Part of the appeal of veterinary surgery is the reward of achieving a “before and after” moment for a sick animal. It might be the Dachshund with intervertebral disk disease transformed from dragging a paralyzed hind-end to being able to trot over to greet me. Or the Labrador with laryngeal paralysis who is no longer desperate for air and able to breathe comfortably on a hot summer day. Whatever the underlying problem, when there’s something positive and tangible to show for our efforts, owner satisfaction and a sense of our own accomplishment are givens.
But it was precisely the absence of any possible “before and after” moment for a delicate, two-year-old black Standard Poodle named Vivian — a service dog in training — that gave me pause when her person, Lisa, suggested that a preventive gastropexy for GDV be performed while Vivian was being spayed.
What is a gastropexy?
GDV— gastric dilatation and volvulus, commonly called “bloat” — is a bizarre, unpredictable and potentially catastrophic event in which fermented gas accumulates in a dog’s stomach and causes the entire organ to twist and flip over on its long axis. Left untreated, bloat can kill a dog within a matter of hours. Treatment often consists of a gastropexy (or “pexy”), in which the dog’s stomach is sutured to the body wall, preventing it from twisting. This procedure is typically performed in response to a GDV bloat emergency where a large abdominal incision (laparotomy) is made to untwist the stomach and secure it. Preventative gastropexy may use minimally invasive (laparoscopic) techniques.
“Hmm,” I said in response to her remark. “It sounds like you’ve had another dog who developed bloat and needed emergency surgery.”
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“Actually, it happened to a friend’s dog, and Vivian’s breeder also recommended it,” said Lisa. “I figured if you’re in there doing a spay, you might as well pexy her stomach at the same time. Once she’s healed up, I can get back to her training.”
Lisa, a pretty college student with cerebral palsy, had another Poodle, nine-year-old Ethan, who was also helping tutor Vivian in the art of opening and closing doors, turning lights on and off, and helping Lisa take off her socks and pull her arms out of coat sleeves. In short, Vivian was Lisa’s insurance against a loss of continuity in essential canine care.
My downturned lips, raised eyebrows and nod demonstrated my understanding, but my mind was elsewhere, beyond Vivian’s health and on her role as Lisa’s service dog. Every dog is “the best dog in the world,” and owners never have to justify what makes their animal special to them. If they put their trust in me, I hope they do so with the certainty that I “get” it. However, I confess to feeling a twinge of added pressure when the dog in question works for a living. Vivian was learning all kinds of tasks vital to helping Lisa live independently. What if something went wrong with an elective surgery intended to prevent a problem that the Poodle might never develop?
There wasn’t much more to my examination, which disclosed a perfectly behaved dog in perfect health. All that was left was a discussion of the pros and cons of a gastropexy.
“It’s hard to argue against personal experience or the accumulated knowledge of your breeder, but the procedure will require a longer anesthesia, there will be more than one incision and, on occasion, dogs have minor intestinal problems afterward.”
“It sounds as though you’re not recommending it,” said Lisa.
“No,” I said. “I know that if Vivian did experience GDV, we would both curse the day we decided against taking steps to prevent it. But at the same time, I wonder what the chances are of Vivian developing it. My sense is that the risk is fairly low. If this is true, then it would be like removing a healthy person’s appendix to prevent appendicitis — a surgery in anticipation of a problem that’s statistically unlikely to occur.”
“I’m still inclined to have the pexy done,” said Lisa. “Could you find out more about her risk of developing GDV?” I said I would, and when I did my research, everything changed.
In my search of the veterinary literature, I could find only one scientific study focusing on the statistical likelihood of a purebred dog developing GDV during his or her lifetime, but the results were chilling: 24 percent for large-breed dogs, 22 percent for giant breeds and 42 percent for Great Danes!* Naturally, one should be wary of a solitary study; however, my earlier estimate of the risk was probably too low. When taken in combination with Lisa’s innate inclination toward prevention, we decided to sign up Vivian for both procedures. All went well, and she was released to Lisa’s care the day after the surgery.
The next time I spoke with Lisa, I asked her to tell me what Vivian provided, beyond assistance with the tasks of daily living. “She’s a typical Poodle,” Lisa said, “whip-smart, with a clown’s personality. Vivian is teaching me to be creative, to be silly. I’m normally quite shy and reserved, but when she does something correctly, I gladly make a fool of myself in public singing her praises.”
That was when I realized I might need to accept that sometimes, “before and after” can be equally rewarding when they’re exactly same.