You will have to bear with me, I started this new exercise program and I may die while typing this blog. If I die it will be from sheer lactic acid buildup. Otherwise, I could possibly get hit by a car because I physically can’t get out of the way of a speeding car or projectile because I am so stiff and sore I can’t move that fast.
My first class was on Friday. Saturday I had to work, walking around like an old person. I felt like I could barely hold up the little 1/4 ounce bottle of microscope oil.
Anyways, as I was hobbling around, the receptionist runs back and announces that there is a new client in the lobby and she says her dog is bloated. “Yah right” I think, clients always think their dog is bloated, but they never are.
Bloats only happen at night…. (key the ominous music)
The staff rushes the dog back, its a beautiful Springer Spaniel, it’s flat out on its side, it’s gums are white and it’s stomach is totally distended and tight as a drum.
Holy crap it IS a bloat!
I immediately panic (on the inside, I was cool and calm on the outside, because that’s how I roll), and summon Dr. Rogers who has worked at the emergency room and loves this stuff. Subsequent to that, I quickly absconded into the nearest exam room to deal with the appointment side of things while Rogers swooped in to the rescue.
Bloat is the mother of all emergencies. AKA Gastric Dilatation and Volvulus (GDV). It’s when the dogs stomach twists around itself. Whatever food material is in the stomach immediately starts to ferment and produce gas and the stomach swells. The stomach loses blood supply because it’s twisted, often the spleen goes along with it and gets compromised as well. The rest of the GI tract starts to lose blood supply when the stomach gets so distended.
All that blood supply loss quickly results in the buildup of toxins and the death of tissue (very often the stomach or spleen). According to the (brand-new version of) The 5 Minute Veterinary Consult, the overall survival rate from bloat is around 84%. Dogs with stomach necrosis seem to have around a 66% survival rate.
The reason I said bloats only happen at night, is because in a total of 20 years in the vet biz (13 of those as a practicing vet), I’ve never actually seen a bloat case. I’ve only ever worked days.
Even in vet school, when I was on emergency duty I never saw one. I’m not sure I ever saw any emergencies, actually, when I was in vet school. Generally regular people didn’t come to the vet school for run-of-the-mill things, they took that stuff to their regular vets. We pretty much just stayed up til 10 or whenever our shift was over and answered the phone and ate pizza. Somehow the real emergencies went to the live-in vet students who did the late night calls. Rumor has it that Texas A&M has a pretty awesome critical care facility now, so things have changed from the late 90’s when I was there.
Back to the present, the treatment for bloat is to decompress the stomach as quickly as possible by passing a stomach tube while concurrently treating the patient’s shock and circulation issues with aggressive IV fluids. I know this because I memorized it in vet school, not because I’ve actually done it. I did pass a stomach tube once my first year out of vet school on a dog that had been poisoned with sleeping pills by an angry neighbor (two of the client’s other dogs had died, but we saved that one).
Generally dogs that bloat have severe dry-heaves and their bellies swell, then they pass out/go into shock. Diagnosis is confirmed with a right lateral x-ray where the stomach takes on this characteristic “smurf hat” appearance.
Dr. Rogers’ patient had all the signs and the tell-tale x-ray.
Back in the ER: there was a moment of panic when Dr. Rogers couldn’t find the stomach tubes (because we never use them!), she had to call Dr. Sharp in Michigan so he could tell her where they are. She quickly sedated the patient with Propofol (she is a trained professional and is very capable of using this drug without killing her patient, unlike Michael Jackson’s doctor). It took her two tries to finally get the tube passed, because of the severity of the twist. She let out the air and flushed out as much food and debris from the stomach as she could.
The next step in this process, once the patient is stable is to take them to surgery to attach the stomach to the body wall so it can’t twist again. While in there, you have to also check for organ damage secondary to the twist (generally in the stomach and spleen). This dog ended up going to the emergency clinic for surgery (so she wouldn’t have to be transferred post-op as we would be closed for the weekend, Dr. Rogers is a very capable surgeon, it was just a logistical thing). They ended up taking out her spleen as it was damaged, and her stomach was heavily bruised but ok.
The post twist and post op periods for a GDV case are the most critical. Remember all that tissue that lost blood supply? Once blood starts flowing back into those areas, all kinds of nasty toxins get released and wreak havoc elsewhere in the body. The biggest problem is that it cause cardiac arrythmias. Many dogs die post op because of this complication.
This dog spent the weekend in the ER, and went home from the hospital on Monday minus her spleen, but doing great.
Dr. Sharp, the old guy said he’s only seen a handfuls of daytime bloats in his 40+ years in the day-practice biz, so hopefully we won’t see another one for a long time. One is plenty.