Bloat in Golden with IBD
Question: Hello Dr. Mike,I have a 6 year old golden retriever who was diagnosed with IBD of thetype eosinophilic gastro-enteritis (at the moderate stage) this pastJanuary. He also has some fibrosis in his liver (which has been reducedgreatly by daily dosages of vitamin E). He is on 50 mg of prednisone,every other day (he weighs 70lbs) and eats Eukanuba's fish and potatoblend (I think it is their skin and coat formula). Tonight I rushed himto the animal critical care unit here in Vancouver because, all of asudden, he started to inflate in his lower abdomen area. He ate hisdinner about an hour earlier, had some water, went for a walk, went poo,came back, had some more water, and just started to inflate (it feltlike air trapped in his bowels).
The x-rays that they took of him tonight showed a great amount of gas inhis bowels and a little in his stomach. They put an IV in him, gave hima sedative, and will watch him over the next 12 hours to see if he willpass the gas. The doctor mentioned the possibility of his stomachtwisting, and trapping the gas in the stomach, which they would have hadto operate immediately had that been the case. She mentioned that withMurphy having IBD and being on the prednisone, makes him susceptible tothis condition, and that it could happen at any time, no matter what hisactivity may be.
Do you know if this stomach turning event is related to his IBD or is itmore because of the prednisone? Is there anything that I can do toprevent this from happening again (non-gaseous diet)?
As a side, I was going to start weaning him off the prednisone (with thevet's guidance) because I don't like the effects the drug is having onhim -- predominantly muscle weakness.
Thanks in advance,Wendy
I hope that your golden did well and bloating was the only problem, withouttwisting of the stomach.
I have not seen any mention of an associating between prednisone use andgastric dilation (bloat). Inflammatory bowel disease is suspected tocontribute to the tendency for a dog to experience gastricdilatation-volvulus (GDV) syndrome but this has not been absolutely provenat this time. Obviously, it is better to be aware there might be aconnection and to watch for the problem than to assume there is not aconnection, though.
It would be good if you can get him off of the prednisone. You can try tolower the prednisone dosage by adding azathioprine (Imuran Rx) as asecondary agent, or you might find that there is some success usingsulfasalazine ( Azulfidine Rx) or tylosin (Tylan Rx), although I am underthe impression that the latter two medications are not as effective ineosinophilic inflammatory bowel disease as in other forms.
Stress reduction and considering having his stomach tacked to the body wall(prophylactic gastropexy) are the only two things I know that have beenshown to reduce the incidence of bloat and gastropexy has only been shownto help prevent twisting of the stomach, not bloating (although ourclinical experience suggests it helps with both conditions). There havebeen lots of studies looking at diets and so far none have really shownanything that really works well to prevent bloat. I wish I did know betterways to prevent this condition.
Mike Richards, DVM11/27/2000
Bloating again after stomach staple in Chow
Question: Dr. Mike:Have you ever heard of chows bloating, having the stomach stapled, andthen bloating again?We have a 9 year old female black chow, Keeko, who was healthy untilFebruary. Keeko, at this point, weighed about 56 lbs. In early February, Iwoke up around 5:00 am because she was crying, drooling, etc... I called myvet at home, he came over and got her, and performed emergency surgery onher. She had bloated and was in shock. He stapled her stomach to the chestwall.She recovered well. We watched her food intake - 1/2 can day 3 times aday and 1 cup of water every 30 minutes. We continued to give her broiledflounder as a treat occasionally. Then, in early July, my husband came homeone Friday night to find Keeko's abdomen distended and she was drooling. Wetook her to an emergency clinic. The vet lavaged her around midnight; around5:00 a.m. her abdomen became distended again; the vet lavaged her again; thevet lavaged her at least 2 more times over the weekend. The vet then tookx-rays and found that her bladder was enlarged, but not her stomach.Monday morning, we took her to our regular vet and he performedexploratory surgery. He also removed her spleen. However, he could not findanything wrong with her -her stomach was still stapled to the chest wall andher bladder was a normal size. He said Keeko had bloated again, but that hehad never seen a dog bloat again after having the stomach stapled. She seemsto have recovered fine, again, and she's on ID Science Diet - 1/3 can 3 timesa day and 2 cups of water every hour, and she never gets table food anymorebecause our vet insists that was a contributing factor as she had flounderthe night she bloated the 2nd time.I remain anxious because I understand that even though the stomachcannot twist anymore, she can still die from shock in as little as 2 hours if shebloats again. I bought an elevated feeder for her and I check on her everyhour. My questions are: (1)Is there anything else we can do to preventanother bloating episode? (2)How does bloating occur when the stomach isstapled? (3)Does removing the spleen decrease her chances of having anotherepisode? (4)Are chows among the at-risk group as a general rule? (5)Is itnormal for bloating to occur so late in life? I have searched for informationeverywhere on the web and haven't found a whole lot out there.Thanks, Wyn
In a study of 136 dogs who had bloat, just under 11% of dogs who hadgastropexy (fixation of the stomach to the body wall) had recurrences ofbloat. In our practice, we have had two patients who had recurrences ofbloat after gastropexy that worked (we have had two failures of thegastropexy surgery itself as we learned to do it). One of these patientsbloated three times after the surgery but the stomach did not twist and itlived through each episode. It is possible for dogs to die from the effectsof bloat without torsion but it is less common for this to occur withoutthe stomach twisting.
