BLOAT (GASTRIC DILATION) IN DOGS

  

There has always been an assortment of great food choices when traveling throughout our state. I recently traveled up to Butner, NC to visit Architectural Trees to obtain some specimens for a conifer garden at the house. On the way home, Bill’s Bar-Q enticed me into getting some southern comfort food, topped off by coconut pie. Yes it was quite good!

Unfortunately, many times pets, either by choice or by accident, present with over distended stomachs.  Sometimes it is by getting into extra food or the trash cans. In other cases there is no obvious cause of the swelling.  In the case below, a young puppy overate, then vomited, and aspirated food into his lungs.  

WHAT IS CLASSICAL BLOAT/DILATION?    HOW IS THIS DIFFERENT FROM VOLVULUS?                                               

Bloat, a veterinary emergency in dogs, is a condition in which the stomach is distended with air, more scientifically called Gastric dilation. When the dilated stomach rotates 90 to 360 degrees it called gastric dilation and volvulus (GDV).

It is more common in large breeds of dogs over seven years of age.   The most commonly affected breeds are the Great Dane, Weimaraner, Saint Bernard, Gordon setter, Irish setter, Doberman Pinscher, Old English sheepdog, and Standard Poodle. The Bassett hound is at greatest risk among smaller breeds.  The underlying causes for GDV are poorly understood, although there are several recognized risk factors which are described below. 

WHAT ARE THE SIGNS NOTED BY OWNERS?

 They are often that of acute distress: distended abdomen, pain, drooling, retching, increased heart rate, and difficulty breathing. 

EXPLAIN THE SEQUENCE OF EVENTS LEADING TO THE RAPID CRISIS?

 Due to a compromise of the circulatory system from a compression of vessels by the dilated stomach, acute collapse, shock, and even death may come quickly. The severe shock comes quickly and is accompanied by death of the stomach lining, enlarged spleen, and even stomach rupturing which releases toxins into the abdomen and general circulation. Death may happen in as little as 4 to 6 hours, and it the second leading cause of death in large breeds of dogs, second only to cancer. 

ARE THERE COMMON FINDINGS ON RADIOGRAPHS (X-RAYS)?

 Radiographs demonstrate a severely enlarged, gas-filled stomach that if twisted has several compartments called a “double bubble” that may ping when thumped.

EMERGENCY CARE STEPS?

 In many cases, the patient is so compromised that emergency treatment to tap off the gas from the stomach is required by placing catheters in two to three veins to administer lifesaving IV fluids for shock. Emergency surgery supersedes the ability to take time for diagnostics. Definitive treatment involves surgery to correct the position of the stomach, remove devitalized, non-viable tissue (spleen and portions of stomach if necessary), and to perform a gastropexy (stomach tack) to lower the risk of reoccurrence. Intensive 24-hour post-surgical care is critical to decreasing mortality. Treatment for infection, electrolyte abnormalities, shock, pain, and heart arrhythmias can be emotionally and financially draining.

RISK/PROGNOSIS?

The prognosis is up to a 15% mortality rate for patients with GDV treated surgically with a viable stomach lining. However, if circulation to the stomach wall has been compromised with delays of five or more hours, there is an increased risk of death. Other factors associated with a guarded prognosis include low body temperature and low blood pressure at presentation.

NAME THE ACTIONS THAT MAY LOWER THE RISK?

Prevention is an evolving target with no solid definitive answers. It is strongly recommended to perform a Prophylactic gastropexy (stomach tacking) in breeds at high risk for GDV to lower the risk of stomach twisting. Some surgeons perform the procedure via laparoscopy. Several recommendations have been made to prevent gastric bloat after discharge or to prevent GDV in dogs that have not had a gastropexy such as dividing feedings into several small meals a day, do not feed dry foods that contain an oil or fat ingredient listed as one of the first four ingredients,  or feed a small kibble size (<30mm). Avoid stress during feeding. Do not elevate feeding bowl during eating and discourage rapid consumption. Restrict exercise before and after meals.

