| Bloat
Kills!
Great Dane owners should familiarize themselves – ahead
of time – with the symptoms of Bloat and Torsion (Gastric
Dilatation and Volvulus, or GDV). If your dog bloats, you may
have little time to save him.
Prompt emergency veterinary care is essential. Recently,
I wrote a lengthy article about GDV and the Great Dane's unique vulnerabilty
to
this
dreaded condition. The series
ran in DaDane of DaWeek and because
it was so well-received, I decided to provide it as a resource
for people visiting
our "Emergency Bloat Links" page.
This article offers important information
for Great Dane owners.
According
to a 1998 study by Purdue University School of Veterinary Medicine,
the Great Dane is over
40 times
more likely to develop GDV than a mixed breed dog. Danes topped
the list of vulnerable breeds with the highest incidence of GDV – nearly
double the risk compared to the second most vulnerable breed,
the Akita. Because GDV is one of the leading causes of death
in the Great Dane, you should know the symptoms and develop your
own plan for handling this
life threatening emergency.
— Ginnie
Saunders
Gastric
Dilatation and Volvulus (GDV) – Bloat and Torsion
By Ginnie Saunders
Note:
The information presented below is not intended to substitute
for professional veterinary care. Please discuss GDV ahead of
time with your veterinarian and seek his or her assistance in
all actual or suspected emergencies.
What is
Gastric Dilatation and Volvulus?
" Gastric Dilatation" is the technical name for an abnormal accumulation
of air, fluid, and/or foam in the stomach; we usually call this BLOAT. "Volvulus" refers
to a dangerous twisting, rotation, or torsion of the stomach. As the stomach
swells with fluid and/or air, it can twist between its two fixed anchors
points, the esophagus and the duodenum. When this happens, a devastating
sequence of
events starts to unfold. Once the esophagus has been clamped off, everything
is trapped inside the stomach. An afflicted dog cannot vomit or belch to
relieve the internal pressure, so the problem intensifies. As pressure continues
to build
within the torsioned stomach, it enlarges and compresses the veins in the
abdomen. This restricts blood flow back to the heart and leads to low blood
pressure,
followed by dangerous cardiac problems and, often, shock. Meanwhile, the
stomach's lining starts to break down (die) due to the loss of circulation,
creating toxic
by-products. In some cases, the stomach will actually rupture. Not only
that, but the dog's spleen, bowels, liver or pancreas may also be severely
damaged
by this grisly cascade of events.
Obviously, GDV is a dangerous condition that constitutes an extreme medical emergency.
If left untreated, or if treatment comes too late, your dog will die a
very painful death. The speed with which you provide your dog with competent
medical attention can mean the difference between life and death.
Is your Dane at Risk?
GDV occurs most often in large breed dogs with deep chests. As
a breed, the Great Dane is at high risk for bloat. According
to a 1998 study
by Purdue
University School of Veterinary Medicine, Great Danes are 40 times
more likely to develop GDV than a mixed breed dog. Danes topped
the list of vulnerable
breeds with the highest incidence of GDV – nearly double
the risk compared to the second most vulnerable breed, the Akita. In
fact,
the Purdue
report states: "Assuming that these Great Danes live to be 10 years
of age, we conservatively estimate that more than 50% will eventually suffer
an episode of GDV!! This is quite alarming given that nearly 25% of dogs
can be expected to die during or shortly after an episode of GDV and it is
consistent with previous findings that GDV is one of the leading causes of
death in many giant and large breeds of dogs." While I find these
high numbers a bit questionable, the fact remains that bloat is one
of the leading
causes of death in the Great Dane. You should know the symptoms and
develop your own plan for handling this life-threatening emergency.
A
note about the Purdue Studies
The Purdue Bloat Studies have
been highly controversial in the Dane community. Some people have claimed
the research has not been "peer-reviewed" and they feel it
has little merit. I suspect the Journal of American Veterinary Medical
Association would
beg to differ, having published two of the studies: Incidence
of and breed-related risk factors for gastric dilatation-volvulus in dogs (January
1, 2000) and Non-dietary
risk factors for gastric dilatation-volvulus in large and giant breed dogs (November
15, 2000).
That
said, my personal view is that some valid arguments can
be made against certain assumptions in these papers.
I feel the research
has merit, but it is not definitive by any means.
Perhaps the most vocal detractor of the Purdue research is Linda Arndt. Please
review the Purdue articles and then review Ms. Arndt's article, The
Purdue Bloat Study: On My Soapbox. She raises some good points. (For example,
I absolutely agree with her assertion that feeding from elevated food dishes
does NOT contribute to bloat.)
In the end, it is up to each of us to look at the body of information that's
been offered and decide for ourselves what we will use and what we'll put
aside.
What
are the symptoms of Bloat?
GDV begins with a variety of symptoms. If you see any of these symptoms in
your dog, you should be alert to the possibility of bloat and take appropriate
action:
-
Gagging,
unproductive attempts to vomit
-
Foamy/slimy
mucous around mouth and lips (or vomiting this substance)
-
Distended
(hard) abdomen that sounds hollow when thumped
-
Accelerated heartbeat and a weakened pulse
-
Anxiety or restlessness, whining
-
Pacing, refusal to lie down
-
Heavy panting, salivating or drooling
-
Discolored gums (very red in early stages, blue or white in late stages)
-
Weakness and collapse
When it comes to bloat, time is
of the essence. Depending on a number of factors – most
of which are out of your control – your dog could
have as little as 30 to 45 minutes to live after you identify
the symptoms.
What are the causes of
Bloat?
The short answer is that
nobody really knows what causes bloat. We used to hear
that GDV is caused by vigorous exercise after a large meal. The
rationale
was that running and jumping causes an overly heavy,
bulky stomach to twist around in the abdomen. Although this was
once
a commonly
accepted explanation, there has been no scientific evidence
to support the theory. In fact, most bloat victims do not have
overly full stomachs, nor have they recently engaged in strenuous
activities. More recent theories suggest that for reasons unknown,
the stomach's contractions lose their regular rhythm. Food, air and
gas is then trapped in the stomach, and this leads to torsion.
But the bottom line is this: No definitive cause of bloat has
yet been identified. (Personally, I would still prevent any dog from ingesting large amounts
of food or water and I would restrict vigorous exercise for an
hour or two after eating.)
The following factors may influence
whether or not your dog experiences a bloat episode:
-
Rapid eating, or ingesting a large amount of food in one session
– Instead, feed smaller meals 2 or 3 times a day
-
Drinking too much water
before or after eating
– Monitor or ration the amount of water ingested before and after
a meal
-
Vigorous exercise before and after
eating
– Monitor and limit your dog's activities before and after meals
-
Feeding
a low quality dog food
– Feed a quality meat-based dog food with natural preservatives
– Consider adding probiotics or enzymes to your dog's diet
– Or feed a raw diet (B.A.R.F.)
-
Feeding gas-producing foods
– Avoid soybean products, brewer's yeast
-
Emotional Disposition (possessing
an anxious or fearful temperament)
– Know your dog; a "sensitive" dog may be more vulnerable to
bloat
-
Stress (changes in normal routine,
travel, boarding, etc.)
– If your dog seems prone to stress, minimize stressful situations
-
Heredity
(having a close relative that has bloated)
– Bloat seems more prevalent in some lines, indicating a genetic predisposition
-
Physical
Build (large dog, deep narrow chest)
– Keep your Dane at a healthy weight, neither overweight nor underweight
Age
– Older dogs are more likely to bloat than younger ones
If my dog is experiencing early symptoms of bloat, what should I do?
Many people, myself included, always keep a ready supply
of the antacid Simethicone nearby, usually in the form
of Phayzme® or Gas X®. (Among my contacts,
Phazyme seems to be preferred; that's what I use.) Simethicone is considered
quite safe, even when administered in large doses. Its purpose is to
break up large gas bubbles in the stomach, enabling the
accumulating gas to
be more easily passed.
At the first hint of a gassy stomach, you can give a generous dose of Simethicone. If you are using Ultra Strength Phazyme® 180 mg softgels, slit open 5-10 capsules and squeeze the liquid directly into your dog's mouth. Some people report they get faster/better results using Phazyme® Quick Dissolve 125 mg chewable tablets. With either product, one dose of Simethicone may be sufficient to relieve pressure and settle the stomach before the condition gets any worse. More Simethicone can be given later, if needed.
I have used this technique twice on my own Dane, Merlin. I am not sure if he was actually headed into bloat, but both times he seemed to be displaying some of the early warning symptoms that we discussed last week. After administering the Simethicone, I made plans to rush Merlin to the emergency vet clinic if his symptoms increased or failed to resolve within a short period of time. Fortunately for both of us,
Merlin's discomfort subsided and he was perfectly fine.
