What GS owners need to know about BLOAT

These articles were written by Nancy Liebes. She is a breeder of Komondorok and has lots of experience with bloat and there is much to be learned from these articles, as you will see. Though most people are unaware of bloat or that it happens in Giants, it does and since hearing of several cases this year I thought this should be our first topic.

BLOAT part 1

It just happened again. Five year old Ivy went to the Komondor National early in June and had a very successful but stressful weekend. Since he had not been shown much in his earlier years he was not as familiar with the show routine as the other mature dogs or even the younger dogs. After four days of showing and winning two majors, Ivy went home to Iowa as a new champion. The next evening Ivy torsioned and bloated.

This is not an unusual occurrence with many of our big bodied working breeds. Many breeds in the Working Group can be described as being “bloating breeds” and stress often triggers this terrible condition. For the purposes of this article I will call the condition “bloat”, but understand that I am also implying that torsion is part of the condition. Over the years we have experienced bloat and torsion too many times, but each time we learn something. Ivy was saved because of our national club newsletter. The Komondor Komments, aggressively prints everything that can be found on bloat and also has people share their experiences so others can learn. Ivy’s owners remembered something they had read in the Komments and acted quickly and appropriately, saving Ivy’s life.

New Komondor owners often ask, “How can I learn about this? How will I know when it’s happening? How will I know what to do?” The short answer is that until it happens you have no idea what it looks like. It is easy to talk yourself out of getting the dog to the vet quickly if you are not aware of how dangerous and deadly this condition is. So we share war stories. The more we share the more lives we might save.

I lost my first Komondor, Ohegyi Narcisz, to bloat in 1974. The trigger that time was hormones – she was at a vet’s kennel being bred. The loss was devastating to me. She was my first Komondor, my first champion, and my first experience in this wonderful breed. Since I was not there to see what happened to Narcisz I learned nothing other than that bloat kills. After that experience I heard of a lot of dogs bloating, some survived and some did not. Ten years later I still had not learned anything about bloat, at least not enough to know what to do if it happened to me again.

In 1984 we flew three dogs from Denver out to the Komondor National that was held in Los Angeles. The evening of our arrival there was a big party in the hospitality room, which was also our room because the inn was full and a regular room was not available for us. The oldest of the three we took, Marley, had won the National the previous year and our hopes for another win rested with her. She happily went around the room meeting old friends and mooching food tidbits from everyone. At around midnight everyone left so we could get some sleep, and about an hour later Marley woke me up, stomach distended and clearly bloated. We frantically got on the phone, found an open emergency vet, got directions, and got her there. They took her right to the back and said we should check with them in the morning. By morning they had deflated her stomach but had not done surgery (as was the practice in those days). She was stable but had to stay there. We had to go to the Specialty, but my heart was not in it. Marley’s daughter, Piggy, won that specialty instead, but it was small gratification in the light of Marley’s crisis. Eventually I was able to fly Marley home but they had not done the surgery. Since she was now stable and recovering, my regular vet said that surgery was not necessary. About two months later she bloated again and died. I was inconsolable and at that point declared that I would never lose a dog to bloat again. So far we’ve been lucky, but we also have been very aggressive about learning from every experience and being up front with veterinarians about our expectations for care. Twenty years ago veterinary protocol was not where it is now in terms of how to handle bloat, but thankfully they are getting better about dealing with it aggressively and quickly. Such was not the case 20 and 30 years ago.


What we learned from Marley:

It was common practice to use a needle to puncture the stomach to relieve the pressure of the bloated stomach pressing on the heart and other vital organs. The practice of puncturing the stomach with a large bore needle leaves weak spots in the stomach wall. When the stomach distends again it can tear and cause the death of the dog. Also, the vet who did the necropsy told us that the top 12” of her intestine was thick and hard, like a garden hose, showing signs of chronic irritation. Her pyloric valve appeared small and deformed which caused food to leave her stomach too slowly and bacteria would build up. Could this be a cause? We made a note to ourselves to have each vet check the pyloric valve when doing surgery in the future.