Betsy Sigmon DVM

Hospital director/owner Creature Comforts Animal Hospital

Special thanks to Dr. Kyle Mathews, Professor, Small Animal Surgery at NCSU for his assistance in review of this article

The Chi is Caroline Sheremeta

The French Bull dog is Soho Dettelbach

The Shepherd cross featured in this article is Murphy Lauberts.

THE VISIT TO A VETERINARY SPECIALIST IN A REFERRAL CENTER

I spent this past weekend with my five siblings in the Blowing Rock area of North Carolina for a family reunion and to enjoy the autumn foliage.

This annual fall gathering is a chance to share board games, coffee, and stories that make our family unique & bonded. I've learned that there is an actual term for the fear of peanut butter sticking to the roof of the mouth, arachbutyrophobia. Between meals that resembled the buffet line at “Golden Corral” and homemade breakfast, lots of exercise was needed to wear off the calories. One of the best hikes was the Flat Top Mountain trail up to the fire tower. 

The multiple panoramic views of the fall colors were stunning.   The National Park site is the former estate of Moses Cone, also called the “denim king” of Greensboro textiles.  

The multiple panoramic views of the fall colors were stunning.   The National Park site is the former estate of Moses Cone, also called the “denim king” of Greensboro textiles.  

Unfortunately, I knew that the upcoming week would require further investigation into the reason for the sudden and unexpected significant heart murmur in my precious dog “Taco Belle” during her annual physical. I selected the NCSU College of Veterinary Medicine cardiology service, recognized for their excellent facility and outstanding clinicians. 

WHAT SHOULD YOU TAKE TO REFERRAL CENTERS FOR PLANNED SECOND OPINIONS & DIAGNOSTICS?

I had emailed her digital radiographs prior to the appointment. However, obtaining your own digital link or a CD (replacing hard copy radiographs of the past) is a useful backup plan. In addition, pre-faxing medical records, medications, laboratory test results, and immunization dates (specifically Rabies) is helpful to expedite the check in process. 

HOW DID TACO BELLE TAKE THE NEW HOSPITAL VISIT AT NCSU?

Taco Belle is a great traveler and waited in her blanket until the examination and Doppler blood pressure check.

DESCRIBE WHAT HAPPENDED DURING THE CARDIOLOGY Echocardiogram EXAMINATION?

With technicians holding her gently on a padded table (with a semi-circular opening) centralized  over the heart, the veterinary cardiologist, Dr. Terri Defrancesco applied a gel covered probe on the skin near the heart from different directions. 

Utilizing sound waves, the images of the four heart chamber sizes and velocity of blood flowing through the heart are recorded. Later the dimensions are measured & calculated on a separate computer screen.

WHAT WAS FOUND?

Taco Belle has mitral valve endocardiosis and insufficiency along with left atrium enlargement. 

In simple terms, this means that the heart valve that controls the blood flow between the upper and lower chambers on the left side of the heart (mitral valve) is starting to deteriorate. The sudden onset is suspect that one of the attachments of the valve (called the chordae tendineae) has slightly ruptured. 

WHAT IS THE TREATMENT? 

She is already on a Royal Canin GI low fat diet that has the lower sodium of 100mg/100 kcals. To slow the onset of heart failure, a medication, enalapril, to help the heart work more effectively  is prescribed. The picture below is of Taco Belle's cardiologist with the gift of the new children's book I recently wrote.

WHAT IS THE PROGNOSIS?

Taco looks and acts fine. She sleeps and plays as usual with the occasional hesitation to go up the steps. She still performs her “happy dance” racing through the house 90 miles an hour on occasion that makes her family happy. There is no way of predicting when she will go into heart failure: 6 months or 3 years from now. When she does, the next steps to treat the anticipated coughing, distended belly, and weakness will include added medications such a diuretic to remove fluids and pimobendin to help the heart work more effectively. 

Betsy T. Sigmon, DVM, Diplomate American Board of Veterinary Practitioners, Canine & Feline

Creature Comforts Animal Hospital

Cary, NC

Below are some pictures I took today at the farmer's market and on my front porch to celebrate the fall.

Happy Halloween !

