BLOAT
 An Article Every Dane Owner Should Have On Hand

Prepared by:
Siefried Zahn D.V.M
Adapted from "Bloat in Large Dogs"
Published by Univelt, Inc. 1983
(ISBN 0-912183-00-4)

BLOAT KIT CONTENTS
2" needle/ Cannula (gas release) Rolled gastric tubing (cut and measured to individual dog) PHAZYME gelcaps ADULT (cut tip off and squeeze 3-6 into throat) Tempory Help till you get to the Vet!	Water Soluable Lubricant Nylon stocking or Electrical Tape 2" roll of medical tape (place in mouth, muzzle w/nylon stocking, tube thru hole in tape roll) 2 X 2 X 8" block

 

PURCHASE BLOAT KIT from Collie Health Foundation
All proceeds of the sales of this kit benefit Collie Club of America Foundation

What Is Meant by the Term 'Bloat' in Dogs?
This is a term that is synonymous with the more scientific term "Gastric Dilatation/Volvulus." It is often called GDV. That means that a dog's stomach distends with air, twists and cuts off blood flow, to the point that the dog goes into shock and may die. Dilatation means that the stomach is distended with air, but it is located in the abdomen in its correct place. Volvulus means that the distention is associated with a twisting of the stomach on its longitudinal axis.

How or Why Does This Occur?
We really do not know the answer to either of those questions. Original theories suggested that it occurred when a dog ate a large meal of dry food and then drank a lot of water. The water caused the dry food to well. At the same time, the dog was supposed to be engaged in strenuous exercise that included running and jumping. That resulted in the dog's stomach twisting on itself as the heavy organ was jostled about in the abdomen.

Although that is the most common explanation given, there is no scientific evidence to support this theory. In most dogs experiencing GDV, the stomach is not excessively full of dry food and the dog has not recently engaged in strenuous exercise. The most current theory is that the stomach's contractions lose their regular rhythm and trap air in the stomach; this can cause the twisting event. However, the sequence of events for most cases defies a good explanation.

How Is It Diagnosed?
The first step in diagnosis is to determine if the correct breed is involved. This condition almost always occurs in deep-chested dogs of large breeds. Some of the more commonly affected breeds include Great Danes, Irish Setters, German Shepherds, and Afghan Hounds.

The next step is to establish that the stomach is distended with air. An enlarged stomach will cause the body wall to protrude prominently, especially on the dog's left side. The swelling will be very firm and obvious enough to see across the room. Occasionally, this distention is not very apparent. This occurs in dogs which have a large portion of the stomach up under the rib cage. In most cases, however, the owner is able to detect the distention. A dog which experiences significant pain will be very depressed. It may lie in what is commonly called a "praying position" with the front legs drawn fully forward. This should occur quickly, within two to three hours at the most.

The presence of a rapidly developing distended abdomen in a large breed dog is enough evidence to make a tentative diagnosis of GDV. A radiograph (x-ray) is used to confirm the diagnosis of dilatation. It can also identify the presence of volvulus, in most cases.

What Happens When the Stomach Is Distended With Air?
The first major life-threatening event that occurs is shock. This occurs because the distended stomach puts pressure on the large veins in the abdomen that carry blood back to the heart. Without proper return of blood, the output of blood from the heart is diminished, and the tissues are deprived of blood and oxygen.

The reduced blood output from the heart and the high pressure within the cavity of the stomach cause the stomach wall to be deprived of adequate circulation. If the blood supply is not restored quickly, the wall of the stomach begins to die; the wall may rupture. If volvulus occurs, the spleen's blood supply will also be impaired. This organ is attached to the stomach wall and shares some large blood vessels. When the stomach twists, the spleen is also rotated to an abnormal position and its vessels are compressed.

When the stomach is distended, digestion stops. This results in the accumulation of toxins that are normally removed from the intestinal tract. These toxins activate several chemicals which cause inflammation, and the toxins are absorbed into circulation. This causes problems with the blood clotting factors so that inappropriate clotting occurs within blood vessels. This is called disseminated intravascular coagulation (DIC) and is usually fatal.

What Is Done to Save the Dog's Life?
There are several important steps that must be taken quickly.

      1. Shock must be treated with administration of large quantities of intravenous fluids.
      They must be given quickly; some dogs require more than one intravenous line.

      2. Pressure must be removed from within the stomach. This may be done with a tube
      that is passed from the mouth to the stomach. Another method is to insert a large
      bore needle through the skin into the stomach. A third method is to make an incision
      through the skin into the stomach and to temporarily suture the opened stomach to
      the skin. The last method is usually done when the dog's condition is so grave that
      anesthesia and abdominal surgery is not possible.

