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– Bloat: Overcoming the
June 9, 2003 – This week's DaDane
is the final installment in a four-part series on a dangerous medical
known as Gastric Dilatation
and Volvulus (GDV) or, as many call it, BLOAT. We first heard from Gaysie
a five-year-old Great Dane who survived an episode of bloat and torsion. She
shared her story, enabling us to experience GDV from a Dane's point of view.
Next we heard from Paula Stebbins, who provided an owner's perspective by offering
a candid look at what she and six-year-old Gambler went
through together. Last week we
took a closer look at GDV – its physiology, symptoms, risk factors and
potential causes. This week we'll conclude the series with a discussion about
emergency bloat surgery and post-operative care.
Note: The information presented below is not intended to substitute for professional veterinary care. Please discuss GDV ahead of time with your veterinarian and seek his or her assistance in all actual or suspected emergencies.
If my dog is experiencing early symptoms of bloat, what should I
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
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.
I have used this technique twice on Merlin (pictured above). I am not sure if
he was actually headed into bloat, but both times he seemed to be displaying
some of the early warning symptoms that we discussed last
week. After administering the Simethicone, I made plans to rush Merlin to
the emergency vet clinic if his symptoms increased or failed to resolve within
a short period of time. Fortunately for both of us, Merlin's discomfort subsided
and he was perfectly fine.
(Note: Please discuss this 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 my dog displays obvious symptoms of bloat, what should I do?
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-arrythmics 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.
A note about TUBING 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.
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
somebody who is qualified and willing to teach you.
Pickett at NaturesFarmacy.com offers
two types of bloat kits. Prices range from $25 to $45.
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
What happens during surgery?
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
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%.)
are a variety of gastropexy techniques that may be employed – circumcostal,
belt-loop, incisional, ventral, and tube gastrostomy. A healthy debate continues
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
What about preventive gastropexy?
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
some degree of risk. Preventive gastropexy is often done
coincidental with neutering, spay or some
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;
What happens after bloat surgery?
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.
I asked Gambler's surgeon, Dr. Joe, to explain reperfusion
to us. This is what he said:
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:
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
What is the overall
survival rate of GDV?
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.
What can I do to increase my Dane's odds?
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
$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 my 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
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
of us to make informed decisions and provide quality care for our Danes.
pets are relying on us to do so.
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