Dilated Cardiomyopathy, a Heart Disease with Surprises

Everyone enjoys a good surprise. I am no different, as a surprise birthday party was organized by my husband to celebrate a milestone. On the pretext we were going to dinner with my siblings, 30 friends greeted me in surprise! It was a wonderful occasion to celebrate life and the blessing of family and friends. 

In my garden, each day of summer provides the element of blissful joy to see the unfurling of new flowers on the lilies with their delicious and intoxicating scent.

 Many visitors to my garden delight in the constant fluttering of the butterflies that come on my Joe Pye Weed flowers.. All if these constant changing and evolving " eye candy" are highly anticipated and gorgeous portions of the summer experience in the piedmont summer in the Carolinas.

Last week, I came home to the surprise of a lawn mower photo shoot being shot in my yard. I was overwhelmed by the amount of equipment and number of people ( check out 15+ cars) to take a picture of a riding law mower. 

As my garden travels included a side trip to the Chelsea Flower Show in London, I was surprised by the side trip to the British Museum to see the spectacular beauty of the Elgin Marbles in the British Museum. Sometimes unscheduled events have huge visual surprises.

Unfortunately, some surprises are unexpected and not pretty, namely failure of the heart muscles to effectively pump blood called dilated cardiomyopathy. 

WHAT IS DILATED CARDIOMYOPATHY OF DOGS?

Dilated cardiomyopathy (DCM) literally means “a disease of heart muscle characterized by ventricular chamber (lower section) enlargement." It is one of the most common acquired heart diseases in dogs.

WHAT HAPPENS?

Initially, the chambers of the heart enlarge and the walls stretch to compensate. Eventually, this leads to leaky heart valves and a backlog backing up to the lungs if the left side is not pumping effectively. The belly becomes full of fluid if the right of the heart fails.

WHAT ARE THE MORE COMMON BREEDS OF DOG THAT HAVE THIS DISEASE?

Cocker spaniels, Doberman Pinschers, Golden Retrievers, Newfoundlands, Boxers, Dalmatians, Portuguese Water Dogs, Labrador Retrievers, and Great Danes have a risk for the disease. Testing is available for genetic risk assessment for many of these breeds.

I HAVE HEARD THAT SOME CANCER CHEMOTHERAPIES CAN INDUCE THIS DISEASE? ANY OTHER RISKS?

Yes, it can also be found in cancer patients being treated with IV cancer drugs, such as doxorubicin/Adriamycin, that have a toxic effect on heart muscle. Infections such as protozoan Trypanosoma cruzi can insult the heart muscle (myocarditis), a parasite commonly found in South and Central America. Also, low thyroid levels (hypothyroidism) can lead to heart disease. Parvo virus induces heart muscle damage in many puppies that current immunization (vaccination) protocols have significantly lowered the risk.

NAME SOME DIET RISKS ASSOCIATED WITH DILATED CARDIOMYOPATHY?

Nutritional cardiomyopathy has been reported predominantly in American Cocker Spaniels, Boxers and Dalmatians on urolytic diets such as Hills Prescription Diet u/d. Recently, taurine (a protein/amino acid) deficiency has been reported in several other breeds, including Golden Retrievers, American Cocker Spaniels and Newfoundland, especially if eating a vegetarian diet. In Boxers, another protein/amino acid deficiency, carnitine, has been noted that responds to supplementation. These amino acids are essential for normal heart muscle function.

ARE THERE MORE COMMON SIGNS?

Lethargy, exercise intolerance, weakness, and cold feet can develop surprisingly quickly. This can be followed with coughing and a greatly distended belly (ascites). Most owners report a loss of appetite and difficulty breathing by this time.

CAN YOU LIST SOME TESTS NEEDED TO CONFIRM THIS DIAGNOSIS?

X-rays of the chest and abdomen, electrocardiogram, sound waves of the heart (echocardiogram), blood work, thyroid levels, and possible testing taurine levels (an amino acid).

MOST COMMON TREATMENTS UTILIZED?

-Diuretics such as furosemide

-ACE inhibitors to dilate vessels and help reduce fluid retention

-Pimobendin to slow heart rate and improve efficacy of each heart beat

-Digoxin to slow very heart rates associated with an ECG abnormality called atrial fibrillation

-Beta blockers to slow an extremely fast heart rate.

