From Florida to Pennsylvania: Mae Mae the Lab gets “a new lease on life” after tie back surgery for laryngeal paralysis

This may be one of my craziest success stories ever, and definitely my furthest traveling patient ever.

Mae Mae, a 10 year old Lab who had laryngeal paralysis (which we call “lar par”), was traveling from Florida to NY State with her owner.

As they arrived in Pennsylvania (where I live), Mae Mae had a severe bout of suffocation. Her owner contacted me after finding me on my website. His dog was in serious trouble.

In his own words: “We were on our way from Key West (FL) to The Adirondacks (NY). As we were driving through Harrisburg, PA, around 11 pm, Mae suddenly couldn’t breathe. Her lar par had, in an instant, gone from manageable to life threatening. Fortunately, we were close to a vet ER. They saved her life. They said she was very healthy and a good candidate for lar par surgery.

I sent you an email and was blown away to receive an almost immediate response and then a call. I knew then that Mae Mae was meant to be there in Pennsylvania at that moment and she was meant to live.

We scheduled Mae Mae for emergency surgery at www.BrodheadsvilleVet.com. Surgery went well. She then recovered well with her owner.

Great night sleep, for both of us. She’s doing well.”

But then it occurred. The dreaded complication happened: aspiration pneumonia. This is a type of pneumonia due to aspiration, or inhalation, of food, water, saliva or vomit into the lungs. Mae Mae was coughing and was extremely weak. She had no appetite.

She went to the local ER (www.BartonHeights.com).

She spent a week in the ER. She had been through so much. She had literally given up. Because of COVID, I wasn’t allowed to see her. She was finally allowed in a private room where I spent half the day with her, every day. I would lay on the floor with her for 5 hours a day and try to get her to eat a little. Every day, she made a little more progress.”

It’s true. It looked as if Mae Mae had given up. She wasn’t fighting. So we fought for her. The doctor team and the nursing team did everything by the book to treat the pneumonia: antibiotics, nebulization, antibiotics, coupage, and lots of TLC.

Her biggest cheerleader was her owner. Despite the financial commitment and the emotional rollercoaster, he stood by her side, literally, as much as possible. In the end, Mae Mae recovered and finally continue her trip to the Adirondacks.

Her owner and I are convinced that she recovered thanks to the amazing dedication of one particular nurse, which we will call Shelly.

Mae Mae is a special soul. You (Dr Zeltzman) and Shelly provided the best medical care I have ever experienced for pet or human. I will never be able to thank you enough.

Thank you for giving Mae Mae a new lease on life. Literally it has been like watching her be reborn. She is 10 years old and I am grateful I will get the opportunity to watch this precious soul grow old.”

Then Mae Mae travelled back home in Florida.

After 1 month, she was doing well, but was still pretty weak.

After 2 months, she is happy and much stronger, as shown in this short video: https://youtu.be/67WiKl9tpr4

Bottom line: “lar par is not a death sentence.” It’s a treatable condition. It has definite, well-known, possible complications. Even if we end up with aspiration pneumonia, most dogs who are treated aggressively can overcome this aggressive and potentially deadly complication.

Thanks to her owner’s amazing dedication, Mae Mae can breathe easy in Key West, where she enjoys a life of rest, walks on the beach, good food and puppy love.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

www.DrPhilZeltzman.com

Dr. Phil Zeltzman

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!

What causes bloat?

“Bloat” is also called many different things: twisted stomach, Gastric Dilatation Volvulus (GDV), gastric torsion, stomach torsion etc.

Great Dane making a funny face

Side note: it’s unfortunate that we (vets and dog owners) have gotten used to calling it bloat. After all, bloating is not a big deal in people. Yet “bloat” can kill a dog in a matter of hours.

Classic belly X-ray showing Gastric Dilatation Volvulus, with 2 gas bubbles in the stomach

Vets sometimes tell pet owners that we don’t really know what causes GDV, and therefore we don’t know how to prevent it. However, that is not exactly accurate…

Here is a summary of the main known causes.

