This week, two dogs of similar age and physical fitness developed a problem, for which they were presented to our emergency clinic in Mount Pleasant. Each had the exact same problem. It started the same way and progressed at the same rate, in both dogs. Despite all of this, one will survive, relatively unscathed. The other will not. Why? The problem is called gastric dilation and volvulus (GDV), or more commonly, bloat.
How a disease develops is known as it's pathophysiology. In the case of GDV, the stomach becomes distended with gas, fluid and foam, and then flips over, or twists. When this happens, the esophagus and the intestine, as it leaves the stomach, become kinked, leaving no escape for gas, which is continually forming in the stomach. As more gas is produced, the stomach becomes severely distended.
Things go rapidly downhill from here. The pressure inside the stomach becomes so great that it cuts off its own circulation. Deprived of a blood supply, the stomach wall will die.
The stomach becomes so large that it actually compresses the major blood vessels in the abdomen, preventing blood from returning to the heart. This effectively removes half of their blood from circulation. Breathing becomes difficult and the pain becomes excruciating. The progression to shock and death is nearly inevitable.
So, why the difference in outcomes? It's a matter of time and pressure. The longer this situation goes untreated, the greater the damage. The greater the distension of the stomach, the faster the damage will occur. The key is early recognition and intervention.
Elvis was the first to arrive. He was an 8-year-old bloodhound. Until that moment, Elvis was in peak health. He was an active, gregarious dog who loved to play at the dog park and follow scents in the woods. Three days a week, he would be left at doggie day care because his owners often worked late. This was not one of those days.
He ate breakfast normally and had a short, early morning walk. His owner was only going to be gone for about six hours. When she returned, it was immediately apparent that there was a serious problem. His normally pink gums were dark. He had been drooling profusely and he could not stand. His abdomen was massively swollen and tight as a drum. He had to be carried to the car and we carried him into the hospital. Everyone worked furiously to stabilize him. I.V. fluids and pain medications were administered. A stomach tube was passed to relieve the pressure. Blood was seen along with the stomach contents, which indicates severe damage.
At surgery, his stomach was found to be necrotic (dead) over a large area, which had to be resected. Despite receiving intensive medical and surgical support, Elvis did not survive. The damage was simply too severe. It is likely that Elvis began to bloat shortly after his owner left home, leaving his condition up to 6 hours to progress.
The next case was Jimmy. He is an 11-year-old Goldendoodle (half golden Retriever, half poodle). Jimmy's owners were at home with him when he began to become restless. He could not seem to get comfortable. He was pacing, panting, drooling, and he began to retch. It was as if he were trying to vomit but nothing was coming up.
Luckily, his owners were not only present, they were astute and informed. They noticed his behavior and recognized what it could indicate. With this, they came to the emergency clinic. Jimmy looked uncomfortable but did not yet demonstrate signs of shock. Based upon his appearance and the owners' description of events, it was clear that we were in the early stages. An X-ray confirmed the diagnosis and within an hour-and-a-half of first demonstrating signs, Jimmy was in surgery. There was virtually no damage to the stomach and he sailed through surgery like a champ. By the following evening, he was eating and drinking and on his way home, bearing an excellent prognosis.
GDV typically affects large-breed, deep-chested dogs. Great Danes, Irish Setters, German shepherds and bloodhounds are breeds at risk, but any large dog can be affected. Basset hounds are also reported, and I had one case in a Dachshund. The signs are, as mentioned above, restlessness, drooling, non-productive wretching, abdominal distension and pain. If you have an at-risk breed, know the signs and do not delay medical care if you suspect an episode.
GDV can be prevented with a surgical procedure known as a gastropexy. This means that the stomach is permanently attached to the abdominal wall to prevent a twist from occurring. This may be done at the time of spay/neutering your at-risk breed. This can even be accomplished in a minimally invasive way with an endoscope. Ask your family veterinarian if this would be right for your dog.
The risk of GDV occurring also can be minimized by avoiding heavy exercise for 30 minutes after eating, and splitting up feeding into three or four smaller meals per day.