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	<title>WebCanine.com &#187; bloat</title>
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	<link>http://webcanine.com</link>
	<description>Information for People who care for Dogs</description>
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		<title>Influence of barometric pressure on GDV (bloat)</title>
		<link>http://webcanine.com/2010/influence-of-barometric-pressure-on-gdv-bloat/</link>
		<comments>http://webcanine.com/2010/influence-of-barometric-pressure-on-gdv-bloat/#comments</comments>
		<pubDate>Sun, 05 Sep 2010 21:30:19 +0000</pubDate>
		<dc:creator>mom</dc:creator>
				<category><![CDATA[Bloat (GDV)]]></category>
		<category><![CDATA[bloat]]></category>
		<category><![CDATA[gdv]]></category>

		<guid isPermaLink="false">http://webcanine.com/?p=1066</guid>
		<description><![CDATA[<p>Abstract:</p>
<p>Gastric dilatation-volvulus (GDV) is a life-threatening condition in dogs and other species in which the stomach dilates and rotates on itself. The etiology of the disease is multi-factorial, but explicit precipitating causes are unknown. This study sought to determine if there was a significant association between changes in hourly-measured temperature and/or atmospheric pressure and the occurrence <span style="color:#777"> . . . &#8594; Read More: <a href="http://webcanine.com/2010/influence-of-barometric-pressure-on-gdv-bloat/">Influence of barometric pressure on GDV (bloat)</a></span>]]></description>
			<content:encoded><![CDATA[<p><strong>Abstract:</strong></p>
<p>Gastric dilatation-volvulus (GDV) is a life-threatening condition in dogs and other species in which the stomach dilates and rotates on itself. The etiology of the disease is multi-factorial, but explicit precipitating causes are unknown. This study sought to determine if there was a significant association between changes in hourly-measured temperature and/or atmospheric pressure and the occurrence of GDV in the population of high-risk working dogs in Texas. The odds of a day being a GDV day, given certain temperature and atmospheric pressure conditions for that day or the day before, was estimated using logistic regression models. There were 57 days in which GDV(s) occurred, representing 2.60% of the days in the 6-year study period. <em>The months of November, December, and January collectively accounted for almost half (47%) of all cases</em>. Disease risk was negatively associated with daily maximum temperature. An increased risk of GDV was weakly associated with the occurrence of large hourly drops in temperature that day and of higher minimum barometric pressure that day and the day before GDV occurrence, but extreme changes were not<br />
predictive of the disease.</p>
<p><a href="http://webcanine.com/wp-content/uploads/2010/08/GDV_biometeor.pdf" target="_blank">pdf</a></p>
]]></content:encoded>
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		<title>Med-surgical treatment for bloat</title>
		<link>http://webcanine.com/2007/med-surg-treatment-for-bloat/</link>
		<comments>http://webcanine.com/2007/med-surg-treatment-for-bloat/#comments</comments>
		<pubDate>Mon, 30 Apr 2007 23:37:44 +0000</pubDate>
		<dc:creator>mom</dc:creator>
				<category><![CDATA[Bloat (GDV)]]></category>
		<category><![CDATA[bloat]]></category>
		<category><![CDATA[gdv]]></category>

		<guid isPermaLink="false">http://webcanine.com/beta/2007/med-surg-treatment-for-bloat/</guid>
		<description><![CDATA[<p>Bloat is a life-threatening, acute emergency prepare a bloat kit (google search for bloat kit to choose one), print out this article to keep in a safe place and in your car, to take to the ER vet. Know the symptoms of bloat.</p>
<p align="left">Medical and Surgical Considerations Regarding Bloat        <span style="color:#777"> . . . &#8594; Read More: <a href="http://webcanine.com/2007/med-surg-treatment-for-bloat/">Med-surgical treatment for bloat</a></span>]]></description>
			<content:encoded><![CDATA[<p>Bloat is a life-threatening, acute emergency prepare a bloat kit (google search for bloat kit to choose one), print out this article to keep in a safe place and in your car, to take to the ER vet. Know the symptoms of bloat.</p>
<p align="left"><span id="more-107"></span><strong>Medical and Surgical Considerations Regarding Bloat          Gastric Dilatation Volvulus Syndrome in the Bloodhound </strong></p>
