI might reveal the root of her troubles.
Karen Vernau, chief of neurology and neurosurgery, was immediately struck by the dog’s sweet disposition, despite a painful condition that would eventually be diagnosed as muscular dystrophy. Given that the dog wasn’t a great candidate for adoption, Vernau and her family decided to foster Bean until her quality of life became poor “or something else happened and we would humanely put her to sleep at the end of her life”.
Almost immediately, Bean’s health began to deteriorate. Muscular dystrophy affects every muscle in the body and Bean’s oesophagus was the hardest hit, causing her to keep regurgitating food and forcing vets to insert a feeding tube. The Vernau family had already fallen in love with her, however, and decided to adopt her.
As quickly as Bean was settling in, her body was failing her. She was regularly inhaling her own vomit and choking, leading to chronic pneumonia and frequent stays in the hospital for treatment with oxygen and antibiotics. After the third episode of breathing in her own vomit and passing out, the Vernaus knew they had to make a decision: put an end to Bean’s suffering or do something big. They chose the latter.
Peter Belafsky, director of the university’s Voice and Swallowing Center, agreed to join a veterinary surgeon in performing a total laryngectomy on Bean, an operation previously done only on dogs with laryngeal cancer. Removing the voice box would allow the doctors to permanently separate Bean’s airway from her throat and oesophagus, and halt the chronic regurgitation, choking and pneumonia.
It worked. Bean’s airway now runs unimpeded from her lungs to a stoma, or small hole in her neck, and she hasn’t had any more episodes of pneumonia.
Bean may be unique in the dog world, but Belafsky says a total laryngectomy is sometimes the best option for people with severe dysphagia or laryngeal cancer. Those people include British physicist Stephen Hawking, who has lived with amyotrophic lateral sclerosis for more than 50 years. In his 2013 memoir, My Brief History, Hawking wrote that the separation of his windpipe from his throat saved his life.
There are downsides, of course. Without a voice box, people can no longer talk normally and Bean can no longer bark. Nor can she cool off by panting, which would require her to pass air over her tongue. Breathing requires an open stoma at all times, and eating means being fed three times a day through a small tube connected to her stomach. Swimming is out of the question, and even a walk in the rain could be hazardous. “Fortunately for pit bulls, they hate water,” Vernau says.
After the surgery, everyone kept asking the same question: How’s Bean doing? As so many people expressed concern, Vernau started a “How is Bean?” Facebook page in 2013 to provide regular updates. Amid a remarkable collection of videos and pictures chronicling her medical odyssey, Bean’s daily adventures read like those of most well-tended dogs: she runs after squirrels and pulls on her leash during walks. She chews soccer balls and plays tug of war with the Vernaus’ other dogs. She clumsily tries to chase the family’s two cats.
But Bean has since become something much more than a loved member of the family. For about a year, she regularly accompanied Vernau to work. Tour guides leading visitors through the veterinary hospital stopped by to greet Bean and talk about the hospital’s capabilities. The dog attended lectures and student club functions – even a talk in New York sponsored by a pet-food company. As a teaching aid, Bean helped veterinary students and residents learn about canine muscular dystrophy, laryngectomies and the proper way to use a feeding tube.
The veterinary school’s One Health initiative promotes the idea that both humans and other animals can benefit from knowledge gained by studying shared symptoms and disorders, such as swallowing difficulties. The school has a canine dysphagia clinic, where it treats dogs with swallow-impairing conditions such as amyotrophic lateral sclerosis, Batten disease, cerebellar ataxia, gastroesophageal reflux disease and megaesophagus – all of which affect humans too.
Because Bean’s stomach can’t tolerate large meals, engineers at the university developed a feeding tube adapter for smaller-volume but nutrient-rich meals. When Bean’s breathing hole began to shrink and started closing off whenever she tensed her neck from stress or excitement, her veterinary team fitted her with a small device called a button, which keeps her breathing hole open. “She’s one dog, but the hope is that the things that we’ve learned and that we’ve done will help other dogs and other people,” Vernau says.
In Sacramento, California, Belafsky oversees a support group for people who have had total laryngectomies, called the 49er Lost Chord Club. Bean accompanied him to one of the meetings and was an instant hit. “The thing about her is she is a happy dog, all of the time,” Vernau says. A dog that has been through the same struggle – one that is still wagging her tail and licking your face and loping around the room – can be profoundly inspiring.”