BLOAT - Gastric Dilatation and Volvulus: A Life-Threatening Emergency

On New Year's Day, I had a very unexpected turn of events. We were off to a good start to 2012. I got up; took care of my two German shepherds, Mojo and Turbo; got in 5 miles on the treadmill and was feeling energized and ready to kick off the New Year in a positive way.

Later that afternoon I took Mojo and Turbo over to my learning center to do some scent work. Mojo thoroughly enjoys this sport and all was going well. We came home, I fed the dogs and then something went terribly wrong.

Mojo is boundary trained on my property, so I've never worried about him going beyond the boundary he has learned. I don't leave my dogs outside unsupervised, as no matter how reliable a dog is, things can happen that can draw your dog away from his property. But, Mojo has been trained to go out and potty and return to the back door. He stays within the immediate yard and is only outside for five minutes for "potty-stops".

All seemed to be fine and then it happened. About thirty minutes after Mojo ate dinner, he was acting like he had to vomit. This is not uncommon, because dogs do vomit for a variety of reasons.  I wasn't overly concerned because Mojo is the type of dog that will vomit occasionally and then he's fine. But I noticed Mojo was not acting right. I recognized "the walk".

Mojo seemed a bit disoriented as he was walking through the yard, getting further and further away from the house. This was NOT normal! I recognized that walk from June 2010 when we lived in Texas. I just knew he was bloating. In June 2010, Mojo's stomach had filled up with gas and he was in so much pain that he didn't know what to do. He started walking and just kept going. At that time, in 2010 the stomach did not twist, so our veterinarian in Texas put in a stomach tube and decompressed the stomach. That treatment was successful with relieving the gas build up and emptied the stomach contents.

When I recognized "the walk", I got a leash and ran down the driveway where Mojo now crossed the boundary.  I knew something was terribly wrong. I walked him back to the house. As soon as I got Mojo inside, I could see his abdomen was becoming distended. From that moment, every minute counted.

I called the Milwaukee Emergency Center for Animals (MECA) and told them I was bringing in my 10 year old German shepherd who I believed was in the early onset of bloat. I loaded Mojo into my vehicle and off I went for the half hour drive, knowing that every minute was critical.  We were about ten minutes from our destination when I could hear Mojo retching. He was trying to vomit. This may seem unpleasant, but I was very much hoping when I arrived at MECA, I was going to find contents from Mojo's stomach on the floor and he'd be feeling so much better.

The fear set in when I opened the door and there was no vomit. I knew at that instant Mojo's stomach had twisted, also called torsion and now every minute was truly critical. I rushed Mojo into the waiting area and within a minute, a technician arrived and took Mojo away.

I was very distraught because I know that bloat is a fatal condition if not caught early. I prayed I caught it in time and the medical staff at MECA would be able to save my sweet boy. And so the story unfolds.

I had the privilege of interviewing the veterinarian, Dr. Roz Elliott who saved Mojo's life by performing an emergency surgery, a gastropexy. Dr. Elliott was very kind to take the time to work with me on this article so that not only can I share Mojo's story, but also educate dog owners on the severity of bloat and hopefully provide enough information so dog owners can recognize the signs of bloat early, as I did.

Paws-A-Tive Choice (PC):  Where did you receive your veterinary degree? 

Dr. Elliott: University of Wisconsin Madison School of Veterinary Medicine, class of 2001

PC:  How long have you been practicing veterinary medicine and do you have a specialty?

Dr. Elliott: I have been out for almost 11 years. After graduation I did a 1 year rotating medicine and surgery internship at the Cornell Veterinary Teaching Hospital, and then a 1 year surgery internship at a private practice in Albany, NY. Since then I have worked exclusively in 24-hour emergency and referral hospitals.

PC:  Why did you choose to work at an emergency veterinary hospital such as MECA?

Dr. Elliott: I have always enjoyed the 'unknown' of emergency medicine. You never know what is going to walk through the door. I get the opportunity to work with specialists, manage critical cases, and do emergency surgeries, all of which I find immensely enjoyable.

PC: When Mojo arrived at MECA on January 1, 2012, what was your first impression upon examination?

Dr. Elliott: His history of acute 'unproductive retching' is classic for a bloat dog, but after my physical exam I was a little skeptical that his stomach was truly twisted. His abdomen was not palpably distended and his heart rate was not elevated above normal, both of which you usually see in a GDV dog. This is because they are in shock from the pressure of the distended stomach on the venous blood return. We do see quite a few dogs that come in for suspected bloat but turn out not to be. I think Mojo's clinical presentation was so subtle because you brought him in so quickly after he showed his first symptom.

PC: What did you find when you radiographed his abdomen?

Dr. Elliott: His stomach was filled with gas and had the classic 'double bubble' look. This indicates that the stomach has twisted on itself.  The film left no doubt that Mojo had gastric dilatation and volvulus or GDV. This is the medical term for bloat.

PC: Upon diagnosing him as having bloat, what was your next immediate step? 