<p align="left">Dr. John Hamil</p>
<p align="left">Of the approximately 1,300,000 dogs registered annually by the AKC only 1500 are bloodhounds. Consequently, most veterinarians will see only a few in their practice lifetime</p>
<p>This brochure is offered by the American Bloodhound Club in an attempt to educate the owners of bloodhounds about the life-threatening nature of this complex syndrome as well as to familiarize veterinarians with some of the peculiarities of our breed and a protocol which has been employed successfully in treating GDV syndrome.</p>
<p align="left"> Definition: this is an acute life-threatening condition which initiates complex cardiovascular and metabolic changes that result in high mortality following dilatation and rotation of the stomach on its long axis.</p>
<p align="left">CONCERN: Early recognition of the signs of GDV and immediate veterinary attention will greatly improve survival rate. Only if veterinary care is not accessible should the owner attempt to tube or trocarize the dog, although this may be life saving if you must travel a great distance.</p>
<p align="left">CAUSE: Unkown. Probably multifactorial. No age or sex predilection. The bloodhound&#8217;s size, deep chest, frequent ingestion of foreign material, and genetic predisposition make them common victims of this condition. GDV syndrome is seen primarily in large deep chested breeds and, although heritability has not been proven, does seem to be more prevalent in certain lines. This syndrome is often associated with ingestion of large meals and drinking water, post feeding exercise, following general anesthesia, stress (boarding, traveling, showing, breeding, trailing, etc.) ingestion of foreign bodies, and gastroenteritis with vomition.</p>
<p align="left"><strong>SIGNS: The observant owner may notice the early vague signs of restlessness, pacing, lethargy, dull, vacant or painful expression, and/or shallow respiration. Repeated measurements around the abdomen at the level of the last rib with a cloth measuring tape will demonstrate early increases in abdominal size if you are in doubt. Every owner should be able to recognize the more sever signs of unresponsiveness, unproductive retching, salivation, arched back, anterior abdominal pain, abdominal distention, abdominal tenseness, pale mucus membranes (eyes and mouth), weak pulse, blue-gray mucus membranes, weakness, inability to stand, moribund appearance, and, with endotoxic shock, red injected mucus membranes and rapid capillary refill time.</strong></p>
<p align="left">RULE OUTS: Small intestinal volvulus, splenic torsion, gastric or intestinal foreign body, intussesception, peritonitis, cardiomyopathy, or pleural effusion. Bloodhounds are predisposed to both dilated and hypertrophic cardiomyopathy. They are very likely to ingest foreign objects and seem to be susceptible to intussusception.</p>
<p align="left">DIAGNOSIS: Signalment, history, clinical signs, xray in right lateral recumbency if not in shock or after decompression, this position may show the pylorus and duodenum dorsal to the cardia.</p>
<p align="left">THERAPY: If in shock, decompress immediately by gastric tube, or if necessary, by trocharization with multiple 16-18 gauge needles at the point of greatest distention or perform temporary gastrostomy in right paracostal area, if necessary. If possible have assistants establish IV and initiate treatment for shock simultaneously. If assistant is not available, decompress first, then follow remainder of protocol.</p>
<p align="left"> If not in shock try to pass lubricated stomach tube marked at distance from nose to last rib. If unable to pass stomach tube, stand dog on rear legs and &#8220;bounce&#8221; up and down. if still unable to pass tube in sitting position, trocarize, if still unsuccessful take to surgery immediately after establishing IV and administering medication.</p>
<p align="left">* start IV LRS (50 cc/lb rapid IV infusion for first hour)</p>
<p align="left">* place IV catheter (multiple if needed for severe shock)</p>
<p align="left">* give corticosteroids (500 mg Soludelta cortef IV) for endotoxic    shock</p>
<p align="left"> * flunixin meglumine (one time 0.5 mg/lb IV) for endotoxic shock</p>
<p align="left">* gentamycin (1 mg/lb) or cephalothin sodium (10 mg/lb) in initial    fluids</p>
<p align="left"> * sodium bicarbonate (2 meq/lb in initial fluids) if suspect    metabolic acidosis</p>