1. Breed

Large and giant dog breeds are at risk for GDV, including Great Danes (the #1 breed), German shepherds, Weimaraners, St. Bernards, Dobemans and Old English sheepdogs. These breeds are roughly 25% more likely to get GDV than others.

A few smaller breeds, such as basset hounds, boxers, and standard poodles can also be prone to GDV.

2. Conformation

Conformation has to do with the shape of a dog.

Dog breeds called “deep-chested,” have a tall chest and a skinny belly. Think of a Great Dane. A deep chest, combined with stretching of ligaments that attach to the stomach, increases the chance of stomach torsion.

A typical deep chested breed, with a tall chest and a skinny belly

3. Genetics

Dogs with a first-degree relative who had GDV are at greater risk of getting

it themselves. This chance increases by 20% with each additional year. These factors confirm that GDV is a partially genetic disease and dogs at risk should be spayed or neutered.

In addition, better selection should be taken seriously by breeders.

4. Stress

Stressful situations can also contribute to a twisted stomach. Boarding, thunderstorms, moving, vet visits and hospitalization are all potential triggers for nervous dogs.

One study showed that having a high-stress environment or being fearful contributed to GDV compared to similar dogs who were in a non-stressful environment.

5. Feeding

Eating fast, and how often dogs are fed, have been shown to increase the risk of stomach torsion.

Therefore, if your dog eats fast, it’s important to find ways to slow it down. There are special bowls made for that purpose.

In addition, dogs fed once per day are more likely to have GDV, compared to dogs who are fed 3 times daily. Several small meals throughout the day are better for dogs at risk.

6. Food

Believe it or not, studies have shown that moistening dry dog food before feeding actually increases the risk of GDV in large-breed dogs.

Ironically, feeding a dry-only diet has also been shown to increase risk.

So what’s a concerned dog owner to do?

Recommendations have been made to help prevent a first episode by avoiding exclusively dry, expanded, cereal-based, or soy protein-based commercial dog foods.

Feeding a combination of dry and canned food together may be a way to lower the chances of GDV. I insist: “may be a way.” There are no guarantees here, only ways to try to lower the chances.

Also, foods with fat listed among the main 4 ingredients have been shown to increase the risk of GDV. So please look at the list of ingredients on your dog food.

Dobies and German shepherds are at-risk breeds

7. Water

It is recommended to avoid drinking large amounts of water before and after exercise.

Ironically, too little water before and during meals may increase the chance of a dog suffering from GDV! A recurring “hot story” about ice water causing GDV regularly shows up online and appears to be a complete hoax.

8. Exercise

A fairly classic recommendation to reduce the risk of stomach torsion is to avoid heavy exercise 1 hour before and 2 hours after eating a meal. The idea is that it’s easier for a stomach to twist when it’s full compared to when it’s (partially) empty.

9. Age

Even though I always say, “age is not a disease,” age can play a role in a dog’s risk for stomach torsion.

In Great Danes specifically, age is a very important risk factor for GDV.

One of the reasons may be the stretched ligaments, over time, as mentioned above.

10. Other risk factors

There are countless other risk factors that are unproven, controversial, or contradicting.

. For example, some studies show that a raised bowl is better to decrease aerophagia (aka swallowing air), while others imply a bowl on the floor is ideal.

. The at-risk gender varies from study to study.

. The month, the cycle of the moon, and a previous spleen removal are also fuzzy risk factors.

  • Gastropexy

This last point is not a risk factor – on the opposite, but it’s important to mention here.

A gastropexy, or tacking the stomach to the inside of the belly, is a simple surgery that can prevent twisting of the stomach. In good hands, it’s successful over 95% of the time.

Importantly, it prevents twisting of the stomach, not true “bloating” – aka the stomach getting full of air – we don’t know how to prevent that and it remains a risk for life.

Classic belly X-ray showing Gastric Dilatation only, with 1 giant gas bubble in the stomach

The gastropexy or “pexy” in short is part of the surgery to treat GDV. But it can also be done preventively, or prophylactically. So it’s called a prophylactic gastropexy.

