As the Stomach Turns

By:  Rebecca Ball, DVM, MS, DACVS

Gastric dilatation-volvulus (GDV) is a costly medical and surgical emergency condition that is fatal if untreated.  Luckily, GDV is also a preventable condition.  GDV occurs when the stomach distends with air and rotates along its axis, effectively shutting off any means of air, food and liquids getting into or out of the stomach. 


Image depicting rotation of the stomach seen with GDV

GDV is most commonly seen in large and giant breed dogs.  The Great Dane, German Shepherd Dog, Standard Poodle, Weimaraner, Saint Bernard, Gordon and Irish Setters, and large mixed breed dogs are represented most commonly.

Predisposing factors that have been identified include advancing age, feeding types, patterns and habits, anatomical variations, underlying gastrointestinal disease, relatives with a history of GDV, and temperament.  Feeding habits that have been shown to be associated with an increased risk of developing GDV include feeding a single type of food or food that has small particles, fast eating and swallowing large amounts of air, feeding once daily, feeding out of elevated bowls and feeding foods that have oil or fat among the first 4 ingredients.   Anatomical variations shown to be associated with GDV include a deep narrow chest, being underweight, and weakness of the supporting ligaments of the stomach.  Underlying gastrointestinal disease and alterations in motility have been suspected to also contribute to the development of GDV.  Dogs with a first degree relative with a history of GDV and a fearful temperament have also been implicated as a predisposing factors, while dogs described by their owners as “happy” have been shown to have a decreased risk of GDV, possibly showing genetic and environmental factors in the etiology of GDV.  




X-ray of a dog with GDV, note the gas distended stomach in
a “reverse C” shape



Proposed precipitating factors of GDV include stress (recent kenneling and car rides) as well as seasonal and temperature variations.

Mortality associated with GDV varies between 16%-33%.  Early recognition and treatment are essential for a successful outcome.  As the stomach becomes distended with air, it compresses the vena cava (the largest vein in the abdomen), resulting in  lack of blood return to the heart and shock.  Treatment of a GDV includes supportive care (IV fluids, pain medications) and early surgery to unrotate the stomach.  In addition, a gastropexy is recommended to prevent the stomach from rotating again.  A gastropexy is a procedure where the stomach is permanently adhered to the right side of the body wall to prevent it from rotating again.

A gastropexy is very effective, however not 100%.  In addition, a gastropexy should prevent the stomach from rotating, but dogs may still bloat or become distended with gas.  Radiographs may be needed to differentiate bloat from GDV and evaluation by a veterinarian is recommended if signs of bloat are noted.

 

"Tiny Tim" Turned "Hercules"



God bless us, everyone!

A figurative “Tiny Tim” of the feline persuasion presented to Dr. Kate Fitzwater, DACVS, and our Surgery Department on Halloween.  Hercules (his real name) was just six weeks old, smaller than his litter mates, and had a condition called bilateral carpal varus.  Put in simple terms, both his front limbs turned inward.  Try as he might, this little fellow just could not keep up and was doomed to life long problems. 

Hercules is also a polydactyl cat, which means he has extra toes that make his paws look like mittens! This is an inherited trait in cats.  People often refer to them as "Mitten Cats" or “Hemingway Cats”, named after the famous author who adored and protected them.  Many decedents of Hemingway's first polydactyl cat still occupy his estate in Key West Florida.    



Radiographs before
treatment

To give Hercules a chance for a normal life, he was placed in bilateral forelimb splint bandages for 4 weeks to straighten his deformed legs.  These were changed weekly to accommodate his growth and make sure he didn’t form any sores.  The bandages did not seem to bother him and all.  Karen, his owner, reported that with his “boxing gloves”, aka bandages, he started standing up to the big cats and boxing them in the face!



Karen and Hercules

At the end of 4 weeks, the bandages were removed.  Now, in this festive holiday season, Hercules has lived up to his name; he is walking well and playing with the big guys.  He will continue to become stronger on his forelimbs and should grow normally without any foreseen complications.  And, just as any proud polydactyl cat would do, he happily shows off his mittens to everyone he meets!   .

Unlicensed Veterinarian + Untrue Accusations = Slanted News

By:  Matthew Lemmons, DVM, DAVDC

You may have seen a recent story on ABC’s 20/20 reporting veterinarians upsell their clients with unneeded services.  The former veterinarian claiming this stated in particular that dentistry is equivalent to McDonald’s asking if you want fries with your order.  He seems to mean that dentistry is just a side item your pet does not need.  This is simply a horrible analogy.  Preventative dental care is important to our pet’s health, just as it is with our own health.  Prevention of periodontal disease can save our pets from having to undergo dental extractions which is more painful and requires longer anesthesia periods than preventative cleanings.

20/20 set up an “investigation” to see if they could catch veterinarians making medical recommendations that the pet did not need to simply make money.  In the investigation a pit bull named “Honey” was determined to be healthy by a veterinarian hired by 20/20.  “Honey” was then taken to several veterinarians to be examined.  One veterinarian stated “Honey” had dental tartar or calculus and recommend a dental cleaning.  The report spun her recommendations to sound as if she was pushing for a service that “Honey” didn’t need and that was potentially harmful to her health.  I applaud the veterinarian who made the recommendation.  Not only did “Honey” have calculus, but she had gingivitis, worn or fractured canine teeth, and an oral tumor that needed a biopsy.  “Honey’s” owner should be happy this veterinarian was observant and proactive in recommending preventative treatment.

The coup de gras of the story was the part of their interview with Dr. Marty Becker that ABC chose to air.  Watching the interview, it seems that Dr. Becker would not recommend dental cleanings for pets unless there was already disease present because of the risk of anesthesia.  Dr. Becker has since said this comment was taken out of context.  His point was that he would not anesthetize an unhealthy animal for preventative care.  He also reports that he was interviewed for two hours and only this small portion was used.

