I’ve been fielding emergency calls for 30 years, but I still get an unwelcome adrenalin rush every time my telephone rings when I am on duty. Will it be something silly? A tourist panicked because their dog has a tick or was sprayed by a skunk?
Maybe something urgent but easily treated? A cat with a urinary blockage? A dog with a badly cut foot?
Or will it be something sending me into hours of emergency surgery? A ruptured spleen? A C-section?
One Saturday afternoon I was getting ready to take my daughter to the orthodontist when the answering service rang. “What’s the problem?” I asked, tensely.
“A 60-pound dog named Friend ate two chocolate cupcakes,” the operator replied. I exhaled and relaxed. We get these calls all the time. It’s great that people know chocolate can be lethal to dogs, but most owners have no idea about the specifics. The smaller the dog and the darker the chocolate, the greater the risk, but baked goods rarely contain enough to be dangerous, especially for a large dog. Two cupcakes? Big dog? No worries there. I called the owner.
“Two chocolate cupcakes are no problem in a dog that size,” I explained. Then, to be thorough, I asked if the treats contained chocolate chips or chunks.
The owner said no, then added hesitantly “I wouldn’t have called, but he’s awfully lethargic.”
“Chocolate toxicity usually causes hyperactivity, not lethargy,” I replied, still unconcerned. The lethargy likely had some other cause.
“And he looks bloated,” she concluded. My adrenal glands jumped to attention. A number of things can cause abdominal distension in dogs…and most are bad news. Cancer. Heart or liver failure. And my particular bugaboo, bloat.
We’ve discussed bloat before. Typically occurring in large breed dogs, the stomach bloats massively with gas, then, sometimes, twists. (Picture someone twisting a balloon to make balloon animals.) This creates a situation called gastric dilatation and volvulus, or GDV. The twist prevents the stomach from deflating and also occludes local blood flow, leading to tissue death.
As it continues to swell, the stomach presses on the aorta, creating severe cardiovascular problems. GDV is a surgical emergency with guarded prognosis. Every minute counts. I have a rule. If an owner says a dog looks bloated, I want to see that animal. Now. Immediately.
“You should come right down,” I advised, gesturing to my husband to take the kid to the orthodontist. “We need to rule out bloat.” At first, the owner was reluctant. Friend didn’t seem that sick. “Any retching?” I asked.
“He just gagged a little,” she reported.
My adrenal glands started jumping up and down. Non-productive retching is a classic GDV symptom. “What causes bloat?” she asked, thinking if we ruled out exposure to the causes, perhaps we could rule out the diagnosis? Sorry. Bloat has no single definitive cause. Theories abound, but we can’t rule out GDV strictly based on history.
Soon Friend was bouncing happily in my door, but I knew GDV dogs can occasionally look deceptively chipper at first. He wolfed down my offered liver treat. Good. GDV dogs rarely accept food. His belly was a bit barrel-shaped, but it felt soft and doughy. My adrenal glands started to doze. Heart rate, normal. Capillary refill time (a test of circulatory health), a little slow, but his gums were a healthy pink. “Nothing obviously wrong,” I said.
Not being his regular veterinarian, I wasn’t familiar with Friend’s usual appearance. His owner shook her head skeptically.
“This is definitely bloated for him,” she insisted. “And another weird thing. Did you see how the blood vessels on his sides are standing out?”
No. I hadn’t noticed that. Looking closely, there they were. Prominent blood vessels coursing along both his sides. My adrenal glands sat up again. Something serious was going on in that round tummy and it was affecting his cardiovascular system. It was radiograph time. I escorted Friend to the X-ray room. On the way, he tried to steal some dog food, which was truly astounding, considering what I saw when I developed his film.
Friend’s stomach was distended three to four times normal size, but not with gas. With something like food. Friend had gone on one serious binge. Since we can’t tell exactly what was eaten from the X-ray image, we just call it “ingesta.” Food bloat is generally less serious than GDV, though occasionally the stomach can twist or rupture. Treatment depends in part on exactly what the animal ingested.
“Could he have eaten anything like raw bread dough, uncooked grains or beans, foam insulation?” I asked. These substances can continue to swell in the stomach, increasing the risk of rupture. Fatty or spicy foods can lead to pancreatitis. Rotten or toxic stuff can cause food poisoning. Indigestible items may stay stuck in the stomach, causing an obstruction. The owners conferred and agreed Friend had probably gotten into the compost.
So what do we do now? In uncomplicated food bloat, inducing vomiting is usually not recommended, as it can increase the risk of rupture. Besides, the ingesta will often pass on its own with simple “tincture of time.” In certain cases, “gastric lavage” to flush the stomach via a long tube passed down through the mouth or nose may be indicated. Rarely, the ingesta may require surgical extraction, but most cases of food bloat can be treated conservatively. Intravenous fluid therapy may be helpful because keeping the patient well-hydrated assures the ingesta stays moist, making it pass more easily. Pain medication, antacids, lubricants, and/or gastrointestinal protectants may all be useful.
I prescribed an oral lubricant, and discussed how to manage food and water for the next few days and what complications might occur. His owners, now confident their buddy was not in danger, found the situation humorous. Apparently this was not the first time Friend’s appetite had gotten him in trouble. My adrenal glands were not amused.
And Friend? Well, he continued to look hopefully at my jar of liver treats. Really?