Our advice to all new puppy buyers was and still is to not wait but get the dog immediately to a vet if they suspect any stomach abnormalities. Any kind of discomfort counts; we tell them not to wait for any reason at all. Over the years a few dogs of our breeding have bloated and with one sad exception the owners have called us immediately when seeing the first symptoms and all but that one were saved. We’ve spoken to the attending veterinarians in almost every case and have been able to ask them to check the pyloric valve, and in all but one case it needed to be tacked open. We were beginning to think that this might be a contributing factor for our dogs, so we make sure we always get the information we need when the vet does surgery.

And yes, the dog gets the surgery (one of the growing number of stomach tacking surgeries) as soon as we can arrange it. Because of Marley we don’t wait to see what might happen next. We do not for any reason talk ourselves out of acting immediately.

An excellent diagnostic tool to determine if your dog is torsioning is to give him a drink of water. If it comes right back out with force, you are dealing with torsion and must get the dog to a vet immediately. I have had more than one person over the years tell me that if you can drop a tube into the stomach the dog is not torsioned. This is not true, as the following story will describe.

Piggy, winner of the 1984 National Specialty the day her mother bloated, had her own bloating experience in 1987. She was 5 weeks pregnant and the smoke alarm went off in the house (I’d charred a steak). She startled at the noise and a few hours later began showing signs of acute abdominal discomfort. So, off to our local country vet we went at 2 AM. (Note: Bloat often happens very late at night.) There we were at 3 AM, Eric handling the anesthesia, me passing tools, the vet reading his textbooks and doing surgery. We had her abdomen open and while we were watching her stomach flipped over completely on its own, lengthwise. At that point the vet asked Eric to drop a tube just to see what happens. The tube went right in as though nothing was wrong. It looked like it was in the stomach, but we knew, because we were watching, that the stomach was indeed torsioned. Not side to side as one would assume, but rather end to end.

The vet who did Piggy’s surgery was a fearless and excellent surgeon. A Colorado country vet who did mostly cows and pigs, he boldly dove in having only seen the surgery once while in veterinary school. I think it’s the first time I’ve ever seen a veterinarian do surgery with a textbook open on the table next to him. She survived, had one puppy, and was never bred again. Piggy died of old age some 10 years later.


What we learned from Piggy:

Dropping a tube gives you no accurate information at all and in fact can be misleading. Torsion has a life of its own and a stomach can turn and unturn at will. (It’s spooky to watch too.) That can also affect taking an x-ray. It is possible to be fooled if you take an x-ray at a time when the stomach is in a normal position. It could be just as possible that a minute before the picture was taken it was twisted and it can twist back again right afterwards. Also some vets are looking for trapped gas, which is distinctive on the x-ray. The presence or absence of gas at the moment of the x-ray is not diagnostic.

Not every dog who bloats is an older dog. Although it seems to be the norm in our breed we had a young bitch who did not live with us bloat late one night. Scarlet was only 18 months old when she bloated for no apparent reason. Thankfully her owner had listened carefully when we discussed the problem and that, in addition to her horse knowledge of colic, helped her determine late one night that her dog could be in trouble. She got her to her local vet and called us. We spoke to the vet who said he could not do the surgery but could stabilize her for transport the next morning. He started an IV for fluids to keep her electrolytes stable, got her calm, got a tube dropped to relieve the pressure in her stomach, and had her completely stable by the time I got there early the next morning. I took her to my regular country vet, who by now was becoming quite expert at the surgery. This time he was able to do surgery during normal working hours on a stable dog whose condition was uncompromised by shock and trauma, a situation he considered to be a luxury. Scarlet was WB at the Komondor National a few years later and lived to the age of 15.


What we learned from Scarlet:

Getting the dog to the vet fast, without second guessing yourself, helps determine a better outcome. The faster you can deal with the trauma of the condition, the safer surgery will be. If your vet does not do this surgery have a back-up plan which comes into effect the next day. Also, the onset of bloat is not solely determined by age. At 18 months Scarlet was the youngest of our experiences and there was no obvious trigger.

