What Every Dog Owner Needs to Know About Bloat

Welcome to a special webinar are brought
to you by the AKC Canine Health Foundation Bloat Initiative. Our presenter is Dr. Elizabeth Rozanski, a board-certified specialist in
emergency medicine and critical care and professor at the Tufts University
Cummings School of Veterinary Medicine Dr. Rozanski graduated from the
University of Illinois College of Veterinary Medicine in 1992 and completed an internship at the
University of Minnesota and then a residency an emergency and
critical care at the University of Pennsylvania she’s a diplomate of the American
College of Veterinary Emergency and Critical Care and the American College of Veterinary
internal medicine. Since 1996 she has worked at Tufts
Veterinary School where she directs the critical care
service. In this webinar Dr. Rozanski explains what every dog
owner needs to know about gastric dilatation volvulus or
bloat. She will present the signs and treatment options for bloat along with current options for
prevention. The AKC Canine Health Foundation Bloat Initiative also includes a significant research
effort. CHF would like to extend a special thank you to the champion level
sponsors of this initiative the Collie Health Foundation, the Irish Setter Club of America Foundation, the Greyhound club of
America and the Saint Bernard club for America and
Charitable Foundation. they’re extremely generous contributions
along with the support countless other clubs and individuals
has helped us reach our funding goal so that we can ultimately define the
cause of this devastating disease. So what we want to cover today is what is bloat. Dogs are clearly a major member of our families
families and bloat is one of those diseases that
can take a happy family and create devastation within a very
very very short order. and that’s really the biggest reason we
want to talk about bloat today is to get people familiar with what it is, how they can help their specific dog as well as what’s happening in why we think this
disease develops. So bloat is known as the kinda password or kinda
common language for (inaudible) call it torsion but this is actually medically incorrect its really a twisting of the stomach and this disease is a surgical emergency in infected dogs and unfortunately despite aggressive treatment up to twenty or
thirty percent affected dogs die and this is something that we will be
working hard to change. What our focus is today though it’s really covering what happens in bloat and what we can
really do about that and what you was a dog owner can do to help keep your dog from dying of this disease. So when we
think about what causes bloat really one of the bigger players is genetics in
anatomy so we know that there’s certain breeds
of dogs that are very very over-represented in the development of bloat and if you have
a breed at risk it’s very very important to know what’s happening with your individual breed and it’s very important to know that there’s also the variations in specific breeds there’s also a lot of individual dog
factors and these include things like a stressful event. From a veterinary standpoint one of the things I think about most is boarding kennels, trips away from home, fireworks, thunderstorms those sorts of
things that for an individual dog really peeking out that dog’s individual
anxiety level and what we worry about with that individual dog is that they get into problems
developing this condition. Personality is important we know that
dogs that tend to be anxious or more nervous in general and that’s absolutely something that
varies within individual breeds as well as within certain breeds are certainly slightly
more nervous or anxious than other each breeds of dogs and advancing age is also
individual talk factor. First-order relatives so having parent
or litter mate affected has also been shown to increase
the risk sometimes this is easy to know and other times it’s harder
to know that you’re dogs individual relative is affected with bloat. The large breed, deep chested dogs that are at greatest risk reported most
commonly in Great Danes and one study actually Great Danes had up to a third lifetime risk so one in two Great Danes could be affected this bloat
over the course in their lifetime. German Shepherds are number wise a very
popular breed of dog and very very over represented as well. Setters and Poodles as a slightly smaller but also deep chested
dog, Bloodhounds but really we can see it in any breed of dog. and as you look at different breeds of
dogs that are affected we really remember that can happen in any breed of
dog even been reported in cats and ferrets, and every now than the rare person can develop bloat as well. And again first-order relatives so
very close litter mate, a parent or grandparent can really
increase that risk if that’s information that’s available. We again recognize that our Great Dane
friends have up to a 30 percent lifetime risk. This is just a video some Great Danes
playing in a field. and when we look at these dogs a lot of people who have these big breed dogs have more than on and this is something where one of these dogs could very well be expected to develop bloat
in this lifetime. And it’s something that we really want
to work hard to prevent. So what happens in bloat? I want to go through what happens in the disease what’s
