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Bloat and Torsion - GDV
Bloat in Golden with IBD
Bloating again after stomach staple
Elevated food bowels and bloat
Mesenteric Volvulus
Gastric dilitation/volvulus syndrome
also see IBD
also see Digestion
Question: Hello Dr. Mike,
I have a 6 year old golden retriever who was diagnosed with IBD of the
type eosinophilic gastro-enteritis (at the moderate stage) this past
January. He also has some fibrosis in his liver (which has been reduced
greatly by daily dosages of vitamin E). He is on 50 mg of prednisone,
every other day (he weighs 70lbs) and eats Eukanuba's fish and potato
blend (I think it is their skin and coat formula). Tonight I rushed him
to the animal critical care unit here in Vancouver because, all of a
sudden, he started to inflate in his lower abdomen area. He ate his
dinner about an hour earlier, had some water, went for a walk, went poo,
came back, had some more water, and just started to inflate (it felt
like air trapped in his bowels).The x-rays that they took of him tonight showed a great amount of gas in
his bowels and a little in his stomach. They put an IV in him, gave him
a sedative, and will watch him over the next 12 hours to see if he will
pass the gas. The doctor mentioned the possibility of his stomach
twisting, and trapping the gas in the stomach, which they would have had
to operate immediately had that been the case. She mentioned that with
Murphy having IBD and being on the prednisone, makes him susceptible to
this condition, and that it could happen at any time, no matter what his
activity may be.Do you know if this stomach turning event is related to his IBD or is it
more because of the prednisone? Is there anything that I can do to
prevent this from happening again (non-gaseous diet)?As a side, I was going to start weaning him off the prednisone (with the
vet's guidance) because I don't like the effects the drug is having on
him -- predominantly muscle weakness.Thanks in advance,
WendyAnswer: Wendy-
I hope that your golden did well and bloating was the only problem, without
twisting of the stomach.I have not seen any mention of an associating between prednisone use and
gastric dilation (bloat). Inflammatory bowel disease is suspected to
contribute to the tendency for a dog to experience gastric
dilatation-volvulus (GDV) syndrome but this has not been absolutely proven
at this time. Obviously, it is better to be aware there might be a
connection and to watch for the problem than to assume there is not a
connection, though.It would be good if you can get him off of the prednisone. You can try to
lower the prednisone dosage by adding azathioprine (Imuran Rx) as a
secondary agent, or you might find that there is some success using
sulfasalazine ( Azulfidine Rx) or tylosin (Tylan Rx), although I am under
the impression that the latter two medications are not as effective in
eosinophilic inflammatory bowel disease as in other forms.Stress reduction and considering having his stomach tacked to the body wall
(prophylactic gastropexy) are the only two things I know that have been
shown to reduce the incidence of bloat and gastropexy has only been shown
to help prevent twisting of the stomach, not bloating (although our
clinical experience suggests it helps with both conditions). There have
been lots of studies looking at diets and so far none have really shown
anything that really works well to prevent bloat. I wish I did know better
ways to prevent this condition.Mike Richards, DVM
11/27/2000
Bloating again after stomach staple in Chow
Question: Dr. Mike:
Have you ever heard of chows bloating, having the stomach stapled, and
then bloating again?
We have a 9 year old female black chow, Keeko, who was healthy until
February. Keeko, at this point, weighed about 56 lbs. In early February, I
woke up around 5:00 am because she was crying, drooling, etc... I called my
vet at home, he came over and got her, and performed emergency surgery on
her. She had bloated and was in shock. He stapled her stomach to the chest
wall.
She recovered well. We watched her food intake - 1/2 can day 3 times a
day and 1 cup of water every 30 minutes. We continued to give her broiled
flounder as a treat occasionally. Then, in early July, my husband came home
one Friday night to find Keeko's abdomen distended and she was drooling. We
took her to an emergency clinic. The vet lavaged her around midnight; around
5:00 a.m. her abdomen became distended again; the vet lavaged her again; the
vet lavaged her at least 2 more times over the weekend. The vet then took
x-rays and found that her bladder was enlarged, but not her stomach.
Monday morning, we took her to our regular vet and he performed
exploratory surgery. He also removed her spleen. However, he could not find
anything wrong with her -her stomach was still stapled to the chest wall and
her bladder was a normal size. He said Keeko had bloated again, but that he
had never seen a dog bloat again after having the stomach stapled. She seems
to have recovered fine, again, and she's on ID Science Diet - 1/3 can 3 times
a day and 2 cups of water every hour, and she never gets table food anymore
because our vet insists that was a contributing factor as she had flounder
the night she bloated the 2nd time.
