Bloat

Bloat

Sue Matthews' story

Well, it's been an interesting weekend at the Matthews household and while I thought I had picked up a lot of information about bloat and Bouvs over the years, I learned a whole lot more about it yesterday and today, unfortunately first hand.

The good news was that I was home when it started. There could have been really bad news if I had not been since Chevelle went from peacefully napping on my pillows with a normal belly to getting up and acting nauseated. Even then her belly felt normal, but within 15-20 minutes there were very significant changes. My vet was not at home so we were on our way to the weekend/after hours vet who is fairly close by and arrived within 35-40 minutes of onset.

The bad news is that, while she appeared slightly shocky looking to me and finally started drooling about 15 minutes into it, there was no restlessness, no burping, no hiccuping, no whining or other overt signs of pain. Had I not felt her belly I could have easily overlooked the fact that she was quickly heading down a really slippery slope.

The good news is that the vet on duty was an especially skilled surgeon who had done a number of gastropexies before (yes, I did ask!), though he was very frank with me about the 50% mortality rate rate for bloat surgery (of course it's 100% without, not to mention a terribly cruel experience for the dog!). Following the surgery, he commented that Chevelle came through the surgery better than any other dog he's seen, and I have to think that the mortality rate is probably directly connected to the time that elapses before the dog receives treatment.
{Pam's note : the actual survival rate is more like 2 out of 3 with surgery. Some years ago Morris Animal Foundation funded studies of contributing factors (which turned up some surprises) and of factors predictive of outcome. Amoung factors affecting outcome : dogs that are alert and able to walk into the clinic have a much better outlook than those who are less alert and need to be carried and those are better than the ones who are really zonked or comatose. Time elapsed was less predictive since one could only measure time elapsed since owner noticed and became alarmed. I would think that the true time elapsed since onset would be relevant, and very early owner alert and alarm followed by rapid transit to vet should improve odds. One factor that is highly relevant but cannot be known until surgery is underway is whether and how much stomach is necrosed, ie amount of tissue that is dying or dead. Some research effort, funded by Morris Animal Foundation, is going into into trying to find ways to determine this prior to surgery.}

The bad news was that no one had ever mentioned before that dogs who undergo surgery for bloat are all too likely to experience PVCs (premature ventricular contractions) post op. The good news was that the surgeon's recommended that I take Chevelle to an overnight ER clinic where she could be monitored with EKGs. By this morning she seemed fine in terms of her cardiac status, but she was still really groggy, so I left her to come home and take a nap. The bad news is that the vets were correct and a little after noon that she threw the first PVCs. The good news is that the monitoring detected them, the vets knew what to do, and Chev responded well to treatment. She'll be monitored through the night as well to make sure she's stable. We spent time with her this evening and the great news is that she's aware and interested in what's going on around the clinic, she was glad to see Mike and I, and was able to go for a little walk with us to the lawn outside and have a good pee.

This has been a real learning experience, and while I would hope that no one else has to ever experience it, I thought I'd offer a couple ideas anyway....

• (1) Be familiar with how your dog's abdomen feels. Take time each week to stand over the dog and run both hands down the sides of the dog's belly so that you know what it feels like under normal circumstances.... how firm it feels, what the contours are like. That will help you recognize any changes that may occur.

 

• (2) Take a few minutes to re-read some of the bloat resources online. You may want to print some out and keep copies in the house, and in the RV, and in your vehicle in case something happens when you are on the road. {Two god links to such resources are given at the end of this article.}

 

• (3) It's essential to know how to contact your vet both in and out of office hours, and have a "Plan B" in case you can't reach him in an emergency. Ask your vet to suggest others to contact if he is not available. It's reassuring to know which clinics are close to you, what their hours are, and where the most experienced clinicians and surgeons are. It's important to have an after hours/weekend/holiday plan as well. Dogs, like kids never seem to get seriously ill during normal hours. Bloat does not give you the luxury of time to shop for a vet ... you need to be able to get the dog to the best person immediately.

 

• (4) Be aware of the signs of bloat, but understand that all the signs may not be there, and those that are may be very subtle. If you have ANY suspicion that that dog may be bloating, get him to a clinic soonest so that treatment can get going before damage sets in. Better safe than sorry.
  
 

• (5) Also think ahead about how you'll pay for treatment. Most ER clinics will not take a personal check because they've been burned too many times. They will want a deposit before commencing treatment (last night it was "we'll start with $500 please") and the balance following surgery in either cash or plastic form. You should be able to get a realistic estimate of the total charges... my experience is that you should expect the final total to be at the high end of the range provided. {Pam's note : expect at least $1500 to $2000. At least that would be a common range for my area, Davis, California.)
  If the dog needs aftercare at a different facility as Chevelle has , there will be additional charges. Although there was a sign on the wall about deposits being required for all hospitalized dogs, I was not asked for one last night or today. I did ask about their fees this morning to get a general idea what to expect. My guess is that by the time she comes home in the morning, the total there likely be another 25% over the cost of the surgery.
  I'm not in the habit of carrying large wads of big bills around with me and don't keep any stuffed in the mattress either, so my plan has always been to have a clean credit card available {that means a credit card kept sacred to the dogs (pets) and never used for any other purpose}. Yesterday it was a good plan indeed.