happening to our patients. What are clinical signs and treatment. How do we prevent it and then a little bit about research that is happening because again this is a huge focus of research to veterinary practitioners, to emergency clinicians, and certainly to the dog owners on
because it’s a disease that we’d like to be able to prevent if we could. So in bloat what happens is the stomach
feels with air and rotates on it’s axis. So it kind of twists off both the inflow to the stomach from the
esophagus and the outflow to the stomach through the duodenum so this motion comes down the esophagus go
through the stomach begin digestion and then past easily out into the duodenum where digestion continues to occur. And in bloat the stomach fills with air and twists and then there’s additional air production in the stomach so basically the stomach acting almost as a fermentation chamber and more gas is being formed within
the stomach. The stomach agains continues to englarge with air and this isn’t just air but it’s air that’s forming within the digestion process and this increasing distension actually
worsens the obstruction. What can happen with this is the blood
flow is cut off to areas of the stomach and as the stomach twists it can also
pull the spleen with it. Just anatomically the spleen is kinda of
connected to do the stomach and as it flips over the blood supply to
the skin can be damaged as well. And we’ll see areas in some dogs of the stomach that can actually die from the lack of blood flow and we can
actually see an entire stomach dieing from this if left untreated for too long a time period. So I want introduce you to Honey. As you can see Honey is a much loved English Setter. And she is here recovering from her bloat. And I want to tell you a little bit about what
happened with honey because this is the kind of story that can be really hard for any owner any dog lover anywhere so
as you can see Honey is a lovely English Setter. She developed bloat at home shortly after the puppy was introduced. Sshe was considered a calm happy dog a very good-natured dog. And whether or not the puppy had
anything to do with it’s not really clear but certainly she became very sick
after the came into the household. She went to the emergency clinic where
she’s properly treated. She had immediate surgery which is again
really the standard care this disease. Which she had a slow and
incomplete recovery. She came to us as care hospital for ongoing support and we identified that she had fluid in her chest
cavity so she had something called a power thorax. Fluid leaking in across her diaphram which is the muscle that separates the chest and the abdomen and she had ongoing to dead pieces of her stomach within infection in her abdomen that was
contributing to why she felt so bad. Again the emergency clinic did a wonderful job. Honey is a very loved dog but ended up
having a very severe complicated course. And we mention her because this kind of nightmare we all think about. This is honey over the clinical course, this her when she is thinking about going home. She was hospitalized for about two weeks
we can see that she is set here to go running when she gets home. She ended up having another operation
she much treatment for sepsis or infection in her body. She
underwent nutritional support because she just didn’t feel like eating for a
little while and a lot of TLC certainly buy her family and certainly by all the nurses and doctors in a hospital. So again when we think about Honey this
is the kind of dog that represents the horrible clinical course then can
accompany bloat. Some dogs have bloat go home very very quickly but honey represents one of the out liars of the dogs that have a very tough go of it despite being very well-loved and having a very good course. So how do you
recognize bloat at home? This is probably the biggest thing to recognize. When I think about talking to talk to
dog families, the first thing that I think about is knowing your breed. Pure bred dogs are wonderful and many people have mixed breed dogs that are identified as part shepherd or part Dane or any of those sorts of things. So recognizing that if you have a deep chested or big breed dog that these dogs are going to be at risk for bloat. Clinically what you see is they are restless and don’t want to settle down. um they lay down for a minute, dogs that are well trained you’ll send them to their beds they’ll get up they’re restless, they jsut can’t settle, they will retch. They will unproductively vomit they won’t really settle down. They are up and down. You let them out in the yard, you think maybe they are having GI upset they will come back in they’re just not any better. They are nauseous and have a lot of drool. They may have a distended abdomen. That’s something that we would
classically think would happen and certainly some families would recognize this. But some of our deep chested dogs, some of our Setters for an example, their stomach is actually underneath their ribcage so you can’t actually palpitate that. If you feel it or if you identify a dog that has a distended stomach that is something to absolutely to jump on. But I just want to point out that it’s really the restlessness, difficulty settling, nausea and drooling that’s really going to point to that something is going on. And I think that most of our dog families recognize this but kind of a key point here is this is not something to sleep on this is not something to see how the dog might look
in the morning. And again as a good emergency doctor was