      3. The stomach must be returned to its proper position. This requires abdominal
      surgery which can be risky because of the dog's condition.

      4. The stomach wall must be inspected for areas that may have lost its blood supply.
      Although this is a very bad prognostic sign, the devitalized area(s) of the stomach
      should be surgically removed.

      5. The stomach must be attached to the abdominal wall (gastropexy) to prevent
      recurrence of GDV. Although this is not always successful, this procedure greatly
      reduces the likelihood of recurrence.

      6. Abnormalities in the rhythm of the heart (arrhythmias) must be diagnosed and
      treated. Severe arrhythmias can become life-threatening at the time of surgery and for
      several days after surgery. An electrocardiogram (EKG) is the best method for
      monitoring the heart's rhythm. 

What Is the Survival Rate?
This will largely be determined by the severity of the distention, the degree of shock, how quickly treatment is begun, and the presence of other diseases, especially those involving the heart. Approximately 60 percent to 70 percent of the dogs will survive.

What Can Be Done to Prevent It From Occurring Again?
The most effective means of prevention is gastropexy, the surgical attachment of the stomach to the body wall. This will not prevent dilatation (bloat), but it will prevent volvulus in most cases. Various dietary and exercise restrictions have been used, but none of these have proven value.

To avoid surgery after an occurrence of bloat (or prophylactically), the following steps should be taken to minimize the risk factors for bloat:
      Feed a high quality wholesome diet. 
      Prevent obesity.
      Feed several smaller meals rather than one large one.
      If you have more than one dog make sure that they are calm (to minimize swallowing
      air) during meals. You may have to feed them separately.
      Do not feed your dog before or after vigorous exercise.
      Avoid sudden diet changes. Make any major dietary changes gradually over 7-10
      days.
      Be aware of the symptoms (abdominal swelling and unproductive coughing/retching)
      if you have a deep-chested breed of dog.
      Call your veterinarian or emergency clinic if you have any questions. 

1. INTRODUCTION:

A. The procedures in this document should be used to provide first aid only to dogs in a bloat condition. They are not intended to replace prompt, professional treatment by a qualified veterinarian. Please read and understand these instructions completely before attempting the first aid procedures described herein

B. A bloat kit, which includes these instructions, was prepared for use on my Danes by people entrusted with their care and well-being. Additionally, I provide a copy of these instructions to everyone getting a Great Dane from me. NEVER ASSUME THAT ANYONE ALREADY OWNING OR PURCHASING A DANE KNOWS ABOUT BLOAT. Please share these instructions with others that are concerned with bloat and what aid they can give to dogs in a bloat condition. I strongly believe properly administered first aid will help to ensure a dog in a bloat condition has a good chance of survival once it gets to a veterinarian.

PROMPT, PROFESSIONAL HELP IS ALWAYS REQUIRED IN BLOAT CASES!

C. Recommended Bloat Kit Contents: 
   1.) Instructions for use 
   2.) Stethoscope 
   3.) Rolls of tape (3 rolls, 1 in. x 10 yd) 
   4.) Stomach tube (2) (different diameters). 5 ft. length bevelled at one end, with two holes
     drilled in tube 2 & 3 inches up from the bevelled end. Pre-measured and marked for each
     Great Dane in household (see page 4, NOTE 1) 
   5.) 14 gauge or larger needles (2) (1 1/2" to 3" length) 
   6.) K. Y. jelly 
   7.) Gas absorbent (Digel, GasEase, etc) 

D. A bloat kit should be available wherever Great Danes are located (home, van, RV, etc).

2. BLOAT PHASES, SYMPTOMS & RECOMMENDED ACTIONS: 

A. Canine Bloat (GASTRIC DILATION-VOLVULUS) is an acute disease or digestive problem
believed to be caused by excessive swallowing of air while eating, gastrointestinal secretions, and
gas for food fermenting in the stomach. 

 BLOAT IS A LIFE-THREATENING EMERGENCY.

B. Some symptoms may be anxiety, evidence of abdominal fullness after meals, heavy salivating,
whining, pacing, getting up and lying down, stretching, looking at abdomen, unproductive attempts
to vomit, labored breathing, disinterest in food, and stilted gait. Severe symptoms, such as dark red,
blue, grey or white gums, a rapid heartbeat and a weak pulse are normally followed by prostration
and death.

3. Determining Bloat Phases:

A. Observing the dog's behavior and symptoms and comparing to those listed in TABLE 1 is the
initial step in this process.
   1.) Look at color of gums (subpara 3B. (1)). 
   2.) Determine dog's heartbeat/pulse rate (subparas 3B. (2) and 3B. (3)). 
   3.) Note the rate of abdomen distention. 

