Bloat -- How Diagnose?

[greyhead]

Spencer my IBD dog has returned recently to tummy rumbling and swelling, especially at night. (Of course he looked fine when he saw the vet Monday!) I reported this by phone a while ago and they said I should bring him in for an x-ray to see if it's "really bloat". I've been giving simethecone since yesterday, but all that seems tso help is the passage of time (overnight) and then it starts returning the next day as he starts eating.

 

Right this minute it's a little swollen but, to judge by experience, not as bad as it will be tonight. If I take him in in the next two hours for an x-ray, do you think it will show anything? If so, what?

Edited July 9, 2009 by greyhead

[pokealong]

From my understanding bloat is not something that comes and goes. Bloat is when the stomach flips and cuts of everything moving in and out of the stomach. An animal does not last for more than a few hours if it is not treated immediately.

[greyhead]

I thought so too until I read last night that bloat is not the same as torsion, which sounds like what you're talking about. Bloat is what happens before torsion, which may or may not occur. Or am I wrong?

 

I imagine torsion will show on an x-ray, but if it's just the swelling of bloat, what could they see? Gas?

Edited July 8, 2009 by greyhead

[Batmom]

What you'll see on a bloat film is a great big wad of gas that isn't passing. That may not sound serious, but it can be very very serious. I would want to get to the bottom of things (and I know you do too) if my dog was swelling up on a regular basis.

 

Torsion (stomach or other organ such as spleen flipping over) can occur without bloat, and bloat can occur without torsion.

[greyhead]

I just called the vet and we're on our way.

 

Thanks a lot!

[CaliforniaGreys]

If you can, please let us know how it went

[GreyPoopon]

Just to add to what Batmom said: a neighbour had a Chow that survived bloat and torsion. During the surgery, the dog's stomach was tacked so that torsion could not recur. Bloat could. And did. Repeatedly. After one occurrence, my vet said that bloat could be just as bad as torsion, maybe worse. Eventually, he bloated twice in one day, and did not survive the second time.

 

I hope Spencer is not bloating, and that you can find a solution to the gas.

[Guest Energy11]

Good Luck at the vets! Hope they fix things quickly!

[greyhead]

I'm fit to be tied, I'm afraid. The x-ray didn't show any bloat. They said it showed hyper-motility of the gut and that I should give Immodium, 2.5 pills 3X/day for five days. Didn't get to talk to the vet, just a very non-verbal tech! She said this rumbling tummy is what occurs before diarrhea and that the Immodium will slow things down and he'll absorb better.

 

The thing is, I'm afraid they're wrong, but I don't know what's right. For one thing, he has gained a pound or two since Monday, so it sounds like he's absorbing better than usual!

 

I didn't really want the x-ray now because the swelling had just recommenced and, if he follows his pattern, will reach his max around 11 p.m. Beyond that, he's not having diarrhea these days, he doesn't want to go out unless it's for a walk. After all his discomfort last night, and about 5 simethecone pills, I figured he'd want to go out; but he didn't go out before bed, nor this morning -- not until we took our walk an hour after breakfast, around 10 a.m. And even then he didn't pee like a racehorse, just marking this bush and that very casually! And no diarrhea, just the usual soft-serve after a half-mile of walking.

 

When we saw the internist a few months back, she said she doesn't like things like Immodium that change motility. I realize Spencer's situation may have changed. So I'm real reluctant to give him Immodium when he's not even having diarrhea. So I think I'm going to hold off on it while I research hyper-motility and get opinions from GTers. And there's always the ER vet tonight if the swelling is alarming again. But right now I feel that the vet's office is as lost as I am. (The vet was supposed to contact Dr. Vilar at OSU about his IBD, but she hasn't done it yet.) Sigh. What do you think?

 

ETA: I gave Spencer 250 mg. simethecone an hour before he had his x-ray -- right before I called the vet for guidance. Could it have dispersed the gas by then?

Edited July 9, 2009 by greyhead

[Guest BatesieGreys]

I would see another vet for a second opinion if possible. You know your hound better than anyone else...and vets are human too. They DO make mistakes. I would trust my instincts and do what I had to do to make sure that he got the right diagnosis. Good luck!

[sweetdogs]

Oh Mary - I don't have any advice. But I'll be thinking of you both.

 

I generally don't like any motility meds either - would rather let things run it's course. But with Spencer's issues that may be wrong. Or right. Any way you can talk to the vet tonight?