<p align="left">* metoclopramide (10 mg SQ) improves gastric emptying and antiemetic</p>
<p align="left"> * ranitidine (1 mg/lb IV every 8 hours)</p>
<p align="left"> * start ECG and cardiac medications (60 mg lidocaine in initial fluids) for expected arrhythmias, give additional lidocaine as needed (1 mg/lb IV bolus)</p>
<p align="left">* pass stomach tube and lavage stomach removing all content, give coative with simethicone. Take to surgery as soon as possible, particularly if digested blood or mucosal shreds are found in stomach content.</p>
<p align="left"> Monitor intensively for cardiac complications until surgery, usually within 4-6 hours, some surgeons prefer to wait until the next day. When stable, hopefully with cardiac signs normal, perform permanent abdominal wall gastropexy. Although patient is not as critical at this time, all precautions must be taken:</p>
<p align="left"> * Add 60 mg of lidocaine to initial fluids</p>
<p align="left">* Induce anesthesia with Propofol, Numorphan, Ket/Val, etc. (no    barbiturates or nitrous oxide)</p>
<p align="left"> * Intubate and inflate cuff</p>
<p align="left">* Maintain on isoflurane or halothane 1-2 %</p>
<p align="left">* Lead 2 EKG monitoring</p>
<p align="left">* Careful on incising linea due to presence of distended stomach    or spleen</p>
<p align="left">* If markedly distended, decompress stomach with 16-18 gauge needle    and suction before trying to derotate</p>
<p align="left"> * Remember stomach usually rotates from right to left with pylorus passing ventrally to rest dorsally on left side above the cardia. Always determine position prior to derotation and be gentle, as stomach wall may be friable particularly on greater curvature near cardia. Standing on the right side of the patient in dorsal recumbency, reach across the stomach and elevate the pylorus while pushing the body of the stomach down and away from you, thereby reducing the usual clockwise rotation. If devitalized, excise and close with a 2-layer inverting pattern with 2-0 PDS. Try not to open stomach if it can be avoided.</p>
<p align="left">* have assistant pass stomach tube, empty and lavage stomach</p>
<p align="left">. * Inspect spleen for infraction or thrombosed vessels. Splenectomy    if necessary. Always ligate close to spleen.</p>
<p align="left">* Permanent abdominal wall gastropexy (Circumcostal, belt loop,    or muscle flap).</p>
<p align="left">* Inspect abdomen. Look for torsed intestinal mesenteries. Resect    if necessary.</p>
<p align="left">* Standard abdominal closure.</p>
<p align="left">* Continue cardiac monitoring post operatively until fully recovered from anesthesia. If lidocaine drip fails to control VPC&#8217;s:</p>
<p align="left">* Give 3-10 mg/lb quinidine deep IM</p>
<p align="left"> * Give 375 mg oral pronestyl every 6 hours</p>
<p align="left"> * May need 500 mg oral Procan-S-R every 8 hours If patient experiences    tachycardia with rate over 200 bpm</p>
<p align="left">* Give 1/2 mg Inderal IV and monitor return to normal rate. Can repeat as needed up to 3 mg total dose. POST-OP: * NPO for 12 hours</p>
<p align="left">* Tepid water and warm ID gruel tid for 4-5 days, should eat within 24 hours, if not suspect ileus, possibly due to intussesception.</p>
<p align="left">* Canned ID or dry ID soaked in warm water</p>
<p align="left">* 500 mg oral Keflex bid for 7 days</p>
<p align="left">* 10 mg oral cisapride bid for 3 days (same effects as metoclopramide except not antiemetic plus stimulates motility in small and large intestine)</p>
<p align="left">* Antiarrhythmic drugs as needed tapered in 7-10 days</p>
<p align="left"> * Recheck, including EKG in 7 days</p>
<p align="left">* Sutures out at 10-14 days</p>
<p align="left">PREVENTION:</p>
<p align="left">* Feed 2-4 times daily</p>
<p align="left"> * Soak dry kibble in hot water for 5-10 minutes prior to feeding</p>
<p align="left">* Limit exercise and water consumption for one hour after eating</p>
<p align="left"> * Prophylactic gastropexy if relatives have been affected (disadvantage    in trying to evaluate breeding potential)</p>
<p align="left">* Add simethicone to food<</p>
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		<title>Breed related risks for bloat</title>
		<link>http://webcanine.com/2007/breed-related-risks-for-bloat/</link>
