Bloat in dogs

by:Larry Glickman

Several times a week I receive a phone call from someone whose dog has died of bloat. Usually my role is to provide a sympathetic ear and assure the callers that there was nothing they could have changed to prevent the incident. Our current knowledge of bloat does not allow us to identify specific events that trigger an acute episode in susceptible dogs, although some form of "stress" was probably involved. One of our long-term research objectives is to better define what constitutes stress for dogs and to measure their physiological response to it. However, the primary goal of the research is to determine why some dogs are more susceptible to bloat than others, i.e., what are the risk factors for bloat. This has led to studies of the physical conformation of dogs, their diet, vaccination histories, and even to new ways to evaluate a dog's temperament and personality.
The overall bloat fatality rate approaches 30% for dogs with a dilated, rotated stomach. Approximately half of the dogs that die with a rotated stomach will do so before veterinary medical or surgical treatment is obtained. Dogs may be found dead or die on the way to the hospital, or may be euthanized by the veterinarian because of their poor prognosis or the owner's financial considerations. In contrast, dogs properly treated have [greater than] 80% probability of surviving a bloat episode and then leading a normal life. Veterinarians over the past 2 decades have reduced dramatically the postoperative fatality rate from gastric dilatation-volvulus (GDV) from [greater than]50% to [less than]20% by using improved therapy for shock, safer anesthetic agents, and better surgical techniques.
Too often, however, owners of dogs that died of bloat tell me that they had recognized that the dog had a serious problem and rushed the dog to a veterinarian, only to be told that it was probably only a "belly ache," or that the dog's stomach was dilated, but not rotated. Sometimes the veterinarian recognized dilatation, but not a rotation (volvulus, torsion), passed a stomach tube to relieve the pressure, and sent the dog home. Or the dog was diagnosed as having dilatation and rotation, and a stomach tube was passed to relieve the pressure, but surgery (gastropexy) to permanently correct the rotation was delayed, either because the dog was thought to be too ill to withstand the surgery, or the veterinarian was not adequately equipped or prepared at the time to perform the operation. The latter may occur if the veterinarian is in the midst of busy office hours or if -- especially at night -- there is insufficient technical help available to properly perform the surgery, which requires careful administration of anesthesia, appropriate fluid therapy, and close monitoring of the dog's vital signs. Numerous clinical reports from Europe and the United States show that gastropexy to prevent gastric rotation should be performed as soon as possible following stomach decompression on all dogs with gastric dilatation, whether or not the stomach is thought to be rotated at the time. The recurrence rate of gastric volvulus in dogs treated for bloat conservatively, i.e., without surgery, approaches 100%, whereas the recurrence rate following gastropexy is [less than]5%. The stomach of a dog that has had a gastropexy can still dilate, but it is unlikely to rotate, so if dilatation does occur after gastropexy, it can probably be treated conservatively.
What does all this mean to you? If your dog suddenly develops a distended abdomen, appears uncomfortable, and gets progressively worse, rush the dog to a veterinarian, preferably one equipped to do emergency surgery. Gastric distention is a life-threatening condition, even if the stomach has not rotated. Immediate decompression is required to relieve pressure on blood vessels and to restore circulation to the heart, because shock can occur within minutes of the first clinical signs. Fluid therapy is indicated to treat shock, and drugs may be needed if the heart rhythm is irregular. This should be followed as soon as possible by surgery to reposition and immobilize (gastropexy) the stomach before it is irreversibly damaged. The best indicators of how well the dog will do postoperatively are its physical condition (state of shock) prior to surgery and the appearance of the stomach during surgery (since dead or dying stomach tissue implies a very poor prognosis). Intensive monitoring is usually required for several days postoperatively in case complications occur.
If you suspect your dog has bloat, but the veterinarian dismisses it as a minor problem, inquire about radiographs to rule out GDV. If dilatation with or without volvulus is diagnosed and the stomach is decompressed, either by passing a stomach tube or by piercing the stomach with a large needle (trochar) passed through the body wall, the dog should be considered as a candidate for immediate surgery, unless its condition is too unstable to tolerate anesthesia. If the veterinarian recommends that surgery be delayed for any other reason, seek a second opinion immediately. Delay in surgery will increase the chance of the stomach rotating if it hasn't already, or will decrease the chance of the dog surviving if rotation has occurred.
Following is an excerpt of a letter that illustrates some of these points. "I noticed Kelly [an Irish Setter] attempting to vomit with nothing coming up. Grass? Chicken bone? I watched her and we continued to walk. She was happy and greeted people, wagging her tail, ... and had fun. We went home and Kelly went upstairs where she attempted to vomit several times. I immediately called my vet. Kelly and I arrived at the veterinarian's office within five minutes of the phone call. I told the veterinarian that Kelly had vomited two or three times with nothing coming up. I said that she looked a little broad around the ribs. The veterinarian did a physical examination and concluded that Kelly's problem was just a "stomach ache." ... I was directed to give her Pepto Bismol®. I took Kelly home and she lay down on the bed. About 45 minutes later she went out to the back yard. When I went out 10 minutes later, I found her bloated up. I grabbed her, took her back to the veterinary hospital, but she died on the operating table." (Comment: There is no guarantee that if radiographs had been taken during the first veterinary visit, Kelly's outcome would have been different. However, radiographs might have confirmed the presence of gastric dilatation or volvulus, and thus the need for immediate gastric decompression and surgery.) Be prepared -- Teamwork between you and your veterinarian is your dog's best hope when it comes to bloat.
For more information on the early signs of bloat, talk with your veterinarian. Ask what treatment he/she recommends for bloat, and if their hospital has a 24-hour emergency service.

