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!

4 things you should never say or hear about lumps

Removing skin masses is one of my most common surgeries.

Some skin masses are small. Some are in difficult locations, making the surgery tricky. Some are gigantic. Many were claimed to be “impossible to remove” – yet we still removed them. Some were supposed to be cancerous – and were benign. Some were supposed to be benign – and were cancerous. Yet others were indeed impossible to remove and required leg amputation.

What’s a pet lover to do? What is the right thing to do?

The problem with small skin masses is that they can be very misleading. I have come across multiple tiny masses, sometimes the size of a grain of rice, that were aggressive cancers.

Here is an example of a 1/3 inch mass, barely visible, hard to feel, under a cat’s fur. By some miracle, his owner found the mass and wisely decided to have it removed.

The biopsy revealed a fibrosarcoma, which is a notoriously aggressive cancer in cats.

Here are the 4 things you should never say or hear about lumps:

. “Just watch it.”

. “Keep an eye on it.”

. “It’s just a cyst.”

. “It’s just a fatty tumor.”

“Just watching” a mass grow bigger and bigger, or “keeping an eye” on a mass that keeps getting larger and larger, is exactly how we end up with masses the size of pumpkins.

By then, surgery is much more invasive, anesthesia is much longer, and the fees are much higher.

The “cyst” myth is just as unfortunate. A cyst is an actual diagnosis. It’s typically a benign mass that is usually filled with fluid. There are different types of cysts: follicular or epidermoid cysts, sebaceous cysts, dermoid cysts etc.

But the vast majority of so-called “cysts” I remove are not cysts. It was an assumption by the pet owner. “Cyst” is often used instead of “mass” or “tumor,” and it’s misleading at best.

“It’s just a fatty tumor” is something else I hear all the time. If someone tells you that, you should have a reasonable degree of doubt. NOBODY can assure you with 100% certainty that they know the diagnosis of a mass with further testing.

Why? Because I have never met anybody with microscopic vision.

You can only say what a mass is after testing it.

Case in point: a mast cell tumor is a very common skin tumor. It is nicknamed “the great imitator” because it can feel like anything – including a benign fatty tumor. As you can imagine, mistaking a benign tumor for a cancerous one can lead to really frustrating situations.

2 tests for skin masses:
There are 2 ways to test a mass.

1. A needle test:
During a needle test or Fine Needle Aspirate (or FNA), a needle is placed in the mass. Some cells are taken out and placed on a glass slide. It is then read under the microscope.
It can either be read “in house,” meaning by your vet, or ideally it is sent out to a pathologist, who reads the cytology (ie the study of cells).
My personal impression is that although cytology is cheaper and faster (a few days), it can provide misleading results.

2. A biopsy:
A biopsy is a way to take a sample of the mass, ie some actual tissue, and not just cells. Being able to study the cells’ architecture, organization and relationship provides completely different information and a much safer diagnosis.
The biopsy is always sent to a pathologist, who reads the histo-pathology (ie the study of abnormal tissue).
My personal impression is that although a biopsy cytology is more expensive and take longer to read (7-10 days), it provides the most reliable results.

So what’s a loving pet owner to do?

At a minimum, skin masses should get tested via a needle test. Occasionally, they should be biopsied before surgery. Ideally, they should be removed and biopsied. Admittedly, it can get expensive since some dogs seem to be covered in masses, sometimes benign fatty masses. That’s where pet insurance is so helpful.

Here is an example of a giant mass in a Lab, whose owner was told to “just watch it” because it was tested as a benign fatty tumor.

So why bother if a mass is benign?

Benign doesn’t mean you should ignore it.

I have removed benign masses that were the size of a tennis ball, or a grapefruit, that prevented the patient from walking normally. I have removed benign masses that required leg amputation. And I have removed benign masses that were the size of a pumpkin that caused pain (by stretching the skin) and made the patients lose their balance.

If you find yourself in a situation where your vet seems to be brushing something off that genuinely concerns you, you have the right to seek a second opinion and I would encourage you to do so.

Bottom line: waiting is rarely a wise option.

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!

Nino’s open chest surgery reveals a shocking finding

Nino, a sweet 11 year old pit bull, had recently developed a cough.

Initially, he was coughing from time to time. Then the coughing became more frequent. His owner took him in to see his family vet. Chest X-rays revealed a shocking finding. Nino had a mass in his left lung. Statistically speaking, this was very likely to be cancer.

X-ray from side
X-ray from the front

The X-rays above show the heart and the mass (with a broken line around it to show it better).

Nino’s owner says: “We were in disbelief and shock. He has always been a very active dog.”

The vet recommended an ultrasound of the chest to collect more information regarding the mass. According to the ultrasound, it measured about 8 by 9 cm (3 by 4 inches), so roughly about the size of your fist.

The client continues: “We immediately left in search of a surgeon’s opinion as we knew this would be a dangerous and heavy procedure.”

“By searching for recommended pet surgeons in Pennsylvania, we found your name and website, along with previous stories and reviews.”