it the things I always think about it’s really important to have a sense
what do you do in an emergency. And I think most pet owners know that
if their veterianarian is open what the closest emergency clinic is. But because this is often a disease of stress or associated with travel, if you are visiting relatives or doing something else or taking your dog to a show or an event know where those emergency clincs are in the area and have a sense of how to get there. And again that might be a little overkill but but really this is a type of disease that 10 or 15 minutes can made a difference in the outcome. So knowing how to act and where to act particularly when you are away from home can be really helpful. When we think about home care a lot of things we talk about is emergency medicine. People want to know is there something I
can try it home and I think we’ll come back to look its bloat tips later in this webinar but really there is nothing practical that’s is wise. Urgent veterinary care is really going to be your best bet and again we will circle back a little bit later. In some cases if you’re very far away from any veterinary care or having a lot struggles getting somewhere bad weather or something like that. there may be some other options that really this is not a disease that you can try Malox ior GaxX and expect it to make a big difference. Again I’d much rather have a guy come in and say I am worried he has bloat and take a radiograph and do an exam and idenitfy the dog is not bloated and send them home. Rather than have someone try to treat them at home because it’s just a disease that requires surgery it’s not going to be something you can do it home. Home triage, again this is true for bloat. But it’s also true for me the any other
condition that you’re thinking about. When we look at our patients having a
hard time what we’re looking for is looking for abnormalities with the heart, brain or lungs so things that you
can do if you are comfortable with. We start to learn what your dog’s resting heart rate is. You can feel the pulse is their inner
thigh or actually by feeling their heart. Which is right below where their elbow is. They should be oriented and they should be breathing comfortably. You can look at their gum color and sorts of things to get you a
sense for what’s happening. What are we gonna do hospital is if aren’t many places you could potentially call ahead and say I might have a dog with bloat and it can be helpful but in general if you can’t get through it you you’re not sure just show up we’re always happy to
help out in the situations. The assessment at the hospital is going to include initial stabilization. Again optimizing these patients for surgery will increase the outcome. You want to establish and confirm diagnosis. Get them into surgery, get them through surgery and then getting home as quickly as possible when we are sure that they are going to be stable. When we talk about stabilizing we’re evaluating for shock. This is a picture of a dog with very very pale
gums. Again I really encourage you to look at your own dogs gums color at home to get a sense of what’s normal for them. Some breeds of dogs like Dobies and Weimaraners have a little bit different color gums than other breeds of dogs. to know what your dog’s gums look like. This is clearly a dog that is very very
pale. We’re gonna evaluate dog’s when they appear in the hospital for heart rate. A big dog’s heart rate in the hospital shouldn’t be above 120 beats per minute. Dogs with bloat are often around 180 or 200. Color of the mucus membrane color or gum color, abdominal palpitations for distended stomach or sometimes we can feel the spleen. Again this is going to be in our deep chested dogs are Shepherds where their stomach twisted inside their ribcage and we don’t feel their stomach, we can actually feel a large mass which is the spleen. We’re going to volumn resuscitate the dog so we are going to give them a IV cathither typically in the front legs because its going to be the return of blood from the back legs are going to be impeded by the dialated stomach and so we are going to put a lot of fluids in the front legs and we are going to control pain. This is absolutely a painful condition but we know that we need to get them resuscitated with some fluids and treat their pain. We are going to confirm a diagnosis. What are going to be looking for is we’re going to be looking for is an enlarged spleen which you can see on some radiographs. And then this white classic lateral radiograph. we often teach our students things like double bubble the dogs in trouble. as you can see this orange line that’s pointing to the compartment location at the stomach or how the stomach is twisted on itself. In the specific dog we can’t see this screen, but sometimes that is visible on a lower bit of the radiograph. And so then as we look for those sorts of things that’s what we’re was looking to see. So It is
a very straightforward diagnosis to confirm and it’s something that we want to know exactly but we are dealing with. Other conditions can certainly mimic bloat and my background as an ER Dr. still ncourages us to bring you these dogs in. You just don’t know what your dealing with at home and I don’t live very far from the hospital I I work at and if my dogs had these signs I would come in ?????? It’s just not something that is easy to play phone triage or home guessing of what is happening. But the other conditions that we can think about are food bloat where dog may eat a lot food and have the thanksgiving dinner sorta appearance to their stomach. Gas bloat where there stomach can fill with gas but not twist, something stuck in the esophagus or something else making the belly big. So food bloat, this is a radiograph and if you think back comparing it to that radiograph that we saw that where the stomach is filled with air and so air is going to look dark, just like what is outside of the patient. In
