Bloat in Review

from the AMCA Newsletter, Volume 45, No 1. January 1997 — Health Column written by Jocelynn Jacobs-Knoll, DVM

Well, as most people who own Alaskan Malamutes know, gastric dilation and volvulus (or bloat and torsion) is one of those conditions that seems to affect our breed with a high frequency. It is not unusual for each of us to know of one or more dogs over the years to be affected with this deadly disease. Even I had the misfortune of having one of my own dogs bloat and torse late last year; fortunately we caught it fast enough and my dog survived. However, many dogs are not as lucky since they bloat and torse when their owners are not home or during the night while out in their kennels. Immediate medical assistance for these dogs is the only way to survive this silent killer. A few years ago, I wrote an article discussing this condition, however, in the recent year there have been some new developments on just why these dogs may be prone to bloating.

What is Gastric Dilatation and Volvulus?

Gastric Dilatation and volvulus (GDV) is a syndrome that can occur when the stomach is filled with extensive amounts of air or food material, and it becomes stretched. The stomach then can begin to twist upon itself within the abdomen in a clockwise rotation causing the inlet and outlet of the stomach as well as blood vessels which supply the stomach to become “cut off.” Needless to say, this is very painful and extremely life threatening to the dog. With time, the stomach tissue becomes depleted of nourishment of oxygen and other important factors supplied by the blood vessels, and thus begins to die even though the dog is living. The dog with GDV can live for a short period of time until the effects of shock begin to set in and cause life threatening events to occur. This condition equally affects both males and females. Although this condition can occur in younger animals, the majority of the affected dogs are middle to older aged dogs. For Malamutes, four years or older seems to be the age at which owners need to become more concerned about their dog developing this syndrome.

What causes GDV?

Originally it was felt that GDV must be caused by either overeating or the type of food the dogs were being fed. Although it is true that one can cause their dog to bloat by overfeeding the dog, the amount of material that would be needed to completely fill the stomach and cause it to distend is more food than most dogs can even consume in one sitting (even if they wanted to — and owning Malamutes, I know how much bigger their eyes are than their stomachs!) Thus, overfeeding is probably NOT one of the major reasons that most Malamute bloat. The type of food used was one of the most commonly accused reasons for dogs developing bloat. It was originally thought that foods high in cereals caused distention in the stomach upon hydration thus causing the bloating condition. Although that is a possibility, it probably is not as much of a risk today. Dog foods manufactured years ago used more bi-products from cereal manufacturing as the main ingredient in the products; but today, most products are made with better ingredients in terms of quality and digestibility. Most breeders know that poor quality dog foods produce poor quality muscle tone and coat quality (as well as other things), and thus most feed their dogs premium dog foods.

Today, other causes are being investigated as major reasons why dogs bloat and torse. Anatomy of the dog is being investigated presently by Dr. Glickman at Purdue University. In the July AKC Gazette, there was an excellent discussion on anatomical ratios and depth of chest is being studied as one of the anatomical causes for dogs to bloat. The thought is that deep chested breeds may be at an increased risk of having the ligaments that hold the stomach in place become stretched and weakened during a bloating episode thus allowing torsion to occur. Thus, certain anatomy of the chest and overall structure of the dog MAY have some affect as to whether the dog will be prone to bloat and torsion. This should NOT be considered a reason to not breed a particular animal at this point. Rather it should be accepted as a possible concern as the puppies grow into adults and enter their prime.

One other area being investigated as a cause of GDV is stress. Many breeders have called me to discuss certain conditions and treatments with their Malamutes over the years, and the onset of a stressful situation seems to be a very common denominator in development of bloat in Malamutes. As I mentioned, my own dog bloated and began to torse late last year. I believe it was initiated by the fact that he was on his way to a rig training session crated kitty-corner to a bitch in heat. Although he normally is not very affected by bitches in heat, the stress of knowing he was going to get to train that day, plus the bitch being very close to her prime, caused him to get to stressed he began to gulp air in between his whining. By the time it was his turn to get harnessed and run, he had vomited a small amount of fluid in his crate, was walking around with his back hunched up, tender to the touch on his abdomen and pacing. When put on the gangline, he actually laid down!! This dog would never think about laying down when being hitched up — he normally is jumping up and down like a ping-pong ball. Thus, my husband knew there was something wrong and rushed him home for me to exam. (I was not at the rig session — I was home at the time). Upon palpation, I could feel his spleen was misplaced (he had begun to torse), and his stomach felt hard and swollen. I rushed him into the clinic, and upon tubing, got all the fluid, air and the little bit of food Tom had given him many hours before out. He didn't take long to recover, and was anxious to return to his kennel to be outside with the rest of his clan within a couple of days.