Dr. Elliott: If a dog comes in with the obvious gas distended stomach and there is a high index of suspicion for bloat based on history and physical exam,  we place 1 or 2 IV catheters and give rapid intravenous fluid boluses. This is because bloat is a cardiovascular emergency first, and a surgical emergency second. A bloated dog usually comes in to the hospital in some degree of shock and IV fluids are used to treat this. Once they are more stable and pain medications have been given, then the films are taken to confirm the diagnosis. In Mojo's case he was so stable on presentation that we placed an IV catheter and started fluids after the film confirmed bloat. He received pain medications, blood was drawn for pre-operative lab work, and he was prepped for surgery.

PC: How critical was Mojo's condition at the time you examined him?

Dr. Elliott: He was one of the more stable bloats I have seen, but he still needed to go into surgery as soon a possible. The longer the stomach is twisted, the more likely that stomach tissue will die due to deprivation of normal blood flow.

PC: Had he not been brought to you immediately at the onset of bloat, what would Mojo's chances of survival been?

Dr. Elliott: Without surgery he would have died, probably within hours. Had treatment been delayed and he had come in as a more critically ill patient, his chances of survival decrease and the chance of complications during and after surgery increase.

PC: In your professional opinion, when a dog suffers gastric dilatation, regardless if the stomach has not twisted, do you automatically perform a gastropexy?

Dr. Elliott: Just so there is no confusion - the term 'bloat' is commonly used to refer to the condition where the stomach fills with gas AND twists on itself (gastric dilatation and volvulus or GDV). This is different than just gas in the stomach (gastric dilatation) which is not uncommon and is not a surgical emergency. We will refer to this as 'gas bloat'. What Mojo had in June 2010 was gas bloat and would not have needed to be treated surgically since the stomach was not twisted.

PC: How long was Mojo in surgery and did you encounter any complications?

Dr. Elliott: The surgery time was about 1.5 hours. This is a little longer than a typical GDV surgery because I found that Mojo had pieces of Kong in his stomach. This is not a typical finding during GDV surgery and was the only 'complication'. (Note from Kathy: All of my German shepherds have been power chewers, also known as "German shredders". I have always done my best to supervise my dogs when they are chewing on toys. I was extremely surprised to learn that Mojo had actually consumed pieces of Kong toys and those two pieces were still in his stomach. We have no idea how long those pieces had been in there. The photo shows the pieces that were removed from Mojo's stomach during surgery. When my dogs start to shred toys, the pieces are immediately picked up and discarded along with that toy. So you can imagine my surprise to find out that those pieces had been consumed.)

PC: Upon finding the two pieces of Kong toy, is there any chance that those contributed to his bloat?

Dr. Elliott: There is a possibility that it contributed. If the Kong really had been in there for over a year, who knows why he all of a sudden bloated.

PC: Was any damage done to Mojo's internal organs?    

Dr. Elliott: Once the stomach was decompressed and rotated back into it's normal position, I found no major damage to either his stomach or spleen. The spleen is often twisted and displaced along with the stomach, and if the blood supply is disrupted we sometimes have to remove it. Mojo's spleen was fine.

PC: From the time a dog begins bloating, approximately how much time does the dog have before damage is done to the organs and then possibly dies?

Dr. Elliott: That is very variable. I have seen dogs bloated for hours and come walking through the door like nothing is really wrong, and I have seen dogs come in soon after clinical signs started and find at surgery that there is extensive tissue necrosis. I don't think they could live much longer than 8-12 hours or so with a fully bloated stomach.

PC: According to the article, "Bloat - The Mother of All Emergencies" by the Veterinary Information Network, Inc. , it states if the stomach is tacked in place, the recurrence rate drops to 6%. How many gastropexys have you performed and do you have any statistics on the success rate of dogs living out their lives without suffering gas-bloat again?

Dr. Elliott: Wow. I've never thought about how many I have performed. If I had to guess I'd say somewhere around 75-100. I don't know of any of my GDV surgery patients that have had a recurrence, but one of the disadvantages of being an ER doctor is that I don't often know what happens to my patients once they are discharged. I have only seen one dog in my career whose gastropexy site broke down and he bloated again (this was several years ago) but our hospital had not performed the original surgery.

PC: Mojo is a 10 year old German shepherd. What was your overall assessment of his health?

Dr. Elliott: Other than his propensity for eating Kongs and his history of gastric dilatation (gas bloat), I'd say he seems in excellent health. He recovered very well Mojo - less than 24 hours after his emergency surgeryfrom surgery, especially for an older dog.

PC: What is his chance of developing any additional medical conditions due to having bloat?

Dr. Elliott: The only possible problem he could continue to have is gas bloat. The surgery doesn't prevent gas build up in the stomach, it just prevents the stomach from twisting.

PC: Mojo had a nasogastric tube put in 3 days following his surgery. Is this common for bloat patients?

Mojo with the NG tube 3 days after his gastropexyDr. Elliott: I'd say about 25% end up needing them. I have worked at other practices that do not routinely place NG tubes in patients so in-hospital post-op recovery can be longer. We don't like to send them home before they are getting some form of nutrition and an NG tube is great for this if they do not want to eat on their own.

