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Friday, February 4, 2011

Preventing Bloat

Stefanie asked a good question...

What is the recommendation for feeding and exercising a dog - especially for deep-chested breeds that are prone to bloat? Is it better to walk a dog first thing in the morning and then wait and hour and feed him/her or feed first, wait an hour and then exercise? 

This is a condition that I have personal experience with.  When I was 16 we had a German shepherd that had to be euthanized because he developed bloat.  We had gotten him when I was three years old, so it was hard for me as that was my friend as I grew up.

For those who aren't aware, let me describe what is commonly called "bloat" in dogs.  The proper medical name is gastric dilatation and volvulus, or GDV. In this condition the stomach twists, either rotating along it's axis or flipping 180 degrees.  In either case, the inflow and outflow of the stomach are closed off resulting in gasses building up inside the stomach.  This can cause difficulty breathing as the stomach balloons against the diaphragm, but more importantly pressure against the wall of the stomach can cut off the blood supply and lead to a rupture.  As can be imagined, this is a critical condition and dogs can die quickly once it begins.

Dogs that bloat most commonly act and look like they swallowed a large beach ball.  Their abdomen becomes large and tense, their gums can become pale, they will become suddenly lethargic, and will usually act like they are gagging or retching.   If you see your dog act like this with a bloated belly, consider this a life-or-death emergency and see a vet immediately.

Though this can theoretically happen in any dog, there are definitely certain breeds that are more prone to GDV. These breeds include English bulldogs, Weimaraners, Rottweilers, German shepherds, Great Danes, and any other large, deep-chested breed.  Though it seems like it's a genetic breed tendency, it's really more a factor of the anatomy of these breeds based on their size and shape.  Studies have looked at how to prevent it, and there is really only one thing that has been shown to significantly increase the risk--exercise after filling the stomach with food or water.  So take a dog of the right size and breed, fill their stomach with food or water, then let them run around a lot.  That's a formula for bloat.

Here are precautions to take to help prevent this deadly condition:
*  Wait at least one hour after eating or drinking before allowing exercise.  This is the main factor shown to prevent bloat.
*  Don't encourage your dog to roll over.  Though a low risk, the twisting action has been shown to lead to bloat.  In fact, some veterinarians do not rotate a dog over their back while anesthetized due to this risk.
*  Feed 2-3 meals during the day rather than one large meal.  However, be sure that you're taking the measured amount of daily food and dividing it into the meals rather than giving the once daily amount two or three times.
*  Don't allow excessive water drinking immediately before or after a meal.  Abnormal amounts of water have the potential to delay breakdown of food and lead to gas production.
*  DO NOT raise the food bowl.  While this was at one time thought to prevent bloat, a study in 2000 showed that this can actually increase the risk.
* Dogs who have had episodes of GDV are at risk for further occurrences.  A surgery can be performed to attach the outside lining of the stomach to the body wall (gastropexy).  While this doesn't completely prevent the stomach from rotating, it does lower the risk.  Some advocate having this surgery performed routinely on high-risk breeds, but personally I disagree.  Even in breeds that are prone to bloat most will never have this happen, and I don't think the benefits of the procedure (since it's not a guarantee that it will never happen) outweigh the risks.  Remember, this is only in cases of preventative surgery.  I certainly do think that it should be done in a dog who has bloated once since they show a personal tendency.

Stefanie, I hope this fully answers your question.  This is a horrible thing to happen, and I hope it never happens to one of your dogs.

41 comments:

  1. I have to disagree with the recommendation not to pexy. All Great Danes should be pexied (in my book). The current estimates/literature show that 1/4 Great Danes will develop a GDV. If my chances of winning the lottery were 25%, I sure as heck would play!

    Also, I think at risk breeds (Dobies, Weims, etc) that are female should definitely be pexied when they are spayed. You're already in there, why not?

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  2. I do agree that as many as 25% of Great Danes will bloat. But personally I'd rather bet on the 75% chance of them not bloating. Again, that's my personal opinion. Also, we're not dealing with spending a dollar on a lottery ticket. We're talking about surgery and all of the complications that can happen.

    Also, the incision you make for a spay is different than the one you make for a stomach surgery. Even with a relatively minor stomach surgery like a gastropexy, you'd have to extend the incision by a few inches (which is more than it may sound) and do surgery in a location pretty far from the area of a spay. All of that is going to extend your surgery time as well as take longer to close and have a longer incision. It's not as simple as "already being there" because the surgical locations are quite different.

