Grumbling GDV?

Re: Grumbling GDV?

Busybee — Wed, 15 Aug 2012 19:08:51 GMT

[quote user="David Mills"]If you've the ability to measure blood lactate[/quote]

unfortunately not

[quote user="David Mills"]I've seen 4[/quote]

I've seen 3 and only been graduated 2 years! One operated on successfully (very chuffed with that one, didn't present classically but I was very suspicious and hey-presto!), two PTS on presentation due to old age and costs.

[quote user="katie mountford"]WIth regards to the intial post-it is really frustrating that these cases get PTS d/t costs but in an older dog then I can kind of see the owners point! I had a frustrating GDV recently in a one year old Great Dane which was PTS due to finances[/quote]

I can definitely see the owner's point, don't worry, I'm just being greedy and want to get more experience The Great Dane puppy case sounds very frustrating indeed! The three I've seen were an English Setter and Akita-crossy thing and this GSD.

Re: Grumbling GDV?

katie mountford — Wed, 15 Aug 2012 02:41:33 GMT

I think the most recent evidence is that serial lacate measurements are of more use as prognostic indicators than a single measurement. So if the dog has an high initial lactate which reduces with appropriate (ie shock boluses) of fluids I'd be less worried than one which stays elevated or contines to rise after fluid therapy. I think there is some correlation between high serial lactates and gastric necrosis (not sure which study I read it in but its in my brain from somewhere!)

WIth regards to the intial post-it is really frustrating that these cases get PTS d/t costs but in an older dog then I can kind of see the owners point! I had a frustrating GDV recently in a one year old Great Dane which was PTS due to finances. The galling thing was the dog was insured( but with one of the E&L spin-offs) and only had a limit of £1000-despite the owners having had a GDV with a previous great dane (and you'd think being more aware of the costs!)

Re: Grumbling GDV?

David Mills — Tue, 14 Aug 2012 23:57:04 GMT

[quote user="Busybee"]

[quote user="Martin Atkinson"] your X-ray presumably only confirmed bloat not an actual twist[/quote]

I beg to differ - the x-ray clearly showed a 'double bubble' image of the stomach, with the pylorus displaced and the spleen was visible alongside the stomach with the head ventrally and the tail dorsally. I was always told that this image was pathognomonic for a GDV and required opening up.

[/quote]

Yes, certainly is. The old smurf sign.

I see the frustration with not being allowed to operate in these cases, but, done right, they cost quite a wedge of money and the outcome - as far as evidence suggests - is not guaranteed so the owner is rightly worried about cost (secretly or otherwise). Sadly, prognosis depends to a very large extent on surgery time too - longer than an hour and things start to look a bit poor; it's a catch-22 and referral isn't an option. If you've the ability to measure blood lactate then this can be a very sensitive indicator of prognosis - I think the cut-off is around 6 (higher = v poor prognosis) - and therefore client can be guided. A hell of a lot depends on early owner detection - I've seen 4, 1 lived because it was brought in within the hour, other three PTS on table. I think it's all well having a go, but owners are far more likely to drag their feet re money if there's a dead dog at the end of it (we're a charity so doesn't apply as much of course.

Re: Grumbling GDV?

Busybee — Tue, 14 Aug 2012 22:26:21 GMT

[quote user="Martin Atkinson"] your X-ray presumably only confirmed bloat not an actual twist[/quote]

Re: Grumbling GDV?

Martin Atkinson — Tue, 14 Aug 2012 12:49:01 GMT

I've had one recently which had a bloat/dilatation and similar symptoms for 24 hrs which I couldn't stomach tube and on ex lap the stomach wasn't actually twisted, the tube went in when it was on its back and emptied gallons of water and noxious gases. I wondered if it had righted itself when I tipped it so I did a gastropexy anyway (spleen already previously removed for benign haematoma). Had a repeat performance a month later, this time found a leiomyoma at the pyloric sphincter, performed a debulking and left it to heal like a pyloric stenosis op (if this is familiar I've already posted this on another thread). Dog has recovered and is so far still doing well. This is not the first bloat I've seen which didn't have a GDV and your X-ray presumably only confirmed bloat not an actual twist. So in answer to your case in the OP a) yes they can twist after the bloat and b) it may not have been a true GDV anyway.

Re: Grumbling GDV?

Michael Woodhouse — Tue, 14 Aug 2012 00:39:42 GMT

Sometimes it is a real shame when people chose PTS over treatment.

Have you spoken to your bosses if they would let you do any sort of arrangement in these cases. I had very good employers who were happy doing '£100 for consumables' if things go wrong. I remember about a year qualified removing a splenic tumour the size of a football, weighing over 4kg on one of these deals. The dog did very well and lived three years (was put down for arthritis).