		<comments>http://webcanine.com/2007/breed-related-risks-for-bloat/#comments</comments>
		<pubDate>Wed, 25 Apr 2007 01:31:55 +0000</pubDate>
		<dc:creator>mom</dc:creator>
				<category><![CDATA[Bloat (GDV)]]></category>
		<category><![CDATA[Diet and Feeding]]></category>
		<category><![CDATA[bloat]]></category>
		<category><![CDATA[gdv]]></category>

		<guid isPermaLink="false">http://webcanine.com/beta/2007/breed-related-risks-for-bloat/</guid>
		<description><![CDATA[<p align="center">GRANT</p>
<p align="center"> Incidence and Breed Related Risk Factors for Gastric Dilation-Volvulus                in Dogs
5-year prospective study by Larry Glickman, VMD, Ph.D., Purdue University</p>
<p>Participating breed clubs Akita, Bloodhound, Collie, Great Dane,            <span style="color:#777"> . . . &#8594; Read More: <a href="http://webcanine.com/2007/breed-related-risks-for-bloat/">Breed related risks for bloat</a></span>]]></description>
			<content:encoded><![CDATA[<p align="center">GRANT</p>
<p align="center"> <strong>Incidence and Breed Related Risk Factors for Gastric Dilation-Volvulus                in Dogs<br />
5-year prospective study by Larry Glickman, VMD, Ph.D., Purdue University</strong></p>
<p>Participating breed clubs Akita, Bloodhound, Collie, Great Dane,                Irish Setter, Irish Wolfhound, Newfoundland, Rottweiler, Saint Bernard,                Standard Poodle, Weimaraner and the AKC/CHF.<br />
<strong>Method</strong></p>
<p>Investigator measured dogs at dog shows and the owners completed                a detailed questionnaire concerning the dogs medical history, genetic                background, husbandry and eating practices, personality and diet.</p>
<p>Five years later, the investigator called and conducted a follow-up                on each the dog.<br />
The incidence of bloat (GDV) was calculated for each breed.<br />
Risk factors were compared to dog measurements and questionnaire                responses to determine any correlation.Â Â  Results: <span id="more-20"></span><br />
<strong>STUDY COMPLETED</strong><br />
Results for the Rottweiler<br />
(Data based on 200 dogs)</p>
<p>* Of the 11 breeds tested, the Rottweiler had the lowest incidence                of Bloat (1%).<br />
* &#8220;Happy/easy going&#8221; dogs were found to be less prone                to bloat. Rottweiler was listed as the easiest going/confident dog                of the 11 breeds surveyed.<br />
* Overweight dogs were less prone to bloat.<br />
* Dogs that are feed 2 &#8211; 3 times a day are less prone to bloat.<br />
* <strong>Restricting water before or after eating, or elevating the dogs                food bowl increased the incidence of bloat.</strong><br />
* Bloat incidence was found to increase with age.<br />
*<em> Giving dogs anti-gas medication on a <strong>regular basis</strong>,                increased the incidence of bloat by 66%.</em><br />
* Do not breed any animal if there has been a  relative that has                previously bloated.</p>
<p><a href="http://www.rottweilerhealth.org/grants_funded.html">http://www.rottweilerhealth.org/grants_funded.html<</p>
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		<item>
		<title>Gastropexy</title>
		<link>http://webcanine.com/2007/gastropexy/</link>
		<comments>http://webcanine.com/2007/gastropexy/#comments</comments>
		<pubDate>Wed, 25 Apr 2007 01:29:35 +0000</pubDate>
		<dc:creator>mom</dc:creator>
				<category><![CDATA[Bloat (GDV)]]></category>
		<category><![CDATA[Diet and Feeding]]></category>
		<category><![CDATA[bloat]]></category>
		<category><![CDATA[gdv]]></category>

		<guid isPermaLink="false">http://webcanine.com/beta/2007/gastropexy/</guid>
		<description><![CDATA[<p>Gastropexy</p>
<p>Finding on use of  gastropexy for                dog owners:</p>
<p>In a study of 1,920 dogs at risk the following recommendations                can be made regarding prophylaxis for bloat:</p>
<p>1 <span style="color:#777"> . . . &#8594; Read More: <a href="http://webcanine.com/2007/gastropexy/">Gastropexy</a></span>]]></description>
			<content:encoded><![CDATA[<p><span style="font-size: medium;"><strong>Gastropexy</strong></span></p>
<p><span style="color: #0000ff;"><em><a href="http://www.vet.purdue.edu/epi/pups.htm"></a></em><span style="color: #000000;">Finding on use of <em> <strong>gastropexy</strong></em> </span><span style="color: #000000;">for                dog owners:</span></span></p>
