Dr. Phil Zeltzman’s Blog

Xena, a beautiful 6 month old female German shepherd, was ready to be spayed. Benefits include eliminating the risk of mammary (breast) cancer and preventing a deadly infection of the uterus called pyometra.

In addition, Xena’s family vet discussed the benefit of performing a prophylactic gastropexy.

A what?

A gastropexy is a simple surgery performed to prevent twisting of the stomach – sadly sometimes called bloat – or more appropriately Gastric Dilatation Volvulus (GDV), stomach torsion or flipped stomach.

Prophylactic means that it’s an elective or preventive surgery performed before the stomach ever has a chance to twist.

The success rate of this simple surgery is very high. It is critical to understand that the dog can still bloat, ie the stomach fills up with air. This still means that they would need emergency treatment to deflate the stomach. But it’s a much safer place to be in, since the stomach should not twist on itself.

It is a potentially life-saving procedure that should be considered in Great Danes (the #1 breed for this disease), German shepherds, Dobies, Weimies, Labs and several other large dog breeds with a “deep chest.”

After Xena’s owner had a friend who lost her Great Dane because of a twisted stomach, she wisely chose the added surgery as recommended.

During the gastropexy, the stomach is tacked or stitched to the inside of the belly. This simple procedure prevents the twisting of the stomach.

Then a standard spay was performed.

I’ve performed many of these life-saving surgeries at the time of a spay or neuter. Occasionally, it is done in an older dog who is already spayed or neutered – which is still a great idea.

Xena recovered well after 4 weeks of restricted activity, pain medications and antibiotics.

And now, her family’s mind is at ease, knowing that they did all they could to help Xena live a long, healthy and hopefully GDV-free life.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

www.DrPhilZeltzman.com

“Bloat” is also called many different things: twisted stomach, Gastric Dilatation Volvulus (GDV), gastric torsion, stomach torsion etc.

Side note: it’s unfortunate that we (vets and dog owners) have gotten used to calling it bloat. After all, bloating is not a big deal in people. Yet “bloat” can kill a dog in a matter of hours.

Vets sometimes tell pet owners that we don’t really know what causes GDV, and therefore we don’t know how to prevent it. However, that is not exactly accurate…

Here is a summary of the main known causes.

1. Breed

Large and giant dog breeds are at risk for GDV, including Great Danes (the #1 breed), German shepherds, Weimaraners, St. Bernards, Dobemans and Old English sheepdogs. These breeds are roughly 25% more likely to get GDV than others.

A few smaller breeds, such as basset hounds, boxers, and standard poodles can also be prone to GDV.

2. Conformation

Conformation has to do with the shape of a dog.

Dog breeds called “deep-chested,” have a tall chest and a skinny belly. Think of a Great Dane. A deep chest, combined with stretching of ligaments that attach to the stomach, increases the chance of stomach torsion.

3. Genetics

Dogs with a first-degree relative who had GDV are at greater risk of getting

it themselves. This chance increases by 20% with each additional year. These factors confirm that GDV is a partially genetic disease and dogs at risk should be spayed or neutered.

In addition, better selection should be taken seriously by breeders.

4. Stress

Stressful situations can also contribute to a twisted stomach. Boarding, thunderstorms, moving, vet visits and hospitalization are all potential triggers for nervous dogs.

One study showed that having a high-stress environment or being fearful contributed to GDV compared to similar dogs who were in a non-stressful environment.

5. Feeding

Eating fast, and how often dogs are fed, have been shown to increase the risk of stomach torsion.

Therefore, if your dog eats fast, it’s important to find ways to slow it down. There are special bowls made for that purpose.

In addition, dogs fed once per day are more likely to have GDV, compared to dogs who are fed 3 times daily. Several small meals throughout the day are better for dogs at risk.

6. Food

Believe it or not, studies have shown that moistening dry dog food before feeding actually increases the risk of GDV in large-breed dogs.

Ironically, feeding a dry-only diet has also been shown to increase risk.

So what’s a concerned dog owner to do?

Recommendations have been made to help prevent a first episode by avoiding exclusively dry, expanded, cereal-based, or soy protein-based commercial dog foods.

Feeding a combination of dry and canned food together may be a way to lower the chances of GDV. I insist: “may be a way.” There are no guarantees here, only ways to try to lower the chances.

Also, foods with fat listed among the main 4 ingredients have been shown to increase the risk of GDV. So please look at the list of ingredients on your dog food.

7. Water

It is recommended to avoid drinking large amounts of water before and after exercise.

Ironically, too little water before and during meals may increase the chance of a dog suffering from GDV! A recurring “hot story” about ice water causing GDV regularly shows up online and appears to be a complete hoax.

8. Exercise

A fairly classic recommendation to reduce the risk of stomach torsion is to avoid heavy exercise 1 hour before and 2 hours after eating a meal. The idea is that it’s easier for a stomach to twist when it’s full compared to when it’s (partially) empty.

9. Age

Even though I always say, “age is not a disease,” age can play a role in a dog’s risk for stomach torsion.

In Great Danes specifically, age is a very important risk factor for GDV.

One of the reasons may be the stretched ligaments, over time, as mentioned above.

10. Other risk factors

There are countless other risk factors that are unproven, controversial, or contradicting.