this dog’s stomach what we can see is that there’s basically a lot of
granular materials which is food filling up the stomach. And this is what
would happen if dogs eat at a bag of kibble or they eat a whole lot of something they shouldn’t or get into the garbage. Its common retrievers probably Labradors are our biggest offenders in this category. But really any dog could eat more than they should. And they feel distended and they’ll feel uncomfortable. And these are dogs that clinically look like they are having and these are jobs that can clinically
look like they’re having a torsion or GDV but really they’re just having a lot of food in their stomach and this is something that will pass over time. On treatment food bloat is really basically supportive. Fluids maybe to help them pass the food
through there. Just because if they eat 10 pounds of dry food sometimes they’ll eat just that much.Typically their stomach is filled with dry dry kibble and it will certainly digest that over time but it could take a little bit longer. And so some fluids will help with that. Maybe a little bit of pain medicine if they’re very uncomfortable. Walking them freely and encouraging them to drink. And these guys will recover pretty quickly episode all food bloat doesn’t really have any
clinical relevance to a later episode to GDV, it’s not going to be
something that we worry that this dog is going to be more likely to have a bloat in the future. It is
something that tells us to keep the food away from the dog but it’s not something that’s going to have medical ramifications. Gas bloat on the other hand is a
condition where the dog’s stomach will distend, again absotlutely just a absolutely just a hundred percent
radiographically looking like the stomach is filled with air and you can see on this dog again this is the right lateral radiograph and gas fields round structure in the
abdomen is just stunning. But the stomach itself isn’t twisted it’s
just filled with air. And we can see this happening
in dogs and we do worry that these dogs are more likely to develop a bloat in the future there’s also a weird condition that we worry about that’s something that’s called a
360-degree vovulous. And what this is, is a condition where
the stomach rotates all the way around on its axis. And for so
it’s back to normal anatomic ???????? But it’s something that is completely
blocked. And so that’s something that we can
distinguish by looking at physical exam findings on the dog. Feeling that large spleen and sometimes by some other xray views. These guys will get distended with gas we think along the same pathways as GDV or Gastric Dilitation Volvulous dogs would do. We can also see dogs with gas filled stomach and they have an upper airway obstruction and they are swallowing a lot of air. And that is something we ??????? Treatment of gas bloat is to decompress these dogs because if you think about it if your stomach is very very filled with air, the natural response is to bloat or tempor and get that gas out of there, so belch and relieve that obstruction. So if they are not belching and getting the gas out of there we will actually decompress them by placing a small stomach tube or puttting a little needle into their stomach. And this is a condition that we worry is a very major warning sign of a future bloat or a future GDV. So while it’s not an emergency need to go to surgery, a dog who has a gas bloat is a dog that is at a much greater risk of developing a future GDV and so we treat those as such. Other things that we can see are esophagal foreign bodies that cause drooling and reluctance to settle. This is more common in our Terrier friends, Westies in particular are over represented. They will eat a bone or something or a squeaky toy or a rawhide. squeaky toy or a rawhide. And they swallow something that is a just little to big to go down and gets stuck in their esophogus and causes the same sort of discomfort. Drooling, reluctance to settle and we are going to identify this on radiograph
and will identify that their stomach doesn’t look like it is filled with air. The last type things we distinguish bloat from is ?????????????? abdomen, and this is something we see with congestive heart failure. and this is something we see with congestive heart failure. Doberman’s are certainly representative in heart failure. We can also see cancer or hemmorage causing these symptoms. Identifying we can also see cancer or hemorrhage
causing those sorts of things. Causing a fluid filled stomach. Identifying ????? you can feel it on palpations. Sometimes you can feel if the abdomen feels tense like a drum. So are dogs with bloat almost feels like really like a drum because the stomach is stretched over a bunch of air. Dogs with fluid in their abdomen feels a little more squishy. Kind of like sloshing around. You can identify it with an ultrasound. This is an ultrasound on the right hand sight of the screen. And those dark areas are fluid in
between organs. And treatment of the ???????
