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Bloat, the Mother of All Emergencies
What you need to know about this life-threatening condition
One day after treating Bauer for bloat, veterinarian Shea Cox scheduled him for surgery to prevent the more serious GDV.

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 time-dependent.

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 intervention.

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 period.

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 food).
  • 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 temperament.
  • 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.

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Veterinarian Shea Cox has enjoyed an indirect path through her professional life, initially obtaining degrees in fine arts and nursing. She later obtained her veterinary medical degree from Michigan State University in 2001 and has been practicing emergency and critical care medicine solely since that time. In 2006, she joined the ER staff at PETS Referral Center in Berkeley and cannot imagine a more rewarding and fulfilling place to spend her working hours. In her spare time, she loves to paint, wield her green thumb, cook up a storm and sail. Her days are shared with the three loves of her life: her husband Scott and their two Doberman children that curiously occupy opposite ends of the personality spectrum.

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