Fortunately, Dr. Glickman is taking time to consider stress as being a very important part of why dogs do bloat and torse. When in veterinary school, little attention was given to the concept of stress. When talking to breeders, though, it is one of the most common factors mentioned when discussing bloat with their dogs. Stress can be caused by dog shows, car rides with unfamiliar dogs, bitches in heat, physical exertion, disruption of their routine for food or other daily events, etc. Food rarely seems to play a part in the entire scheme, although it may in some circumstances be a cause to this condition.

Clinical Signs of a Dog with GDV

As mentioned above, panting, vomiting, restlessness, an arched back can be frequently seen signs. Others include abdominal distention, unproductive retching, excessive salivation, weakness, and lethargy. The mucus membranes of the dogs (gums, lips, vulva, etc.) may change to a variety of shades during the episode. Initially they will be pale while the dog enters the initial stages of shock. With time, the gums can become very deep red indicating an endotoxic shock syndrome, or bluish as the circulatory system begins the fail. If your dogs shows any of these signs, they should be seen by a veterinarian immediately — minutes count when dealing with a dog with GDV.

Diagnosis and Treatment of Dogs with GDV

Upon arriving to the veterinarian, a radiography (x-ray) may be taken to confirm the condition (especially needed if there is little abdominal distention). Then with or without sedation, a tube can be placed down the esophagus to the stomach. If the stomach is not twisted so far as to “cut off” the opening to the stomach, the tube can be passed. However, if the torsion is significant, tubing may not be possible. If the tube is passed, suction is applied to the end of the tube to extract material, air, fluid, etc. from the stomach. Usually once the stomach is deflated, it will return to its normal position. If a tube is not able to be placed, a needle may have to be inserted from the outside of the dog through to the stomach to allow air to escape to a point where a tube may be passed. Surgery can also be performed to remove air and material from the stomach and replace it in its normal position. A “tacking” procedure then can be done to attach the outer wall of the stomach to the inner wall of the abdomen so torsion cannot take place again at a later date. This tacking procedure can be done at the time of surgery or at a later date if the dog is unstable and surgery was not required to remove material or dead tissue from the act of torsion. Many breeders have opted to tack their Malamutes before the dog ever bloats (e.g., to young dogs). This procedure can help the dog have a decreased chance of torsion during a bloating episode, but the dog can still bloat. It is generally accepted that the torsion of the bloating episode makes the condition more life threatening. Thus by prophylactic tacking death may be prevented in many instances.

Of the dogs with GDV that die, 95% will do so during the first four days after the onset of the syndrome. Many complications can arise from the condition occurring which is the reason for this devastating phenomenon. Arrhythmias of the heart, circulatory collapse, recurrent gastric distention and death of tissues lining the stomach are a few complications which commonly arise. Thus careful patient monitoring is very important to ensure the dog will survive.

Prevention of GDV

Because the causes of GDV are so diverse, it may be difficult to prevent this condition from occurring — especially for those dogs that may have the conformation that lends itself to the syndrome. Stress is very difficult to control, however, keeping in mind things that seem to create stressful experiences for a particular dog should be avoided. Sticking to routines are very important (in terms of feeding, exercising, etc.) and may help prevent stress for the animal. New dogs introduced to the household should be done so with time and effort to decrease stress for the older animals. Males that are particularly affected by bitches in heat should be isolated from constant exposure to them. Feedings should be done 2-3 times per day to cut down not only on the amount fed, but the stress of waiting until that next meal. Also don't allow excessive exercise immediately after eating. And lastly, water intake should be closely monitored after bouts of physical activity.

Although these are not guarantees to prevent your dog from bloating, they may be helpful in decreasing the risk. Constant monitoring of dogs that may have an increased risk of this syndrome should be done to possibly prevent the condition from getting to the point of threatening the life of your dog.