B. Helpful hints in deciding the bloat phase of a dog (Practice the following three actions on a well
dog beforehand):
   1.) Look at the dog's gums. If the gums are pink to red shade and you press the gum firmly with
         your finger and then let go, the color returns immediately, then the dog may be normal or may only
         be in phase 1. If the gums are deep red, grey, blue, or white and, you press with your finger, the
         color returns slowly or not at all, you have an extreme situation (phase 3). You should start first aid
         immediately!

Recommend a copy of this table be made readily available as a quick reference wherever Great Danes are located (home, kennel, RV, van, etc).

BLOAT PHASES, SYMPTOMS AND RECOMMENDED ACTIONS
     PHASE1
         SYMPTOMS:
               1. Pacing, restlessness, panting and salivating.
               2. Unproductive attempts to vomit (every 10-20 minutes).
               3. Abdomen exhibits fullness and beginning to enlarge.
         ACTIONS:
          Call Veterinarian to advise of bloat case enroute. Transport dog to
          Veterinarian immediately.

     PHASE 2
         SYMPTOMS:
               1. Very restless, whining, panting continuously, heavy salivating.
               2. Unproductive attempts to vomit (every 2-3 minutes).
               3. Dark red gums.
               4. High heart rate (80 to 100 BPM).
               5. Abdomen is enlarged and tight, emits hollow sound when thumped.
         ACTIONS:
          Apply first aid if Veterinarian care is more than 10 minutes away.
          Then, transport dog to Veterinarian immediately.

     PHASE 3
         SYMPTOMS:
               1. Gums are white or blue
               2. Dog unable to stand or has a spread-legged, shaky stance.
               3. Abdomen is very enlarged.
               4. Extremely high heart rate (100 BPM or greater)and weak pulse.
         ACTIONS:
          Death is imminent! Apply first aid immediately. Transport dog to
          Veterinarian as soon as possible (even while applying first aid if
          possible).

TABLE I
     (1) Listen to the dog's heartbeat using a stethoscope if possible. If a stethoscope is not
     available, use your ears and eyes. The heartbeat can be best heard on the left side of the
     dog's chest just behind the elbow and is strong enough to be visible on the chest wall 

     (2). A normal heartbeat is irregular when the dog is resting and often consists of a double beat
     (thump...thump...thump-thump...thump...thump, etc). Using a timepiece with a second hand,
     count the number of heartbeats for 10 seconds. Multiply the number of heartbeats x 6 to find
     the Beats Per Minute (BPM) (12 beats x 6 = 72 BPM, etc.). The normal heart rate/pulse
     rate of a large breed dog is 60-80 BPM.

     (3) Take the pulse rate of the dog by pressing your fingers inside the dog's rear leg just
     below where it joins the body. At this location, you can feel a cord-like structure called the
     Femoral Artery (figure 2). Count the pulses for a ten second period and multiply by six to
     determine the rate of the dog's pulse.  Also, observe the strength of the pulse at this location.

     4. Recommended actions:
     A. When your dog is showing any of the bloat symptoms you should: 
        1.) Attempt to determine the bloat phase he may be in. 
        2.) Call your veterinarian, discuss symptoms and ask for guidance. 
        3.) If you conclude your dog is in phase 1 bloat and you can reach your veterinarian
          within 30 minutes, do not apply first aid procedures. Go directly to the veterinarian. 
        4.) If you conclude your dog is in phase 2 bloat and you cannot reach your veterinarian
          within 10 minutes you should attempt to insert a stomach tube before going to the
          veterinarian. 
        5.)For phase 3 bloat, if you cannot reach your veterinarian within 10 minutes apply first
          aid immediately. Attempt to insert a stomach tube. If this is not acomplished quickly,
          you should use Trocharization procedures to relieve the gas pressure! Death is
          imminent! 
 

B. DOGS MAY GO TO PHASE 3 BLOAT WITHOUT SEEMINGLY GOING THROUGH PHASES 1 OR 2. PHASE 3 CAN BE FATAL IN MINUTES. BE ALERT!

     5. First aid:

     A. In bloat Phases 2 and 3, attempt to pass a tube through the dog's mouth into the stomach.
     Two persons are normally required for this procedure.

