Josh was a ten-year-old brindle Great Dane, a fantastic, beautiful show dog whose owners had driven across three states to purchase him because they discovered full-blooded German Danes were almost impossible to come by. Due to German Dane's longer lifespan, they were happy to make the trip. On this day, Josh was being carried into the emergency clinic unable to walk under his own power. When he was placed on the blanket, his grotesquely swollen abdomen, heavy panting, and cries of agony made it clear what was wrong: bloat, and not only bloat, but full volvulus. In the minutes leading up to his euthanasia, he suffered hideously, every second stretching like hours, every tortured breath ripping through his body, his agony immense despite being injected with strong narcotics. Could his terrible pain and tragic death have been avoided?
Bloat, or gastric dilatation and volvulus (GDV), refers to when a dog’s stomach accumulates massive quantities of air, fluid, or food, sometimes through gasping or overeating. Bloat may occur with or without volvulus, or torsion. The stomach is suspended at each end; first, at the esophagus, which delivers food, and second, at the duodenum, which attaches to the upper intestine. With torsion, the stomach rotates between those two points from 90° to 180°, while full volvulus refers to a twist of 180° to 360°. Both effectively trap air, fluid, or food inside, allowing gastric gases to quickly build up. In addition, the portal vein, vena cava, and splenic vein become severely compressed, which quickly leads to tissue death (necrosis) of the stomach wall and then the spleen. Bloat causes a multitude of potentially fatal complications, including peritonitis, cardiac arrhythmia, bacterial septicemia, shock, and severe dehydration. The three stages of bloat move quickly with the first obvious symptom progressing to death as quickly as one hour.
Owners usually take notice when their dog’s stomach first begins to dilate (gastric dilatation, when the stomach begins to overstretch due to excessive contents). Your dog will become anxious and uncomfortable, but still be able to walk; pacing, panting, and repeatedly attempting to vomit without success other than occasional white foam. Due to their inability to swallow, they salivate heavily and constantly. They may walk with a stiff-legged gait, exhibit abdominal tetany (cramping and tightness of the muscles) and be very sensitive to the touch. Gently tapping their abdomen after it has filled significantly produces a hollow, drum-like sound. Often, they take great, heaving breaths, dramatically and unremittingly. Their abdomen continues to swell. During this stage, torsion, or volvulus, may occur.
In the course of the second stage, your dog’s pain level becomes intolerable. Restlessness and panic grow and their ability to walk is failing. They stand with all four legs spread wide apart, often hanging their heads while occasionally trying to vomit or belch. Their stomach is grossly distended and their gums have turned dark red as their heart rate rises and temperature spikes. Capillary refill time (CRT) becomes quite rapid, and they may experience a bounding pulse, meaning very strong and leaping, coming and going abruptly. These are some of the early symptoms of hypovolemic shock. Hypotensive shock, a major hallmark of which is dangerously low blood pressure, frequently occurs simultaneously. Compression of major veins begins to cause necrosis (tissue death) of the stomach wall and spleen, as the spleen becomes engorged. This is your last chance to save your dog.
Finally, in the third and lethal stage, your dog loses the ability to stand. They may struggle to stand shakily but ultimately fail, collapsing to the ground, whimpering, breathes shallow, heart rate dangerously high even as their pulse becomes thready and weak. Their temperature drops steadily, whereas they were feverish before, now they develop a severe chill from progressing shock. Capillary refill time slows noticeably and their gums turn white or pale blue as hypovolemic shock advances. The chance that your dog can be saved at this point is quite literally nonexistent. As shock moves into its final, deadly act, your dog experiences heart failure, respiratory distress, and severe hypotensive shock; mercifully, they often lose consciousness.
Bloat moves with quick lethality. The first hour after your dog first begins to exhibit signs of bloat is the most important. Never hesitate to call your veterinarian should you suspect bloat, and never drag your feet taking your dog to see your vet. Time matters. Make sure you know where the best twenty-four hour emergency clinic is because not only may they be your only option, they also tend to have more experience treating and surgically intervening in bloat and torsion. And never assume an emergency clinic is automatically staffed with competent, let alone skilled, vets. Do research well in advance of ever needing the services of an around-the-clock clinic so you can be sure your dog will receive the best possible treatment.Word of mouth tends to be the most reliable source of information, and much like the way you should always ask the opinion of nurses when it comes to evaluating your own physicians, ask the opinion of talented, trustworthy veterinary technicians in order to choose your vets for basic and emergency care.