[Batmom]

Simethicone works pretty fast but I'm not sure that it would turn something into nothing in that amount of time. Hopefully somebody else (houndznigz, maybe? or Burpdog?) knows better.

 

I'm not fond of Immodium either, for the same reasons as your vet. There are times to use it, but unless I know what's wrong I prefer pepto bismol for rumbly guts, pepcid for acid tummy.

 

Arrrrgh. I'd want to talk to the vet as to whether the x-ray showed any possible reason for the abdominal distension you saw.

[greyhead]

I would see another vet for a second opinion if possible. You know your hound better than anyone else...and vets are human too. They DO make mistakes. I would trust my instincts and do what I had to do to make sure that he got the right diagnosis. Good luck!

Thanks so much, I need to hear that. I want my vet to be right, but my instincts are good in general and about Spencer in particular. Of course, when my instinct is working, it's usually very calm, and right now I'm anything but calm! The thing about this vet is that she only works three days a week, and I don't even think she laid eyes on him this afternoon. That's what happens when these folks book themselves up so completely -- there's no time for taking quick peeks, only dealing with clear emergencies.

[greyhead]

Arrrrgh. I'd want to talk to the vet as to whether the x-ray showed any possible reason for the abdominal distension you saw.

 

Thanks to you and to Dierdre too. As it happens, I left the CD they made of the x-ray on the counter at the vet's. They're open for the next 45 minutes and if I hit it just right, maybe I can catch the vet after her appointments but before she leaves. I'll try. At least in a just world I should be able to tell her everything I just told you guys! I'll let you know what happens.

 

 

[CaliforniaGreys]

I hope you get to speak with the vet. I have no experience at all so I can't offer anything, but what I do know about is instinct saying one thing and the vet saying another.

I'll be anxious to hear about your conversation

[pokealong]

send an email to OSU and tell them what the vet said, get their opinion.

[BertnLil]

I agree with Claudia. You know your dog best--follow your gut instinct. Please keep us posted.

[macoduck]

Is Spencer able to rest despite the rumblings? Does he stretch, pant, pace, have trouble lying down?

[KF_in_Georgia]

See here: http://www.peteducation.com/article.cfm?c=...59&aid=1432

 

Especially, note the potential side effects:

 

May see constipation, bloat, or sedation. Rarely see paralytic ileus (intestines lose ability to move ingesta along), pancreatitis, or central nervous system (CNS) effects.

 

If bloat is a potential side-effect, I'd steer clear.

[greyhead]

I missed the vet and everyone else was bustling to get clients and their animals wrapped up and out the door. Vet won't be back for an entire week. But I'm calmer. I have a plan, which I'll share in a minute.

Is Spencer able to rest despite the rumblings? Does he stretch, pant, pace, have trouble lying down?

He doesn't pace, but he doesn't really rest either. He can't seem to sleep, just lays there with his eyes open and blinking, changing positions occasionally, some of which don't look comfortable, only to change positions again very soon. Seems unable to curl up. I know it's not as easy to quantify as if he had the more worrisome list of things you list, but still it's not normal behavior for him. The only way I can characterize it is restlessness while lying down! He'll flinch when first touched, which the vet called hyperaesthesia the other day, but then seems to appreciate been gently stroked.

 

I'm calm now. So here's my plan: no Immodium, smaller food quantity at dinner and no late-night snack, and watch him closely. Call ER if concerned and see if there's anybody present who's at all familiar with greyhounds, bloat without torsion, and/or IBD. If so, go, if only for a second opinion delivered when the distended stomach is clearly observable even without an x-ray! If not, call other ER's and see who's on duty. If really alarmed, go to closest one no matter who's there. Meanwhile, keep researching and consulting, look for Burpdog and Houndznigz and anybody else suggested. And if I don't find that she has contacted OSU by early Friday, and we're still having problems, I'll do it myself.

 

Speaking of which (problems), another thing he does when he seems uncomfortable is get off the beds and lie on the carpeted floor. Most of the beds are very soft, with stuffing that shifts around. It just seems as if he's trying to keep his tummy stable, straight. Is this something anyone is familiar with gassy or bloaty dogs doing?

 

Thanks so much, everyone. It feels like we've been dealing with this, Spencer's intestines, forever. Well, a whole year anyway. The longer it continues, the more nervous I become. Thanks for not getting too bored to help!