For example, Great Danes have a 40 % chance of having GDV in their lifetime. Ideally, this life-saving surgery should be performed at the time of the dog’s spay or neuter – or as soon as possible after that. Of course, it’s never too late to prophylactically pexy a dog… until they have an episode of GDV.

Please beware, the next picture of a gastropexy can seem graphic to some readers.

I have helped a number of pet owners perform gastropexies over the years. Some were wise to do it before GDV happens in their at-risk dog. Some learned the hard way (i.e. their dog got a twisted stomach, and that’s how they learned about the pexy option).


Either way, it can be done as a “stand alone” surgery, or at the time of a spay or neuter.

To recap, we know a lot about the risk factors of GDV. Be aware of them, and prevent those you can control. You could very well save your dog’s life.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Dr. Phil Zeltzman

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!

Should you wait to get help for your pet?

Your pet is vomiting. Should you wait to go to the vet?

Your pet is limping. Should you wait to seek help?

Your pet has a mass. Should you wait to have it looked at?

These are common dilemmas, and the answer is… it depends!

Let’s keep our 3 examples.

. Many pets vomit every once in a while, and they are perfectly healthy otherwise.

Other times, repeated vomiting is a sign that something is brewing inside. And it could be anything: stomach problems, intestinal conditions, kidney disease, cancer etc.

. Some pets limp because of a sprain and get over it by the next day, just like a human.

Other times, ongoing limping is a sign of a problem: elbow arthritis, hip dysplasia or the most common cause of limping: a torn ACL.

. Many pets have skin masses. Most masses can only do one thing: get bigger. Very rarely does a mass get smaller. It would defy science: as cells divide, which they are genetically programmed to do, the mass gets bigger. It can be slow or it can be fast, but they usually get bigger over time. The only way to objectively know what is going on is to measure it.

So what’s a pet lover to do?

Should you keep an eye on it?

For a short while, possibly.

Waiting any longer is rarely a good idea.

. Repeated vomiting can lead to dehydration and electrolytes imbalances.

. An untreated joint problem invariably leads to arthritis, which can only get worse over time.

. A small mass is easier, less invasive and cheaper to remove than a large mass. This translates to longer anesthesia, higher surgery fees and higher chances of complications.

Occasionally, you will be a bit early and it’s a false alarm.

Most times, you will be right and acting early will save you time, money and frustration while avoiding pain for your pet.

At the very least, call your vet to ask questions. Many vets now offer telemedicine consultations, which means you don’t even have to take your pet to the vet. You can get advice from the comfort of your home.

Just keep in mind that vomiting may require X-rays or an ultrasound, limping may require X-rays and a mass may require lab testing.

Either way, don’t procrastinate, it rarely leads to good results.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Dr. Phil Zeltzman

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!

What is a TRUE emergency?

When should you rush to your family vet? When should you go to the emergency clinic? When is it safe to wait until the next day?

Here is a list of 13 true emergencies that require immediate vet care, day or night, week day or week end*.

  1. Severe bleeding or bleeding that doesn’t stop within 5 minutes.
  2. Choking, difficulty breathing or nonstop coughing and gagging.
  3. Bleeding from nose, mouth or rectum; coughing up blood; blood in urine.
  4. Inability to urinate or defecate, or obvious pain or straining while eliminating.
  5. Injuries to an eye.
  6. Your pet ate or drank something poisonous (antifreeze, xylitol, chocolate, rat poison etc.).
  7. Seizures and/or staggering and/or paralysis.
  8. Fractured bones or severe lameness.
  9. Obvious signs of pain or extreme anxiety.
  10. Heat stress or heatstroke.
  11. Severe vomiting or diarrhea – more than two episodes in a 24-hour period, or either of these combined with obvious illness or any of the other problems listed here.
  12. Refusal to drink for 24 hours or more.
  13. Unconsciousness.

The bottom line is that ANY concern about your pet’s health warrants, at a minimum, a call to your family vet.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

* This list was compiled by the American Veterinary Medical Association.