Note: Please discuss
this Simethicone remedy with your veterinarian ahead of time, before you ever
need to use it. Clearly, if your dog can't get the medication down,
he's too far gone and needs immediate medical attention. Get him
to the vet as soon as possible.
If my dog displays obvious
symptoms of bloat, what should I do?
If you suspect your dog is experiencing a bloat episode (gastric dilatation), get him to the vet as soon as
possible. Bloat events often occur after normal business hours and sometimes late at night, necessitating travel
to an emergency facility instead of your usual clinic. Know in advance
where you must take your dog should this occur.
It is a good idea to call ahead to let the medical staff know you are
bringing in a bloat patient. This gives them some extra time to prepare
for your arrival. Your dog may need x-rays, an ECG and blood tests. Depending on his
condition, treatment may be started before the test results are in.
If your dog is "shocky" he may be given steroids and IV fluids. Antibiotics and anti-arrythmics for his
heart may also be administered. Most veterinarians will first attempt to "tube" a
bloating dog. This involves passing a flexible tube from your dog's
mouth to his stomach in order to decompress the stomach by venting
the gas. If tubing doesn't work, decompression might be accomplished by forcing a large-bore
needle (trochar) through the skin and muscle, directly into the stomach.
A successful tubing or trocharization, along with medication, may be sufficient
to stop gastric dilation before torsion occurs. If torsion has already
occurred, though, surgery will be necessary to untwist the stomach and save your dog.
A
note about TUBING your dog
Many experienced Great Dane breeders and exhibitors
keep a Bloat Kit nearby at all times. A Bloat Kit provides all the items you need to tube your own dog if a serious bloat emergency develops when medical attention is more than 15-20 minutes away. Some people feel
strongly that EVERY Dane owner should buy a bloat kit and learn how to tube his or her pet. That said,
however, most people would agree that an inexperienced (or panicked) person should never attempt to tube a dog. Precious time is lost and the dog could be injured – possibly fatally – before he gets the professional medical treatment
he so desperately needs.
Jeanette Pickett at NaturesFarmacy.com offers two types of bloat kits. Prices range from $25 to $45. |
|
My advice is to talk with your own veterinarian about tubing. Ask if he
or she would be willing to teach you the proper technique, using
your own dog for the training session. You may have to pay a
little for the lesson, but it could be a life-saving exercise.
If your vet refuses, find out why. Depending on how strongly
you feel about this issue, you should not give up until you find
somebody who is qualified and willing to teach you.
Keep in mind that a successful tubing does not mean you needn't
go to the vet. Your dog still needs expert medical care – tubing
merely buys you extra time to get him there. A comprehensive discussion
about tubing and bloat kits can be found in a manual titled BLOAT
IN LARGE DOGS by Siegfried Zahn, DVM. It is a very useful resource, but
again I urge anyone who wants to learn this procedure to discuss it with their
vet and get qualified hands-on training.
What happens during surgery?
The immediate purpose of surgery
is to rotate the stomach back to its normal position and
restore normal blood flow to the heart. The spleen, which
is located adjacent
to the stomach, sometimes twists along with the stomach.
A twisted spleen, too, must be corrected. Both the stomach
and the spleen
are then evaluated for signs of damage due to tissue necrosis.
Any dead or dying tissue on the stomach wall must be removed.
Also, depending on the condition of the spleen, the doctor
may perform
a splenectomy. It should be noted that in cases of extensive
damage to the stomach, the patient's mortality rate increases
dramatically. Furthermore,
long-standing or severe twisting may cause necrosis in
portions of the esophagus. If this happens, chances for
survival are further
compromised. Whenever there has been a lot of damage to
the internal organs, euthanasia should be seriously considered.
If there are no signs of irreversible damage, the veterinarian
usually performs a gastropexy. The procedure involves
attaching the stomach to the abdominal
wall to make it more difficult for the stomach to torsion during future
incidences of bloat. (Without gastropexy, torsion recurrence
rates can run as high as
75%.) There are a variety of gastropexy techniques that may be employed – circumcostal,
belt-loop, incisional, ventral, and tube gastrostomy. A healthy debate
continues in the veterinary community as to which method is most effective.
(More
info here) Your veterinarian will probably want to go with the
procedure he feels most comfortable with.
What
about preventive gastropexy?
Preventive (prophylactic) gastropexy can be performed on a healthy
dog to help minimize the risk of torsion in the future. It
certainly is something to consider, but keep in mind any surgery
involves some degree of risk. Preventive gastropexy is often done
coincidental
with neutering, spay or some other "routine" surgery.
