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Help... My Dog's Stomach is Swollen! Bloat, Torsion, and GDV in Dogs - Part 2: Be Prepared

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Jason Nicholas - Tuesday, February 26, 2013

bloat, GDV, dogs, swollen stomachIn Part 1 of this blog series, I covered Awareness of these three conditions, and highlighted the importance of awareness - for all dog owners. In this installment, I narrow the focus a bit to outline and detail what you need to know about and do to be Prepared should your dog ever be unfortunate enough to suffer from, specifically, Gastric Dilatation and Volvulus (GDV). This will be a very frank, honest, and, at times, seemingly "cold" conversation about this condition. Presenting it in this way though is truly the best way to help you and your dogs, and it's far better for you to know and face this information now, rather than "after the fact" in the ER. So, without further ado, let's jump right in…



How do I know if my dog is suffering from GDV?

This, of course, is the logical place to start a discussion of "Preparedness" - right? After all, if you can't recognize the condition, how will you know when to spring into action! So, if you notice any of the signs listed below, especially if multiple signs are present, bring your dog for IMMEDIATE veterinary evaluation. Time is truly of the essence in cases of GDV/Bloat - so please, do not delay.

  • Distended or "bloated" abdomen  - Note that this may not be so obvious if your dog is very large or "deep chested", as the area of the abdomen where their distended stomach resides may be up behind their ribcage. This sign may also not be so obvious if your dog is very furry. Do not rely on the presence of this sign to determine if your dog may be suffering from GDV/Bloat - the absence of this sign does NOT rule out the condition!
  • Elbows pointed outward with neck extended - This is your dog's attempt to improve their ability to breathe. This is necessary as the rapidly distending stomach makes it difficult for their lungs to expand. Abducting their elbows like this can help them (albeit minimally) by enlarging the space available for the lungs to expand within their chest cavity.
  • Pacing and restlessness - Dogs affected by GDV/Bloat will have a difficult time getting comfortable and laying down. This is because they are in acute physiologic distress and they are in the process of dying. This is often one of the most obvious and early signs, so pay attention to it! In the later stages your dog's pacing and restlessness will progress to collapse and decreased responsiveness (listed below).
  • Unproductive retching - This is where your dog is making repeated attempts to vomit, but nothing (or very little) is coming out. You may see small amounts of water or, more often, large volumes of thick, stringy saliva coming out. This is still considered "unproductive retching" and unproductive retching is (practically) a "telltale sign" of GDV/Bloat!
  • Excessive salivation - The degree of salivation in dogs suffering from GDV/Bloat is sometimes quite profuse. This salivation may be accompanied by "lip smacking". This is likely a result of the feeling of nausea that affected dogs experience with this condition. 
  • Fast, heavy, or difficult breathing - This isn't just a result of the decreased space within the chest that's available for the lungs to expand, as mentioned above. It's also because of the acid-base and other metabolic abnormalities that are occurring in in your dog's body as a result of their GDV/Bloat. And it's also a result of the pain and distress that they're experiencing because of the condition - think about how you feel after you overindulge at the Thanksgiving meal… then multiply that feeling of discomfort by a factor of 20!
  • Rapid heart and pulse rate - This can be an early sign due to the pain and distress associated with this condition. However, it's also typical as the condition progresses, due primarily to the compromised blood flow throughout your dog's body (shock). In the later stages of shock the pulse rate will actually drop, and this is a very bad prognostic sign! For this reason, as well as many others, you should know how to check your dog's pulse rate, and know what their normal resting pulse rate is - ask your vet or one of their techs to show you how to do this. It's simple to do, and can help you save your dog's life.
  • Pale mucus membranes and prolonged capillary refill time (CRT) - The color of the tissues above your dog's teeth can be an indication of the health and function of their circulatory system (heart and blood vessels). I've highlighted "can" because multiple other, non-circulatory, factors can also influence this color. But if you notice that these tissues have lost their typical pink color and are now pale, or if it takes more than 2 seconds (or less than 1 second) for that pink color to return following the application of gentle pressure with your finger, this may indicate a problem - especially if accompanied by any of the other signs in this list. This is another tool that all pet owners should ask their vet (or one of their techs) to show them during a routine visit.
  • Collapse - This is, as you might imagine, a very obvious sign - so long as someone is around to witness it. Sadly though, collapse is typically a very late sign of GDV and by the time an affected dog collapses, the condition has been going on for quite some time and their prognosis is getting even worse by the second. Many conditions in dogs can result in collapse, what's important to note is that, regardless of the cause, collapse is always a sign of a serious problem that warrants immediate evaluation by a veterinarian.