or what we’re going to do for that really depends on the cause. And this is something that probably in
our hospital two or three times a year we’ll have a dog that presents for concern for bloat and we actually identify that they have fluid in their abdomen instead. So then again something to look for at home but it’s not something where it’s the same disease. It’s just figuring out for sure what is happening. After we confirm a diagnosis of bloat or GDV we are going to continue resusitation again. How we’re doing that is with our right lateral radiograph. We’re going to continue fluid resuscitating these dogs in order to make their volumn status better what that means is making sure they have enough intravascular volumn. So enough blood in their system to deliver oxygen to other vital organs. And then we’re also gonna decompress them, which means getting that air out of their stomach. Which improves their circulation and we can do this one of two ways. The first is something called ????? where we will put a needle in their stomach and release the air. And the second by passing a tube under anesthesia. Many years ago we used to pass these tubes awake, and we’ve identified that the dogs are uncomfortable with it. And more importantly and certainly their comfort is important but it can also had some negative cardiovascular side effects to that so now we pass these tubes under anesthesia. Prompt surgical exploration is the next step and this is considered a surgical emergency. We know that duration of torsion or GDV can influence outcome. And the actual how long do you have is really an unknown question. We identify that dogs that are bloated overnight. Some people say that the dog was restless at night and I stuck them in the backyard or kennel and I checked on them at six in the morning. Those are often the dogs that we find don’t
make it through surgery, so duration is certainly important. But on the other hand we also recognize
that these dogs need some stabilization before surgery. And try and get them as stable as possible can with fluids first. Generally we try to get a dog with this disease after identification into the operating room within about an
hour to an hour and a half after presentation. So consider about the ideal amount of
time to get them as good as you possibly possibly can and not have the stomach under pressure for too long. So then prompt not immediate but not the
next morning either. Our goals and surgery are to put
the stomach back in position. Assess for dead areas at the stomach. Look at the screen and look at other
organs. Most often dogs with bloat or GVD don’t have
any other disease in their abdomen. But certainly they could potentially
have something where they have a cancer somewhere ?????? or they have bladder stones. Or sometimes they will have a foreign object in their stomach so we look at everything. And we perform a gastropexy or tacking that will actually stitch the stomach to the side of the body to keep this from reoccuring. What we can find at surgery again is gastric mucosis which is dead pieces of the stomach. We can again find their spleen twisted and when that spleen is twisted it sometimes dies and we may need to remove the spleen. And again as we mentioned we can find
cancer somewhere or we could find in foreign object. Dogs that eat a lot of stuff sometimes can maybe that foreign objects contributous. This is a picture and I apologize for it being kind of graphic. This is a picture of a dead stomach. You see can at the bottom right a hole in the stomach. This was a stomach that ruptured on it’s own got the dog to surgery. And so the red areas that kinda red and
purple areas in the surgeons hands are also dead areas of the stomach. And thats the tissue area we have to remove. But the grey area with the hole in the middle is a area of the stomach that already ruptured. This is the kind of dog that would have a much harder time recovering from surgery. And this is the dog that we really worry about can have a lot of complications. With the gastric mucosis that is shown in the picture we will remove that dead tissue. This does obviously increase
the cost is surgery. will use the human ? staplers for that. Staplers are designed for use in people and the cartridges for that are typically very expensive. you can sometimes also hand sew the tissue back together but increases anesthesia time. This can
increase the risk of death post operatively. Some dogs while they can live with small stomachs with a large gastric
reception, the removal of a lot of the stomach can have a higher chance of
not recovering well. And in some rare cases that surgery that the whole stomach is dead we end up euthanizing dogs in surgery due
to the extent of the gastric mucosis. Because we really
worry that the dogs are not going to have a good quality of life and they’re not going to be able to do well afterwards. So this is a really big break point. And this is one of the big areas where we encourage people to bring
their dogs and very quickly. Recovery for the average dog is typically two to three days in the hospital after surgery. Durning this this time period they are having IV fluids, pain medications usually pairing up with it in antibiotics. We know it’s not an infectious disease
but because they’re shocky they’re at higher risk for developing an