I remain anxious because I understand that even though the stomach
cannot twist anymore, she can still die from shock in as little as 2 hours if she
bloats again. I bought an elevated feeder for her and I check on her every
hour. My questions are: (1)Is there anything else we can do to prevent
another bloating episode? (2)How does bloating occur when the stomach is
stapled? (3)Does removing the spleen decrease her chances of having another
episode? (4)Are chows among the at-risk group as a general rule? (5)Is it
normal for bloating to occur so late in life? I have searched for information
everywhere on the web and haven't found a whole lot out there.
Thanks, WynAnswer: Wyn-
In a study of 136 dogs who had bloat, just under 11% of dogs who had
gastropexy (fixation of the stomach to the body wall) had recurrences of
bloat. In our practice, we have had two patients who had recurrences of
bloat after gastropexy that worked (we have had two failures of the
gastropexy surgery itself as we learned to do it). One of these patients
bloated three times after the surgery but the stomach did not twist and it
lived through each episode. It is possible for dogs to die from the effects
of bloat without torsion but it is less common for this to occur without
the stomach twisting.The spleen is attached to the stomach by a ligament and series of blood
vessels, so if it enlarges it could theoretically cause stomach torsion.
Most surgeons do not recommend removal of the spleen as a prophylactic
measure for prevention of gastric dilitation/volvulus syndrome (GDV), but
there may be reason to do this if there are signs of splenic enlargement,
hematomas or hemangiosarcoma.Unfortunately, unless someone has confirmed a theory very recently, no one
really knows why bloat occurs, nor are there any preventative measures that
work consistently to prevent bloat. There is some evidence that feeding two
or three small meals a day helps prevent bloat and that feeding a small
amount of canned food or table scraps with dry food, when using mostly dry
food, helps and that is about it.The breeds most likely to have bloat are great Danes, Saint Bernards,
Weimaraners, Irish setters, Gordon setters, standard poodles, Basset
hounds, Doberman pinschers, and Old English sheepdogs. I do not know how
frequently this is a problem in chows, but we have seen bloat in this breed.When bloat occurs in older dogs, I think it is important to try to find a
predisposing cause that might cause changes in gastrointestinal mobility or
that might lead to an increase in stress. It is usually not possible to
identify a problem, but it makes sense to look carefully for one.Hope this helps and that the last occurrence will really be the last
occurrence of this problem.Mike Richards, DVM
9/15/2000
Elevated food bowels and bloat
Question: Our 2 large dogs passed away in late 1999 and we now have a young Akita. We
saw ads for raised bowls over the past year, and thought they might have
been beneficial to our older dogs. We have been considering getting raised
bowls for our Akita, but then saw a disertation about raised bowls
increasing chances for bloat.The question, of course, is : Are raised bowls a good idea for any large
dogs or not?
Answer: I found an abstract of Dr. Glickman and associates' article on this study
from the AAHA journal (May/June 97) which states that the only factors that
significantly affected a dog's risk of gastric dilitation/volvulus were
being male, being underweight, being fed only one meal daily, eating
rapidly and fearful temperament. However, there are many times when data
is available that has not yet been published and since the AKC Canine
Health Foundation helped to fund this study, I suspect they have access to
the data whether it is published, or not. I could not find any other
information on this topic so I can't provide statistics that will help in
your decision making.Another portion of this study was published in the Jan 2000 AVMA Journal
(approximately the same authors) but it covered breed susceptibility
mostly. Akitas were slightly more likely to have bloat than the average
incidence for all included breeds, in this study but the difference was
very small and probably not statistically significant. The giant breeds in
this particular article were great danes (highest incidence of bloat),
Irish wolfhound, Newfoundland and St. Bernard. The other breeds were
akitas, bloodhounds (second highest incidence of bloat), collie, Irish
setter, rottweiler (lowest incidence of bloat), standard poodle and
weimaraner.I feed my rottweiler from an elevated food bowl because she eats so fast
that she will choke when fed from a floor level bowl. It helps prevent the
choking but that may not relate to bloating, at all.I'm sorry I can't help more with this question.
