GDV

" 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.

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." These high numbers are 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.

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:

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.

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:

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.

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 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-arrhythmias 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.

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.

Our 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.

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.

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).

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.

Dr. Joe, to explains reperfusion:

"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."

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.

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.

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.

June 16, 2010