"What do you mean, 'They're on their way?' " I asked, forcing my eyes open, now sitting bolt upright in bed. It was still black as night outside.
"She was very upset," the answering service operator said, "She and her husband are on their way to the hospital with the dog. They'll be there in two minutes. She said she thought the dog was having a heart attack."
"A what?" I said as I began dragging on some jeans.
Having no more information than this, and having no way to call the owners who were presumably already waiting in the parking lot of the veterinary hospital, I finished dressing and made my way to work, about two hours before the place was to open.
Unable to communicate some important information, like how long it would take me to get there, I was hoping the owners would not have had heart attacks themselves while waiting for me to arrive. Thank goodness for them I lived relatively close. Thank goodness the dog had not required any first aid, as there was no way for me to instruct them, being incommunicado. I was worried about the atypically irrational behavior of these owners.
When I arrived, I found the dog to be panting heavily, but in no significant distress. The owners were distraught, but otherwise apparently in good health. Sans heart attacks, all around.
The history of this mysterious case was as follows: LuLu the pug, just two years old, was perfectly fine the night before - ate dinner, drank water, did her business outside and went to bed - as usual.
But, when the owners woke the next morning, LuLu was panting heavily, pacing, and was looking very uncomfortable.
She was intermittently whining. She didn't eat her breakfast, which for LuLu was alarming, as she had never missed a meal in her whole two years. She was not vomiting; she went outside to urinate and defecate, both seeming normal.
LuLu was undoubtedly uncomfortable - I recognized a problem right away: Her belly was very big, and she "splinted" or winced, holding her abdominal muscles very tightly when I palpated her there. Her belly wasn't rock hard, but it was definitely distended with what seemed to be gas. I admitted her for tests, but was able to assure the owners that LuLu was not having a heart attack, which seemed to put them at ease.
After assuring her owners over the phone that LuLu's heart was fine and her blood tests were normal I said, "LuLu's abdomen seems to be the source of her discomfort, and the radiographs show that the stomach and the entire length of her intestine are distended with gas.
Did LuLu eat anything out of the ordinary?"
"No, she just ate her own food," Mrs. replied. "We don't give her food from the table. And she didn't eat anything at all this morning."
"Does she chew on toys or objects that she may have swallowed?" I asked.
"No, she didn't even chew stuff as a puppy," she said.
Hmmm. Nothing is easy.
I hung up, feeling deflated, as I was sure this was a clear case of dietary indiscretion.
Nonetheless, I was on a mission to treat my patient, who badly needed to be deflated, too. So to speak.
No, I didn't stick a pin in her and watch her sail backwards all around the room like a balloon. That only works in cartoons. However, a similar technique can be used in a dire emergency (minus the sailing around the room) which I'll get to in a moment. For LuLu, "the doctor said Mylanta." Worked like a charm, and relatively quickly. Within an hour of being more or less forced to swallow the chalky medicine, LuLu was wagging her curly tail wildly and looked much happier. Success.
So, back to that dire emergency I just mentioned. LuLu was bloated - stem to stern, and getting the gas distension under control was very important, before it led to a much more serious condition in which the stomach becomes so bloated, it begins to twist on its own axis. This condition is called GDV: Gastric dilatation and volvulus, but is commonly known as "bloat" or "twisted stomach." Suffice it to say that if this condition develops, the situation has suddenly become very, very bad.
The typical M.O. of a dog with GDV is as such: Large breed dog eats a big bowl of food really fast, perhaps more than a bowl, chugs a whole bunch of water, and runs around like a maniac.
Within an hour, the dog looks as if it wants to die, retches as if to vomit, but can't, and the owners invariably describe a rock hard belly, getting larger before their eyes. Many of these dogs are collapsed by the time the owners make the call.
This situation is dire, and many of these patients die before treatments can be begun.
GDV is diagnosed via telltale signs on physical examination and abdominal radiographs. The first and foremost treatment is the aggressive administration of IV fluids and an attempt to relieve the gas distention, usually by passing a tube into the stomach through the mouth.
Many GDV patients are so debilitated, sedation is not often required. If a tube cannot be placed, but the abdomen is becoming very distended, the dog's breathing may become affected, among other problems, and a trocarization may be performed.
This technique actually does involve the aforementioned 'sticking a pin in a balloon,' in a manner of speaking.
The doctor will use a large gauge hypodermic needle to pierce the bloated stomach right through the dog's body wall, allowing it to deflate some. While this is a quick fix, it does not resolve the problem, and poses the potential for stomach contents to leak from the hole made with the needle - a necessary risk in some cases.
The current thoughts on GDV are that most, if not all cases require surgery to correct the twist, which often involves the spleen along with the stomach.
A gastropexy is then performed to "tack" the stomach to the body wall with sutures to prevent the stomach from twisting again.
The sad reality is that many of these patients have long-term complications following GDV, even after surgery is performed successfully.
Although it is uncommon, small breed dogs can be victims of GDV - the smallest I've seen was a Maltese. Cats do not get GDV, but they can become bloated.
Fortunately for LuLu, she was just bloated but not twisted. Later that day, I got a call from her owner.
"I was wrong," LuLu's owner said. "She did eat something unusual." I couldn't wait to hear this. I was hoping it wasn't something inedible.
"My son had a Valentine's Day party at school yesterday," she said, "and he left his backpack open on the couch.
He didn't notice until this afternoon that there was an entire box - a BIG box - of JuJu-Hearts, you know, like jelly candies, all gone.
LuLu ate the whole box, probably last night. Do you think that's what did this?"
Relieved and feeling somewhat vindicated, I said, "Yes." Another case solved: LuLu's JuJu-Heart Attack.
Daverio is a veterinarian at Williamsport West Veterinary Hospital.