infection somewhere else. so we’ll often keep them on antibiotics for couple days. Anti-nausea medicines encouraging them to eat again. We will watch for abnormal heartbeats they will have some abnormal heart rhythms and these can sometimes be serious particularly in dogs that have pre-existing heart disease like Dobermans. Recovery at home. This is a major abdominal surgery for the dog. They usually take a couple weeks at home to get completely back to
normal. Thery’re to have some less limited exercises, thier incision is healing. Incuraging them to
eat unitil they get their appetite back. Often we will recommend frequent small amount of bland food every three to four hours for the first day of two and then gradually transition back to their regular diet. Typically they’re fully recovered from
this within about two weeks. But it can sometimes take a little
bit longer and for people who have show dogs or performance dogs, complete recovery can take longer. They have lost muscle mass associated with rest and they can also if they are a coated breed it can take a little while for the fur coat to grow back to show characteristics. So is there anything you can do? It’s a disease that we know about eighty percent at the dogs that are presented to the hospital and treated will survive, but thats not high enough. The other thing that you see in emergency services is sometimes dogs when they’re identified with this disease it’s not an appropriate step with their family to go with ahead with surgery whether that’s due to the dog has other diseases or severe arthritis, o cancer something else, or the cost is associated with surgery. So as you might guess this can be an
expensive undertaking. And again depending a lot where you are
in the country but certainly can reach into thousands of dollars for 24-hour care. So that’s something really important to consider as well. So we think a lot about is there
anything you can do to prevent bloat. Things to think about are lifestyle, surgical things and pet insurance. And the are areas to think about separately. People would love a way and I agree I would love a way for this. Is there someway we could do something with feeding habits. People have looked at a variety of these different things. And relatively small group the Dogs. We used to think that big meals might make this stomach so distended that it would flip over. Now we identify that smaller more
efficient will be easier for the dog for other reasons and probably doesn’t matter from a standpoint of bloat. Exercise after eating probably doesn’t matter not if you are going to work the dog very very hard after eating that’s probably not a good idea for a variety of reasons. But particularly from a bloat standpoint eating dinner and playing in the backyard it’s not shown to be a risk. Larger food size does not pulvorize food maybe protected although large breed dogs will eat kibble. And so this is less of a concern and
feeding from a height sometimes as people thought will help, it doesn’t appear to matter. This is I recognize not the great news ???? to say is there something I can specifically do to keep this from happening. And there is not from a feeding standpoint. If there’s dogs that are nervous or stressful, I think this is something that is important we know that anxious dogs will have higher risks and they swallow a little more air. If you are nervous you may not have the same motility meaning that stomach contents may not move thru your GI tract as fast. So it maybe that these dogs have a higher risks. GI exercise maybe a
little bit beneficial more than GI motility. Probably recognizing that some dogs may not tolerate boarding or being at unfamiliar locations as others. And then recognizing what to do if you are out of town and how to make others realize exactly what you are up against. When we think of boarding kennels, again with my background a an ER doctor dogs bloating at a boarding kennel is one of the biggest disasters we can have because sometimes people are unreachable. And certainly now everyone has a cell phone but sometimes it’s still hard to reach people so making sure that a kennel can reach or an authorized delegate decisions regarding surgery. It’s
important because sometimes kennels haven’t talked to people about that
and so I want people to be proactive and say certainly if my dog bloats I would like you to take them to this hospital and have this operation. Here is how you can reach me or my sister who can also make decisions or my coowner or any of those sorts of things. But again this is from an emergency vet standpoint. It’s very frustrating not to be able to reach someone when you have a dog that has something that is fixable. As youwant to talk about preventative
surgery and this is going to be something that’s really important for the individual dog. While we know it’s surgery for dogs that have GDV, we will do a tacking surgery or a gastricpexy. Where we basically stitch the stomach to the lining of the inside of the abdomen to keep it from flipping again. We can also do this is preventive surgery. And as a disease to be prevented this is something
that’s very very helpful and also very effective. and very effective and very safe surgery to prevent this. It doesn’t prevent the gas distention. They can still bloat but they really won’t twist and won’t develop volvulous if their stomach is tacked. This is really an important thing to consider. You can do about it gastric tacking a couple