    I think you're going to get a variety of opinions on the necessity of the surgery. Keep in mind that a gastropexy doesn't eliminate the risk of bloat, as it can happen even when the surgery has been performed correctly. It does lower the risk, but I personally don't feel that it's enough to overcome the risks inherent in a surgery like this. And in almost 14 years of general practice I've never regretted this viewpoint.

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    1. Dr. Bern, Thank you for this information. We have a 7 month old, standard poodle - a spayed female - who quite probably will weigh in the high 60's as an adult. She is very deep chested which is different from our previous poodles. Along with the deep chest, is there any genetic connection? I've thought of contacting the breeder, but would also like a professional opinion. Thank you.

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  3. As an ER veterinarian, I see the other side - the 25% that do bloat. The owners always ask me - could this have been prevented? I explain that while gastropexy doesn't always prevent a bloat, it is certainly a recommended surgery (again, in my opinion) for at risk breeds and helps prevent it from happening.

    Having done lots of pexies on bloated patients, I don't find the procedure to be particularly tricky (the pexy itself), and I can comfortably say it would probably add 15 minutes to my surgery time if I were already in for a spay (although I don't do GP, so I' probably way slower at a "normal" spay than you are).

    I agree that the surgical incision is much longer - but as they say in vet school - incisions heal side-to-side, not end to end. Length doesn't really matter.

    On that note, we can agree to disagree. I do think it should be offered to owners with at risk breeds (esp Great Danes) with everything you said explained - that the risk of GDV still exists and that it's a longer incision and surgery, etc.

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  4. Those are all good points. And I do agree that a long incision heals as quickly as a small one. But I get more concerned about total surgery time. It's interesting because I might be faster at a spay, but the pexy would probably add more than 15 minutes because I don't do as many of them.

    On a slightly different note, I think this brings up an interesting difference between specialists and generalists. ER doctors like yourself see a high concentration of the bad cases. GPs like me see the occasional bad case mixed in with the numerous good ones. So while my view may be skewed by the 1 case of bloat I see per year and the hundreds of normal patients I see weekly, yours is skewed by the weekly or monthly bloat cases you see. The real incidence is probably somewhere in the middle.

    Hmmmm. And this discussion gives me a couple of good blog topics. Coming this week!

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  5. Great points from both of you. I agree with explaining the pros and cons and letting the owner decide.

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  6. having witnessed Mr Rock J Dog go through a bloat I will now have every large breed dog I rescue pexied.

    Once a dog bloats there is such a high risk of death. Shock, toxins from blood build up, heart problems, stomach and spleen damage it is just not worth the risk for me to take with my dog. Although he may bloat again even with the stomach tacked I would rather have a better chance of saving my dog.

    It is really hard to list what can lead to bloat, for instance even with the study of elevated bowls there are some that say the data is skewed. The reason being is one of the questions asked when a dog bloated was he eating from an elevated bowl. If yes it went into the cause of bloat column. It did not take into account the dogs that eat with elevated bowls and do not bloat.

    To be on the safe side though I did take away elevated bowls.

    On another point, stress can be a big factor in bloat. On an Irish wolf hound site they did a survey and 80 percent of the bloat cases all had a stress situation being the start of bloat.

    We had a little dog yappy dog that was staying with us for a few days.
    We had to keep him seperate from Rocky but he drove Rock crazy with that yappin.

    I think the stress of all that yapping caused Rock to stress and bloat. ( of course being a bullmastiff puts him in the possible category and stress was the button)

    Has anyone ever heard of a acupressure point that causes Peristalsis? Does anyone have any experience with this?

    The acupressure point is on the hind leg. If you start at the hock, on the front of the leg (anterior) you can feel the tibia. Move your hand up the leg along the tibia’s sharp crest; what in humans would be called the shin. As your hand approaches the stifle, or the "knee" the crest becomes very pronounced and then curls around to the outside (laterally). Just inside this curve is a depression. The acupressure point is in this depression.

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  7. Thank you Dr. Bern. That did answers my question and I have to say I didn't know that raised bowls could actually contribute to bloat. Although what's the solution for a dog with severe arthritis? I was told by my vet the raised bowls help with that. Bloat sounds painful for the dog and I really hope I never have any fosters in my care that have that happen to them - but if they do at least I've been educated on what to do (seek vet help immediately!).

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  8. I've never heard of raised bowls helping with arthritis. I can imagine that if there is pain in the neck it would help not to bend the neck. But most arthritis pain is in the limb joints, and a raised bowl won't affect this at all.

    In fact, the only condition I know of where raised bowls absolutely DO help is with megaesophagus.

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    1. Can a great Dane be bred with a tack surgery and if so are there any complications ?

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    2. Can a Great Dane with a tacked stomach be bred and if so what are the complications?

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  9. These comments are a great example of great communication among colleagues! I like the productive communication! I was wondering, I have heard that wetting the dog's food (if it is a dry food) also helps prevent bloat, do you know if there are any significant studies on this or have a personal opinion, my boyfriend and I have a German Shepard. Thanks!

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  10. I just adopted a 1/2 great dane 1/2 english mastiff... what are his odds of bloat and should he not have elevated food bowls? I thought that's something Danes needed. I'm confused now.

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  11. Go back and read the blog, as it answers your questions. Deep-chested dogs are at an increased risk of bloating, but it's hard to put a specific risk number on a given dog. Also, read my comments about elevated bowls. This is NOT currently recommended, and anyone still saying this isn't aware of current research.

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  12. ... okay, I went back and read the blog again. It just said there's a study in 2000 that says food bowls shouldn't be elevated. I'd like to know why.. is there somewhere I can see the study? I'd like to take it into my vet to read. Thanks.

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  13. I don't have the study and can't point you to a link, but the idea is that an elevated food bowl causes them to swallow more air. This fills up the stomach and can lead to an increased risk of bloating. Elevating the bowl doesn't slow down the feeding or otherwise lead to a change in the conditions of bloat. In fact, the only condition that elevated food bowls has been shown to help is megaesophagus.

    This is one of these things that gets passed around but has no real proof behind it, and it's not the only one. I challenge anyone to find an original source or study that says that elevated food bowls will help. Honestly, this is anecdotal and I doubt anyone can show definitive evidence.

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  14. What can be done to prevent a reoccurance of bloat? Do you advise the use of Gas-X or any similar product? What about grains in the food? Have read it is best to avoid all foods containing grains due to the fermation in the stomach.

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  15. If bloat occurs, the best prevention is a gastropexy (tacking surgery), avoiding elevated bowls, and avoiding eating or drinking close to exercise. I haven't heard about avoiding grains, and would want to see some data. A dog's stomach contents empty in less than two hours after ingestion, which isn't typically enough time for fermentation. Gas prevention medications may help, but again I'd want to see a specialists opinion on this.

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  16. This is the first I've heard of rolling on their back increasing the risk of bloat.
    My GSD (5 year old, plexied/spayed female with no history of bloat) sleeps on her back most nights. Is this something I should discourage her from doing?
    Thank you.

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  17. I have read this whole page and find it very informative. Thank you so much. I do have some questions about bloat and Great Danes. Is there a certain age at which they become more at risk? And, do you know what the success rate of the pexy is? I have a 5 month old. Everyone I talk to tells me about Danes and bloat. I am thinking about having her stomach attached when I have her spayed.

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  18. Jessica, the issue of rolling on the back is still debatable and I've not seen a lot of evidence for it one way or the other. It is, however, one of the things that is mentioned as a potential risk factor.

    Brandon, I've not seen data on a age-related risk factor, though I do believe that adults are much more prone than puppies. I also don't know the success rate of the pexy surgery, as many of the dogs who have this done would never have bloated anyway. We also do know that dogs with a pexy can still bloat. Someone else may have hard numbers but I haven't seen them.

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  19. I have a 8 month old female with a moderate deep chest that is going to get spayed soon. I am curious what the CONS are to doing the procedure at the time of spay other than an increase in anesthesia time and a longer incision?

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  20. Those are the biggest cons. It also depends on the skill level of the surgeon. The big thing to keep in mind is that a gastropexy doesn't eliminate the risk of bloat, just reduce it.

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  21. Hello, I have a question regarding the rapidity of the stomach emptying its contents. I have had six Great Danes (2 purchased, 4 rescued) and currently have two, a Mearle male and a Mantle female. The Mearle, ironically, came from a reputable breeder and champion European blood line and he's the one that has GDV issues. The female Mantle has eaten at least five sox at separate times and, nothing. Threw them up. Anyway, the male has been "saved" once form a GDV situation, and we have rushed him to the ER at least five times from concern of developing GDV (flicking his swollen stomach and hearing that "ping" almost like an aired up rubber ball, among the other mentioned symptoms). The other night I noticed his stomach swelling again. And so I made him ingest two tablespoons of hydrogen peroxide (I know the risks of this if it is a GDV situation), it took about three to five minutes but did regurgitate the contents-and IT WAS FAR MORE THAN WHAT HE HAD BEEN FED JUST THREE HOURS PRIOR.