The spleen is attached to the stomach by a ligament and series of bloodvessels, so if it enlarges it could theoretically cause stomach torsion.Most surgeons do not recommend removal of the spleen as a prophylacticmeasure for prevention of gastric dilitation/volvulus syndrome (GDV), butthere may be reason to do this if there are signs of splenic enlargement,hematomas or hemangiosarcoma.
Unfortunately, unless someone has confirmed a theory very recently, no onereally knows why bloat occurs, nor are there any preventative measures thatwork consistently to prevent bloat. There is some evidence that feeding twoor three small meals a day helps prevent bloat and that feeding a smallamount of canned food or table scraps with dry food, when using mostly dryfood, helps and that is about it.
The breeds most likely to have bloat are great Danes, Saint Bernards,Weimaraners, Irish setters, Gordon setters, standard poodles, Bassethounds, Doberman pinschers, and Old English sheepdogs. I do not know howfrequently this is a problem in chows, but we have seen bloat in this breed.
When bloat occurs in older dogs, I think it is important to try to find apredisposing cause that might cause changes in gastrointestinal mobility orthat might lead to an increase in stress. It is usually not possible toidentify a problem, but it makes sense to look carefully for one.
Hope this helps and that the last occurrence will really be the lastoccurrence of this problem.
Mike Richards, DVM9/15/2000
Elevated food bowels and bloat
Question: Our 2 large dogs passed away in late 1999 and we now have a young Akita. Wesaw ads for raised bowls over the past year, and thought they might havebeen beneficial to our older dogs. We have been considering getting raisedbowls for our Akita, but then saw a disertation about raised bowlsincreasing chances for bloat.
The question, of course, is : Are raised bowls a good idea for any largedogs or not?
Answer: I found an abstract of Dr. Glickman and associates' article on this studyfrom the AAHA journal (May/June 97) which states that the only factors thatsignificantly affected a dog's risk of gastric dilitation/volvulus werebeing male, being underweight, being fed only one meal daily, eatingrapidly and fearful temperament. However, there are many times when datais available that has not yet been published and since the AKC CanineHealth Foundation helped to fund this study, I suspect they have access tothe data whether it is published, or not. I could not find any otherinformation on this topic so I can't provide statistics that will help inyour decision making.
Another portion of this study was published in the Jan 2000 AVMA Journal(approximately the same authors) but it covered breed susceptibilitymostly. Akitas were slightly more likely to have bloat than the averageincidence for all included breeds, in this study but the difference wasvery small and probably not statistically significant. The giant breeds inthis particular article were great danes (highest incidence of bloat),Irish wolfhound, Newfoundland and St. Bernard. The other breeds wereakitas, bloodhounds (second highest incidence of bloat), collie, Irishsetter, rottweiler (lowest incidence of bloat), standard poodle andweimaraner.
I feed my rottweiler from an elevated food bowl because she eats so fastthat she will choke when fed from a floor level bowl. It helps prevent thechoking but that may not relate to bloating, at all.
I'm sorry I can't help more with this question.