     NOTE 1: Pre-measure and mark each stomach tube for each Great Dane in the household.
     To do this, place the dog in a sit position. Measure the stomach tube on the outside of the
     dog from the front of the mouth to the last rib and mark the tube at the front of the mouth
     with a piece of tape

       1.Remove an eighteen inch strip of tape from the tape roll. Insert the roll of tape in the
          dog's mouth behind the front teeth. Ensure the tape roll hole is pointed toward the
          dog's front and rear. Using the strip of removed tape, tightly bind the do g's muzzle
          with the roll of tape in position (figure3). 
       2.Lubricate the bevelled end of the stomach tube with K. Y. jelly (be careful not to plug
          up the tube holes with the jelly). 
       3.Carefully insert the tube into the dog's mouth through the hole in the tape roll (figure 4)
          Some resistance will be felt when the tube reaches the dog's throat. However, the
          dog will start to swallow as you push the tube deeper into the throat and the tube
          should enter the esophagus with little resistance. It the dog does not swallow the tube
          or the tube seems stuck, gently move the tube back and forth until it enters the
          esophagus. 
       4.Once the tube is in the esophagus, gently blow through the tube as you advance it
          toward the stomach. This will expand the esophagus and allow the tube to pass more
          easily. 
        5. The tube may encounter a resistance when it reaches the stomach because of muscle
          spasms in the stomach valve or twisting of the stomach (torsion). If this happens, blow
          more strongly through the tube while turning the tube in a clockwise direction. If the
          tube does not enter the stomach, continue blowing and carefully turn the tube back
          and forth. 
        6.You will feel a quick, forward movement of the tube when it enters the stomach.
          Caution! Do not insert the tube too far into the stomach and pierce the
          stomach wall. 
        7. Immediately remove the tube from your mouth. Gas will be expelled through the tube
          as it enters the stomach (figure 5). Fluids will follow the gas. 
        8. After the gas and fluids stop, you should squeeze the dog's abdomen to remove as
          much of the remaining stomach contents as possible. To do this, stand over the dog
          facing the same direction as the dog. Grasp the dog with locked wrists around the
          abdo men and squeeze firmly (figure 6). Continue to remove the stomach contents for
          five/ten minutes.
      9. Cover the end of the tube with your thumb and carefully remove the tube from the
          dog. Then, transport the dog to the veterinarian immediately. 

     Note 2: If you are unsuccessful in inserting the tube into the stomach after five minutes, it is
     probably not possible to pass a stomach tube.

     B. If you are unable to pass a stomach tube and the dog displays phase 3 bloat symptoms,
     you have a very short time to act to save the dog's life. By this time, the dog will normally be
     gasping for air and unable to stand. The abdomen will be very distended and sound like a
     drum when thumped. The heart rate will be over 100 BPM and the gums will be white, blue
     or grey.

     C. Trocharization must take place immediately. This action can save your dog's life. The
     veterinarian will appreciate the fact that you took the Trocharization action and brought in a
     dog that has a chance of recovery.

        1. Locate the last rib on the dog's left side. The stomach is located on the left side of the
          dog's abdomen under the last few ribs (you will not have any problem finding the
          stomach because it will be very distended). 
        2. Remove the cap from the 14 gauge needle. 
        3. Firmly grasp the blunt end of the needle and with a sharp motion, stab the needle into
          the dog's stomach on the left side behind the last rib (figure 7). Gas will be expelled
          immediately through the needle. Do not be concerned about hurting the dog because
          he is already in such intense pain from the bloat and torsion he will not notice the pain
          from the needle.
         4. Squeeze the abdomen (subpara 5.A.(8) above), then remove the needle. Immediately
          transport to a veterinarian. 

     6. Recommendations to help avoid Canine Bloat:

     A. Veterinarians continue to study the bloat problem and still have many unanswered
     questions. Researchers prepared the following recommendations to help prevent canine
     bloat. You should discuss these recommendations with your veterinarian and other Great
     Dane owners:

        1.Feed the dogs two or three times daily, rather than once a day, and at times when
          someone can observe them after they have eaten. 
        2.Avoid vigorous exercise, excitement and stress one hour before and two hours after
          feeding. Walking is okay because it helps stimulate normal gastrointestinal function. 
        3.Feed dogs individually and in a quiet location. 
        4.Make diet changes gradually over a 3-5 day period. 
        5.Ensure water is always available but limit the amount immediately after feeding. 
        6.Watch for any actions or behavior that may signal abdominal discomfort (abdominal
          fullness, pacing, salivating, whining, getting up and lying down, stretching, looking at
          abdomen, anxiety and unsuccessful attempts to vomit, etc. 
        7.Establish a good relationship with a veterinarian. Discuss emergency procedures,
          preventative surgery (Gastropexy (circumcostal, tube, incisional)) and overall medical
          management of your dog. 
     If you are interested in purchasing a complete Bloat Kit, this can be done by contacting:

Dr. Cindi Bossart
Fort Lauderdale Animal Hospital
1630 East Oakland Park Blvd
Ft. Lauderdale, FL 33334
(954) 561-8777

All proceeds of the sales of this kit benefit Collie Club of America Foundation