of ways. You can do it laproscopically and you can do it as open surgical procedure. I want to encourage people to think about this for those breeds of dogs at risk in particular. This is the picture doing it
laparoscopically and so this is similar to what people would have done. The little purple line on the dogs abdomen. To orient you, the dog is laying on his
back on again this is very similar done in the OR (operating room) just like a human procedure would be done. But there’s really small little incisions using a camera we can reach in, find the stomach and then using that make a small incision and stitch the stomach to the side of the body in a good anatomic location. This is very very fast recovery time. This can be coupled with ovariectomy or some other procedures if that’s a boon. But it’s very simplevery straight forward very rapid recovery. And it’s done in many many places throughout the country and is in growing popular technique. Again this is the type of incision you have and you have a couple of small incisions but nothing really big nothing thats going to
be a hard recovery for the dog. You can also do the surgery open and
this is commonly done combined with the combined with a spay. Particularly for a show dog that is at the end of it’s breeding career and they are being spayed and are at an at risk breed. Having them pexyed or tacked at the same time is a very good idea. Also in other abdominal surgeries we will think about doing this. We in fact just had a standard poodle this last weekend that had a ??????????????? this summer and need and operation to remove that and at the same time we did a gastropexy in order to keep him from developing bloat in the future. You can also do it as an isolated surgical procedure. And this is something that is pretty straight forward with a much much more rapid recovery. Than with the standard bloat surgery if it’s a dog thats actually had a GDV where they have all of the biochemical profusion complications, this a realy quick recovery for them. So again gastric tacking is the most effective technique to prevent bloat in the individual dog. When you think about it, it doesn’t do address why bloat develops, it doesn’t do anything for the genetics, but for the individual dog this is
the way to prevent the disease. Until scientist we we can get on top why
it’s happening and we can identify the genetic causes and get it not to show up in dogs. For the individual dog a preventive gastric tacking is the important way to go. Questions come up is what is dogs actual relative risk in his lifetime. And that is hard to predict. For Danes for sure this is a very high risk sort of disease. So Great Danes, Shepherds, Setters, Standard Poodles are very highly represented and these are dogs I believe in strongly in doing the gastropexy in individual dogs of different breeds, if they tend to be deep chested. They have a very long chest in relationship to the ribs of their chest. Or if you know they have a relative who has had a GDV. That’s going to be a high risk of bloat as well and so that’s what I’d strongly consider in additionally. So again thinking about this, work with your colleagues as far as other people and if your in the show dog world making sure you know about in family lines. For individual dog owners, talk to your breeder, talk to your veterinarian, about your individual dogs risk. But for the individual dog the gastropexy is the best by far the way to go to keep this disease from happening. The other thing to think about is pet insurance and again everybody has a different financial status or what they’re comfortable with. But costs associated with surgical therapy for GVD are high and this is something that’s not a planned cost so depending on your financial situation considering pet insurance can be a really helpfull way to go. A lot of them will have a catastrophic
clause so it can be a relatively low-cost. they really only pick up at the high end things. So this is absolutely something that can be lifesaving. And cost can sometimes result
euthanasia of the dog with otherwise a good prognosis and we always hate as veterinarians that money comes into it. And to me it’s appealing to able to avoid adding the financial stress to times of emotional stressful times. So
consider this again depending on your financial status on what you’re comfortable with but it can be a very reasonable plan to be thinking about as something that is worth doing. Other things to kinda finish up a little bit. What are some special scenarios. I want to talk about bloat kits. I wanna talk
about some blood markers because I think that’s one of the areas