So, that's a list of some of the signs that can be seen in dogs experiencing GDV/Bloat. But now I'll go you even one better… they say that a picture is worth 1,000 words, right? Then surely a video must be worth 1,000,000 - don't you agree? Below is a truly fantastic (and eye-opening) video from the good folks at Akita Rescue Mid-Atlantic Coast. Be sure to watch it - because as a community we are very lucky that they were able to catch such a clear example of GDV/Bloat in progress! As you'll see, and as they highlight in the voiceover, the poor dog in the video is exhibiting many of the signs outlined above.

One point from the video that I'd like to clarify regards one of the statements they make at the end - that "Bloat" is 95% fatal. It is important to note that this quoted mortality rate (i.e. the percentage of affected dogs that die or are euthanized) is for cases that go undetected and/or untreated. The prognosis is significantly better though for cases that are (1) caught earlier and (2) treated appropriately and promptly. I'll go more into why I keep stressing appropriate treatment a bit later in this blog post - just appreciate that, all other things being equal, the type and quality of the treatment a bloated dog receives can have a significant impact on their chances for survival. Mortality rates for dogs treated promptly and appropriately have been reported as low as 15% - as opposed to the 95% mortality rate for untreated cases. Again, I'll go more into "prompt and appropriate" a bit later in this post - just be aware that dogs with GDV/Bloat can be, and frequently are, saved.



What should I do if my dog bloats?

So now that you know about the condition and what signs you may see in the even that it happens, you might be wondering if there is anything you can do at home? Sadly, the answer truly is… not really and, certainly, not reliably.

If you suspect GDV/Bloat, your dog needs to be brought for immediate veterinary evaluation. Some people talk about giving certain over-the-counter medications to your dog in the earlier stages of GDV/Bloat, but honestly, doing so can make matters worse and the time it takes to do so may just be the difference between your dog living and dying. So, unless you are very familiar with this condition, and your veterinarian has instructed you otherwise, don't bother with any over-the-counter medications at home… just proceed directly for professional veterinary evaluation and treatment.

Even if you're concerned about the costs of appropriately treating a case of GDV/Bloat (more info on that in a minute), your dog should still be brought to the vet if you suspect this condition. If confirmed, and appropriate treatment cannot be authorized - for financial or other reasons - your suffering dog can be humanely euthanized at the vet's office, rather than left to languish and suffer the miserable death of GDV/Bloat. Please, don't trifle with this condition.



What you should be prepared to do on your way to the vet hospital:

If it won't unnecessarily delay your arrival at the hospital, be sure to call your vet, or whatever emergency hospital you are planning to go to, while you are on your way. By making them aware of your impending arrival, you allow them to do some advanced preparation (and possible schedule reorganization) to more promptly be able to provide your dog with the necessary evaluation and care. They can also let you know if they are ill-prepared to deal with your emergency at that time and, hopefully, direct you to another local hospital for more immediate care. 

While the second statement above may sound like a strange thing, if your regular vet is backed up with appointments and short-staffed on a busy Saturday they may (and should) direct you to the nearest emergency hospital for care. Similarly, if you are fortunate enough to have multiple veterinary emergency facilities in your town and the one you normally go to is overrun with emergencies and has their only doctor in surgery or dealing with another critical case when you call, then they too may be able to (and should) direct you to one of the other local emergency rooms so that your pet can receive their necessary care in a more timely manner.

You should also start to have a frank and honest discussion in your head, or with the other family members in the car, about your goals for your pet's condition and also, very importantly, what your time, emotional, and financial resources are, and if they will allow you to realize those goals. I know this sounds crass and cold, so I'll apologize now, but I would be misleading you and not helping you if I didn't tell you that this truly is "gut check" time, and that such an exploration and discussion is truly in your dog's best interest - as well as yours. You should start getting a sense of "how far you are willing to go". Sadly, though understandably, for many people, this often translates into how much money they are willing/able to spend. I know this is sad and that it sucks - but it is the reality. GDV/Bloat isn't just medically devastating, it can also be emotionally and financially devastating, as well. So, it truly is best for you, and for your dog, to at least be thinking about these factors before you arrive at the hospital - because things are going to move very fast once you get there and you'll be asked to make major decisions quickly.

