Gastric
Dilatation-Volvulus; Bloat
By Patricia Long
June, 1997
Updated January, 2008
Edited by Dr. Kathy Berge, DVM, Health Chair
of BMDCA
Contributors: Sherri Starbird;
Berner-list: Susan Ablon, Marianne Becktel, Judy Benoit, Liz Bradbury, Cathy Burlile, Dr. Laurel Cain, DVM, Dino Candelaria,
Gael Goldsack, Gisela Haas, Valorie
Horney, Linda Klei, Bronnie Longhurst, the McHales, Christine Nielson, Marjorie Reho,
Roscoe (with thanks to the newf-l), Frankie Rubel,
Phil Shaffer, Debbie Tripp, Jerry Uhl
Have you ever
eaten too much at a family gathering? Remember that uncomfortable bloated
feeling? All you did was sit down and relax for an hour or two, and you were
ready for dessert. So why does everyone panic over bloat in their dogs?
Gastric dilatation-volvulus is an acute, life-threatening situation which
requires immediate medical and surgical attention. Gastric dilatation means
stomach distention or enlargement. This may or may not be accompanied by volvulus, or torsion, or twisting of the stomach on its
long axis. Once the stomach twists, the stomach contents are trapped in place
as the gas continues to build. As the stomach expands, it can press on major
arteries and veins in the abdominal cavity, restricting blood flow and lowering
blood pressure. Once this happens, the heart rate increases and the pulse becomes weak as the dog goes into shock. If the stomach
swells enough, it can displace the spleen, cutting off circulation, and causing
enlargement and even twisting of the spleen. With circulation for the stomach
constricted, parts of the stomach wall can necrose,
or die. All of this can happen over a period of hours, or even minutes. But
once it starts, it needs immediate medical attention. Classic symptoms of bloat
include pacing, difficulty walking, panting, discomfort, agitation, depression, drooling, foaming or frothing at the mouth,
unproductive vomiting or retching, distention of the stomach. The swollen
stomach may be grossly large, and hard (tympanic) to
the touch. If the dog is going into shock, the gums will appear pale or grey,
and when they are depressed with a finger, the color will be very slow to
return; the heart rate will be fast, but the pulse will be weak. [Try looking
at your healthy dog right now. Look at the color of the gums. Now you know
their normal color. Press on the gum with your finger for a second. When you
remove your finger, you will see a white mark where all the blood was pushed
out of the capillaries. The speed with which the color returns shows a good
blood pressure as the capillaries refill. Anytime the blood flow is
compromised, the capillaries are the first to shut down. Now try to find the
pulse. I just tried, and according to my findings, Maggie is dead. You can find
the pulse by placing your finger on the femoral artery - high up on the inside
of the back leg. I finally found Maggie's, but practice before you have to find
it on a sick dog.]
In theory, the
treatment for bloat is simple. Treat the shock with IV fluids, decompress the
stomach, and if the stomach has twisted, get it back into position. In reality,
it gets more complicated. An x-ray will usually show if the stomach has rotated
or not. If a tube can be put down the throat into the stomach, this is what is
preferred. The stomach contents are emptied and the stomach is rinsed with
water or a saline solution. If the dog cannot be tubed
[the danger with entubation is that it can rupture
the lower esophagus], then another possible procedure is trocarization,
or inserting a large bore needle directly into the stomach wall. [The danger
with this procedure is peritonitis from stomach contents leaking into the
abdominal cavity and causing infection. For an untrained person, the danger is
that the needle will be put into an enlarged spleen instead of the stomach, or
the wall of the stomach will rupture because the stomach wall has stretched too
thin.] Once enough gas has been released by the trocar,
the dog can sometimes be tubed to further decompress
and empty the stomach. The other procedure is to make an incision in the
stomach wall in order to empty the stomach.
Surgery may be
required to reposition the stomach, and if part of the stomach wall has necrosed, that part will have to be removed (resected). If the spleen has sustained enough damage, it
will have to be removed. Once the dog has bloated, there is an extremely high
probability that he will bloat again. To prevent the stomach from twisting, and
to significantly reduce the probability of bloat recurring, the stomach should
be tacked in place (gastropexy). Some dogs with a
high degree of risk can have a gastropexy done before
the dog ever bloats. The easiest form of this is a laparoscopic gastropexy. Using a laparascope
to see, small incisions are made, and the stomach is tacked at each incision
site. Done on an outpatient basis, it could cost under $400US. When surgery is
required for bloat, it typically costs about $1200US if there are no
complications. With complications, stomach resection, splenectomy,
the cost can reach $5000US.