 

May see constipation, bloat, or sedation. Rarely see paralytic ileus (intestines lose ability to move ingesta along), pancreatitis, or central nervous system (CNS) effects.

 

If bloat is a potential side-effect, I'd steer clear.

 

No kidding! Thanks for that link/info. DEFINITELY not using Imodium at this point!

 

ETA: This thread, "Bloat Non-Grey" from the Food subforum last week has people describing "pre-bloat" and it sounds like what I've been seeing. http://forum.greytalk.com/index.php?showtopic=233606

Edited July 9, 2009 by greyhead

[greyhndz]

I agree with Claudia. You know your dog best--follow your gut instinct. Please keep us posted.

 

Just caught that one.

 

I agree with the consensus about ex-naying the immodium. If a dog (or human) has intractable diarrhea and no underlying bowel disease, maybe, but if he's not even having diarrhea, what's the purpose? If you don't yet have an answer to the problem, I wouldn't compound it by giving him something that could slow bowel motility considerably, putting him at risk of obstruction. If Spencer does indeed have true IBD, "bowel motility" isn't the only issue, and the treatment for IBD (proven by biopsy) is quite different.

 

Having looked at human abdominal films for 20+ years, I'm trying to figure out how the vet can discern "increased motility" by a plain film. You can do a contrast study (like an upper GI with small bowel follow-through, or barium enema) which watches the progression of the contrast throughout the GI tract, and can get a sense of transit time. There are also special studies done via endoscopy. But hypermotility is often a clinical diagnosis - loud, sometimes high-pitched bowel sounds, frequent and/or loose stools, signs of abd. discomfort.

 

I'm kind of coming in at the end of this - has Spencer been formally diagnosed with IBD, and is he on a treatment plan of some kind? A hypoallergenic diet?

 

I'm trying to dig up some articles that might be helpful (and reader-friendly), but the other thing that comes to mind regarding the abd. distension associated with loud bowel sounds would be: is there some type of partial obstructive process in the bowel that might cause distension above that level, relieved when the fecal material passes through the partial obstruction? Is his belly filling with fluid rather than air -- is he leaking protein out of his gut which pulls fluid along with it (ascites)? (How are his serum albumin and protein levels? Cobalamin?) Has he had an ultrasound, looking at bowel wall thickness for signs of inflammation?

 

Is the distension occurring above the level of the pyloric valve -- that is, is there "delayed gastric emptying", with food/fluids taking an excessive amount of time to leave the stomach, resulting in distension? This can be confirmed by an upper GI or more specialized radiologic studies. Medications such as Reglan or Propulsid are helpful for this problem.

 

To throw another fly into the ointment (ew), this is some info from an article too long to cut and past, but I wonder if this has been considered: (BTW - borborygmi = excessive loud, high-pitched bowel sounds)

 

 

Stress-associated Colitis (Irritable Colon Syndrome, Irritable Syndrome)

Stress-associated colitis is a condition with similarities to irritable bowel syndrome and presents with signs of intermittent, often mucoid, diarrhea, with urgency, occasional vomiting, tenesmus and hematochezia. In some cases borborygmi, flatulence, "bloating", and abdominal pain are described. This often occurs in nervous/highly strung dogs e.g., toy breeds and competition dogs. The etiopathogenesis is poorly understood, but a number of hypotheses have been suggested:

 

- Primary intestinal motility defect

- Heightened sensation of intestinal distension/motility

- Psychological factors

- Undiagnosed organic disease

 

There are no specific diagnostic tests for stress-associated colitis, and diagnosis is made by consideration of the signalment together with exclusion of all other organic diseases. Treatment involves eliminating stressful events if possible, behavioral modification and (in some cases) drug therapy (anticholinergics, sedatives, and antispasmodics, e.g., hyoscine, diazepam or peppermint oil).

 

The syndrome of fiber-responsive colitis has recently been reported (Leib et al., 2000). The etiopathogenesis is poorly understood but may well have similarities to stress-associated colitis (see above). As the name implies, therapy involves dietary management with a high-fiber diet (>8% crude fiber or 15% total dietary fiber DMB). It may be interesting to test various sources of soluble and insoluble fiber.

 

So, basically, I think your trepidation is right-on. Masking symptoms isn't going to solve the problem, but it could potentially exacerbate it. If you haven't already, can you hook up with an Internal Medicine specialist who is comfortable diagnosing and managing bowel diseases?