. For example, some studies show that a raised bowl is better to decrease aerophagia (aka swallowing air), while others imply a bowl on the floor is ideal.

. The at-risk gender varies from study to study.

. The month, the cycle of the moon, and a previous spleen removal are also fuzzy risk factors.

• Gastropexy

This last point is not a risk factor – on the opposite, but it’s important to mention here.

A gastropexy, or tacking the stomach to the inside of the belly, is a simple surgery that can prevent twisting of the stomach. In good hands, it’s successful over 95% of the time.

Importantly, it prevents twisting of the stomach, not true “bloating” – aka the stomach getting full of air – we don’t know how to prevent that and it remains a risk for life.

The gastropexy or “pexy” in short is part of the surgery to treat GDV. But it can also be done preventively, or prophylactically. So it’s called a prophylactic gastropexy.

For example, Great Danes have a 40 % chance of having GDV in their lifetime. Ideally, this life-saving surgery should be performed at the time of the dog’s spay or neuter – or as soon as possible after that. Of course, it’s never too late to prophylactically pexy a dog… until they have an episode of GDV.

Please beware, the next picture of a gastropexy can seem graphic to some readers.

I have helped a number of pet owners perform gastropexies over the years. Some were wise to do it before GDV happens in their at-risk dog. Some learned the hard way (i.e. their dog got a twisted stomach, and that’s how they learned about the pexy option).

Either way, it can be done as a “stand alone” surgery, or at the time of a spay or neuter.

To recap, we know a lot about the risk factors of GDV. Be aware of them, and prevent those you can control. You could very well save your dog’s life.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

A surprising number of pet lovers have dogs at risk for “bloat”, yet they don’t know much about the condition.

If you own a dog at risk, it is very important for you to know about it.

What is GDV?

Bloat is a life-threatening condition with many synonyms, including twisted stomach, gastric dilatation and gastric torsion. The medical expression is Gastric Dilatation Volvulus (GDV), which is what vets typically call it.

In this condition, a dog’s stomach distends with air to dramatic proportions (see X-ray). This is called gastric dilatation (GD). An X-ray of the belly would show a “single bubble”, which means that the stomach contains air in a single “pocket”.

The stomach can also twist onto itself, cutting off blood supply to the stomach and other major organs. It also blocks the exit of air and stomach contents. This is called Gastric Dilatation Volvulus (GDV). An X-ray of the belly would show a “double bubble”, which means that the stomach contains air in 2 separate “pockets”.

Obvious signs of GDV include a huge (bloated) belly and “retching”, which means unsuccessful attempts at vomiting.

Less obvious signs of GDV include pacing, salivating, restlessness, inability to lie down, a distressed attitude, rapid breathing, and pale gums.

What causes GDV?

There are many risk factors. Some are questionable if not plain ridiculous. Here are a few scientifically proven causes of GDV.

* Large and giant breeds are at higher risk for developing GDV. Breeds such as Great Danes (the number 1 breed), Mastiffs, German Shepherds, Old English Sheepdogs, Weimaraners, and St. Bernards are all at risk but it also occurs in smaller breeds like Boxers, Basset Hounds and Standard Poodles.

* The disease is related to the dog’s body conformation, i.e. his or her shape. Deep chested dogs are more likely to have GDV. This picture of a Great Dane is a great example of what we mean by deep chest.

* Developing GDV can also be partially genetic: a dog related to a dog who suffered from GDV is at a 20% higher risk.

* Stressful situations or environments can contribute to GDV. We know that dogs who are boarded can bloat, possibly from being stressed out. The same applies to storm and fireworks.

* Food and water intake have been a commonly heard cause of GDV. Rapid eating, once daily feeding, and the type of food given can all be a factor in GDV risk. Too much water prior to vigorous exercise or prior to/during meals are believed to play a role in the development of GDV.

* Age can play a role in GDV. As dogs age, they experience some changes in their abdominal cavity (e.g. stretching of ligaments of the stomach), which can increase their risk.

Prevention

While scary and life-threatening, the twisting of the stomach can be prevented with surgery. Dogs at a higher risk for suffering from GDV can have a preventive surgery called a prophylactic gastropexy, or “pexy” for short.

This surgery entails stitching the stomach to the inside of the belly. When performed by someone experienced, it dramatically decreases the risk of the stomach twisting. This simple procedure can be done at the same time as a spay or a neuter.

The picture below shows the end result of a prophylactic gastropexy after a recent patient of mine, Zeke, a 1 year old German Shepherd, was neutered.

Very importantly, the dog can still “bloat” (a terrible, very misleading name) after a prophylactic gastropexy. It’s meant to prevent the twisting, not the “bloating.”

Should it happen, the dog must be rushed to the closest vet or ER to pass a tube into the stomach to remove the air, followed by stabilization with IV fluids etc.

Treatment

If a dog’s stomach has distended and twisted, surgery entails:

. Removing the air from the stomach ASAP.

. Repositioning the twisted stomach in its natural position.

. Performing a gastropexy (see above).

. Assessing the spleen, which can be damaged and may need to be removed.

. Looking at every organ in the belly to make sure nothing else needs to be addressed (“exploratory laparotomy”).

For additional information about Gastric Dilatation-Volvulus, follow this link to read a more in-depth article I wrote for veterinarians:

www.veterinarypracticenews.com/what-causes-gastric-dilatation-volvulus

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified