When I was 9 or 10 years old, my childhood cat, Mandy, used to be fond of lying on my chest when I reclined on my back. (Two things: First, I realize I’m writing on Dogster. I’m going somewhere with this, I promise. Second: No, my cat was not a stripper. She was a Burmese, and her name was short for Mandalay.) Everybody sneezes now and then, and Mandy was no exception. When she was lying on my chest, she often sneezed directly in my face.

I never got mad at Mandy, but one day my 10-year-old brain thought I might teach her a lesson. I felt the need to sneeze, and Mandy was nearby. I ran over and sneezed in her face.

The only individual who learned a lesson that day was me, and it boiled down to this: an eye for an eye makes everyone blind. Mandy jumped up and ran away, and I immediately regretted my action. From then on I let her sneeze in my face without ever again attempting to exact revenge.*

Fast forward a few decades. The other day my pal Buster, an 8-year-old Lab mix, was on his back for a tummy rub. I took note of how deep chested he is, and I felt a twinge of anxiety. Deep chested dogs are prone to bloat. As if on cue, Buster rolled over, got up, nuzzled my face with his muzzle, and then belched. His burp went straight into my nose, smelling rankly of partially digested dog food.

This time I felt no urge to chug a beer and return the favor. In fact, I felt distinctly relieved: Dogs who are good burpers are less likely to suffer from bloat.

Let’s be clear: When I say bloat I’m referring to gastric dilatation with volvulus, also known as GDV, and not to other things that cause distended abdomens in dogs. GDV is a condition in which the stomach twists into an abnormal position in the abdomen. It is one of the most severely urgent and life-threatening emergencies in the world of veterinary medicine. It is just about the worst thing that can happen to a dog.

GDV occurs when the outlet of the stomach, which normally resides on a dog’s right side, twists 180 degrees over to the left (in some severe cases the stomach can actually twist 360 degrees). This causes several problems. The entrance and exits to the stomach become occluded by the twisting in an effect similar to the kinking of a hose, and the stomach may become massively distended with gas that is naturally produced in the organ. The twisting of the stomach also impedes blood flow from the back half of the body to the heart, leading to shock. Circulation to the spleen and to parts of the stomach can be compromised, causing death of the organs.

The circulatory derangements and organ deaths that occur with GDV are incredibly severe. The pain caused by the stomach distention is extreme. Many dogs with GDV die within 12 hours unless they receive emergency treatment.

The hallmark symptoms of bloat include a distended abdomen (which is how GDV earned its colloquial name) and unsuccessful attempts to vomit followed by weakness, pale gums, and collapse. For some dogs, especially Standard Poodles (but potentially any dog), the symptoms may be more subtle: panting, restlessness, and reluctance to lie down may be all that are noticed by the owners.

The cause of bloat is somewhat nebulous. In many cases, swelling of the stomach with gas precedes torsion (twisting) of the stomach. That’s where burping comes in: Dogs, like Buster, who are good burpers are less likely to develop the devastating syndrome because burping clears gas from the stomach. Sometimes consumption of foreign material may lead to blockage of the stomach’s outlet, followed by distention with gas and subsequent torsion.

Besides poor burping ability and consumption of foriegn material, there are several additional known risk factors. Older dogs are more prone to the syndrome, most likely because the structures (called ligaments) that hold the stomach in place weaken over time. Deep chested, large breed dogs are predisposed to the syndrome, likely because those same ligaments must maintain much more strength to keep the stomach properly aligned. Labrador Retrievers, Great Danes, German Shepherds and Standard Poodles are famous for bloating, but the condition has been documented in just about every breed, including Dachshunds (a small, shallow chested dog). Dogs who have suffered stress by being boarded, groomed, or treated at veterinarians are predisposed to the condition, likely because stress causes dogs to swallow air.

Some recent studies have indicated that consuming dry kibble, eating from an elevated bowl, eating one large meal each day, eating rapidly, and restricted access to water around meal times increase rates of GDV; all of these likely can be explained by the phenomenon in which dogs’ stomachs distend before they twist. Similarly, nervous and anxious dogs (who swallow more air) are significantly more likely to suffer from GDV.

Dogs who have had their spleens removed are prone to bloat. This is probably because the spleen, which is attached to the stomach, helps hold the stomach in place. For this reason, dogs who undergo removal of their spleens should simultaneously undergo gastropexies (see below).

There are some features of bloat that leave me scratching my head. For instance, GDV almost always occurs in the evening. Dogs who spend more than five hours per day with their owners are more likely to bloat. Dogs living in the United Kingdom are predisposed to the condition.

Regardless of the cause, rapid intervention in always necessary in cases of GDV. The condition is simple for veterinarians to diagnose using X-rays. Treatment involves decompression of the stomach with a stomach tube or trochar (a needle that allows gas to pass from the stomach through the abdominal wall) or often both. Treatment for shock and pain should be followed as soon as possible by surgical intervention. Surgery is needed to replace the stomach to its proper position and to assess the stomach and spleen for damage that might require treatment. A procedure called gastropexy, in which the outlet of the stomach is tacked to the proper position, is performed during surgery to reduce the risk of recurrent gastric torsion.

The prognosis is relatively good for dogs who receive immediate veterinary attention. Sadly, the prognosis deteriorates rapidly with time in untreated dogs. Therefore, any person who notices any symptoms — even subtle ones such as panting and restlessness — of GDV in his or her dog should seek immediate veterinary attention.

I certainly hope my pal Buster never bloats. He has some things, such as his mellow disposition, going for him. Others, such as his size, deep chestedness, and tendency to scarf meals are going against him. In the end there is a certain amount of luck involved — I have known dogs with virtually all of the risk factors who never bloated, and dogs with seemingly none who did.

But while I keep my fingers crossed, Buster is welcome to burp in my face any time. Each burp makes it just a little less likely that my pal will bloat.

*Buster also has an annoying habit of sneezing in my face. No revenge or punishment has ever been exacted.

Learn more about dogs with Dogster:

• The 10 Biggest Misconceptions About Guide Dogs for the Blind
• 6 Things to Remember When You Have a Fearful Dog
• Four Things You Should Know About Your Dog’s Growl

Got a question for Dr. Barchas? Ask our vet in the comments below and you might be featured in an upcoming column. (Note that if you have an emergency situation, please see your own vet immediately!)

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