By 1990 veterinary care was catching up to our needs. By then our personal protocol when dealing with bloat was to give the dog water first. If it came right back up we took the dog to a good vet as fast as possible and asked them to do three things: Immediately treat for shock including IV fluids, mildly tranquilize the dog to calm him (which could be just the surgical pre anesthesia), and begin to prep for emergency surgery. If they want to take an x-ray to make sure the dog has not swallowed a sock, fine. But we know that any other information the x-ray might reveal may be irrelevant. Whether the stomach looked twisted, bloated or normal changes nothing; we plan the surgery. We have been lucky that every vet we worked with has agreed with our requests.

Our favorite way to experience bloat is to figure out what is going on before the dog does. One night in 1995 our then middle aged bitch Libby began to act as though she had a stomach ache. She let out a “dry heave” kind of a groan which we recognize and dread. We watched her for a minute and then gave her something to drink. One would think that dogs in distress won’t drink water on command, but our dogs are always willing to, possibly because they are panting and dehydrating. Her water came right back out so Eric took her to the local vet (we had since moved from the country vet in Colorado and by now were in Houston). The vet on call looked at her and declared that there was nothing wrong – just a tummy ache. Eric persisted, so to humor him the vet put her on the table and tapped on her stomach. It was normal. Eric asked for IV’s and tranquilizers. The vet wanted to take an x-ray to make sure there was nothing blocked. He did, there wasn’t, but by then the stomach began to look different. The vet tapped again and got a drum response.

Next they dropped a tube to relieve the pressure and the gas. As soon as the tube was removed the build-up began again. The next time they tried, the tube would not go down. IV’s were started, and she was prepped for surgery. She too had a successful surgery (by one surprised vet who was certain she was not bloating 30 minutes before, when she came in) and lived almost to the age of 15.


What we learned from Libby:

Torsion and distress can be happening long before the gas begins to build up in the abdomen. If you suspect anything is wrong, even before the stomach appears distended, get the dog to a vet. Sometimes the stomach never distends at all, but the internal backup of blood in the organs can kill a dog who is otherwise not showing symptoms.

There are different types of bloat. What we’ve experienced in Komondors seems to be mostly some weird electrical smooth muscle problem, possibly brought on by bacteria and stress. The deformities in the pyloric valves we’ve encountered could be contributing greatly to the bacterial build-up, but we have no proof of any of this. As breeders it’s hard to breed away from something that cannot be seen until it happens and we often joke that we shouldn’t breed a dog until we’ve done a barium swallow and watched the fluid go through the stomach and the pyloric valve. Since this is not a practical solution, we just pay close attention and do not use dogs who have bloated in our breeding program. We do not implicate any direct relatives of a bloating dog, however, because of the very small size of our gene pool.

Our Greyhound bloat experience was quite different. We think Bart, the greyhound, bloated completely for mechanical reasons. He ate, went out, ran around, his stomach flipped over, and it wasn’t flipping back no matter what the vet did. It was strictly a structural problem and once the stomach was repositioned and tacked he was fine and never experienced another incident.

Bloat can also present in many different ways. Marley presented with a completely distended stomach, which is the most common presentation and easiest to decipher. It looks just like what you would think bloat would look like. Veterinarians often look for a “drum response”, which means that when tapped the stomach feels like the head of a drum. Piggy hunkered over and began gagging and retching. Libby, Piggy’s granddaughter and the end of that breeding line, just started panting and acting like she had a tummy ache. We had an Ibizan Hound blow up through the ribcage, not the stomach. That was a very odd and frightening presentation which caused us to move fast and she too was saved.

Ivy, the dog at the beginning of this story and one not of our breeding, seemed to be in pain and had swelling only on one side. The swelling turned out to be his spleen, which had become enlarged. The swelling went down as soon as his stomach was repositioned and tacked down.

What we learned from Ivy:

The spleen swells when the stomach twists because blood backs up into it and other vital organs. Sometimes the spleen needs to be removed because the extra blood can cause tissue death. Any swelling is a sign of something very wrong. Get the dog to a vet immediately. One real concern the vets have is heart failure after successful bloat surgery. This may be due to either this blood flow interruption or the physical effects of the enlarged stomach during bloat. Well equipped vets will have the dog on a heart monitor after the surgery.