    He is fed twice a day and we monitor both dogs the entire time that they feed and they have no access to any other food, and are inside dogs. So I can guarantee he didn't eat anything I didn't know about.

    Short story long, the contents of his stomach I would estimate to be about 1.5 gallons in volume, and not liquid, but partially digested kibble and moist food. It all actually looked like a can of dog mash with a bit more moisture. And his last meal that day was the smaller of the two am/pm we give the dogs.

    So, what the heck could be going on with our boy? It seems to us that he exhibits extremely slow digestion based on the two to three hours mentioned above, and other similar instances. This last time it looked as if it were the entire days worth of feeding that was regurgitated.

    Any advice or feedback is greatly appreciated!

    Alan

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  22. Normal gastric emptying time is about 2 hours, though this can vary a little based on several factors. I would recommend talking to a vet about having an endoscopic exam (likely at a specialist) to see if there are any masses at the outflow area of the stomach or upper small intestine that could be delaying emptying. Abdominal ultrasound may also find this. Regardless of the finding, I would strongly recommend having his stomach tacked (gastropexy) to lower the risk of GDV happening again in the future.

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  23. Hello all. Just read everything. The other night, my 85 black lab and I were sitting after he ate and he immediately jumped up and wanted out. I took him outside and he ate anything he could find on the ground... leaves, sticks, grass, anything... I freaked out and knew something was wrong and grabbed some hydrogen peroxide and poured 2 large gulps down his throat. After that, I felt his stomach and it was as hard as a rock. About 1o minute later he threw all of it up, his food and all the leaves. I didn't feed him until the next night and he has been fine ever since. First, I have always fed him with an elevated bowl, which I didn't know was bad (stopping that now) and I was wondering, did he save his own life by knowing he needed to throw up. He also pooped out some of the leaves so I know there isn't a blockage or anything. He is a 11 year old lab and I lost my first lab to bloat when I was 10, so I am living in fear that it will happen again. I do wet his dry food also place a tennis ball in the bowl to slow his eating down. Does any of that help? Thank you.

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  24. Hard to say what caused that, and it's great that he's doing okay. Hydrogen peroxide is a good home solution that can cause a dog to vomit, however, don't do it without consulting with a vet first. If your dog swallowed a caustic chemical (such as bleach), vomiting it back up could cause more severe irritation to the esophagus. In a situation like this, call a vet and discuss the situation.

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  25. In your opinion would slow feed food bowls help to reduce the risk of bloat?

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  26. I haven't seen studies on this, but I do think it may help. Rapid eating often causes swallowing of air, which could potentially increase bloat risk.

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  27. Great information here!! I have a 4 year old female bullmastiff who thankfully (knock on wood,) has not had a bout with bloat thus far. My vet had advised on the above recommendations with the exception of the elevated feed bowl, he encouraged me to use one which I have for 3 1/2 years without incident. Question is, being that she is accustomed to eating at that level (apprx 15+ inches), could the sudden change of placement have a negative effect? Would it be advisable to lower it in degrees just as a precaution?

    Also, I don't allow her to have rawhide or any kind of bones. Many years ago I had a medium sized mix breed who bloated. At the time, I didn't know what bloat was, I just knew that he was acting like a colicing horse. So thankfully I got him to the vet immediately and he survived. The vet had told me not give him bones anymore as he believed that was what caused it. Since then, I stopped giving rawhide chews and the like. What are your general thoughts on this? In addition to the stomach twisting, does bloat occur from an impaction/obstruction as with colic? Sorry for the bombardment of questions

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  28. I don't think that a change in height would affect her much. I'm sure she'll adjust well, though making small changes may help if she's reluctant.

    I don't like bones for many other reasons, such as a high risk of broken teeth. I think that rawhides are okay in moderation as long as the dog doesn't have a sensitivity to them. But if you want to be absolutely certain, then I have no problem with not giving them. I've seen plenty of GI obstructions in my career so far, and none of them have resulted in bloat.

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  29. Thank you so much for answering all of these questions and everyone adding their own tidbits. I have a Dane pup, 14 months, and I am hearing the horror stories of bloat and it too reminds me of a colicing horse. I know for horses that walking them helps. And plenty of fluids since they cant vomit so they can pass it. But mostly walking helps. Have you heard of anything like this helping at all. Just a steady walking pace.

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  30. The digestive systems of horses and dogs are very different, and the way colic and bloat work are very different. Bloat is a torsion of the stomach, while colic involves the intestines. I've never heard of walking helping bloat, mainly because of how it is caused.

