Allie is a 10-year-old female black Lab, and she is in serious trouble.
She arrives at the Veterinary Emergency Care in Mount Pleasant at about 1:30 a.m. so bloated and weak that she can barely raise her head, much less walk. The technicians rush to the the parking lot with a gurney and quickly ferry her to the treatment area.
Treatment begins immediately, only briefly interrupted by a quick X-ray that confirms the problem but surprises no one, including me (Henri Bianucci). A large needle is placed through the abdominal wall into the stomach, which is now dangerously distended with air. The hiss of the air, as it escapes through the hub, attests to the severity of the problem, and marks the beginning of its resolution.
How can the body of a healthy dog go so wrong, so quickly? Only three hours ago, Allie went out for her regular just-before-bed walk. A couple of hours before that she ate her usual meal, followed by a couple of snacks.
Nothing out of the ordinary occurred. She had a little water, and went to bed like the rest of the family. At about 1 a.m., the owners were awakened by Allie pacing around the house. She was very restless, and seemed to be desperately seeking relief. But from what?
They let her into the yard, but she only continued to pace. Then she began to wretch, but no vomit came up. Suddenly, she simply dropped to the ground, unable or unwilling to take another step. That’s when she was rushed to us.
The problem was that somehow Allie’s stomach began to fill with gas. It may have been something she ate or air she simply swallowed while panting.
In any case, the stomach became distended, which caused its right side to displace to the left, and vise versa. With the stomach flipped, the esophagus is twisted shut and the intestinal outlet is similarly kinked. This condition is known as gastric dilatation and volvulus, or GDV.
Under these conditions, gas from fermentation in the stomach is produced at a rate faster than it can escape into the intestines or as a burp. As the stomach swells, the pressure inside it builds to a point where it compresses the blood vessels in its wall, stopping its own blood supply.
Under these conditions the stomach wall begins to die. The bloated stomach also compresses the great vessels in the abdomen, which prevents most of the blood from behind the stomach from getting back to the heart. This condition leads to severe metabolic and cardiac derangements, shock and, if not treated immediately, death within hours.
GDV is most commonly seen in large and giant breed dogs. Notable exceptions are the bassett hound and the dachshund, both of which have graced our operating tables on occasion.
Many causes have been named, with little supporting evidence. GDV has been ascribed to overeating, exercise too soon after a meal, delayed emptying of the stomach and food type.
The most consistent physical attribute is a deep chest. Irish setters are particularly prone, owing to a high chest depth-to-width ratio. Anecdotally, many patients are described by their owners to be “greedy eaters,” suspected of gulping air along with their food.
Overall for at-risk breeds, the incidence of GDV in one study was surprisingly high, at almost 6 percent. Studies have reported mortality rates of around 15 percent to 20 percent overall; however, advanced cases carry a much higher risk of death.
Interestingly, one study found that dogs described with the personality trait of “happy” had a significantly decreased risk of GDV, which makes you wonder how labs are even on the list.
In surgery, Allie was found to have a severely damaged stomach wall, necessitating the removal of about one-fourth of the organ. At 5:30 a.m., we rolled out of the operating room and with a few days of intensive care, prayers and a little luck, Allie made a full recovery.
The damage she sustained was a function of time and pressure. The longer the time GDV goes untreated and the degree of the pressure dictates the damage. Therefore it is of utmost importance that owners of “at risk” breeds know the signs and seek veterinary care without delay when GDV is suspected. Swelling of the abdomen, restlessness, hyper-salivation, and nonproductive retching are the most common signs. When these are seen, time is truly of the essence. This one absolutely cannot wait until morning.
GDV is entirely preventable. A simple procedure, in which the stomach is sutured to the abdominal wall, known as a gastropexy, will cause an adhesion to form, making it impossible for the stomach to flip. This can be performed at the time of a spay or neuter, or independently. In our practice, the procedure is often done with the assistance of a laparoscope in a minimally invasive manner. This procedure is safe, simple and a whole lot more pleasant than the 2 a.m. bloat.
Dr. Henri Bianucci and Dr. Perry Jameson are with Veterinary Specialty Care LLC. Send questions to firstname.lastname@example.org