Nino’s owner reached out to me to discuss surgery (lung lobectomy). Could this mass be removed?

Nino’s owner said: “After several consultations with you, we were hopeful but never more terrified. The level of risk explained was almost too much to handle for any loving pet parent. There was no choice other than to perform the surgery. You get a small sense of hope when you know you’re doing the only thing possible to help him. But the doom and gloom prevail. We dreaded the surgery date until it finally came.”

We worked quickly to get Nino’s surgery on our schedule.

FAIR WARNING: THE FOLLOWING PICTURES ARE GRAPHIC.

Once we got into surgery, there was one tiny little problem: the mass was much larger than the ultrasound suggested!

It was about 15 cm (or 6 inches) in diameter, or about the size of a large grapefruit!

REMINDER: THE FOLLOWING PICTURES ARE NOT FOR THE FAINT OF HEART.

Nino’s owner and I had made a deal before surgery. If anything was different from what we thought, or if the risk was higher than expected, I would call him to brainstorm.

Of course, I kept my promise. We talked in the middle of the open-chest surgery to discuss my findings. I said I was 90% sure I could remove the mass safely. The owner was committed to doing what was best for Nino, so he gave the OK to continue on with surgery.

We went back to surgery. I will spare my sensitive readers of the details of the surgery, obviously it was somewhat delicate…

Meanwhile, the emotional roller coaster goes on: “Once we got your call that we could have a successful outcome with a 90% “belief,” we were extremely excited. A huge weight felt like it was lifted, even though the hard work hadn’t started yet. We continued to do nothing but pray and try to be positive through what will always be one the worst times of our lives yet.”

In order to remove the entire mass, it appeared that we would have to sacrifice the entire left lung, not just the one lobe as planned (removing a whole lung is called a pneumonectomy). In the end, the tumor was removed – safely. Pfew! Mission accomplished.

(Quick crash course in anatomy if this makes no sense. We have 2 lungs, left and right. Each one is made of several parts or “lung lobes”. So instead of removing just the lobe with the mass, we removed all lobes on the left, i.e. the entire left lung. The right lung of course stayed in place.)

FINAL WARNING: THE NEXT PICTURE IS VERY GRAPHIC !!!

Once the left lung was removed, we needed a way to remove air and fluid from that side of the chest. This is done with a device called a chest tube. It usually only stays in place for a few days after surgery, and can be removed once there is no more air and not too much fluid left.

Nino recovered from surgery and anesthesia smoothly.

That’s when I called the owner again to confirm that surgery was over and Nino was safe – for now.

He later commented: “The news that the mass was removed and he was in recovery was simply a miracle. Nothing else compares to that feeling. Never been more thankful in my life.”

Nino was transferred to the local emergency clinic for overnight care, so the nurses could monitor Nino’s comfort and breathing, and take care of the chest tube.

Nino did so well overnight, that the chest tube was removed the very next day. He was discharged shortly after that. He recovered uneventfully at home.

The next day, his owner sent this amazing update: “He’s been resting and taking all medications without issue. We’ve had no whining/crying at all, and his appetite is great.”

In addition: “Nino has not coughed once. He hasn’t moved much either, but he used to cough just sitting there. So that’s great!

We love having him back home. Nothing is better. And we were so glad to get him back sooner than expected.

His breathing also seems to be much smoother and normal paced.”

About a week later, the biopsy results came back and confirmed the suspicion of lung cancer (pulmonary carcinoma).

Two weeks after surgery, another great update: “Nino is still doing great. He is eating, drinking and relieving himself regularly with no issue. (…)

He has more energy and strength than expected, so our biggest battle lately is keeping him from running or playing.

His breathing seems to be slower and more controlled than it was before his surgery and he seems more comfortable in general. We have had a couple random coughs but nothing alarming.”

In case you’re wondering: dogs, like people, can live with only one lung. Nino may not be able to run a marathon, but this amazing 11 year old trooper should be able to live a happy, comfortable life as a family pet.

As of this writing, it’s been over 2 months since surgery and the patient is doing well.

Nino’s super dedicated owner concludes: “Thanks to you and your team, we have a second shot at life. This has been a nightmare since our first visit with our vet. I had never been so scared of something and so scared of trusting anyone. You and your team saved our dog’s life. There has been no greater moment in our lives.”

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!

Even dinosaurs got cancer!

We regularly talk about cancer in this blog.

And we’ve talked about one aggressive type that can affect dogs (and people) (and rarely cats): bone cancer, aka osteosarcoma.

For the first time ever, scientists just discovered that even dinosaurs got cancer!

The dinosaur in question is a Centrosaurus.

Centrosaurus was a lovely plant-eating “horned dinosaur” that stood 18 foot tall (almost 6 meters) around 76 million years ago.

Scientists from the Royal Tyrrell Museum of Paleontology (Alberta, Canada) discovered the bone with cancer in a pile of bones in Dinosaur Provincial Park in Alberta. The dinosaurs may have died in a flash flood.

