THIS IS THE FACE OF BLOAT by Kate Connick

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Editor's note: My thanks to Boxer owner extraordinaire Kate Connick for sharing this "bloat early warning system" with those of us who have never experienced the condition in the dogs we live with. And for providing the best home for one of my puppies this breeder could ever have hoped for.

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Yes, Tonka experienced GDV (gastric dilatation and volvulus, aka bloat/torsion) on Tuesday. This isn't an uncommon disorder, and I'm sure some of you have experience with it. My very first exposure was watching a neighbor's great Dane die this way when I was a kid. Horrible way to die, I might add.  But some of you haven't had firsthand experience with bloat, so I figure I'll share Tonka's tale to make it real for you. If you aren't already familiar with GDV, you want to know about it - whatever kind of dog you have. This is potentially one of the ugliest, most urgent and lethal situations that you may face as a dog owner, and you don't want to be farting around online asking people what they think about your dog's retching and pacing as he slowly dies in front of you. Take a few minutes to learn so that you're prepared.

An excellent article about bloat can be found here: https://www.akcchf.org/canine-health/top-health-concerns/bloat/understanding-bloat.html#Warning

Tonka belongs to several of the high risk categories: He's a large, deep chested, male boxer with a temperament that is excitable and anxiety-prone. His 9th birthday arrives before the end of the month, and age is a significant risk factor. They don't know exactly why that's so, but it may be that ligaments become more lax, or other health conditions like tumors may serve as contributing factors. Whatever the reason, bloat risk increases with age.

Tonka leads a sensibly bloat-preventive life. He doesn't exercise before or after meals, doesn't eat large meals, and isn't fed when he's panting. He has a varied diet, eats multiple small meals daily, doesn't gorge his food, and generally doesn't overindulge at the water bowl. He's lean but fit and overtly healthy.

Even though he has ARVC ("boxer cardiomyopathy") and a cardiologist told me, years ago, that he was "at high risk for sudden death, with or without medication," he has led a full, active life. He hikes, swims, runs, plays, and you'd never know he was a cardiac patient if I didn't tell you. But he is - and this is relevant. Since his ARVC diagnosis when he was a year and a half or so old, he's been sedated and locally anesthetized for a few, relatively minor procedures, but he hasn't undergone general anesthesia. Too risky.

There was absolutely nothing unique about the day he bloated. It was a typical day. He had hiked the day before, and the morning of, he went swimming with his "siblings." He retrieved, swam with me, and rode on a float - but his exertion level wasn't unusual, and he didn't have an unusual amount of treats or drinking water. It was a typical day.

My first sense that something was amiss was on the car ride home. He usually sleeps, but he was restless - and this is unusual for him. Anyone who has ever ridden in my car knows that I keep it cold enough to induce hypothermia in a polar bear, but Tonka was panting. He would lie down, then get up - panting - and look out the window. I'm not a worrier, so my assumption was that he probably had to go to the bathroom. Still, I must have had some sense of foreboding; I kept an eye on him in the rear view mirror as a drove. He did settle, but not as restfully as usual, and he would alternate rest with standing and panting. Why didn't I just pull over and give him a chance to go to the bathroom, you ask? Oddly, that's what I would have done any other day. My thought bubble was telling me I should just pull over, yet I felt a bit of urgency to just get him home.

It's an hour drive. Once home, it's another half hour to unload the car and put stuff away. The dogs were in the backyard or house - kind of following me around. Tonka's behavior didn't seem particularly unusual at that time.

Then I sat down with my sister to chat, and that's when I grew increasingly concerned. Know your dog. Know what's normal and what isn't. And pay attention to it. All of Tonka's symptoms were relatively subtle, but I found myself staring at him. I wasn't even consciously thinking. I was just staring at him with a pit in my own gut, until I said, "I think he may be bloating."

What were his symptoms?

* Panting. Yes, it's a summer day, but I keep my house cold. The dog should not have been panting. It was more of a pressured panting, the kind prompted by stress or pain.

* Comfort Seeking. Yes, he's an affectionate dog, but he'll typically flop on a dog bed and snooze when we get home. He persistently stood next to me, basically in heel position beside my chair, and solicited contact. Sometimes dogs aren't flattering you but are trying to ask you for help.

* Restlessness. Again, his typical behavior would be to just lie down and relax. He wanted to. He'd approach a bed or the sofa, maybe dig a little like dogs do before they lie down, and then abandon his effort to return to my side.

* Posture. His back was slightly arched, just enough to look slightly uncomfortable.

* Tight abdomen. His belly felt very tense to me.

* Inability to vomit? A couple of times, he dropped his head and bee-lined away, in the way a dog might as it's preparing to vomit - but then he simply didn't, and he returned to my side.

Mostly, he just appeared to be panting, restless and clingy - and this is not typical behavior for him, but it also wasn't overwhelmingly obtrusive. If the house wasn't air conditioned, if there were other activities going on where his restlessness and neediness weren't so apparent, would his dilemma go unnoticed? It can happen. Bloat can happen very quickly, often at night, and it's easy to not realize what's happening until things are more advanced. There were some characteristic symptoms that he didn't display. He never physically tried to vomit; there was no retching, dry heaves, or anything like that. His belly wasn't swollen; it simply felt extra-firm to the touch. His color was good. He wasn't having any mobility issues (jumping into the car, for example). He's stoic, so you could squeeze his belly like a python might, and not get any reaction.