 

I hope I haven't been redundant by suggesting things that you've already done. I know you're anxious to have answers and to get on track with a treatment plan. If I can research anything for you, please let me know, or PM me.

 

Jordan

 

 

 

 

[greysmom]

Here's my two cents:

 

Firstly, I haven't been following all the previous posts, so I'm really just reacting to the info in this one.

 

Bloat is caused by an excess of gas in the stomach that can't escape by normal means, ie. through the digestive tract. This can show up on an xray. If he's doing this every day, I would probably think about taking him off all food (and treats), and fasting him for 24 hours. Let him drink as much water as he wants. Then, begin feeding with SMALL amounts of a very bland, home-cooked diet - rice with boiled hamburger or chicken. No commercial kibble or canned food. Feed one small meal (like a cup total) and wait for several hours before feeding again. Stop feeding if he begins to build up gas.

 

If it's food in general that's causing his discomfort rather than a specific kind of food, he may have something like IBD or another chronic disease. He may be allergic to grains, for instance. Or have trouble prcessing a certain type of protein - chicken or beef - and need a unique protein food (like fish, duck or venison).

 

Make sure this really is a gas build up and not a simple distension from eating (or another cause). If it is gas, all that simethicone should have done something to relieve it, and it doesn't seem like it's helping at all. Does he have a temp when he has these attacks? Lots of times my guys will lay on the floor rather than a bed because it's cooler.

 

Also, that gas has to go somewhere - does he burp and/or fart a lot? Have a noxious smell? His soft serve poops seems to indicate some sort or intestinal trouble - either with his food, with absorption, with incompatibility with his system of some sort. I would assume that since you've been dealing with this for som time, you have tried the simple things like changing his food, adding pumpkin or another high fiber additive, changing his meal times, changing his meal amounts - that sort of thing. Does he eat all his food? Does he snarf it right down like nobody's business or eat slowly, leaving his bowl and returning over a period of time to finish? If he's eating too much too fast, that can also cause several of the systems you list.

 

I would not give him Imodium at this point, since you son't know what the problem is. If he does get a distended stomach again tonight I would take him in immediately - a simple tube into his stomach should allow the gas to escape. Gas build up in the stomach can be dangerous, even without torsion. It can press on the other organs, most dangerously the heart, and cause problems with them as well.

 

OK - That was long and rambling. I hope you figure out what's up with your guy!

 

Good Luck!

greysmom

 

PS - just went back and looked at your first post! Duh! Already diagnosed with IBD. I still might suspect his food is the cause of the problem. I know people with IBD have to avoid food triggers, and it should be the same with dogs. Is he on any meds for his IBD??

Edited July 9, 2009 by greysmom

[greyhead]

Thanks a ton, Jordan and Greysmom. You put a lot of thought and energy into your replies...while I was slacking and just walking the dogs! Seriously, Spencer does seem to require a mile's walk to get his bowels to move, which is another reason that hypermotility doesn't seem realistic. The vet probably was reacting to his very noisy gut in making her assessment; too bad she didn't have time to actually talk to me.

 

Let me fill in the blanks I left in Spencer's history. He has had just about every test for gut issues except for biopsy, which I refused. His loose bowels began after a dental + antibiotics last July. After two months of soft-serve followed by diarrhea, I tried pumpkin and then sweet potato; he refused both. Tried beet pulp; didn't work. Finally got vet to take it more seriously and tests showed malabsorption localized in small intestine. B12 shots begun and continue weekly even now. Tylosin also didn't help, nor did Flagyl. Saw an internist, who didn't have much to add. Problem continued and I agitated until they tested poop for germs and found a stunning overgrowth of Clostridium in late Feb. So we now add SIBO to the diagnoses and treated with 3 a/b's in succession; after 3 months or so he tested normal for intestinal flora. But the poop quality was still bad, so we did ultrasound and found structural changes in small intestine (thickened walls, dilated lacteals and distended villi) consistent with severe IBD (according to radiologist). I refused surgical biopsy because he'd lost 20 lbs and I didn't want the additional setback from surgery, and refused endoscopy because it can only access the extreme ends of the small intestine and wouldn't give much info. Plus, the treatment would be the pretty similar regardless of the specific inflammatory cell found. So yes, he's on Flagyl and budesonide for the past two months and largely improved. Regained 10 lbs. But the stomach rumbling and distension returned for a couple days last week and now again this week. Vet increased budesonide from 2 mg to 4 mg, but his tongue swelled up hugely, so that only lasted one day. I took it on myself to back him down to 3 mg (it was the weekend, vet not available) for two more days, and he improved. Back to 2 mg and fine for a few days but now this. Which was why I arranged for vet to consult with OSU's Dr. Vilar, cuz she doesn't really know when or if to add in azothioprine or what to do when things don't go well, except to recommend simethecone for gas. So I wish she'd get with it, but her life is complicated, and she'll be out for a week now. And that's the shortest history I can write! Oh, except to say that he can't seem to handle much in the way of carbs/grains, or now poultry or even beef, so he's been on venison for 2-3 months. Started with raw venison and still feed it, 2/3 of his diet. The other 1/3 is Natural Balance venison & sweet potato because it enables his poops to be pick-upable. But more than 1/3 and he gets diarrhea again, as he does with 100% raw.