Mike Richards, DVM3/3/2000
Mesenteric Volvulus in Borzoi
My name is Tamara and I recently had a Borzoi who passed away from anemergency episode which has been described to me as a Mesenteric Volvulusof the anchoring area of the intestines. I have been scouring the net insearch of any information regarding this type of affliction. I have foundalot about bloat but very little about this type of volvulus. It happenedvery quickly with very few symptoms before severe shock set in. The x-raysonly showed a slight enlargement of the spleen and he did not have anybloating or abdominal pain. The main symptom we were seeing was the shock.Could you recommend any studies, information or contacts that may know morebout this unusual type of volvulus.
Thank You Tamara
The mesentery is the suspension system for the intestines. Even thoughthere are many feet of intestines, they are suspended by a pretty small"mesenteric root" that contains the attachment of the mesentery and themajor blood vessels providing nutrients to the intestine. For some reasonthis system usually works without the intestines twisting around the baseand cutting off their own blood supply. When this twisting does occur it isknown as mesenteric volvulus. If the intestines do rotate around and twistthe base of the mesenteric the result would be the same as twisting a hose-- the blood stops flowing to the intestines. This causes an rapid onset ofshock and abdominal pain. Most dogs die before their condition can bediagnosed. Dogs that do make it to the veterinary hospital present adilemma for their vets. There are not many signs of this condition onX-rays and it is often impossible to palpate (feel) the twist. Theveterinarian must be aggressive enough to attempt surgery in the face ofsevere shock and an uncertain diagnosis. Since there are conditions thatcan cause similar signs, such as necrotizing pancreatitis, for whichsurgery may not be advisable, it is a difficult call. Most vets considerthemselves very very lucky to make the right choice, get to the problem intime to untwist the mesentery and allow the blood to flow and to still haveenough viable intestine to allow the dog to live.
This problem seems to occur more commonly in German shepherds than in otherbreeds but has been reported in many breeds. At the present time I thinkthat this condition is considered to be an unusual accident of naturerather than a problem from a specific genetic defect or other cause. Anycondition the predisposes the dog to abdominal pain or unusual intestinalactivity can be a predisposing cause.
There was a review article on this condition in the July/August 1993 issueof the Journal of the American Animal Hospital Association and there areprobably a few other references but this condition is not widely reportedon, probably due to the poor outcome of most cases.
I am sorry to hear that you lost your Borzoi to this condition. Your vetmay have the AAHA journal with the article in it if you wish to continue tofind out more about mesenteric volvulus.
Mike Richards, DVM
Gastric dilitation/volvulus (GDV) syndrome - German Shepherds
Q: WOW! What a great site. I'm relatively new on the net and just came across this and I think it is wonderful! I've been involved in training/showing/breeding dogs most of my life (I no longer breed). I've had German Shepherd Dogs for over 20 years now so I'm very aware of GDV, but couldn't find any info here. I've looked under bloat/torsion and gastric dilitation volvulos. Is it hiding or am I just not doing this right. Regardless, what a wonderful resource this is! Thank you. Louise
A: Louise- No one has asked about gastric dilitation/volvulus (GDV) syndrome yet. That is pretty surprising!
I am not aware of any new information on GDV (bloat). There still is not a firm consensus on the best way to treat this problem when it occurs and not much concrete information on the causes of this condition, although it is widely accepted that large deep chested dogs are at the greatest risk.
Gastric dilitation (bloat) and volvulus (twisting or torsion of the stomach) can lead to a number of secondary problems, including shock, blood clotting abnormalities, cardiac arrythmias (heart beat abnormalities) and death in approximately 1/3rd of the cases. It is an awful disease for the dog and the dog owner. I wish that we did have more information on it.
If a dog is ever noted to have sudden enlargement of the abdomen the situation should be treated as an absolute emergency. It is always better to be sure in this situation than to be sorry. Anyone who owns a large deep chested dog should definitely know the exact emergency procedures for the veterinary hospital they go to - who to call after hours, how to get to emergency clinics or alternative facilities and what payment arrangements those facilities will require.
Again, I wish we knew more about this problem!Mike Richards, DVM
Subject: Regarding Bloat - web sites seeking data
I don't know if this might be of any interest to you. We are compiling data on dogs that have bloated and those that have not. This will be running a year. We are finding similarities between thyroid and IBD dogs. Heavy bloat incidences.
The site may be viewed at http://www.blkdane.com/bloats.htmThank You Dana P.
Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater Virginia. Dr. Richards graduated from Iowa State University's College of Veterinary Medicine in 1979, and has been in private practice ever since. Dr. Richards has been the director of the PetCare Forum...