The bone in question is a fibula, the small bone along the tibia or shin bone (and the sharp bone in a chicken leg or drumstick). The scientists confirmed the type of cancer via CT scans and under the microscope. The findings were published in the medical journal The Lancet.

© Royal Ontario Museum

Why should we care? It’s very interesting from an evolution standpoint. It means that cancer existed when dinosaurs lived, well before mammals and reptiles became two different animals.

Royal Ontario Museum paleontologist David Evans told Smithsonian writer Riley Black: “Dinosaurs can seem like mythical creatures, but they were living, breathing animals that suffered through horrible injuries and diseases. This discovery certainly makes them more real and helps bring them to 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!

Top 10 Reasons To Neuter Your Pet

Clearly today’s topic is sensitive and it will ruffle some feathers… but please hold the hate mail.

It never ceases to amaze me the number of cats and dogs who end up on my surgery table because they were not neutered. Many end up hit by a car. Many end up with a specific type of hernia (more below).

Then there are all the non-surgical reasons, starting with behavior problems.

Are you wondering whether you should neuter your cat or your dog? Here is a non-exhaustive list of 10 reasons to do it.

1. Unwanted pregnancies

Ah… Love at first sight… It’s really difficult for an intact male to resist a female in heat! An intact male classically runs away and can follow the smell of a pretty female in heat located miles away. And keep in mind that one single incident can lead to 4, 8 or 10 puppies or kittens!

Incidentally, you may be liable if your male procreates with somebody’s prized female. Suddenly, the miracle of life has a bittersweet taste, doesn’t it?

2. Pet overpopulation

Meanwhile, 3 to 4 million of unwanted pets are euthanized each year. What a tragedy… This is called “pet overpopulation”.

Many of these deaths could have been avoided by neutering males (and spaying females).

So sterilizing your pet ultimately makes the world a better place.

3. Behavior

Unneutered pets have all kinds of behavioral problems. In male dogs, the most common behavior is an aggressive temper. Of course, there are many intact pets who are perfectly sweet. Neutering, when done early in life, can reduce aggressiveness and improve behavior overall. For example, it decreases the always-awkward “mounting” behavior in dogs.

4. Marking

Few things smell worse than intact male cat urine. Some people make their indoor cat an outdoor cat when they can’t tolerate the smell anymore. This increases the risk of being hit by a car or getting into a fight. Neutering, when done early enough in life, virtually eliminates the odor of male cat urine and should prevent marking in male dogs.

5. Roaming and getting in trouble

Pets are rarely taught how to cross the street safely. So when they roam, searching for trouble or looking for a partner, they might get hit by a car.

In fact, many pets I treat for a fracture are intact. Neutering reduces the urge to roam or run away from home.

In addition, neutering decreases the risk of getting into a fight, especially in tom cats. They commonly get nasty abscesses from these fights.

Family and emergency vets regularly see wounds from dog bites, and I assure you that it’s rarely pretty. I’ve seen many dogs die after getting attacked by another dog.

6. Roaming and getting lost

Every year, millions of pets get lost. Some are returned to their owner. Most are not. To decrease the risk of such a tragedy happening in your family, neuter your pet, pet-proof the fence in your backyard and always keep your pet on a leash during walks.

In addition, talk to your vet about the benefits of tattoos and microchips.

7. Prostate disease

Intact male dogs can have a number of diseases of the prostate including cysts, abscesses and enlargement. The latter is called “benign prostatic hyperplasia,” just as in older men. Neutering (of dogs!) prevents these problems.

8. Perineal hernia

A perineal hernia is a fixable but annoying problem mostly seen in intact male dogs. Organs from the belly can slip or herniate through weakened muscles in the pelvis. The consequence is a bulge on one or both sides of the anus. The hernia can contain fat, fluid or even the bladder. These hernias frequently cause constipation.

This condition is believed to be due to testosterone (from the testicles). Neutering dramatically reduces the risk of these hernias.

9. Testicular tumors

Neutering eliminates the risk of testicular cancer. This condition, mostly seen in intact male dogs, is believed to be due to testosterone (from the testicles). It’s simple, really: no testicles, no testicular cancer.

One more reason to neuter is when a male is cryptorchid, i.e. when a testicle does not come down and remains in the belly. The testicle left in the belly has a much higher risk of becoming cancerous. So this may require 2 surgeries: 1 to remove the “outside” testicle, and 1 in the belly to find and remove the other one. Occasionally, both testicles are in the abdomen.

10. Genetics

Yet another reason to neuter is to prevent spreading bad genes. Pets with hip dysplasia, eye diseases, heart conditions and many other genetic conditions should not be allowed to breed.

It seems, however, that neutering does not decrease, and in fact may increase, the risk of prostate cancer. Luckily, this is a very rare tumor. Therefore, the combined benefits of neutering vastly outweigh the risk of prostate cancer as you can see from this top 10 list.

The next controversy is when to neuter your pet. Again, hold the hate mail: most reasonable vets recommend neutering at 6 months of age.

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!