Some breeds are more prone to bloat than others, with Great Danes topping the list, followed by Bloodhounds, Weimaraners, St. Bernards, Gordon Setters, and Irish Setters. Research shows the likelihood of bloat occurring in a Great Dane is over forty percent. German Shepherds, Standard Poodles, Boxers, Irish Wolfhounds, Rottweilers, and Doberman Pinschers are also high-risk large breeds. Mid-size breeds are less likely to bloat, but Chinese Shar-Peis and Basset Hounds are at-risk. Small breeds are very rarely afflicted, with the exception being Dachshunds. There are other breeds at risk and the trait they all share is a deep chest and small waist, however, do not assume the lack of this characteristic exempts your dog from suffering bloat. Most dogs who bloat are either middle-aged or senior citizens in good health at a lean weight with active lifestyles. Genetics do come into play, so if possible, find out if your dog has any first-order relatives (siblings or parents) who have bloated. A dog with a first-order relative who has bloated has as much as a 65% greater risk of bloating themselves.
Although you will hear “nobody knows why bloat happens,” and while it is true the exact cause is unknown, the reality is there are many known contributing factors. Many dogs that bloat ate an overly large meal or drank a large amount of water in a short period, often right before or right after heavy exercise or excessive excitement. Poor nutrition or being fed one large meal rather than several smaller meals throughout the day has also been noted as an issue. Dogs with fearful or otherwise anxious dispositions and dogs under unusual stress are significantly more likely to bloat.
There are several things you can do to lessen your dog's chances of bloating. Do not assume that just because your dog does not have a barrel chest and tiny waist they are unable to bloat. Any dog can bloat; some are simply more susceptible.
- Do not feed your dog or allow access to water one hour prior to or one hour following activity. When your dog eats or drinks, they should be calm and relaxed, not panting, excited, or otherwise wound up.
- Some suggest car rides are a risk factor due not to the excitement but to the jolting and jostling your dog goes through as you drive. Your dog cannot brace themselves with the steering wheel or hold onto the grab bar or "chicken" strap the way a person can.
- Behavioral work through positive training, herbal remedies (which should only be administered with the supervision of your holistic veterinarian), and proven treatments such as the Tellington TTouch Method created by Linda Tellington-Jones will help your anxious or hyper dog relax.
- Quantity is important since overfeeding can cause food bloat. Feeding your dog several smaller meals throughout the day is highly preferable to one large meal for more reasons than only bloat. Do not free-feed; meaning, do not leave dog food constantly accessible to your dog. Store kibble in a tightly sealed bin, not in an open bag or any container they can simply tip over and spill. Quantity also applies to water, and giving very cold water has also been claimed by some to be an unnecessary risk.
- Feed your dog from an elevated bowl. This is the cause of some debate among owners and professionals alike. Opinion should be based on personal experience and logic since there are not any properly executed and controlled studies on this issue. One "study" done nearly two decades ago had several flaws including the fact that although the researcher in charge purportedly used nearly 2,000 dogs, only 11 of those dogs were actually giant breeds. That means only 0.55% of the dogs in the study came from the highest at-risk group. Additionally, Great Danes have been repeatedly proven as the absolute highest risk breed, are a giant breed, and since it does not say how many of those 11 giant breeds used were Danes, it is a very safe assumption that less than one-half of one percent of the dogs used in this study were Danes. This is an issue that needs more extensive and varied research, and suggestions made in this article are based on personal and professional experience, and should not replace the advice of a specialist knowledgeable about your specific dog. To figure out what size stand to use for your dog, measure from the ground to the top of your dog’s shoulder and subtract six inches. The resulting number is approximately the height your dog’s food and water bowls should be at, for example, a forty-inch Dane would require a thirty-four inch bowl stand. The taller the stand, the more likely you’ll need to special order it online or even build one yourself. For a puppy you’ll need to raise the bowl gradually as they grow. When you may come across the occasional argument against raised bowls, consider the fact that bending to the floor forces your dog to gulp in excess air, which is an important factor in bloat. Raising the bowls also reduces the strain on your dog’s hips and neck while encouraging them to slow down and removing the stress of “chasing” the bowl across the floor. Dogs who eat too quickly increase their risk of bloating by as much as eighteen percent.
- Gastropexy: the practice of surgically tacking your dog’s stomach to their abdominal wall. If you’re having your female dog spayed, it’s a good time to request a gastropexy be performed. Some at-risk breed owners have the procedure done prophylactically rather than simply waiting and seeing if bloat happens later in life. Although it does have an impressive success rate, it is not a guarantee, so even if your dog has had a gastropexy you should continue to follow preventative measures.