Of course, you can take the financial aspect of that decision out of the equation by having your pet covered by a good pet insurance policy. Just make sure that they are covered beforehand, and be sure to do your research to ensure that you're choosing the right company and policy for your pet. For more information on pet insurance and other means of "financial preparedness" see my previous blog post on the subject here.



gastropexy, pexy, dog bloat, GDVWhat you should be prepared for once you arrive at the vet hospital:

Any dog that is presented to the hospital with a known or suspected case of GDV/Bloat will be rushed to the treatment area for immediate evaluation, initial diagnostics, and stabilizing care. This initial level of care is crucially important, as it gives the attending medical team an opportunity to assess your dog's condition, begin lifesaving stabilizing treatments, and start to gather answers to the questions that you will, no doubt, be asking of them. As emotionally-charged and scary a situation as this will be for you, do not do anything that delays your dog's initial evaluation and stabilization. Time truly is of the essence with this emergency, let the medical team get to work on their job of stabilizing and saving your dog.

One thing that often further upsets and confuses owners of dogs suffering from GDV/Bloat is when they learn that they will not be able to accompany their dog back to the treatment area. You should know, in advance, that this is for a number of very good reasons, but primary among them is that the medical team that will be attempting to save your dog's life needs unobstructed access to your dog and they need to keep, what will already be a very busy environment, as quite and calm as possible. Please, do not argue this point with the technician who comes up to triage and receive your dog - doing so will only delay your dog's care, which will, in turn, worsen their chances for survival and further increase your stress level. As hard as focusing will be, you should take this opportunity to complete the paperwork that will be necessary to gather history and continue care. A technician and/or doctor will come out shortly after presentation to provide an initial update and answer questions. And though it will likely feel like an eternity waiting for that initial update to come, it's often only a matter of 15-20 minutes.

Initial assessment and diagnostics will include a focused evaluation of your dog's vital body systems - particularly their cardiovascular (or circulatory) system, as many of these patients present already in a true state of physiologic shock. Once their vital body systems are stabilized, and if you authorize continued care, further diagnostics will be pursued - particularly the taking of X-rays (radiographs), the definitive means of diagnosing a true GDV. (*Note that preliminary diagnostics, including blood pressure measurements, EKG traces, and preliminary blood testing will likely have occurred as part of the initial evaluation and stabilization.) While only one X-ray view of your dog's abdomen is usually necessary to confirm or rule-out GDV, it will typically be recommended that additional X-rays be taken, including of your dog's chest, prior to going to surgery to fix their GDV/Bloat. These additional X-ray views are important for ruling-out the presence of cancerous tumors, aspiration pneumonia, or certain other complicating conditions in your dog prior to undertaking involved and expensive surgery. Depending on the findings of these additional tests, this is often a critical decision-making point for many pet owners. So make sure that they are done, or at least considered, and be sure to thoroughly discuss the findings, and their potential impact, with the attending veterinarian.

If treatment progresses, your dog will need to go to surgery for definitive repair of their dilated and torsed stomach, as well as to evaluate the health of the stomach wall and their spleen. The surgery that will need to be performed is called a gastropexy. During a gastropexy (or "pexy" for short) the stomach is surgically "tacked" to the inner surface of your dog's abdominal body wall, making a permanent adhesion that will prevent a future episode of torsion. You should know that a stomach that has been tacked can still bloat or dilate, it just can't rotate or torse. There are several different types of pexy that can be performed, the attending surgeon will make the choice of type based on multiple factors, including your dog's medical status and stability under anesthesia, as well as the surgeon's skill and comfort level with each of the different types of pexy. In most cases, the choice of pexy type is not important as it relates to your dog's survival or their chances of suffering another episode of GDV/Bloat. (An exception to that statement will be highlighted in the third installment of this blog series - "Be Preventive".)