Once a dog has
bloated, there is a good chance that he will bloat again. He should be fed at
least 2 times a day, avoid vigorous exercise for one hour before and two hours
after eating. And always watch for signs of bloat, especially after any type of
stress.
An ongoing
study is being conducted at
- Sherri Starbird’s
Flash showed well enough on Saturday May 12th 2007 to get an Award
of Merit at the National Specialty, but Sherri knew he was off. She thought he
might just need to poop. He relaxed, he settled in, but by dinner time he was
gagging up white foam and they rushed him to the ER. He was in full torsion and
had immediate surgery to reposition the stomach and tack it to prevent further
rotation. The surgery went well. However, over the following days he continued
to fail, as his sodium level rose along with the temperature. Not only is there
a risk of cardiac issues after the surgery, but sodium can elevate dangerously,
and treatment has to be aggressive – a line into the jugular and a urinary
catheter. Flash didn’t make it, his temperature soared
along with the sodium levels - a rare but very dangerous side effect of bloat.
[Dr Simmons told her that approx. 20-30 percent of bloat cases don't make it,
that it is a very life-threatening event, and not always in predictable ways. (This in part due to the cells in the blood/fluids that die during
the torsion - when circulation is cut off.) Once the torsion is
released, he said those now necrotic cells are released in the dog’s system,
and it is unpredictable where the "poisonous" stuff ends up and
causes damage. In Flash's case, they may have ended up in the hypothalamus
causing inability to regulate the body electrolytes and temperature, or caused
that chain-reaction which damaged the brain regulatory center (hypothalamus).]
There have
been many stories on the berner-L from people whose
dogs have bloated. Marianne Becktel and Marjorie Reho advocate giving the dog Mylanta II or Maalox before
taking the dog to the vet.
From best case to worst case, here are the
List examples:
- several people
report their dogs have a gulping episode, but after an hour of this, it goes
away with no other symptoms.
- pre-bloat behavior (pacing, discomfort)
was noticed by Gisela Haas (Chuckie), Judy
Benoit (Sarah), Liz Bradbury (Boots), and Pat Long (Vesta).
- Susan Ablon's
Granville bloated 5 hours after eating, the vet successfully tubed him to decompress the stomach, there
was no torsion or surgery. He bloated again at age 8.5,
it's thought to have been triggered by the GI ulcer caused by all the
medications he was taking.
- Linda Klei
had just moved, her other dog was being kept at her Mom's house while
undergoing chemotherapy, and on her first day at work, 9 year old Dutchie bloated after eating a lot of cedar chips and part
of a blanket. Although she was about 180 degrees torsed,
Dutchie was successfully tubed.
- Cathy Burlile's
Cailler bloated when he was 4 years old, she feeds
him 4 times a day, and he is now 9.5 years old. He had had minor surgery 36
hours prior to bloating.
- Judy Benoit's Sarah had a root
canal, came home and curled up in the yard. When she came inside, she couldn't
get comfortable. It was bloat. Sarah's sire and one littermate died of bloat.
- Valerie Horney's
Booker was smiling and wagging, but his stomach looked distended. She had to
insist on getting an x-ray because the vet didn't think it was bloat. It was,
and Booker was already partially torsed. After
surgery, he was raring to go!
- Phil Shaffer's Boris had shoulder
surgery, bloated 24 hours later, but never did have any of the classic
symptoms.
- Jerry Uhl's
10 year old Harbo bloated immediately after coming
home from the place where he was boarded for 4 days. He successfully survived
the surgery and lived another 2 years until his death from old age at 12.
- Debbie Tripp's Kim bloated right
after checking into the Specialty. Kim had all the classic symptoms, it was
bloat with torsion. With quick action on Debbie's part, plenty of luck, and a
lot of good medical help, 10.5 year old Kim survived the bloat and the surgery.
It is believed that Debbie survived the Specialty!
- Frankie Rubel's
Matt bloated at 1:30am. Having previously lost a dog to bloat, Frankie's son
recognized the symptoms. Quick action and surgery helped Matt pull through
successfully. The procedure cost $2108 at U of P Vet Hospital. Matt's sire is
Cathy Burlile's Cailler.
- The McHale's
- Marge Reho's
Anneke had surgery to correct and ear-flap hematoma, and went into cardiac arrest from an allergy to
the anesthetic (before the days of isoflurene). She
was put on heart medication which is no longer on the market, because it
produces stomach problems. The first time Anneke
bloated, she was successfully tubed. The second time
she bloated, Marge was able to fix the situation with almost half a bottle of
Maalox. The last time, Anneke was given some ice
cream in celebration of her 6th birthday. Anneke
bloated, the stomach torsed completely, she was
unable to be tubed, and because of the allergy to
anesthesia, surgery would have been immediately fatal. The stomach did not
twist back on its own, and Anneke
did not survive. The vet felt that the cold food was the immediate trigger for
the bloat.