<p>In a study of 1,920 dogs at risk the following recommendations                can be made regarding prophylaxis for bloat:</p>
<p>1 &#8211; with prophylactic gastropexy; after an episode of bloat, gastropexy                decreased GDV recurrence by 95%. We would consider it to be just                as effective as a preventive measure on dogs at risk for GDV (ie;                all deep- chested dogs, dogs with first degree relatives with GDV)                You should go to a veterinary surgeon to perform the surgery                as many vets do this procedure regularly. Also these dogs                should be sterilized to prevent passing on bloat risk to their progeny.</p>
<p>2 -Add Simethicone to each feeding (adult human dose)</p>
<p>I believe          if the risk of GDV developing in a dog&#8217;s lifetime  is high, then it is          appropriate for owners and veterinarians to  consider performing a prophylactic          gastropexy (a surgical  procedure to prevent the stomach from rotating)          in order to  prevent a first episode of GDV from occurring. However, I would not recommend  that prophylactic gastropexy be done          unless the dog were  surgically neutered, so as not to increase the pool          of dogs in a  breed that are prone to develop GDV. Persons considering           prophylactic gastropexy for their dog should discuss the procedure with           their veterinarian and with owners of dogs that have had this  procedure.</p>
<p><strong> </strong></p>
<p>To find a veterinarian in your state who performs this surgery I would search for : <strong>Board Certified Veterinary Surgeon</strong> (<em>your state</em>).  Unfortunately, the American College of Veterinary Surgeons does not at  this time have a complete listing of Certified surgeons by state.</p>
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		</item>
		<item>
		<title>Diet related risks for bloat</title>
		<link>http://webcanine.com/2007/diet-related-risks-for-bloat/</link>
		<comments>http://webcanine.com/2007/diet-related-risks-for-bloat/#comments</comments>
		<pubDate>Wed, 25 Apr 2007 01:27:02 +0000</pubDate>
		<dc:creator>mom</dc:creator>
				<category><![CDATA[Bloat (GDV)]]></category>
		<category><![CDATA[Diet and Feeding]]></category>
		<category><![CDATA[bloat]]></category>
		<category><![CDATA[diet and bloat]]></category>
		<category><![CDATA[gdv]]></category>

		<guid isPermaLink="false">http://webcanine.com/beta/2007/diet-related-risks-for-bloat/</guid>
		<description><![CDATA[GDV (Bloat) and diet
Summary: Dogs at risk for bloat (deep chested dogs) should not be fed on raised food bowls, or a food that has FAT as one of the 1st four ingredients, or fed foods with citric acid that are moistened. They should be fed food that has a rendered meat with bone in the <span style="color:#777"> . . . &#8594; Read More: <a href="http://webcanine.com/2007/diet-related-risks-for-bloat/">Diet related risks for bloat</a></span>]]></description>
			<content:encoded><![CDATA[<div id="_mcePaste">GDV (Bloat) and diet</div>
<div id="_mcePaste">Summary: Dogs at risk for bloat (deep chested dogs) should not be fed on raised food bowls, or a food that has FAT as one of the 1st four ingredients, or fed foods with citric acid that are moistened. They should be fed food that has a rendered meat with bone in the first four ingredients. We   recommend that you evaluate the food choices by reviewing several sources such as ; Your dog&#8217;s nutritional needs.,</div>
<div id="_mcePaste">http://www.dogfoodanalysis.com/dog-food-index-a.html</div>
<div id="_mcePaste">WDJ dog food recommendations.</div>
<div id="_mcePaste">Dietary Risk Factors for Gastric Dilatation-Volvulus (Bloat) in 11 Large and Giant Dog Breeds: A Nested Case-Control Study</div>
<div id="_mcePaste">ABSTRACT *Malathi Raghavan, DVM, MS; Lawrence T. Glickman, VMD, DrPH; Nita W. Glickman, MS, MPH; Diana B. Schellenberg, MS.</div>
<div id="_mcePaste">Dietary risk factors for gastric dilatation-volvulus (GDV) in dogs were identified using a nested case-control study. Of 1,991 dogs from 11 large- and giant-breeds in a previous prospective study of GDV, 106 dogs that developed GDV were selected as cases while 212 remaining dogs were randomly selected as controls. A complete profile of nutrient intake was constructed for each dog based on owner-reported information, published references and nutrient databases. Potential risk factors were examined for a significant (p&lt;0.05) relationship with GDV risk using unconditional logistic regression.<span id="more-18"></span></div>