PC: During the five days Mojo was at MECA, what were the daily care procedures Mojo went through? Was he hooked up to IVs? Heart monitor?

Dr. Elliott: He had IV fluids up until the day of discharge. He had blood pressures, EKG's, and vitals checked several times a day. He was on IV antibiotics and a constant rate infusion (or CRI) of pain medication to keep him comfortable. The NG tube was used to give him liquid food and between feedings was suctioned to keep his stomach from filling with too much fluid. And of course he was walked outside several times a day as well!

PC: What advice can you provide my readers on what they can possibly do to prevent this condition from happening to their dogs?

Dr. Elliott: For the most commonly affected breeds, we usually recommend that you limit your dog's activity for 1-2 hours after eating. There is still a lot of debate as to what does and does not contribute to the development of GDV.

If you have a dog that is a high-risk breed, please consider having a prophylactic gastropexy done. It is the same 'tacking' of the stomach to the body wall that we do during GDV surgery, but it is done in a healthy dog to prevent it from happening, not after it has already happened. It is far less risky to perform surgery on a healthy dog rather than one in crisis. An ounce of prevention is most certainly worth a pound of cure in this case!

PC: Can any breed and any size of dog bloat?

Dr. Elliott: Technically the answer is 'yes', but it is almost exclusively seen in large or giant breed, deep-chested dogs. I have read reports of it happening in some smaller breeds but I have not seen it myself in an atypical breed.

PC:  Is there any other information you'd like to share regarding Mojo's case or your experience with working with dogs that bloated?

Dr. Elliott: My best advice to your readers - know the clinical signs of bloat and get your dog to a veterinarian immediately if you suspect that your dog may have GDV.

The classic signs are unproductive retching (sometimes they will bring up white foam) and a large, gas distended and painful abdomen. When in doubt, have your dog seen by a veterinarian. I would rather take 100 films on dogs that come in for bloat and find with relief that they are not a true GDV, than to have 1 dog sit at home suffering.

PC: According to the article on VeterinaryPartner.com, "Bloat - The Mother of All Emergencies", several statistics were noted. Apparently dogs weighing more than 99 pounds have an approximate 20% risk of bloat.

In 1993 a study was conducted at the School of Veterinary Medicine in Hanover, Germany involving 134 dogs: 88 of the dogs were treated with decompression and surgery; 9 of those dogs died during surgery; 16 dogs died in the week following surgery and 63 dogs went home in good health. Of those 63 dogs, 4 dogs had a second episode of bloat later in life. For full details on the statistics of this study;  visit www.VeterinaryPartner.com.

I would like to include from that article the factors increasing the risk of bloat:

• Feeding one meal per day (Mojo is fed twice daily)

• Dogs in the same bloodline that had a history of bloat (There were some distant relatives in Mojo's bloodline that had bloated)

• Dogs that eat rapidly (Mojo is a speedy eater)

• Dogs that are thin or overweight (Mojo is at a healthy weight)

• Feeding from an elevated bowl (Mojo's bowl is not elevated)

• Restricting water before and after meals (Mojo has access to water at all times)

• Feeding dry diets with animal fat listed in the first four ingredients (Mojo is on a good quality diet with the first four ingredients: fresh chicken; chicken meal; pearled barley; oatmeal)

• Fearful or anxious temperament (This certainly fits Mojo. He is a very high-drive, intense dog. He can go from 0 to 60 within a matter of a few seconds. I thought that personality profile for increasing the risk of bloat was interesting.)

• History of aggression towards people or other dogs (This also fits Mojo. He is a dog-reactive dog.)

• Male dogs are more likely to bloat than females (Mojo is a male)

• Older dogs (7-12 years) were the highest risk group (Mojo is 10 years old)

Unfortunately, there is no way to prevent GDV in a dog. But taking a few simple steps may at least lower the risk of bloat.

1) Break up your dog's meal into two or three meals rather than feeding one large meal.

2) Do not allow your dog to exercise heavily for one hour prior to eating and for at least one to two hours after eating.

3) Try adding canned dog food to your dog's diet.

4) Keeping your dog calm before, during and after eating a meal. (I now feed Mojo in a separate room and give him "quiet time" for about an hour following his meal so he can digest it and stay relaxed.)

Mojo - 3 days after his surgeryThank you for reading Mojo's story. He spent 5 days at MECA where he received the very best care. I was highly impressed with the entire staff at this emergency hospital. They truly saved my sweet boy's life! I am so grateful to each person who directly cared for Mojo; especially Dr. Roz Elliott. She is an outstanding surgeon!

Mojo on Jan. 12, 2012I am thrilled to report that at the writing of this article, Mojo appears to be 100% recovered. He's back to enjoying life and seems healthier now than he has in a very long time.

Milwaukee Emergency Center for Animals is located in Greenfield, WI at 3670 South 108th Street. www.erforanimals.com