It is unfortunate that an individual who is no longer licensed to practice was given such a large stage to air his agenda (which includes selling books and DVDs on the subject).  It is also sad that a respected veterinarian’s comments were twisted to sensationalize a story.  We advise that pet owners have a trusted veterinarian whose advice they can rely on.  The vast majority of veterinarians have the best interest of their patients, and not profit, in mind.   

The Great Greta - On the 'Wheels' of Love

The old saying, "A picture paints a thousand words", could not be more true here, only it is video that tells this story.  Greta received her wheelchair during her latest rehabilitation session and surprised everyone with her instant liking to this new form of mobility. 

Once she figured out what this new contraption was supposed to do, it was full speed ahead...literally!  There was no doubt that Greta was on a roll as she explored her new-found freedom.  The hospital filled with cheers and smiles, including one from Greta, as she made her rounds.

Technology and Dogs Make W-A-L-K-I-N-G Fun!

By:  Karen Hull, DVM

Veterinary Physical Rehabilitation

Fall in Indiana is a great time of year.  The leaves are beautiful, the air is crisp…what better time to make your dog happy and get some exercise at the same time?   Now there is an app available to make walking your dog both fun and informative.  

MapMyDogWalk by Subaru is a free app available for both Android and iOS.  MapMyDogWalk tracks and maps your dog walking route.  It keeps track of things like duration, speed, distance, pace, elevation, and calories burned (for you) in real-time.   The app uses the built-in GPS technology of your device to create your route on an interactive map which you can save.  I have used the app both on neighborhood streets and on paths in Ft. Benjamin Harrison.    The app does a good job of mapping both.   An additional feature is geo-tagging photo capability, which allows you to take pictures along your walk and automatically upload them with your saved route.

When you save your dog walk, the app automatically syncs with your training log on MapMyFitness.com (also free).   There, your routes and statistics are saved.  There is a multitude of ways to view your statistics.  If you are so inclined, you can earn “Achievements” by joining a challenge or by creating your own personal goal.

MapMyDogWalk is among a suite of fitness tracking apps, and as such, it can keep track of more than just dog walks.  The app can log other types of workouts, log food, and you can share your routes with friends.  Dog specific features are drop markers for things such as water sources and poop bag dispensers, as well as videos of dogs driving a Subaru!

Exercise is beneficial for our dogs, just as it is for us.  Some dogs have mobility limitations, but if your dog is able, you can mix it up on your walks.   Incorporate hills or weaves, and vary surfaces and speeds for a bit of a workout.   MapMyDog walk will keep track of your elevation changes and pace.   

If you are motivated by statistics, then this app will do well to motivate you.  If making your dog’s day is motivation enough to take him or her for a W-A-L-K, then this app will provide a fun way to log your exercise.  In any case, this is a great time of year to get outside with the best walking companions ever and enjoy the Fall!

The Great Greta - Continued

Greta continues rehabilitation.  Her family reports that she can wag her tail again, ever so slightly, which means a lot since she was always very expressive with her wagging.   To the left is a picture of Greta during one of her land exercises and below a video of one of Greta’s sessions in the underwater treadmill. 

 

 

 

Along with her exercises, Greta receives laser therapy and acupuncture.  She is being fitted here for a wheel chair and getting the proper fit is vital to the success of its use.  Greta truly has a great attitude and it is a joy to work with her, and her family!

Is General Anesthesia Really Necessary for Dental Cleanings?

By:  Matthew Lemmons, DVM, DAVDC

The American Animal Hospital Association (AAHA) recently made a requirement that all of its member hospitals only perform dental cleanings under general anesthesia with an endotracheal tube in place, AAHA Dental Guidelines.  This decision has come under fire from groups who perform dental cleanings without anesthesia.  Fairly, we should look at each side’s concerns.

The groups who perform dental cleanings without general anesthesia argue that their trained staff can safely and completely clean the teeth without general anesthesia.  They also correctly state that there is an inherent risk whenever general anesthesia is performed.  Some of these groups only recommend non-anesthetic dental cleanings (NADs) in between complete cleanings under general anesthesia as preventative maintenance.  Some believe general anesthesia is only required if there is a need for extractions or other involved treatments.

Those who believe general anesthesia is required state that scaling of all the teeth surfaces and cleaning below the gum line is not possible when a patient is awake.  Additionally complete diagnostics including periodontal probing and dental x-rays cannot be adequately performed in an awake patient.   One group taking this stance is the American Veterinary Dental College, who are the only group of veterinary dental specialists recognized by the American Veterinary Medical Association.  The College’s position can be found here, Dental Scaling Without Anesthesia.

I believe that some of the groups supporting NAD do have the pet’s best intention in mind.  Their thought is that the risk of an adverse reaction under general anesthesia is too high to justify an anesthetized cleaning.  I agree that if general anesthesia is not properly performed, the risk of a problem occurring is high.  However if the right precautions are made, the risk of an event under general anesthesia is minuscule in a healthy pet.

Adequate dental care can not be provided on an awake patient in the vast majority of cases.  Most of the patients I see have some degree of gum recession and bone loss which requires more than simple scaling and polishing.  As well, a number of patients I see who have had a recent anesthetized dental cleaning have large amounts of dental tartar left behind.  If dental tartar is left behind in some anesthetized patients, how can it be completely removed in an awake, uncooperative patient?

In conclusion, adequate dental scaling and polishing does require balanced and monitored general anesthesia.  It is my opinion that cleaning teeth without general anesthesia is simply cosmetic and not therapeutic.  It is a disservice to the pet and client.