- Bev
Barney fed her 10 month old bitch one morning, crated her that night, and
she was already bloating the next morning when the crate was opened. The bitch
died on the way to the vet.
- Cathy Burlile
lost her
- Marge Reho's
Heike underwent an emergency spay, bloated that night at the vet's clinic, and
was dead the next morning when they opened at 6am.
- Dino Candelaria's
Diver started to show classic early signs of bloat, and when she called the vet
he agreed. He told her to take her to the emergency clinic for overnight
observation, but to first perform a "full nelson bloat joggle"
(Dino's term!). She put her arms behind Diver's front legs, then under and up
in front and then up and over behind the neck (a full nelson on a person). Dino
picked Diver up and joggled her up and down to allow the weight of the food to
help straighten the stomach. It allowed Diver to start belching, and by the
time Diver reached the emergency clinic, there was no gas in the stomach, and
the stomach had not twisted. Diver stayed overnight for monitoring, but no
surgery was required. Dino stresses that the bloat joggle should not be used
instead of going to the vet, but only as the first line of defense.
Some of the other contributions to the list
include:
- Christine Nielson's friend's dog
who had his teeth cleaned Friday, bloated on Saturday and tubed
successfully, bloated again on Sunday and was again successfully tubed.
- Gael Goldsack
knew of an 18 month old irish wolfhound who died of
bloat after eating too much bread, which was felt by the owner to have
fermented, causing gas (gas in the stomach of dogs with GDV has been shown to
be primarily air, not gas produced by bacterial fermentation. - paraphrase from
Small Animal Clinical Nutrition as per Cathy Burlile).
- Roscoe posted all the newf-L
posts about bloat, one of which linked bloat in her dog to a soy based diet
(although no study has ever been done which links soy to bloat); another
related the story of a newf on a natural diet who
bloated.
- Bronnie
Longhurst knew a Saint Bernard on the BARF diet
who bloated.
- Cathy Burlile
knew someone with a GSD who used Gas-X successfully on the first 2 occurrences
of bloat, but the third time there was full torsion that required immediate
surgery.
As you can see
from this collection, there are many different symptoms, and many different
outcomes. One of the keys to helping a dog survive bloat is to know your dog.
If he's not acting normal and you suspect bloat, go to the vet and have it
checked. If your vet isn't sure, but you are, insist on having x-rays taken.
Many of the cases of bloat presented here followed surgery - stress. Always
watch a dog carefully for the first 24 hours following any surgical procedure.
If the dog has to remain at the vet's clinic, ensure that the dog will be
monitored regularly around the clock. Otherwise, consider Dr. Laurel Cain's
advice and move the dog to an emergency clinic where he will receive careful
monitoring. Feed your dog at least twice a day. I found that mixing in a couple
of large spoons of canned food with the dry helped to slow Vesta
and Maggie when they eat. Minimize exercise before and after eating. And keep those
guys happy!
See this great Health site list for more
links to bloat information: http://members.rogers.com/rcamken/BMD_Health_Info_Links.html
"A report: The Purdue bloat study"
http://www.vet.purdue.edu/epi/bloat.htm
Report to Morris Animal Foundation, 1/10/93,
"Combined Final Report/Progress Report For Phase
I", Dr. Glickman, DVM, 1/10/93.
"Multiple Risk
Factors for the Gastric Dilatation-Volvulus Syndrome
in Dogs: A Practitioner/Owner Case-Control Study", Dr. Glickman,
DVM, et al, Journal of the American Animal Hospital Association, May/June 1997 Vol 33 No 3, pp 197-204.
U.C. Davis Book of Dogs, edited by Mordecai Siegal,
1st edition, 1995.
Saunders Manual of Small Animal Practice, Stephen J. Birchard, DVM,
Robert G. Sherding, DVM, W. B. Saunders, 1st edition,
1994.
Essentials of Small Animal Internal
Medicine, Richard W. Nelson, DVM, C.
Guillermo Couto, DVM, Mosby
Year Book, 1992.
The Merck Veterinary Manual, Merck & Co., 7th edition, 1991.
Back Digests of the Berner-List, 051, 202, 203, 207, 208, 226,
230, 279, 295, 298, 299, 384, 385, 386, 387, 440, 443, 502, 523, 525, 528, 538,
568, 569, 662, 701, 715, 727, 729-734, 736