Gastric Dilation Volvulus, a.k.a. Bloat

Gastric Dilation Volvulus, also known commonly as bloat and torsion, is a scary, life threatening condition that can strike dogs of any size at any age, although it tends to afflict the larger breeds with deep chest cavities. It is the mother of all veterinary medical emergencies. No one is sure exactly what causes it, but the veterinary profession has an abundance of theories. Bloat occurs when the stomach rapidly fills with gas then, because the enlarged stomach is top-heavy, the stomach flips over (torsion), twisting the ends off and trapping the gas. The gas continues to expand, with no exit route, and the stomach can grow to massive sizes. You can easily imagine from there how quickly things can go downhill. Often the twisted stomach tissue starts to die as the blood flow is compromised, and other organs get displaced as the stomach grows. The twisted stomach can block major blood vessels that carry blood back to the heart, quickly sending the dog into shock. Shock can occur within minutes of bloat starting, so this is not a ‘wait and see’ type of medical condition, this is truly a dire emergency.

Most dogs will act uncomfortable, sometimes pacing, trying to throw up but nothing comes. Many people, including vets, often think it’s just a ‘stomach ache’ and instruct owners to give some pepto bismol and call back in the morning. The veterinary and dog breeder world will offer you many suggestions for the prevention of bloat- from elevated feeders and no play for 30 minutes after eating, to feeding non-grain or raw based diets, not letting your dog scarf down food, and not allowing them to drink loads of water at a time. But despite all this bloat can still strike. Tiki, my 10 year old long-haired German Shepherd, is a dainty eater. She often takes upwards of 10 minutes to eat a cup of food, and generally will leave a bit behind. She eats grain free, from an elevated feeder, and being 10 years old with early stages of arthritis, she doesn’t run around much during the day, let alone after she’s eaten dinner. She’s never been a water tanker, taking a few dainty sips at a time before laying down, coming back for more later if she’s still thirsty. When bloat stuck at 7pm as I was fixing dinner, she hadn’t even eaten since breakfast that morning, and certainly hadn’t engaged in any physical activity within the 90 minutes prior.

All I can say of the experience- harrowing to say the least- was that I thank everything in the universe that I was at home when it started. Had I been at work, even with my roommate home all day with her, she certainly would have perished. My roommate is not a dog person, and while she likes dogs, she’s certainly not well versed in their medical anomalies. In fact, if someone hadn’t educated me on this subject in the past, I’d almost certainly have not dropped everything, grabbed Tiki up, and rushed the the emergency vet. Many people aren’t sure what’s going on, and decide to wait and see, or take their dogs to the vet first thing in the morning. By then it’s too late.

When bloat first presented itself, Tiki was laying in her usual corner of the kitchen while I cooked and my roommate worked on her laptop on the table. She started panting- no entirely unusual in Texas for a long haired GSD, even with the a/c on, but something about her expression made my roommate suddenly ask, “What’s wrong with Tiki?”

I looked over at her and sure enough, she was panting lightly, but had the barest hint on her face that she was uncomfortable. I called her to me, and she got up and obediently came, and I kneeled down to put my hands on it. I rubbed her face then ran my hands down her side, and stopped cold at her stomach. It wasn’t overly distended- yet. But it was rock hard. Outwardly nothing looked amiss, the stomach hadn’t grown yet to be noticeable enough just looking at her (although that’s what most people will first notice about bloat- the visibly distended belly. By that time, it’s almost always too late.)

My heart stopped. I knew instantly what is was. It felt like she had eaten a really big meal. My naturally dainty, slender GSD had a thanksgiving dinner belly- hard to the touch and larger than normal. I switched off the stove top, gabbed my keys and wallet, and literally threw Tiki into the back of my car. The e-vet was 20 minutes away and I made it in barely 10, going 105mph down the freeway while Tiki cried in the back. If I had gotten pulled over I was prepared to lead a police chase right to the front door of the vet.