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  31. Hi my 11 year old weimaraner Max retches but doesn't bring anything up, he drinks excessive amounts of water before and after meals, he eats from an elevated bowl, I will from reading the above remove both of these and make sure he has enough water at all other time apart from 1-2 hours before and after his meals, he doesn't have a bloated stomach although he does retch, can the elevated bowl and excessive water intake be the reason

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  32. Thank you for all of the information. I have 2 Akitas. My vet, whom I love and trust, has suggested that I think about Gastropexy for my boy when she does his neuter. He is 11 months and I don't plan to do his neuter until 20-22 months (that is a whole other conversation). She does it laparoscopically. He is larger than my female and gobbles his food, where as she gently nibbles at hers. Have you seen this problem with 110-120 lb Akitas? Any advice is appreciated.

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  33. Would a female be more prone to bloat after having spay surgery? Thanks.

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  34. Not that I would imagine. Removing the reproductive organs shouldn't change the organization of the GI tract, especially the stomach.

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  35. I am looking at receiving a GSD service dog in just a couple of months and reading about bloat has me very worried. I did buy a raised food bowl which I will be taking back. I am considering asking the program I am getting him/her from about their idea on getting my SD plexied. I have a question about it though. I know the surgery doesn't necessarily prevent bloat, but will it prevent the torsion and twisting of the stomach? That seems to be the most dangerous part, preventing ways of emptying the stomach. If the surgery will prevent the twisting, it seems like it would be a very beneficial surgery because if the dog did bloat, you would be have means to empty the dogs stomach, or am I misunderstanding this?

    Another question is will my GSD be at higher risk for bloat due to the fact that it will be eating and drinking on the go sometimes, then having to walk around a lot. I am currently a college student, so there will be days that my dog will eat one of its meals and drink water on campus, then we will need to walk to our next class, etc. Will this increase it's risk?

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  36. I might seem an odd opinion to some, but if bloat is frequent in certain breeds, and breeds are basically human's interference with nature, shouldn't people consider to own different dogs such as mongrels? If knowingly breeding a "style" of dog causes what must be a painful experience, then surely that is animal cruelty.

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  37. Hi Dr. Bern, I have a 2 1/2 year old male Standard Poodle that developed bloat 9 months ago. He is deep pretty chested. His stomach was twisted and his spleen had fallen down behind the stomach. He was tacked and spleen was ok. I have been feeding him the only dry kibble I could find here where I live that does not contain citric acid as I have learned researching on bloat that it contributes to bloat. I feed him 3 to 4 times a day at smaller portions with some cooked chicken breast added for extra protein. He also gets greek yogurt, 100% Pure Organic Cold-Pressed, Unrefined Coconut Oil and pumpkin daily. BM's are good. He seems to have a slow digestion system because he has thrown up a couple of times since his bloat and both times were more than 3 to 4 hours after eating. He had mush with visible pieces of food in what he threw up. He does not seem to be getting his muscle tone or weight back on his back strap hips area. You can feel his hip bones and side bones. He is a fast eater and does eat out of a slow feed bowl. (not raised) I have read that high fat contributes to bloat so I am reluctant to feed too many extra calories, but seems like he needs more to gain that weight and muscle tone back where he is not so skinny. Could you please possibly give me some pointers on what I might do to help in that area? Blessings

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  38. RE: "A dog's stomach contents empty in less than two hours after ingestion..."

    This seemed interesting to me since I often don't see different foods in my little ones poop until 24+ hrs later!? So does that mean my mini-dachel digests too slowly? Or did his body just try to digest those steamed carrots for a while longer, didn't happen, so expelled them later?

    I try to give my dog a variety of foods (along with low-fat kibble) so as to half-mimic a species appropriate diet where they would probably not eat the same exact food every day. Plus he has seasonal allergies so I started introducing "environment" into feeding as well. Anyway that is veering away from the point so I'll continue with digestion.

    I've only been alerted to bloat recently, since my little one turned 10. He's one of the only small breeds prone to this affliction and research has shown, not as prevalent until older. Well he's been "loud farting" every once in a while, especially when anxious about something. Sometimes he sits alone, out of his bed, laying in a weird position for an hour, then comes back to us. I wonder if he's trying to deal with his gas issues as an old man or somthing. Anyway the above mentioned statement did interest me and made me wonder if I had an abnormal dog.

    Thank you for all of this information Chris, and all of the great comments from everyone! Cheers, RC

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