Dr. Phil Zeltzman

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!

What you need to know about “bloat”

A surprising number of pet lovers have dogs at risk for “bloat”, yet they don’t know much about the condition.

If you own a dog at risk, it is very important for you to know about it.

What is GDV?

Bloat is a life-threatening condition with many synonyms, including twisted stomach, gastric dilatation and gastric torsion. The medical expression is Gastric Dilatation Volvulus (GDV), which is what vets typically call it.

In this condition, a dog’s stomach distends with air to dramatic proportions (see X-ray). This is called gastric dilatation (GD). An X-ray of the belly would show a “single bubble”, which means that the stomach contains air in a single “pocket”.

A classic example of the “single bubble” of GD in a German Shepherd. The arrows show the size of the stomach

The stomach can also twist onto itself, cutting off blood supply to the stomach and other major organs. It also blocks the exit of air and stomach contents. This is called Gastric Dilatation Volvulus (GDV). An X-ray of the belly would show a “double bubble”, which means that the stomach contains air in 2 separate “pockets”.

A classic example of the “double bubble” of GDV

Obvious signs of GDV include a huge (bloated) belly and “retching”, which means unsuccessful attempts at vomiting.

Less obvious signs of GDV include pacing, salivating, restlessness, inability to lie down, a distressed attitude, rapid breathing, and pale gums.

What causes GDV?

There are many risk factors. Some are questionable if not plain ridiculous. Here are a few scientifically proven causes of GDV.

* Large and giant breeds are at higher risk for developing GDV. Breeds such as Great Danes (the number 1 breed), Mastiffs, German Shepherds, Old English Sheepdogs, Weimaraners, and St. Bernards are all at risk but it also occurs in smaller breeds like Boxers, Basset Hounds and Standard Poodles.

* The disease is related to the dog’s body conformation, i.e. his or her shape. Deep chested dogs are more likely to have GDV. This picture of a Great Dane is a great example of what we mean by deep chest.

* Developing GDV can also be partially genetic: a dog related to a dog who suffered from GDV is at a 20% higher risk.

* Stressful situations or environments can contribute to GDV. We know that dogs who are boarded can bloat, possibly from being stressed out. The same applies to storm and fireworks.

* Food and water intake have been a commonly heard cause of GDV. Rapid eating, once daily feeding, and the type of food given can all be a factor in GDV risk. Too much water prior to vigorous exercise or prior to/during meals are believed to play a role in the development of GDV.

* Age can play a role in GDV. As dogs age, they experience some changes in their abdominal cavity (e.g. stretching of ligaments of the stomach), which can increase their risk.

Prevention

While scary and life-threatening, the twisting of the stomach can be prevented with surgery. Dogs at a higher risk for suffering from GDV can have a preventive surgery called a prophylactic gastropexy, or “pexy” for short.

This surgery entails stitching the stomach to the inside of the belly. When performed by someone experienced, it dramatically decreases the risk of the stomach twisting. This simple procedure can be done at the same time as a spay or a neuter.

The picture below shows the end result of a prophylactic gastropexy after a recent patient of mine, Zeke, a 1 year old German Shepherd, was neutered.

Very importantly, the dog can still “bloat” (a terrible, very misleading name) after a prophylactic gastropexy. It’s meant to prevent the twisting, not the “bloating.”

Should it happen, the dog must be rushed to the closest vet or ER to pass a tube into the stomach to remove the air, followed by stabilization with IV fluids etc.

Treatment

If a dog’s stomach has distended and twisted, surgery entails:

. Removing the air from the stomach ASAP.

. Repositioning the twisted stomach in its natural position.

. Performing a gastropexy (see above).

. Assessing the spleen, which can be damaged and may need to be removed.

. Looking at every organ in the belly to make sure nothing else needs to be addressed (“exploratory laparotomy”).

For additional information about Gastric Dilatation-Volvulus, follow this link to read a more in-depth article I wrote for veterinarians:

www.veterinarypracticenews.com/what-causes-gastric-dilatation-volvulus

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Dr. Phil Zeltzman

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!