"It is referred to in emergency circles as the mother of all emergencies."— Dr. Michael LoSasso, DVM, on GDV (bloat)
Episode summary
If you have a dog — especially a large or deep-chested breed — this is the episode to listen to and remember. Dr. LoSasso gives the most thorough, plain-language explanation of GDV (gastric dilatation-volvulus) you will find anywhere: what physically happens inside the dog's body, why it progresses so quickly, which dogs are at risk, and exactly what to do if you suspect it.
His core message is unambiguous: if your dog is dry heaving and not bringing anything up, do not call ahead. Get in the car and drive to the nearest emergency vet immediately.
He also covers the surgical procedure (gastropexy — "tacking" the stomach) that prevents recurrence, the prophylactic version that can be done at the time of spay, and why the dog in Marley & Me died — she was decompressed but never tacked, and she re-bloated.
"I've seen dogs where the stomach was so necrotic and under so much pressure that it ruptured. And I've seen dogs where we got there in two hours and once I decompressed and got in surgically, you'd never know anything had ever happened. The difference is time."— Dr. Michael LoSasso, DVM
The one sign that means go immediately
If your dog is trying to vomit repeatedly but bringing nothing up — dry heaving or retching without producing anything — and does it a second time, Dr. LoSasso says: put them in the car and go to your nearest emergency hospital. Do not wait. Do not call first. Drive.
Questions answered in this episode
The following questions are answered by Dr. LoSasso in this episode, drawn directly from the conversation. These are real clinical answers from a practicing emergency veterinarian with 30+ years of experience.
GDV — gastric dilatation-volvulus — is a condition where the stomach fills with gas and then rotates on its own axis. Dr. LoSasso describes it like spinning a loaf of bread closed: the rotation seals off both the esophagus and the beginning of the small intestine, isolating the stomach completely. Bacteria and stomach acid continue producing gas inside, but nothing can escape. The stomach expands enormously, pressing on all the major blood vessels, restricting blood return from the back of the body, and causing the stomach tissue to begin dying from lack of blood supply. Without emergency surgery, it is fatal. Dr. LoSasso calls it 'the mother of all emergencies.'
The most characteristic sign of GDV is unproductive retching — the dog trying very hard to vomit but bringing nothing up. Dr. LoSasso says if your dog does this twice, put them in the car immediately. Other signs include a distended or hard abdomen (though not all bloat cases show dramatic abdominal swelling, depending on the dog's build), restlessness, drooling, and progressive weakness. The absence of a distended belly does not rule out GDV.
Deep-chested breeds — those with a large distance between the breastbone and the spine — are most at risk because this body shape gives the stomach room to swing and twist. High-risk breeds include Great Danes, German Shepherds, Dobermans, Weimaraners, Vizslas, Standard Poodles, and Basset Hounds. Interestingly, Dr. LoSasso notes the breed with the highest statistical association to GDV is the black male Standard Poodle. He has even seen GDV in Dachshunds and Corgis. Barrel-chested dogs like Pit Bulls are at much lower risk.
Treatment begins with IV fluid stabilization to bring up blood pressure, then stomach decompression — either by passing a tube down the esophagus to release the gas, or by inserting a needle through the stomach wall as a temporary comfort measure. Once stable, the dog goes to emergency surgery. The procedure involves untwisting and decompressing the stomach, assessing for tissue death, removing any non-viable tissue, and performing a gastropexy — surgically attaching the stomach to the body wall to prevent recurrence. Dr. LoSasso says the stomach is given a 'third anchor point' so it cannot twist again.
A gastropexy (or 'stomach tacking') is a surgical procedure that creates a permanent attachment between the stomach and the body wall, preventing future GDV. It is performed as part of emergency GDV surgery. It can also be done prophylactically — preventively — at the time of a spay or neuter, adding only 20 to 30 minutes to the surgery. Dr. LoSasso recommends owners of high-risk breeds discuss prophylactic gastropexy with their veterinarian. He references Marley & Me: the reason that dog died at the end was that she was decompressed but never tacked, and she re-bloated.
Dr. LoSasso says restricting exercise after meals is probably not a bad idea, but the honest answer is that we don't fully understand what triggers GDV. He knows it is not simply about having a full stomach — 'food bloat,' where a dog eats an enormous amount and the stomach swells, is a different and less dangerous condition than GDV. The most reliable prevention for high-risk breeds is prophylactic gastropexy. Owners of deep-chested breeds should be hypervigilant for signs and know that if they see unproductive retching, they should not wait.
JulieWill you walk us through why bloat is so life-threatening, and how it is treated?
Dr. LoSassoWhat veterinarians would refer to as gastric dilatation and volvulus — GDV — the rest of the world simply calls bloat. What happens is that the stomach rotates on its own axis. People say it flips, but it rotates. And when it does that, it cuts off the esophagus and the beginning of the small intestine — like when you spin a loaf of bread closed. Nothing can go in, nothing can go out. The bacteria and acids in the stomach continue to interact, producing a tremendous amount of gas that cannot escape. And so the stomach gets really, really big. The stomach is putting a great deal of pressure on all the vessels, stopping blood return from the back of the body. These dogs are in some serious discomfort.
JulieHow do you treat this right away?
Dr. LoSassoThe real crux is to get them hemodynamically stable with IV fluids, get their blood pressure up, get them anesthetized, and decompress that stomach. Sometimes we can pass a tube down the esophagus and — if you go gently enough — work through the twist and open a communication from the stomach to the outside. That decompresses the stomach and makes them feel significantly better. Then we take them to surgery and perform a gastropexy — tacking the stomach. We make an incision into the stomach wall and an incision in the body wall, and sew those together to give the stomach a third anchor point. Without that, the stomach can re-bloat. That's the reason the dog in Marley & Me died — her stomach was decompressed but never tacked, and she re-bloated.
JulieWhich dogs are most at risk?
Dr. LoSassoDogs whose conformation is very deep-chested — where the breastbone is very far from the backbone. That shape gives the stomach room to swing around. My pit bull? Not in any danger of ever bloating. Her chest is square, barrel-chested. But dogs like a Vizsla, German Shepherd, Doberman, Great Dane — those dogs that have really, really tall chests — these are the ones we commonly see. The breed with the most statistical connection to GDV is actually the black male Standard Poodle. We just don't see many of them. I've even seen bloat in Dachshunds and Corgis because even though they're small, they still have that depth in their chest.
JulieHow quickly does tissue damage occur once blood flow is compromised?
Dr. LoSassoIt really depends on severity. I've seen a three-year-old dog that had been bloated for a couple of hours — once I decompressed and got in surgically, you'd never know anything had ever happened. But I've also seen dogs where they said 'he started trying to vomit last night' and they came in 12 hours later, and the stomach is black and has totally lost its blood supply. Those unfortunately do not make it. I've even seen a case where the stomach was so necrotic and under so much pressure that it ruptured.
JulieAny tips for pet parents to recognize the warning signs?
Dr. LoSassoIf you have a breed prone to this — and we're looking at that depth of chest, Basset Hounds too — then be hyper vigilant. If they try to vomit and you notice they can't bring anything up, and they do that a second time, I would put them in the car and get to your nearest emergency hospital. It is referred to in emergency circles as the mother of all emergencies.