Do you have a large or giant breed dog? Then you should know that bloat (aka, gastric dilatation-volvulus) is a surgical emergency worthy of any gut-wrenching Emergency Vets episode.

Great Danes, Wolfhounds, German shepherds, Dobermans, Labs and other deep-chested large breeds (including mixed breeds with similar proportions) are especially at risk due to loose gastric ligaments that allow a stomach to twist when filled with excess gas, thereby cutting off it’s formidable blood supply and progressing quickly to stomach tissue death and its hard-core, systemic consequences.

It’s a nasty business and an every-minute-counts kind of emergency. If you’re one of my big dog clients and you call me up with a case of non-productive retching and a big abdomen, you’ll hear the urgency in my voice (or the staff’s): “You’d better come in right now!”

I hate these cases. They’re both deadly and expensive to treat. So owners often hesitate when presented with a sliding scale of fair to poor odds, which depends on the dog’s age, presenting condition and level of care. Because they inevitably end in surgery, it’s rare to expect recovery for less than a grand or two at a general practice and two to four thousand at the specialty hospital (where odds of survival increase, generally in proportion to the greater expense).

Every big dog owner should know the protocol: At the first sign of distress (pacing, retching, lethargy and/or abdominal distension) get in the car with your dog and drive to the your vet or the closest emergency or specialty hospital. In most cases you’ll need to be rushed in, so call ahead to give a heads up to the staff. Here’s the protocol:

First up, lots of fluids—two large, bore catheters are best to dump fluids into the collapsing circulatory system. Next, an X-ray to see if the stomach is indeed the cause. A big plastic tube is then pushed through the mouth and, hopefully, past the clenched-tight spot where it’s twisted.

If we can’t get past the too-tight twist, we use a big needle called a trocar to punch a hole into the stomach through the skin. This gets the gas out, loosening the twist and restoring some blood flow to the area—but it has its dangers, too. Sometimes it’s better to go straight to surgery.

In my career, I’ve done this dozens of times. Still, nothing prepares vets and their staff for these scenarios—they all play out differently. An awed owner (amazed and confused by our efforts), a dying dog and aggressively ugly techniques attempted in record time. It’s no wonder I dread the famed bloat.

Worse yet, sometimes the twist is so awful that the nearby speen is squelched, too. Emergency surgery relieves the twists, but afterwards, rapid release of the body’s own toxins, sometimes initiating deadly cardiac rhythms that require their own special treatment.

We GP’s see these cases far less often than our emergency vet counterparts. Because bloat often results after big, nighttime dinners and a casual romp in the backyard, they tend to occur after hours. So e-vets are much more adept at handling these cases. Still, there’s no vet I know who hasn’t handled a horrorshow bloat during daylight hours.

Most owners, after the fact, want to know how they could have prevented it. Since giant breed dogs are so predisposed, I sometimes offer to “tack” the stomach to the body’s wall (so it can’t twist when gas-filled) during other routine abdominal procedures such as spays and, though less routine, bladder surgeries as well. Some vets forget to ask. Unfortunately, it’s up to many owners to worry about these things and request them. 

Twice daily feedings for these big guys are another regular recommendation. Although we’re still not sure of all the factors involved, big meals and post-meal exercise are common to too many cases, so we advise against these practices.

A bloat, though relatively common to vets, isn’t so common to owners. Only knowledgeable breeders and well-educated, experienced pet owners seem to be in-the-know. Here’s a perfect example:

Yesterday, I saw a client who made an unusual appointment to discuss her large-breed dog’s sudden death. Although she carried in two bags of dog food, wondering whether they might have been the cause, the signs were obvious: She’d found her dog in the last throes of a bloat, dying on her patio when she came home from work. The abdominal distension and puddles of retched-up saliva surrounding him were unmistakable. She had no idea what a bloat was and it took some convincing for me to get her off the topic of the foods.

Still, I can’t say for sure it wasn’t a toxin, especially since he’d been acting abnormally for the preceding week. Though her foods weren’t on today’s updated list, I’ll send out samples of the food on Monday to confirm they weren’t the source.

Bloat happens suddenly and ferociously. I wish I could say there was any way to prevent it with 100% certainty, but all dogs are potentially at risk (though rarely the barrel-chested, smaller canines, such as beagles and Frenchies). Your best bet? Know your dog and watch him. Tack your giant breed. Feed any big dog twice daily. Beyond that, it’s the surgeon’s nightmare…and your own, should you ever find yourself in this unenviable position.