Dr. April Shattuck
I have been practicing veterinary medicine for almost nine years now, most of which has been spent in an exam room with clients discussing appropriate care for their beloved pet. My life has been filled with the amazing people and pets I have encountered, all of which I will remember forever. So when an opportunity arose to join the West Central Ohio Veterinary Emergency Services hospital, needless to say, I was hesitant.
Change is always scary, and I knew emergency medicine would be a difficult transition for me. However, I was excited at the prospect of learning new medicine and helping pets at the time they need it most. Four years of education and training in veterinary school can only prepare you so much for a lifetime of learning. A veterinarian’s worst fear is being confronted with a case you don’t know how to handle or know how to help. One Sunday morning, my worst fear walked through the door.
Solomon, a five-year-old St. Bernard, was noted by the owners to have an enlarged, “bloated” abdomen and was attempting to vomit. Right away, I knew Soloman was suffering from gastric dilatation-volvulus, also known as “twisted stomach.” GDV is a serious life-threatening condition. Time is of the essence with this emergency since dogs may die within several hours.
There are two parts in the condition of gastric dilatation-volvulus. The first part is the dilatation, or “bloat,” where the dog’s stomach fills with excessive air, food and/or water. The second part is the volvulus, or “torsion.” The stomach twists within the abdomen, pulling vital blood supply and organs with it. With lack of blood supply, the stomach tissue can die rapidly. As time progresses, the dog’s spleen is damaged and a dangerous, abnormal heart rhythm occurs.
The first and most common symptoms you will see in your pet are a swollen belly, retching and non-productive vomiting (your pet will appear to be vomiting but nothing comes up). Other signs include restlessness, rapid shallow breathing and excessive salivation. As the dog’s condition deteriorates, he/she will go into shock and eventually collapse.
When your pet is presented to your veterinarian, the first steps in treatment are to stabilize the patient. Treatment involves intravenous fluids, oxygen therapy and decompression of the stomach with a stomach tube or with a needle directly through the skin into the stomach. Abdominal radiographs may be taken to verify the GDV.
Once your pet is stabilized, surgery must be performed, even if decompression of the stomach is successful. Without surgery, the dog is at high risk for recurrence of GDV. During surgery, all of the organs are inspected, paying close attention to the stomach and spleen. In some cases, the spleen and/or part of the stomach may have to be removed due to necrosis (dead tissue). Lastly, the stomach is surgically tacked to the inside of the abdominal wall to prevent reoccurrence in the future.
The hours to days following surgery are crucial. Even with treatment, as many as 25 to 30 percent of dogs die. Dogs are hospitalized on intravenous fluids, antibiotics and stomach protectants until they are deemed stable, which may take several days.
Many studies have been done, but there is still no clear cause why gastric dilatation-volvulus occurs. Without question, certain breeds are predisposed for having GDV. Large and giant breeds with deep chests such as Great Danes, St. Bernards and Weimaraners are at high risk. Dogs that gulp food or water, are fed once daily or are active following a large meal are also at risk for GDV.
There are several theories on prevention of gastric dilatation-volvulus in dogs. Some preventions include: feeding your dog small meals two to three times daily, encourage your dog to eat more slowly (you can add a large ball to the food bowl), and avoiding vigorous exercise after meals. However, one of the most surefire ways to prevent GDV is prophylactic gastropexy. During a routine spay or neuter of a young pet, the stomach can be surgically tacked to the body wall, thus preventing the stomach from twisting. Prophylactic gastropexy is an elective surgery and only recommended for dogs at risk for developing GDV.
I am happy to report that Solomon has done extremely well since his surgery and has only complained about getting smaller meals. A big thank you to Dr. John McCullough for helping me with the surgery and teaching this “old” vet some new “tricks.” There just might be an emergency vet in me after all!
Dr. April Shattuck is a 2004 graduate from the Ohio State College of Veterinary Medicine, an Army wife and proud mother of two beautiful daughters. Any comments or questions may be directed to her at firstname.lastname@example.org.