I didn’t bother to park, stopping right in front of the door, grabbing Tiki and running into the vet. Luckily a tech came right out when they heard the door chime. I practically threw Tiki at her, mumbling incoherently about bloat, and the tech immediately took her back for x-rays. Not 10 minutes later the vet and tech were both back with x-rays. The news was dire. Her stomach had flipped completely and she would need immediate surgery, with no guarantee of survival. They wouldn’t know the damage to the stomach tissue or surrounding organs until they got in there. Her blood pressure was already fluctuating, and her blood work came back with some irregularities from the bloat. I signed the consent papers at the same time as they were prepping for surgery. Before I even left the vet they already had her open on the operating table- less than 30 minutes from when her bloat started.

The wait was agonizing. Even with proper medical interventions, survival is less than 80%, if any part of the stomach had died off, survival drops to below 50%. Survival depends greatly on how long the stomach has been flipped, if any stomach tissue has died from loss of blood, and if the dog was approaching or already in a state of shock before the surgery. Without aggressive medical interventions, death is nearly certain once the stomach flips, and the emergency vet confided to me afterward that she wasn’t going to tell me this, but that particular e-vet had seen many cases of bloat- and not a single survivor, mostly due to owners not knowing what was happening and waiting too long to bring them in. Manually trying to flip the stomach using a tube down the throat has limited success, and bloat will nearly always reoccur. Surgery was our only option.

It was an agonizing 3 hour surgery, but the vet didn’t call immediately to tell me the damage was too severe, so I was hopeful. When she did finally call it was to say things went as well as they could have, and Tiki was now sleeping. I could come get her the next morning and have her transferred to my regular vet.

Waiting at home for the hour between when the e-vet closed and the regular vet opens.

Waiting at home for the hour between when the e-vet closed and the regular vet opens.

When I picked her up the vet gave me a list of complications to look out for, such as behavior that would signal a change in blood pressure or signs of shock. I paid the bill (a bit over $4000, for the curious. /gulp) and I took her to my regular vet and they admitted her for the day for observation while I was at work. My regular vet, a 60+ year old James Harriot-type man, told me he, also, had never had a bloat survivor in his practice in 40 years as a practicing vet. He was so impressed that she had survived, that he brought in all the techs and the other vets to come meet her while he gave them a run down on bloat signs and symptoms (which he did while kneeling on the floor with Tiki and wrapping a bandage around her stomach). By the time I picked her up after work, the vet was confident she was mostly out of the woods, to keep monitoring her, and he sent me home with antibiotics, telling me to come back in two weeks to remove the 40 staples that were holding her together.

Feeling well enough to jump not eh bed while I was washing the sheets, but oh! too weak to move! when I need to make the bed

Feeling well enough to jump on the bed while I was washing the sheets, but oh! too weak to move! when I need to make the bed

In addition to antibiotics, she received antacids to help with the stomach acid on her healing stomach. Part of her surgery included gastropexy- fastening the stomach to the body wall to prevent torsion in the future (as reoccurrence of bloat in dogs without a gastropexy reaches nearly 100%, with a gastropexy, it’s less than 5%).

Finally feeling well enough, 3 days post-surgery, to show a bone!

Finally feeling well enough, 3 days post-surgery, to chew a bone!

Tiki developed a minor skin infection during the end of the second week of healing, apparently licking in secret as we never caught her actively licking her staples, so into the cone of shame she went and she received a week of antibiotics.

"I do not like the cone of shame"

“I do not like the cone of shame”

4 1/2 months later and Tiki is doing great. Her hair has grown back, she’s had no bloat reoccurrence, no complications, and she healed perfectly. She will celebrate her 10th birthday this fall!

4 months post-bloat!

4 months post-bloat!

 

One thought on “Gastric Dilation Volvulus, a.k.a. Bloat

  1. Time is definitely a huge issue with bloat. My standard poodle bloated three years ago, and was in surgery less than an hour from the start of his episode. He’ll be eleven this year, and has had no recurrence or other issues since then. :)

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