The rationale is that the dog will be under anesthesia and facing
a recovery
period, so
it is as good a time as any to undergo a 'pexy. This is a matter
that should be fully explored with your veterinarian before you
make a
final decision.
A word of caution: if your dog has undergone gastropexy and later
needs abdominal or exploratory surgery, be sure to alert your medical
team to the fact that
your dog has had a 'pexy, and which type was performed; otherwise,
your dog's stomach may be perforated when they make their incision(s).
What
happens after bloat surgery?
If your dog makes it through emergency bloat surgery, you surely
have reason to celebrate. But don't be too complacent, because
your dog may
still be at
risk. Some dogs seem fine after bloat surgery, only to die suddenly
within a few days of their operation. The cause of death is often
attributed to something
called Reperfusion Injury.
I asked Gambler's surgeon, Dr. Joe, to explain
reperfusion to us. (You can read Gambler's bloat story here.)
This is what he said: "Reperfusion
occurs when the torsioned stomach and/or spleen
are untwisted. The blood that was stagnating in these organs
begins to
flow again, bringing into circulation all the toxins that accumulated
while they where twisted. The twisted organs were
hypoxic (lacking
oxygen) and that caused the toxins form.
The longer your dog's organs stay twisted, the more toxins are
produced, and the worse the situation can become. That is why
it is necessary to treat these
animals so quickly. Unfortunately there is no actual prevention
available for reperfusion, but routine treatment for shock with
steroids and fluids would
be the first step in lowering the incidence of problems.
If heart arrhythmias occur, drugs such as Lidocaine can be used
to correct these problems. Sometimes when animals have been
bloated for a long time,
the resulting toxins can overwhelm the system and make it very
difficult to save
them."
For this reason, it is imperative
that your dog's heart is closely monitored after surgery and that
you continue to keep close watch on your dog
after he comes home from
the hospital. Another factor
in your dog's successful recovery is adequate pain management.
This effects not only your dog's comfort level
and sense of well-being – recent research is
beginning to reveal that proper pain management can impact
the ability
to survive.
Dr. Joe had this to say about pain management:
"Pain
is definitely a factor after surgery due to
the large incision and the handling of tissues that occurred.
Veterinarians
approach
these situations in various ways. Different
dogs also respond differently to different medications. Communication
between
all parties is important. Fentanyl patches,
such
as Gambler
had, are a safe noninvasive approach. Torborgesic
is an injectable option, but it can cause some sedation and
confusion
in certain
dogs. Rimadyl is now available in an injectable
form and shows some promise. As time goes on, more and more options
will open
up to us in pain management. Openness and communication
is the key."
What
is the overall survival rate of GDV?
There are many factors affecting outcome, but the most
important variable is TIME. Your dog's chance of survival is directly
impacted by how quickly he gets proper medical treatment. With
fast and aggressive treatment, proper surgery and follow-up care,
the survival rate is said to be approximately 60-70% per incident.
Unfortunately, most dogs that have bloated once are likely to
bloat again during their lifetime. That's why it is so important
to have a gastropexy done soon after your dog has bloated.
What can I do to increase my
Dane's odds?
Know the symptoms of bloat and have a "bloat plan" in place. Familiarize
yourself with the location and routes you can take to get to an emergency facility
if your regular clinic is closed. Confer with your veterinarian well in advance
about all aspects of your dog's treatment – including tubing, surgery,
gastropexy, and aftercare. Emergency bloat surgery and follow-up care can be
very expensive, costing anywhere from $1000 to $3000 depending on the circumstances.
If cost is an issue, you need to decide ahead of time whether heroic efforts
should be put forth to save your dog. Communicate your intentions to your dog's
medical team. If you must let the dog go, make sure it is done quickly and
humanely to minimize his suffering – and your own.
More information
There are many good resources available online for information
about bloat. You can visit the Bloat Links Directory to
access some of them. Your best source, however, is your own
veterinarian.
Initiate an
open, honest discussion with your vet about all aspects of GDV. (You
may need to schedule a formal appointment to do so.) If your vet tells
you bloat is
not an important issue, or if he/she doesn't want to discuss it with
you, then perhaps it is time to find somebody who is a little more
responsive to
your concerns. Your relationship with your vet is very important – you
need to have somebody you can really trust. In the end, it is up to
each of us to make informed decisions and provide quality care for
our Danes. Our
pets are relying on us to do so.
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