Off to the vet we went. I walked in to my vet's office, was greeted by a staff member who knows me well, and when I quietly said, "I think Tonka may be bloating," they mobilized like a tornado. I'm not a very dramatic individual, so I did have a passing thought that I was going to feel like a first-rate jackass if the dog just had a stomachache or a pinched nerve. That said, sometimes you don't want to be right, and I didn't want to be right about the whole bloat thing. Being a jackass isn't always a bad thing.

The vet immediately looked at him. Abdomen didn't seem particularly tense to her (again, know your dog - for him, it wasn't normal). Heart rate was normal. Color good. She almost looked relieved, but obviously they took xrays right away - and while he wasn't dramatically bloated, he had torsed. In simple terms, his stomach got acrobatic and did a little somersault so that it was cutting off circulation to itself and everything beyond. And that's a B.F.D. This is one of those genuine, life or death situations!!!

My options:

Option 1. Euthanasia. That sounds horrific to even consider, but we're talking about a nearly 9 year old boxer with a serious heart condition (who might not even survive anesthesia itself, much less any of the nastier side effects that GDV can bring, like heart arrhythmias, sepsis, organ damage/failure, etc.). This is something people often opt for, out of concern for their animal's comfort and/or an inability to justify the financial burden of more intensive intervention. Resist the temptation to pass judgment on anyone who feels that this is the most sensible decision. Sometimes it's a kindness to spare a dog from the prolonged discomfort of hopeless surgery and aftercare. Seriously, don't judge people who make different choices than you. We all do the best we can for the pets we love, given our knowledge and resources at the time. Be kind.

Option 2. A tricky, difficult, and expensive surgery with no real guarantee of success. These surgeries and the aftercare are very, very expensive - and no, not because veterinarians are thieving villains but because the surgeries aren't easy. The interrupted blood flow can wreak all sorts of damage, and to be honest, my vet's practice isn't particularly equipped to do this sort of surgery. It's more of an emergency-vet thing, but it's also a time-is-of-the-essence thing, and he was already at my vet's - and I was insistent that he have surgery in familiar surroundings, under the care of people I know and trust. Not to be grim, but if he was going to die, I wanted it to be in more comforting surroundings. He's a high anxiety type of dog, and especially with the aftercare, it was important to me that he be attended to by friends and not strangers.

So yes, I went for Option 2. Tonka has been active, happy, and sometimes you just have the subjective sense that the dog isn't ready to die. And no, I don't have health insurance for this dog, but that's okay. I kinda like the old guy, so I'll deal with it. My vet protested and really wanted me to consider taking him to an emergency center for surgery performed by specialists who do this sort of thing frequently, but she understood my reasoning for wanting her to do the job, and she rose to the occasion. Heroically, I might add. I don't think either of us was necessarily optimistic about what she'd find once she cut him open, but apparently I'd gotten him there quickly enough, and they started him on fluids and painkillers right away. In terms of a rough timeline, his bloat symptoms started around 1pm; I had him at the vet by 3:30 or so, and he was being cut by 5-ish.

He was in surgery quickly, and the worst of it was the torsion itself. He wasn't terribly bloated. His organs and blood vessels appeared healthy, so she didn't have to remove necrosed tissue. His spleen looked just fine, as did the stomach and intestines. These are good things. His heart held up astonishingly well throughout surgery. Go figure. His stomach was re-positioned the way it's supposed to be, anchored in place, and he was stitched back up. That's only the first hurdle to recovery.

I visited afterwards, and he was stoned off his gourd. Visited the next day (Wednesday), got him to drink a little water, eat a little food, and pass some stool while taking a little walk. He was still pretty dopey from drugs and fatigue, but they let me hang out on the floor with him in an exam room while he napped.

Pro Tip: Send pizza to the vet office. They like treats just as much as dogs do, and with rare exceptions (I hear you, gluten intolerants), who doesn't enjoy pizza? They genuinely saved this dog from certain death. GDV is that sort of situation.

Realistically, part of this process is understanding that you can only control so much. I did my job by getting him to the vet quickly. She did her job by doing her thing quickly and competently. His body seems to be doing its job, but that's always the wild card. Some dogs just suffer too much damage - and well, he IS an older dog with a defective heart who probably shouldn't even be alive anyway! (Note of hope to those with ARVC-afflicted dogs: The medications can be absolutely amazing in giving these dogs genuinely full lives).

Tonka has been eating, resting, gaining alertness, and he continues to look stable and well. The vet is continuing to adjust medications to finesse his treatment, and she'll recheck his bloodwork later, but I'm hopeful he'll be able to come home soon. If this dog manages to get through this and celebrate his 9th birthday on the 27th, it'll be a minor miracle. Amusingly, his breeder had asked me to choose an Eagles song for his registered name (that was the theme for the litter). As much as I like the song Desperado, I just couldn't name my dog that. So I opted for the song Take it to the Limit. I have a friend who believes that dogs become their names. Maybe there's something to that.

Saturday follow up:  Tonka was able to go home Thursday evening.  He had some issues with reflux, but with medications and many small meals throughout the day, that appears to be under control.  He lost about 6 pounds, but he's ravenously hungry and eager to regain it all.  Astonishingly, his bloodwork was normal throughout this (with the exception of an increase in WBCs), and he is off all painkillers - but other than being tired, he appears to feel pretty good.