 

Costs, complications, and duration of hospital stay:

Regardless of the skill of the surgeon and the rest of the attending medical team, it is important to note that complications can occur. Some of these complications are listed below. They can occur at any time, even once your dog is out of and recovered from surgery, and their onset can be difficult, or even impossible, to predict. It is for this reason that dogs that have suffered from a case of GDV/Bloat need to stay in the hospital and under close professional supervision for a period of time following their surgery. This period is typically 48-72 hours, but it is variable depending on your particular dog's condition and the development of any complications. I've highlighted the point about the supervision to stress that, even if your dog has had successful surgery at your regular, daytime vet's practice, they will need to be transferred to a staffed emergency & ICU hospital for overnight monitoring and care. The decision of whether your dog would then transfer back to your regular vet's office the following day is up to you and your regular vet, with input from the veterinarians at the ER/ICU, of course, too. Regardless though, these patients are critical in the post-op phase and require, amongst other things, injectable pain management and close monitoring of their heart rhythm, respiratory rate and effort, blood pressure, urine output, electrolytes, oxygen saturation, red blood cell count, and several other parameters - this cannot be done effectively, or safely, at home or in a hospital with no skilled and qualified overnight attending staff. Just be aware of this to ensure that your dog is getting the best care possible.

Some potential complications associated with GDV/Bloat (either before, during, or following surgery):

  • heart rhythm abnormalities (called "cardiac arrhythmias") with the potential for resulting cardiac arrest
  • blood loss, possibly necessitating blood transfusions
  • death of sections of the stomach wall, necessitating removal of those portions (called "gastric wall resection")
  • concurrent torsion of the spleen, possibly leading to tearing of the associated blood vessels and irreversible damage to the spleen itself - this might necessitate surgical removal of the spleen (called a "splenectomy")
  • inflammation of the lungs resulting from the presence of stomach contents that have wound up there following episodes of vomiting or regurgitation, this type of lung inflammation is called "aspiration pneumonia", and it can prove deadly
  • delayed return to normal feeding

You might be starting to think that treatment for a case of GDV/Bloat is likely to be expensive, and you'd be correct in that assumption. I bring up costs here because they are a reality, and, as mentioned above, they often figure into people's decisions about the amount and level of care they are able to authorize for their pets. It is fairly typical for the costs associated with treatment for an (uncomplicated) case of GDV/Bloat to reach into the $2,500-5,000 range. The typical price range will of course vary slightly, based on geography, type of hospital their care is received at, your dog's physiologic status at the time of their presentation and during the course of their hospital stay, as well as their prior level of overall health, and a multitude of other factors. For those cases that experience any of the complications listed above, or others, you should expect the associated costs to be more in the $4,000-8,000+ range.

Again, this is where the importance of "financial preparedness" comes into play. I would suggest that, depending on your financial resources and because of costly emergency conditions such as this, it is well be worth it to look into pet insurance for your dog when they're healthy, so that you have it at times like these. This is even more important to consider and explore if you have a dog that would be considered "high risk" for developing this condition. See Part 1 of this blog series for information about Breed Predispositions and additional risk factors, and see my previous blog post regarding Financial Preparedness for more information about pet insurance, CareCredit and other means of paying for emergency pet care.

Well there's a whole lot there, and so that's it for this second installment in my 3-part Bloat, Torsion, and GDV blog series. I hope you've liked it and I hope you've learned loads. But most importantly, though I'm very glad you've read it, I truly hope that you never have need for the information provided here. Please do share it around to help your friends and family, and please stay tuned for the third and final part in this blog series - "Be Preventive". Please also take a second to share your thoughts, feedback, and any personal experiences you've had with this condition in the comments section below.



Again, a special "thank you" goes to my friend and fellow veterinarian, Dr. Ryan Cavanaugh, DVM, DACVS for his editorial review of this post. Dr. Cavanaugh is a highly-respected, board-certified specialist member of the American College of Veterinary Surgeons. He is currently a surgical specialist at Specialized Veterinary Services in Fort Meyers, FL. Along with his expertise in routine and advanced surgical procedures, Dr. Cavanaugh has been recognized as one of the leaders in the field of surgical oncology. You can read his full bio here.

(*A note: Even though I highlighted the difference between the terms "Bloat" and "GDV" in the first post in the series, you've likely noticed that I refer to Gastric Dilatation and Volvulus as "GDV/Bloat" in this and subsequent blog posts. I'm doing this because many pet owners (and vets) use the terms interchangeably, and it's important for everybody to realize that when most people google or say "Bloat", they are really looking for and referring to GDV. So I'm using the conjoined term to ensure that everybody can find and learn from this important blog series. I hope it hasn't cause you any confusion.)



Be aware. Be prepared. Be Preventive


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Information and advice on pet safety and emergency prevention from an experienced emergency room veterinarian. I may not always tell you what you want to hear, but I will always tell you what you need to know. Browse the website for more information and advice, and don't forget to follow along on Facebook and Twitter too.

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