Many years ago I had the pleasure of meeting Dr. Glickman from Purdue. He was gathering Newfoundland data at their National Specialty and made some time to talk with me about my Komondor bloat experiences. During that conversation he asked an unusual question, “Are you able to identify any personality traits that your affected dogs have in common?” I was.

Dr. Glickman & Purdue led the way in the research of bloat symptoms, causes & management in the 90’s. Their website is still a great resource: http://www.vet.purdue.edu/epi/bloat.htm

The one thing all breeds seem to have in common is the fact that many of the dogs who eventually bloat can be identified by a personality characteristic that I described as “a worrier”. Every dog of ours who has bloated has not been a happy-go-lucky dog. Some drool during thunderstorms, some startle easily at loud noises, some just worry or fret. If things are not perfect and normal, they fret and fuss and can eventually bloat.

In 1984 we vowed that we would never lose another dog to bloat. It’s now 2004 and so far we have been able to live up to that vow. Whether by luck or better management, we have saved every dog since then, and we’re knocking furiously on anything made of wood that we can continue our streak into the future. A few weeks after his surgery, Ivy is doing fine. We wish this for everyone who faces a bloat incident.

BLOAT part 2

Bloat – How To Handle It


In our last article we talked about our experiences with bloat and what we learned from each. The question we have gotten most often since that article appeared is, “How do you diagnose it and how do you handle it?”

Managing bloat begins at home. Diagnosis can be made first by observing the dog’s behavior. If any of the following conditions occur you should probably get the dog to your veterinarian or an emergency clinic as soon as possible – especially if you have a breed with a tendency to bloat.
• Any signs of acute abdominal distress which can include:
o Groaning
o Restlessness
o Laying with the stomach on a cold tile floor
o Panting
o Gagging
o Retching
o Swelling

• Regurgitating white foamy liquid (caused by saliva being blocked from entering the stomach and filling the esophagus).
• Forcefully (and immediately) regurgitating water when offered a drink.
• When you tap the abdomen it feels like the head of a drum

At this point what can you do? For the answer to this I decided to visit my regular vet who worked in an emergency clinic for 12 years before he opened his current office. His suggestions were, first, to do anything possible to relieve the symptoms while you are getting the dog to the vet.

The rest of this article follows what we talked about. Our vet has had many experiences with bloat and he is a great partner to us in caring for our dogs.

If you think the dog is bloating you can give it an over-the-counter simethicone product such as Gas-X, or any other antacid you might have around the house. Amphogel is a good one to have on hand. We keep some in both our doggy medicine drawer at home and our grooming bag for traveling. Also, I recently found a product called Bloat Buster at Nature’s Farmacy (on-line). It’s a liquid simethicone and probably should be a part of your dog pharmacy at home.

At this point you must get the dog to a vet. However, when you arrive at the vet you could be faced with two possible scenarios: 1.) A vet who is willing and able to do the surgery on the spot or, 2.) A vet who won’t touch the surgery and will refer you to someone else. The next level of management will depend on which vet you get.

If you find yourself at a practice that does not do the bloat surgery, you can expect the vet to manage the case in a manner which will get the dog ready for surgery quickly. According to an article by Howard Seim, DVM from the Atlantic Coast Veterinary Conference, 2001, (http://www.vin.com/VINDBPub/SearchPB/Proceedings/PR05000/PR00412.htm)
gastric decompression and treatment for shock should be done immediately. He states that “survival is generally determined by early and appropriate presurgical management; not surgery.”

Decompression (relieving the stomach of air) should be performed first. A stomach tube with beveled edges should be measured from the tip of the dog’s nose to the last rib. A roll of tape can be used as a speculum through which the tube is passed. Wedge the tape roll behind the canines and secure the dog’s mouth around it. Pass the tube through this “speculum” until resistance is met at the esophageal-stomach junction. Firmly twist and push the tube to get through the resistance. If it is not advancing, change the dog’s position in various ways (elevate and angle, or roll to encourage the stomach to rotate in a different direction) to see if the tube can be passed through into the stomach.