 

He has been eating fast, Greysmom, and he has sometimes sought cooler spots in the house ever since this problem started way back when. Also noteworthy maybe, he sometimes gets cold paws when the rest of him seems warm, as though there were a circulation problem. His temp is always normal at the vets; we don't take it at home cuz I lost the thermometer and haven't replaced it yet. But this hot/cold thing comes and goes, lasting only a couple hours at a time as far as I've observed.

 

That "Bloat (non-grey)" thread I referenced a while ago mentioned various dogs having "pre-bloat" and also being diagnosed with "motility issues" and being prescribed Reglan, which I thought was an anti-nausea drug at least in humans but still sounds like something that would decrease motility?

 

I'm going to reread your posts now because you said some interesting things I want to consider. And then I'll probably have more questions! Which is great cuz the right questions lead to the right answers. (And even the "wrong" questions are useful in ruling things out!)

 

BTW, Spencer wants another snack, but I'm saying no tonight. I know he wants to eat, but I think it best that he sit tight with the light dinner he had at 7:30. Night-night, to anyone who's still up.

[Guest LindsaySF]

If he has a history of SIBO and Clostridium infection, I would retest for that. They might have come back. Have you tried adding a probiotic supplement? I would also deworm him to be safe (Panacur to get Giardia too).

 

Reglan is a gastrointestinal motility drug. It increases motility and speeds things along, either by helping to empty the stomach, helping the intestinal muscles to contract, etc. You might also try adding fiber to his diet to get things moving. (Edit: Teagan won't eat pumpkin or beet pulp either, I hid Benefiber capsules in his canned food and he never knew they were there).

 

Not sure I understand your vet's diagnosis of "hypermotility". If anything that rumbling and gas tend to mean things aren't moving as they should. The bloating tummy seems to indicate that things are getting stuck there instead of moving along down the digestive tract. Reglan would help to get things moving.

 

The SIBO was probably triggered by the initial antibiotics he was on, but impaired intestinal motility can cause another flare-up. The regular intestinal contractions keep the food moving along and limits the number of bacteria that can grow in the upper small intestine. When the contractions slow down and food lingers too long, too many bacteria grow there. His IBD is probably complicating factors as well, the thickened walls and all. You might need to change foods to find something more suitable. If there is any chance his SIBO is back I'd take him off immunosuppressants like budesonide.

 

It is all weirdly interconnected, what came first the chicken or the egg?, but the bacteria in the first SIBO might have caused an absorption problem, his IBD might be causing more SIBO by limiting motility, SIBO itself can cause intestinal inflammation, etc.

 

 

 

~Lindsay~

 

Edited July 9, 2009 by LindsaySF

[Guest LindsaySF]

Seriously, Spencer does seem to require a mile's walk to get his bowels to move, which is another reason that hypermotility doesn't seem realistic. The vet probably was reacting to his very noisy gut in making her assessment; too bad she didn't have time to actually talk to me.

Just saw this part about exercise helping to get his bowels to move. That's a sign of HYPOmotility. I'm not a vet and I haven't seen your dog so I don't really want to argue with your vet, but, ok I will. I think your vet has the exact opposite diagnosis and was basing it just on the loud rumbly noises and on the assumption that diarrhea was imminent. I agree with you in that they didn't really talk to you to get a complete patient history. Tell him/her about the walks helping, about the gas build up, remind them about his SIBO history, etc. And ask about Reglan and/or adding fiber.

 

 

 

~Lindsay~