<div id="_mcePaste">The study confirmed previous reports of increased risks of GDV associated with increasing age, having a first-degree relative with GDV, and having a raised food bowl. New significant findings included a 2.7-fold (or 170%) increased risk of GDV in dogs that consumed dry foods containing fat among the first four ingredients. The risk of GDV was increased 4.2-fold (or 320%) in dogs that consumed dry foods containing citric acid that were also moistened prior to feeding by owners. Dry foods containing a rendered meat meal with bone among the first four ingredients significantly decreased GDV risk by 53.0%. Approximately 30% of all cases of GDV in this study could be attributed to consumption of dry foods containing fat among their first four ingredients, while 32% could be attributed to consumption of owner-moistened dry foods that also contained citric acid. These findings can be used by owners to reduce their dogs&#8217; risk of GDV.</div>
<div id="_mcePaste">This manuscript has been accepted for publication in the / Journal of the Animal Hospital Association /(JAAHA).</div>
<div id="_mcePaste">Tufts University: Risk Factors for Canine bloat from Canine and Feline Breeding and Genetics Conference 2003 http://www.vin.com/proceedings/Proceedings.plx?CID=TUFTSBG2003&amp;PID=5091&amp;O=Generic</div>
<div id="_mcePaste">Medical Surgical treatment for bloat.</div>
<p>GDV (Bloat) and diet<br />
Summary: Dogs at risk for bloat (deep chested dogs) should not be fed on raised food bowls, or a food that has FAT as one of the 1st four ingredients, or fed foods with citric acid that are moistened. They should be fed food that has a rendered meat with bone in the first four ingredients. We   recommend that you evaluate the food choices by reviewing several sources such as ; Your dog&#8217;s nutritional needs.,http://www.dogfoodanalysis.com/dog-food-index-a.htmlWDJ dog food recommendations.</p>
<p>Dietary Risk Factors for Gastric Dilatation-Volvulus (Bloat) in 11 Large and Giant Dog Breeds: A Nested Case-Control Study<br />
ABSTRACT *Malathi Raghavan, DVM, MS; Lawrence T. Glickman, VMD, DrPH; Nita W. Glickman, MS, MPH; Diana B. Schellenberg, MS.<br />
Dietary risk factors for gastric dilatation-volvulus (GDV) in dogs were identified using a nested case-control study. Of 1,991 dogs from 11 large- and giant-breeds in a previous prospective study of GDV, 106 dogs that developed GDV were selected as cases while 212 remaining dogs were randomly selected as controls. A complete profile of nutrient intake was constructed for each dog based on owner-reported information, published references and nutrient databases. Potential risk factors were examined for a significant (p&lt;0.05) relationship with GDV risk using unconditional logistic regression.<br />
The study confirmed previous reports of increased risks of GDV associated with increasing age, having a first-degree relative with GDV, and having a raised food bowl. New significant findings included a 2.7-fold (or 170%) increased risk of GDV in dogs that consumed dry foods containing fat among the first four ingredients. The risk of GDV was increased 4.2-fold (or 320%) in dogs that consumed dry foods containing citric acid that were also moistened prior to feeding by owners. Dry foods containing a rendered meat meal with bone among the first four ingredients significantly decreased GDV risk by 53.0%. Approximately 30% of all cases of GDV in this study could be attributed to consumption of dry foods containing fat among their first four ingredients, while 32% could be attributed to consumption of owner-moistened dry foods that also contained citric acid. These findings can be used by owners to reduce their dogs&#8217; risk of GDV.<br />
This manuscript has been accepted for publication in the / Journal of the Animal Hospital Association /(JAAHA).<br />
Tufts University: Risk Factors for Canine bloat from Canine and Feline Breeding and Genetics Conference 2003 http://www.vin.com/proceedings/Proceedings.plx?CID=TUFTSBG2003&amp;PID=5091&amp;O=Generic<br />
Medical Surgical treatment for bloat.</p>
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