If the tube is successfully passed into the stomach, empty the stomach of all contents and lavage with warm water. Leave the tube in the stomach to insure that it stays open to the esophagus.

If your vet is unable to drop the tube, he can remove some of the air in the stomach by placing a large bore needle at the point of distention on the right flank. This should be a measure of last resort as the puncture of the stomach wall can create a weak spot which could tear again later should the dog bloat again. Once some air is released you can attempt to pass the tube again.

If the tube still won’t go through, more extreme measures must be taken to relieve the stomach of its contents and ease the tension on the stomach walls.
At this point the stomach can be surgically opened on the side of the dog (a temporary gastrostomy) and its contents removed. This is only done in severe cases when nothing else works, the dog is in danger, and the surgeon performing the surgery is at a different location. The stomach is sutured open until surgery can be performed. The disadvantage of this is the use of sedation on a compromised dog and the dog’s stomach is still rotated.

Treatment for shock should also take place concurrent to the passing of the tube. IV fluids are started and the dog should be mildly sedated. Once the dog is stable he can be moved to the surgeon.

If the veterinarian performing the initial management is also going to do the surgery, the dog can be immediately moved into the surgical suite. At that point there are a few different choices as to what surgery will be performed. The two most common gastropexies are circumcostal and belt loop. Your vet will choose whichever he is most comfortable doing; both secure the stomach into a stable position.

Once the stomach is secured it is also good idea to check the pyloric valve to make sure it is in good shape and will continue to function adequately. If food doesn’t leave the stomach efficiently gas can build up again and stress an already compromised stomach. Tacking the valve open helps keep the food moving through the system and has been necessary in many of our bloat cases.

Please follow your veterinarian’s advice while the dog is recovering. Small meals, restricted exercise, and follow-up visits are needed to make sure the surgery is successful for the life of the dog.

In my next article I will outline my personal approach to handling bloat and what my expectations are of my veterinarian. As you will see, most of this is worked out ahead of time.

BLOAT part 3

In a past article we talked about our experiences with bloat, a disease with which we have far too much experience. I next would like to share with you how we manage the experience when we suspect one of our dogs is bloating. I am not a veterinarian, but have interviewed many that I respect and also have come to some conclusions on my own.

In 1984 we lost our first National Specialty winning Komondor bitch (Marley) to bloat. It first happened at a National Specialty and was probably triggered by stress. When she passed away 8 weeks after the first incident, I promised her and all of my dogs that we would never lose another to bloat – and we haven’t.

I think one of the most important contributing factors to managing a bloat incident successfully is speed. You need to make the diagnosis quickly and move fast. The mistake we made with Marley was to accept the emergency clinic’s decision not to do immediate surgery but to wait. They thought they had gotten it under control. In truth, they had controlled the critical moment, but almost always a dog will bloat again. We feel it is best to do surgery before that happens.

If you have a dog who is acting like his tummy hurts, is gagging, vomiting with very little production, or is arched up and whining, he might be bloating. Offer water. Often dogs in distress need a drink and will actually try to drink water. If it comes right back up with force, you’re seeing a dog who is most likely experiencing gastric torsion. Call the vet immediately.

A word about vets……… We interview veterinarians before we ever need one in an emergency like this. Our criteria include a vet who does not have a bias against breeders, who listens as well as shares information, who is not afraid to do surgery and knows how to do bloat surgery, preferably the belt loop. Very often large animal vets are more open to practicing this type of medicine than small animal vets.

Right now we are lucky enough to have a vet who believes that his responsibility to his clientele is to be able to handle many different specialties well. In this day of specialized medicine it is getting harder and harder to find someone like this, but keep interviewing if you are having problems finding someone suitable. If you find someone who meets these initial needs, the next trick is to get them to do their own emergency calls. Although we have had a good experience using an emergency clinic because they have had a lot of practice with this type of surgery, we would rather be working with someone we know and can talk to, as long as they are competent. Our current veterinarian has his own growing small animal practice, and we are the only clients who have his cell and his home phone number so we can reach him in a crisis. I promised not to abuse the privilege and thankfully haven’t needed it, but if I do I know he’ll be there for me.