Mike Richards, DVM
3/3/2000
Q: Hello,
My name is Tamara and I recently had a Borzoi who passed away from an
emergency episode which has been described to me as a Mesenteric Volvulus
of the anchoring area of the intestines. I have been scouring the net in
search of any information regarding this type of affliction. I have found
alot about bloat but very little about this type of volvulus. It happened
very quickly with very few symptoms before severe shock set in. The x-rays
only showed a slight enlargement of the spleen and he did not have any
bloating or abdominal pain. The main symptom we were seeing was the shock.
Could you recommend any studies, information or contacts that may know more
bout this unusual type of volvulus.Thank You Tamara
A: Tamara-
The mesentery is the suspension system for the intestines. Even though
there are many feet of intestines, they are suspended by a pretty small
"mesenteric root" that contains the attachment of the mesentery and the
major blood vessels providing nutrients to the intestine. For some reason
this system usually works without the intestines twisting around the base
and cutting off their own blood supply. When this twisting does occur it is
known as mesenteric volvulus. If the intestines do rotate around and twist
the base of the mesenteric the result would be the same as twisting a hose
-- the blood stops flowing to the intestines. This causes an rapid onset of
shock and abdominal pain. Most dogs die before their condition can be
diagnosed. Dogs that do make it to the veterinary hospital present a
dilemma for their vets. There are not many signs of this condition on
X-rays and it is often impossible to palpate (feel) the twist. The
veterinarian must be aggressive enough to attempt surgery in the face of
severe shock and an uncertain diagnosis. Since there are conditions that
can cause similar signs, such as necrotizing pancreatitis, for which
surgery may not be advisable, it is a difficult call. Most vets consider
themselves very very lucky to make the right choice, get to the problem in
time to untwist the mesentery and allow the blood to flow and to still have
enough viable intestine to allow the dog to live.This problem seems to occur more commonly in German shepherds than in other
breeds but has been reported in many breeds. At the present time I think
that this condition is considered to be an unusual accident of nature
rather than a problem from a specific genetic defect or other cause. Any
condition the predisposes the dog to abdominal pain or unusual intestinal
activity can be a predisposing cause.There was a review article on this condition in the July/August 1993 issue
of the Journal of the American Animal Hospital Association and there are
probably a few other references but this condition is not widely reported
on, probably due to the poor outcome of most cases.I am sorry to hear that you lost your Borzoi to this condition. Your vet
may have the AAHA journal with the article in it if you wish to continue to
find out more about mesenteric volvulus.Mike Richards, DVM
Gastric dilitation/volvulus (GDV) syndrome - German Shepherds
Q: WOW! What a great site. I'm relatively new on the net and just came across this and I think it is wonderful! I've been involved in training/showing/breeding dogs most of my life (I no longer breed). I've had German Shepherd Dogs for over 20 years now so I'm very aware of GDV, but couldn't find any info here. I've looked under bloat/torsion and gastric dilitation volvulos. Is it hiding or am I just not doing this right. Regardless, what a wonderful resource this is! Thank you. Louise
A: Louise- No one has asked about gastric dilitation/volvulus (GDV) syndrome yet. That is pretty surprising!
I am not aware of any new information on GDV (bloat). There still is not a firm consensus on the best way to treat this problem when it occurs and not much concrete information on the causes of this condition, although it is widely accepted that large deep chested dogs are at the greatest risk.
Gastric dilitation (bloat) and volvulus (twisting or torsion of the stomach) can lead to a number of secondary problems, including shock, blood clotting abnormalities, cardiac arrythmias (heart beat abnormalities) and death in approximately 1/3rd of the cases. It is an awful disease for the dog and the dog owner. I wish that we did have more information on it.
If a dog is ever noted to have sudden enlargement of the abdomen the situation should be treated as an absolute emergency. It is always better to be sure in this situation than to be sorry. Anyone who owns a large deep chested dog should definitely know the exact emergency procedures for the veterinary hospital they go to - who to call after hours, how to get to emergency clinics or alternative facilities and what payment arrangements those facilities will require.
Again, I wish we knew more about this problem!
Mike Richards, DVM
Subject: Regarding Bloat - web sites seeking data
I don't know if this might be of any interest to you. We are compiling data on dogs that have bloated and those that have not. This will be running a year. We are finding similarities between thyroid and IBD dogs. Heavy bloat incidences.
The site may be viewed at http://www.blkdane.com/bloats.htm
Thank You Dana P.
Last edited 08/30/02
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