- Simethicone, found in over-the-counter (OTC) medications such as Gas-X, is a drug you can give your dog to try to relieve some pressure. It is by no means a solution or treatment on its own. By administering simethicone you are improving the odds your dog’s survival. Always check dosages with your veterinarian before you actually need them. The average dose is one-quarter the human dose for a small dog, one-half dose for a medium-sized dog, and a full dose for a large dog. For a more specific dose based on your dog’s size, ask your veterinarian.
- Holisitic veterinarians suggest using digestive enzymes and probiotics in breeds prone to bloat. Acupuncture has also been used to correct liver and stomach imbalance and calm existing digestive issues. A natural treatment called Rescue Remedy may also be useful in treating the shock your dog will go through if they bloat. It is not a treatment but simply something to use to hopefully give your dog a better chance of survival.
Factors sometimes mentioned as potential risks that are not risks at all:
- Use of dry food vs. wet food
- Specific brand of dog food (although quality absolutely matters when it comes to digestion and overall health)
Your veterinarian must move quickly to save your dog’s life. Time cannot be wasted in long, drawn-out decision making on your part or delays due to lack of notification; always call ahead so they know you are coming and why. Upon arrival, diagnosis is made in a number of ways. Your dog’s distended abdomen is quite obvious, of course. Taking your dog’s vital signs helps your vet evaluate severity of shock. An x-ray may be taken if there is time, otherwise, treatment will begin first to increase your dog’s chances of survival.
There are a number of treatment options available dependent on severity of the gastric dilatation and whether your dog has torsion or volvulus. An intravenous catheter (IV) will be started to help stabilize your dog. Fluids raise blood pressure, treat dehydration, and otherwise assist in stabilizing shock, and having an IV in place allows for more immediate administration of other medications, such as pain medicine and pre-anesthetic. A heart monitor may be attached and bloodwork will be drawn at some point, the timing of which depends on your dog's stability upon admittance. An x-ray will give a definitive answer as to whether or not they have torsed, but there may not be time to take any. The simplest solution for food bloat, which is far less dangerous than full GDV and most commonly caused by dogs getting into a bag of kibble and eating to their heart's content, is passing a stomach tube to quickly empty the contents. A stomach tube may also be used to relieve gas. A trocar (a three-sided surgical instrument used to cut into the abdominal wall) or long needle may be inserted through your dog’s side into their stomach to quickly relieve the worst of the gas. If your dog's stomach has twisted (torsion or volvulus depending on severity), emergency surgery must be done to save their life. In surgery, your dog’s stomach will be carefully rotated back to its normal position and examined for devitalized tissue. Their spleen will also be examined. Any dead tissue will be removed, and a gastropexy should be performed.
Dogs treated only medicinally and not surgically have as high as an 80% recurrence rate. When bloat is caught very early and surgery is not necessary, the rate is not quite as high, but your dog is still more likely to bloat than a dog who has never bloated. If your dog survives bloat without surgery, have a gastropexy performed once your dog is healthy enough to undergo the procedure. Dogs with a gastropexy have a bloat rate as low as 5%. Mortality rates for bloat with quick treatment are between 25% and 50%, although in dogs treated surgically that number drops as low as 15%. If your dog survives the first few hours without treatment, but does not receive treatment, additional complications such as peritonitis, sepsis, and disseminated intravascular coagulation (DIC) may occur. Simply put, DIC refers to the formulation of small clots throughout your dog’s blood vessels. When stricken with DIC, your dog may bleed from its nose and mouth or suffer kidney failure, and the bloat must be resolved first to even begin to recover from the DIC. However, dogs who develop acute DIC have a guarded prognosis, at best. Bloat does not resolve itself. Do not wait; if you cannot afford to treat bloat, your veterinarian will most likely suggest euthanasia as the kindest choice. Allowing your dog to suffer an agonizing death at home would be unspeakably cruel.
Take steps to reduce your dog's chances of bloating, and always react quickly when you suspect your dog may be becoming ill. It is imperative your dog receives treatment within the first hour. With bloat, it is all about speed. When Josh, the Dane mentioned at the beginning of this article, developed GDV, he was being watched by a relative. He had been running extensively in their front yard, was panting heavily, fed large biscuits, given cold water in a bowl placed on the ground, and when he became ill, the relative waited over an hour before making what was no longer a life-saving call. To make matters worse, they had been thoroughly educated on bloat prevention and presentation. Playing a wait-and-see game could not only cost you your dog’s life, but puts your beloved pet through unspeakable torture in the minutes and hours leading up to their death. Seeing any dog suffer and die from bloat is a terrible experience; watching your own dog struggle for the breath to cry out as they inch towards an agonizing death is horrifying and will be permanently etched into your mind's eye. Always err on the side of caution.