Okay, so now we’ve determined we most likely have a dog who is torsioning, even if the actual bloating hasn’t begun yet. Next we call the vet and tell him what is going on and that we are on our way. Get to the clinic as quickly as possible because at this point time is of the essence.

At this point one or two things might happen that in my opinion get in the way of treatment, but if the vet doesn’t know you well (it’s a matter of trusting your instincts) you might have to go along with it. One is taking an x-ray. If you are dealing with a breed that is prone to eating inexplicable things, like socks, it might not be a bad idea. This way you can rule out an obstruction. In the case of our breed, Komondors, that is unlikely and I would prefer to skip it since we’re going to have the dog open in a few minutes anyway, but I’ve lost this argument at times and it doesn’t really matter much in the long run.

As soon as the x-ray it taken I insist that the dog is prepped for surgery, including running an IV for hydration and a pre-op sedative. This calms the dog, lessens stress, and begins supportive therapy even before the x-ray film is developed. Heck, we’re doing surgery anyway so we might as well get started.

As soon as the dog is anesthetized we get to the business of fixing the problem. If your timing was good, the dog’s abdomen shouldn’t begin swelling until about now. At this point hopefully not a half an hour has passed. (When I say move fast I mean it.)

The choice of which surgical fix at this point is up to you and your vet. I prefer the belt loop because it creates a living tissue anchor instead of merely scar tissue. Scar tissue has been known to deteriorate, and I’ve known of dogs who have torsioned after the scar tissue fix. However you handle it, a permanent surgical attachment is made to make sure the stomach is not capable of torsioning ever again.

I have never lost a dog after this point. If you move fast enough and do a permanent stomach attachment, the dog should survive. Speed in diagnosis and treatment lessens the possibility of stomach tissue dying, damage to the spleen, heart damage, and toxins getting into the bloodstream. Many times other factors like these can cause enough damage to the dog that he won’t survive the surgery. It is best to avoid delays.

Sometimes things happen when you aren’t around and you come home to a dog who looks like he swallowed a basketball. When that happens I would offer water. If the dog is bloated but not torsioned at that moment, the water will stay down. At that point I would administer simethicone, call the veterinarian immediately, and proceed as described.

You might notice that I have said nothing about ‘bloat kits” or dropping a tube. Frankly, although relieving the air is a good idea, I would rather spend that time getting the dog to a vet. Tubing a dog can take too much time and as often as not can be unsuccessful. If the dog is torsioned, or the pressure is too great, you won’t get the tube down anyway. So I don’t own a tube nor do I intend to.

We always want to know what our dogs are experiencing. They sleep in our room, even at dog shows, and we stopped flying them many years ago. Although we never had a bad experience flying a dog, we decided that we never wanted to, so we drive when we want to go to a show far from home. If we can’t drive we don’t go. It’s simple.

I realize that some of the experienced and competent veterinarians who read this magazine are no doubt cringing by now and I know that many of you have other things that have worked for you in the past also. All I can say about that is this is how we have been successfully handling bloat and torsion cases since the late 1980’s. At that time we were ahead of traditional veterinary thinking. Thankfully the veterinary field has caught up to many of these ideas and I think it is more possible these days to get good advice and care when a dog bloats.

Unfortunately I do still get phone calls from people who live in remote areas or are working with the same vet they’ve been with for 30 years. I’m not advising that you leave that vet, but I am suggesting that interviewing others in case you need them isn’t a bad idea.

As you can see, most of this process is worked out ahead of time. I know which vet we’re using, I’ve already spoken to them about my expectations and needs, and we have a plan and a process worked out before the dreaded crisis ever happens. We act without delay and we remain calm so the dog remains calm.

Thankfully we have not had a Komondor bloat since 1997. But should it happen again, we’re ready for it. It’s not anything we take for granted and we are always aware of what our dogs are experiencing.

Remember to move quickly and have a good plan in place and you will be able to have a good outcome to this frightening and terrible problem.