Wednesday, November 30, 2011

Bloat, the Mother of All Emergencies

Bloat, the Mother of All Emergencies
What you need to know about this life-threatening condition
Shea Cox, DVM | November 30, 2011

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There is no quicker way to jump to the front of the ER line
than if you walk into the hospital with a distended dog. Bloat is a
life-threatening condition that I treat frequently, and a good outcome is

Last week, JoAnna Lou wrote about recognizing the signs
of bloat
and included an educational video of an Akita experiencing GDV (don’t worry, he
survived!). This topic elicited excellent comments and questions, prompting
me to want to expand upon it further. I hope to answer some of the questions
put forth by readers as well as dispel misconceptions that could potentially
harm your pet.

First, some vocabulary: Bloat is a condition when
the stomach fills with air and/or fluid (dilatation). This can progress to a
twisting of the stomach upon itself, called
GDV (gastric dilatation
volvulus). Bloat is often used to describe GDV, but there is a vast medical
difference. We’ll get to the details of GDV in a moment, but let’s start with
the most important take-home message:

If you even remotely suspect bloat or
GDV, take your dog to a veterinary hospital IMMEDIATELY!
What NOT to do:
            Do not give anything by mouth.

       Do not attempt to relieve gas
           from the stomach with medications or by other means.

A note about the use of Gas X: This medication may help to
reduce the amount of stomach gas in the case of “simple” bloat, but it will
do nothing to help your pet in the case of GDV. The problem with GDV is not
the gas, but the actual twisting of the stomach (think of a balloon being
twisted in half, like when a clown makes an animal figure). It is the twist
that kills, and a medication will not undo the deadly rotation of the
stomach. Please do not waste valuable life-saving moments waiting to see if
the medication helps! Taking an x-ray of your pet’s abdomen is the only way
to tell the difference between bloat and GDV, allowing for appropriate
What is GDV and why is it so serious?
The twisted and bloated stomach presses on the major blood
vessels that carry blood back to the heart, stopping normal circulation and
sending the dog into shock. Making matters worse, the stomach tissue is
literally dying because it is stretched tightly and blood cannot circulate
through it. Intense pain is associated with this disease, causing the heart
to race at such a high rate that heart failure will result.

There can be no recovery until the stomach is surgically
untwisted and the gas is released. A dog with GDV will die in a matter of
hours unless surgery is performed. For each hour that goes by, there is a
greater risk for complications during surgery as well as during the recovery

What are the signs of GDV or bloat?
The biggest clue is the vomiting: A dog with GDV appears highly nauseated and retches but little
comes up.

  • Drooling.
  • There is usually an obviously
    distended stomach, especially near the ribs, but this is not always
    evident depending on body configuration.
  • Anxiousness, agitation,
    restlessness and pacing.
  • Depressed attitude.
View some of these symptoms in the video we posted last week.

What dogs are at risk?
Classically, this condition affects deep-chested breeds, and dogs with deep chests that weigh more than 99 pounds have a 20 percent risk of bloat. Although a rare occurrence, I have also treated three
small-breed dogs for this condition in my ten-year career.

There are many theories regarding what triggers GDV, but
truly, no one really knows—it remains a veterinary medical mystery. Risk
factors, lifestyle and personality profiles that may
increase a dog’s potential for developing GDV have been identified
over the years and include:

        Feeding only one meal a day.
  • Having closely related family
    members with a history of GDV.
  • Eating rapidly.
  • Being thin or underweight.
  • Moistening dry foods
    (particularly if citric acid is listed as a preservative in the dry
  • Feeding from an elevated bowl.
  • Restricting water before and
    after meals.
  • Feeding a dry diet with animal
    fat listed in the first four ingredients. (Contrary to popular belief,
    cereal ingredients such as soy, wheat or corn, in the first four
    ingredients do not increase the risk.)
  • Fearful or anxious
  • History of aggression toward
    people or other dogs.
  • Male dogs are more likely to
    bloat than females.
  • Older dogs (7–12 years) are
    the highest risk group.
On the flip side, the following factors may decrease the risk of GDV:

         Inclusion of canned dog food
             in the diet.

  • Inclusion of table scraps in
    the diet.
  • Happy or easygoing temperament.
  • Feeding a dry food containing
    a calcium-rich meat meal listed in the first four ingredients.
  • Eating two or more meals per
    day as well as feeding a smaller kibble size.
  • Not breeding animals with a
    history of GDV in their lineage.
What else can I do?

For breeds with a high risk of bloat, a preventive surgery
called prophylactic gastropexy can be performed at the time of spay or
neuter. Gastropexy involves surgically “tacking down” the stomach to the
inside of the abdomen to prevent rotation. If your dog has already been
spayed or neutered, the same procedure can be done laparoscopically, and is
minimally invasive. I had this procedure performed on my own Dobie, Bauer. I
saw him bloat (and thankfully not twist!) one day at the park, and treated him
at work. The next day, I scheduled the laparoscopic procedure.
This is a same-day surgery with a quick and comfortable
recovery. In the Bay Area, the cost is generally $1,500–$2,000, which is far
cheaper than emergency surgery, and worth its weight in gold for peace of
mind. One of my biggest fears was to have Bauer bloat while I was away for
the day, only to return home to find I was too late.
It should be noted that gastropexy does not prevent future
bloat, but it does prevent future twisting, which is the deadly component of
the condition.

What is the prognosis?
Decades ago, a diagnosis of bloat was almost always a death
sentence, and only 25 percent of pets with bloat survived. Today, the
survival rate is better than 80 percent! Part of the reason for this is
increased owner awareness (go, pet parents!) leading to rapid intervention
and treatment. The earlier the veterinarian gets started with treatment, the
better chance for survival. Extremely aggressive medical and surgical
intervention early in the course of the disease has the most dramatic impact
on overall success.

This is a condition I see much too frequently, but I have to
say from personal experience, nearly all dogs return home (95 percent or
greater) with early and appropriate treatment.

Being the doting mom of two Dobies, this is a subject that
hits close to home, and one I have experienced personally. Thank you to
JoAnna for helping raise awareness of this all-too-common condition in our
large-breed babies. Feel free to ask questions; I am happy to further
elaborate on any area. For now, I’m off to hug my boy, being especially
thankful that he is with me today.

Article courtesy of BARK magazine and Dr. Shea Cox

1 comment:

  1. Quite honestly, I live in relentless fear of GDV being the owner of a GSD that could be the poster child for it. So much fear that when we travel I always position us near a 24/7 capable of handling this situation, tertiary veterinary hospital. That may sound overly cautious, but time as is impressed upon us in this article, and the one I am posting, is surely of the essence (top-notch aftercare during convalescence is important as well).

    I thought perhaps knowing a little more about the signs and stages of GDV might help people to even further understand the emergent nature of this life threatening medical problem.

    Here is an article with those details...

    Thanks fuzzybutts four and Dr. Shea for this very important article. I intend to share it with my friends, family, and students. So many, I find, still do not know about GDV. Keep up to great work you are doing!