Protecting The Smallest Member Of Your Family: A Step-By-Step

by:Burke Jones
Let’s face it – Fido and Fluffy are an important part of your
family. Do you want to have to assign a dollar value to them if
they become sick or injured?

That may well be the case if you don’t have pet health insurance.
Rising veterinary costs mean that pet owners can pay hundreds –
and even thousands – of dollars for their pets’ health problems.
As the bills stack up, uninsured pet owners must determine how
much they are willing to spend on their animal friend. It can be
a heartbreaking decision to make.

Much like insurance for health, cars and homes, pet insurance
helps people put a little money away now to avoid a major payout
later. Coverage and cost vary, so it’s important to thoroughly
research the options if you decide to insure your pet.

Step one: Determine if Pet Insurance is Right for You

When people decide to get a pet, they often don’t consider how
they will deal with the inevitable unexpected illnesses or
accidents. Keeping a pet indoors by no means eliminates all the
hazards. They can still swallow foreign objects, ingest a poison
or injure themselves. As well, living indoors does not make a pet
immune to disease and infection – particularly those that are
common to their breed. Pets with access to the outdoors have even
more opportunities to pick up a disease or get hurt.

Don’t have a dog or cat? Insurance companies are starting to
offer plans that meet the needs of a variety of pet owners. Some
now offer coverage for birds and exotic animals.

Not all owners are good candidates for pet insurance, however.
Pet insurance is ideal for owners who deeply love their pets and
are willing to spend a significant amount of money to keep them
healthy and extend their life. They buy their cherished
companions the best food and care they can afford, sometimes even
putting their pets’ needs before their own. For this type of
owner, pet insurance can be a smart investment that can prevent
considerable costs and bring peace of mind.

Pet insurance is not a good investment for owners who don’t have
a strong emotional tie to their pet. Owners who would rather have
their pets euthanized than spend money on vet bills are not good
candidates for pet insurance.

Step two: Decide What Type of Coverage You Want

Most pet owners will weigh two main considerations when shopping
for pet insurance: budget and coverage. Peace of mind can also be
an important factor, but far more difficult to quantify.

Pet health insurance is still relatively new in the United States
and Canada, so the options available are fewer than for other
forms of insurance. That said, North American pet owners can
choose from a variety of coverage choices, ranging from
injury/accident-only to all-inclusive.

As with all insurance products, the cost of pet insurance
increases as the coverage improves. As a pet owner, you must
decide what is the right balance between affordability and the
care you want for your pet.

- Coverage

When choosing pet insurance coverage, first consider what kind of
insurance customer you are. Do you prefer all-inclusive coverage
that pays for everything from routine checkups and vaccinations
to accidents and chronic illnesses, or are you comfortable with a
lesser degree of coverage that just kicks in during emergencies?
Perhaps you prefer a flexible plan that offers discounts on a
wide range of services, from veterinary care to training. This
decision will lay the groundwork for your final choice.

Some issues to consider:

Make sure to check for coverage of pre-existing conditions as
well as breed-specific genetic ailments, such as hip dysplasia
for large dogs. Some plans refuse to cover these conditions.

Some plans place limits on annual, per-incident, per-illness or
lifetime costs.

How old is your pet? Coverage usually starts at eight weeks, but
some plans won’t cover pets over a certain age (usually between
six and 10 years old, depending on the breed, type of animal and
other factors).
- Cost

Payment options for pet insurance include flat fees or
deductibles and/or co-payments. Not surprisingly, plans with
lower monthly premiums come with higher deductibles and/or larger
co-payments.

Some issues to consider:

Insurance premiums are affected by the age, health and breed of
your pet, as well as the type of animal.

Some plans offers discounts for multiple pets.

Plans generally require customers to pay the vet bill first and
then submit receipts for reimbursement.

Find out if the insurance premiums will increase as your pet
ages.

Depending on the plan you choose, the monthly premiums can range
from less than $10 to about $40.
Step three: Choose an Insurer

You’ve determined what you can afford to spend and the amount of
pet insurance coverage you want.

Before selecting an insurer, here are some final considerations:

Make a list of your questions and priorities in advance. Make
sure to answer or check off each item when reviewing plan
options.

Research the insurer thoroughly. Review its website and sales
materials, read its testimonials, talk to other pet owners and
look for on-line reviews. How long has the company been in
business? Are its customers satisfied? Make sure you feel
comfortable about everything you hear or read.

Compare the plan’s benefit schedule with your vet’s fees to
determine to what degree the plan will cover the actual treatment
costs.

Find out how quickly the insurance company reimburses customers’
claim payments and if it has claim deadlines.

Read the fine print. Make sure you completely understand the
plan’s benefits and, more importantly, the limitations. If
something isn’t clear, ask – and get the answer in writing.
Otherwise, you might find you don’t have the coverage you need if
an accident occurs.

Start a file for your pet. Use it for all receipts and insurance
paperwork so you can keep on top of your claims and make sure you
are maximizing your insurance investment.
Your responsibility as a pet owner doesn't end with food, shelter
and affection. Pet health insurance can give the smallest member
of your family a longer and healthier life – and provide you with
more time to enjoy the unconditional love it so willingly offers
to you.