-In severe cases, draining of the "life threatening" fluid accumulation of fluid in the belly to relieve pressure on the diaphragm that makes breathing difficult.

WHAT IS THE PROGNOSIS?

Generally animals will live three months to a year depending on the severity of changes at presentation.

IN BREEDS AT RISK, ARE THERE SOME SCREENING TESTS?

Yes. Discuss the value of NT-proBNP, Troponin levels, genetic screening, diet review, Electrocardiograms, and Echocardiograms of breeds at risk with your veterinarian.



Betsy T. Sigmon DVM, Diplomate American Board of Veterinary Practitioners, Canine & Feline Practice

Hospital Director, Creature Comforts Animal Hospital

Cary, NC

EATING ODD OBJECTS BY DOGS & CATS: PICA

It is no surprise to most of my clients and friends that I love desserts. I was raised to ask not what was for supper but rather what was for dessert.

 I do not eat a lot of chocolate; yet, delectable pastries get me into “heavenly bliss”. On vacations, the local bakery is often  first stop for me!

Unfortunately, when offered even the best of premium dog food, many dogs and cats chose to eat other things in their spare time.

Many times, owners witness the ingestion. In other circumstances, the objects are passed in vomit or poop such as this golf glove ( radiograph on above shows it in the stomach).

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Sadly, as in this athletic sock ingested (radiograph below), they often cause an obstruction requiring surgery.

WHAT IS PICA?

It is defined as pets eating objects with no nutritional value: paper clips, socks, gloves, needles, razor blades, electrical cords, carpeting, underwear, plants, rocks, plastic, dental floss, golf balls, and toys among other things. It is thought to be a variant of normal exploration, scavenging, and chewing. Some feel there is an appeal of certain textures or preferred tastes to chew.

WHAT IS THE CAUSE?

Experts have not pin-pointed one specific cause of this compulsive behavior. Boredom (lack of exercise), stress, infantile behavior, low fiber diets, irritable bowel syndrome, and other intestinal medical issues are mentioned. Some puppies that were starved under 20 weeks of age have an increased risk of pica. 

ARE THERE GENETIC LINKS?

Doberman pinchers seems to have a propensity for blanket sucking and Oriental cats (Siamese, Burmese, etc.) have a similar increase in wool sucking. However affected cats may also chew on cotton, rubber bands, string, and cardboard. 

CAN YOU EXPLAIN POSSIBLE SIGNS OF A BLOCKAGE FROM EATING OBJECTS?

Vomiting, lack of appetite, dehydration, and painful belly are the most common reports. A radiograph, abdominal ultrasound is often performed to confirm the suspected cause. In the following photo, a cat ate a needle with sewing thread attached.

HOW IS PICA TREATED?

 Avoiding stress is a key factor. The next important portion is anticipation and avoidance of situations that are inciting causes: closing trash cans, putting away laundry, and confinement in areas to limit access to objects when unsupervised. On presentation to a veterinarian a blood profile maybe performed to check for irregularities and a good history to rule out separate intestinal disorders. Treatment includes: higher fiber diets to fill up stomach, increased exercise to enrich the environment, and provide alternate chewing activities such as food puzzle toys, durable chew toys, dental chews, and cat grass. For dogs, imcreases in brain game activities such as obedience training, bumper retrieving exercises, or swimming helps to tire and decrease episodes. This leads to happier dogs and owners!!!

In addition, for added safety some  dogs may comfortably be fitted with a basket muzzle for key periods of the day. Slowing down eating with Buster Dog Mazes is another example. For those that cannot find a cause, an anti-anxiety medication maybe discussed.

For cats, it is very important to enrich the environment with tools with online tools such as the "the indoor cat initiative" to simulate hunting for food,climbing perches,and increasing exercise. similar puzzle games for feeding stations are helpful.

Below is a fall scene from Linville Falls, North Carolina.

Betsy T. Sigmon, DVM Diplomate American Board of Veterinary Practitioners, Canine & Feline Practice

Creature Comforts Animal Hospital, Hospital Director

Cary, NC