I'll be picking Chevelle up in the morning and it will be good to have her at home again. I'm hoping everything will be settled down and she just has to rest up and heal up and get back to being her good old goofball self again. In the last few months I've learned not to take anyone .... first Mike {her husband, who had a recent trip to the hairless primate ER} and now Chevelle .... for granted because life can become precarious all too quickly. I feel so very fortunate that both times, appropriate help was available in time to help them overcome serious health problems.

All good wishes for you and yours...

Sue

After the surgery, I asked the vet who treated Chevelle what he thought about bloat and the reasons for it... he just laughed and said "...and if I had the answer to that I would be a REALLY rich man!" {Morris Animal Foundation has sponsored a study on possible causative factors.} He did go on to say that his best guess was that the ligaments that support the stomach stretch and relax with age, and so that leaves more movement potential. {Bloat risks do seem to increase with age.} Now why the stomach flips and torses.... dunno. Chevelle did try to vomit just before the bloat episode though so I wonder if the force of trying to heave was involved. {Unsuccessful attempts to vomit, ie with nothing coming up, is one of the classic symptoms of bloat.}

{and later on from Sue :}

I talked with the vet about the choice between a gastropexy {surgery to "tack" the stomach, often to a rib, so it can never agin torsion} or not, and his feeling was that once the dog has bloated, it's really better to tack the stomach and avoid another incident. I was talking with another breeder recently and she has a vet in her area who is promoting prophylactic gastropexies performed laparoscopically. I have heard of folks in other breeds who have chosed to do prophylactic gastropexies in their dogs after having a bloat incident with one dog. I doubt I'd do this personally, but it seemed reasonable to do following an actual bloat incident.

{four days after her surgry.} She's doing really well. She decided yesterday that she wanted to hang out upstairs so managed that on her own. Looked very pleased with herself laying on the landing with her paws dangling over the edge. She's still a little unsteady going down so I've been watching her to help her. She's been hanging out with me in my office so I put a cushy bed in here for her, and she has a fan blowing in her face... one happy Bouv. She has a good appetite and walks with a little spring in her step even. When I took her out into the yard the other evening she actually galloped for a couple steps too.... one tough old girl.

Chev has one impressive incision on her belly though... a veritable midline zipper about 13" long. It's stayed clean and dry though and I haven't had to mess with it at all. I'm just amazed at how well she's doing.... it's not like she's a young kid... she'll be 10 on the 23rd.

Thanks to everyone for all the good wishes...

Dr Denise Mankin DVM's additions

I did a bloat surgery this weekend........a beautiful Doberman bitch, owned by a couple that I have known for quite some time. She appeared to have bloated after developing an infection (abnormal white cell count, vomiting started prior to bloating). Last August we had a series of 4 bloat surgeries (there may have been others that were euthanized, but I don't recall) in one week at the ER (we usually have only 1 or 2 a month).....it was during a heat wave. It made us wonder if the heat hadn't caused a major problem.

For our bloat surgeries, we will often put the dogs on a lidocaine CRI (constant rate infusion drip) for their fluids prior to surgery. This can not only help control pain postoperatively, but can prevent arrhythmias. Usually this drip is continued for 12 to 24 hours. Sometimes (especially lately) we add in hydromorphone or other pain relievers postoperatively for a smoother recovery. This drip is also used for other serious major surgeries, such as splenic tumors, foreign bodies surgeries in septic dogs, etc, where cardiac circulation may be compromised or toxins may cause cardiac problems.

It seems that bloats and splenic tumors (bleeds) are two of the worst surgical issues we see. Indeed they are costly, not just for the surgical procedure, but extended postoperative care is often required.

Good to hear Chevelle did well! Hugs to her!!

DrDenise

{In response to an inquiry about reliving a bloat by putting a needle in through the abdomen into the stomach to release the gas inside, a method you will see in some older books, Dr Denise warned that this method can easily kill the dog, as follows :}

There are tremendous differences between cattle bloating and a dog with a GDV, or even a bloat. A "DA" in a cow is dilatation of the abomasum, and it blows up with air, then will shift to one side of the cow. If I recall correctly, an "LDA" (Left) is the most common, and can be very chronic in duration, whereas the "RDA" (right) is much more acute and urgent. It is the result of metabolic problems, especially in dairy cattle. It does not cause the same issues with circulation from the caudal half of the body, like it does in dogs, and it does not torse on the access of the esophagus and pylorus (completely different anatomy).

I would NEVER trochar a dog without the intent of immediate surgery (or euthanasia, if it was a case of an owner deciding, needing a bit of time). In a dog, the trochar can impale and tear the spleen, can rupture the stomach (especially if there is any necrosis of the stomach wall), and can lacerate blood vessels.

The best thing is always seek immediate medical care.

DrDenise

(and in response to an inquiry about passing a tube down the esophagus to relieve the gas, a method you will see in books, she replied as follows : }

I would caution people about trying to pass a tube without having knowledge of what you are doing. With gastric torsion, if you try to pass the tube and force it, you can actually puncture the esophagus and cause worse complications.

The best route.......radiographs to diagnose whether it is a torsion {ie stomach has twisted, taking the spleen with it}, or if it is just gastric dilatation {ie stomach filling with gas, without torsion}. Sometimes even with dilatation, the tube is not sufficient.......we lavage out the stomach, with the dog under anesthesia, then start drugs to improve gastric motility and reduce acid and gas production. I have done that several times when the stomach was dilated but not torsed.

Dr.Denise

• http://www.bogartsdaddy.com/bouvier/health/bloat_emergency_instructions.htm
• http://www.canismajor.com/dog/bloat.html