that sometimes people read about. And its always worth thinking about those things. Trying to think about what might be happening. Or what are those things that might be going on. But first talking about bloat kits. So these will be marketed pretty widely on the internet And these are also something different breed clubs recommend. These are either done as a stomach tube so usually a full tube. So tube that is designed for use in a small horse. Or a large ????????? needle The rationale for this is that if you can pass a tube or decompress the stomach you can buy yourself a little more time. My thought as an ER doctor these are not going to be as helpful if you are anywhere near a veterinarian. If you are somewhere on a field in a very rural part of Northern Maine and you are two hours from the local emergency clinic and its 2 in the morning a bloat kit might be a very reasonable thing to think about. But on the other hand if you are 20 minutes to the emergency clinic or your freind is coming to help you with the bloat kit you are much better off going to a veterinarian. Again the rationale for this is that the fluids we give these dogs a the same time. This is not a disease that you just need to decompress the stomach. It’s a condition where you put the stomach back surgically and in doing so also provide them with some volumn support. But we also recognize that while
everybody is not always within a 20-minute drive of a veterinarin or a half hour drive. And so depending on where your at it may be something to consider and talk to your veterinarian about that. And I absolutely love the idea about dogs going on vacation or trips but if they do that you want to be able to think very clearly follow as to what are we doing
as far as where is the closest vet and do we need to have these sorts of things here. This is not the best use of home first aid. The next thing that I want to talk about is a bio marker called lactate. And a lot of people are familair with the human medical use. So we talk about if you exercise you might reach our lactate threshhold. Blood lactate shows up in the blood when a patient is shocky. So if they are having ineffective oxygen delivered to the tissues thier blood lactate will go up. And its measured on a little handheld kit similar to the monitor given to people who are diabetic. So just a drop of blood can tell you if the patient is in shock. And we certainly use this clincally for a variety of diseases. And about only about fourteen or fifteen years ago there’s was a nice study that came out of the University of Pennsylvania. That talked about high lactate values. A value of less than 2 was normal and they identified that dogs that had a value of greater than 6 were most commonly associated with gastric mucosis and subsequent death in this group of dogs. And what we want to mention here is
that somehow got into some of the emergency clinics and some of the veterinary literature that if your dog had elected a greater
than 6 it wasn’t going to survive. I just want to reiterate that this is not true. Lactate is a good indicater but it doesn’t tell you if the individual tall dog is going to do okay or not. It just gives you a good calculation. So if your veterinarian says the lactate is high it just tells you that your dog is in shock but it doesn’t tell you that it’s not worth treating the dog or that he’s not going to survive. So keep that in mind. Other things to think about again could the dog have something else associated with bloat. And again even in older dogs this is uncommon. This is just something that
happens. We’ll see some dogs with rare intestional masses so they can have a mass that prevents stuff from leaving the stomach. But that is an uncommon spot for the dog to have a tumor but we can sometimes see that. We can sometimes see dogs that have heart
disease that might make anesthesia a little bit riskier but again if you look at euthanizing the dog, thats clearly the worst outcome than attempting surgery. So cardiac disease may play a role in stabilization and may affect survival but certainly its still reasonable to treat these dogs with this. And again we recognize that advanced age is a risk for development of bloat but its not a specific disease. so when you look at if your 12-year-old has bloat is it worth having that dog have surgery it really depends on the dogs quality of life before hand. If this is a dog that was still pretty well, maybe a little bit of arthritis but otherwise spirits you can absolutely expect that the dog would do well. In our hospital I think the oldest dog we did surgery on was 18 or they said she was 18. And she did great. So age is not a risk factor. But underlying ?????? so if you have a dog that has horrible arthritis, really bad heart disease,
bad kidney disease, thats a dog that might have a much harder time recovering but simply age is not a reason not to persue surgery. And so this is going to conclude my presentation and certainly I am happy to answer any questions. But when we think about what to do for
dogs with bloat really kind of a summary of what I want to think about is looking at recognizing the disease. So I want pet owners to recognize that bloat happens. Recognize dogs that are potentially at risk. These are my two dogs, they are both Setters and they’re both pexied without having a bloat ever because I wanted to make sure that that didn’t make sure that that didn’t happen. We’re looking for preventing it by pexying if we can ?????. the AKC Canine Health Foundation is
incredibly grateful Dr. Rozanski for her work on behalf of the health of
our dogs as well as for taking the time to present this webinar. Thank you to all the organizations and
individuals that have supported CHF’s bloat initiative. To learn more about the bloat initiative and to make a secure online donation to support our work please visit www.akcchf.org/bloat Thank you for your support and thank you for listening.

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