Hi everyone, hope you're all surviving the blast of Winter this week!
Being Pet Dental Month, we had intended to bring you a piece on dental health for doggies this week. BUT after encountering a medical emergency with one of our canine crew a few days ago, we thought we'd put teeth aside to talk about a serious condition that ALL dog owners should know about.
A warning before you read any further, there will be a stomach-turning image appearing later in this post. Best not read while you eat!
So! Let's jump straight in and have a chat about HGE.
Note: This post has been updated on 2/7/19.
"HORRIBLE GUT EXPLOSIONS"
WHAT IS IT?
HGE stands for Haemorrhagic Gastro Enteritis, but if you have trouble remembering that, just think "Horrible Gut Explosions" - it's basically the same thing in layman's terms.
WHO GETS IT?
HGE can apparently affect any dog, however it seems to be especially prevalent in breeds who are prone to scavenging, like Labradors and Golden Retrievers. Research has suggested that young miniature and toy breeds are also predisposed to this condition. Dogs who develop HGE are often completely healthy otherwise.
Dogs who have had HGE previously have an increased chance of repeat episodes.
HGE itself is not believed to be transferable to dogs or humans. However, some related/root causes may be contagious (e.g. parasites, Parvovirus), so rigorous hygiene practices are advised.
WHAT DOES IT LOOK LIKE?
HGE usually presents as very sudden acute vomiting and/or bloody diarrhoea (either one can come first). The blood is characteristically bright red and very significant in volume (not just a few drops, as you may see in cases of non-HGE diarrhoea). Refer to the photo at the end of this article for a reference on HGE-typical diarrhoea. It is this fecal presentation which gives rise to the colloquial term, "strawberry jam" or "raspberry jam" (no, we did not make this up!). The smell of HGE diarrhoea is exceptionally foul.
Other signs can include a painful abdomen, decreased appetite, fever, lethargy, and behavioural changes.
WHY IS IT SO SERIOUS?
Untreated, it can be lethal. Dogs experiencing HGE tend to lose a lot of fluid very quickly, and can become gravely ill within hours purely due to dehydration. If your dog appears flat or lethargic in combination with vomiting and bloody diarrhoea, it is absolutely imperative that you visit a Vet ASAP and begin fluid treatment. You cannot treat dehydration simply by encouraging your dog to drink more water. The earlier you respond, the better - never wait to see if it clears up. The point at which it "looks serious" can sometimes be too late to recover from.
WHAT CAUSES IT?
No definitive cause has been pinpointed/proven for HGE, however it has been suggested that the following factors may play a part, or be related in some way:
- Bacterial infection
- Parasitic infection
- Hypersensitivity to ingested stimuli
- Hard diet change
- Anxiety or hyperactivity
- Foreign substance ingestion
- Gastric trauma
It should be noted that the following conditions may initially present clinically similar to HGE, but may be treated differently upon diagnosis:
- Foreign body ingestion
- Immune-related diseases
- Intestinal intussusception or volvulus
HOW IS IT DIAGNOSED?
You can assist your Vet by taking a photo of your dog's diarrhoea/vomit at home, or bringing a sample with you to the clinic... seriously!
Vets can often diagnose HGE with a blood test called a PCV, plus a physical examination. Further procedures (such as scans or even exploratory surgery) are sometimes required to rule out more serious causes. It is absolutely worth going ahead with further diagnostics if your Vet deems them necessary, due to the seriousness of the condition.
HOW IS IT TREATED?
In nearly all cases of HGE, IV fluid therapy is required in order to prevent the dog from dehydration. IV fluid therapy is painless, and involves a drip inserted via a catheter into your dog's vein- just like human patients often have. Finding this vein may require the Vet or Vet Nurse to shave a patch of hair on your dog. Your dog is then confined to a crate or small space while the condition passes. Generally speaking, the earlier your dog receives IV fluid therapy, the less time he/she will need to spend in hospital.
Food may be withheld for the first day or so, to allow the gut to settle.
If your dog is not clinically dehydrated, your Veterinarian may choose to send him/her home under your close supervision, but strictly advise you to come back if the condition worsens.
Many dogs will have an anti-nausea injection to help reduce vomiting episodes. Some Vets will complement this with a gastric-protectant medication. Gut stoppers (to reduce stools/diarrhoea) are usually not used, as it is important for the diarrhoea to pass through.
Some pain medication may be administered if the Vet decides the dog is in pain upon feeling his/her abdomen. Never give your dog pain medication unless it has been prescribed by the Vet - most human painkillers and anti-inflammatories (like Panadol and Nurofen) are toxic to dogs.
If the dog is displaying an elevated temperature, he/she may be given antibiotic treatment. Some Vets prefer to administer antibiotics preemptively to prevent any chance of infection while the intestinal lining is so sensitive; others prefer to withhold antibiotic treatment unless an infection is clearly present - your Vet will know the right course of action for you and your dog.
If parasites (i.e. intestinal worms) are suspected, the dog will likely be given worming treatment in addition to a preventative. To clarify, the preventative is what we buy from the Vet or pet shop and give our dog(s) each month. The treatment is a Veterinary product used to treat established infestation. Unless you can confirm with your Vet the date of your dog's last intestinal wormer dosage, it might be necessary for him/her to treat for this cause.
In severe cases of dehydration, a blood or plasma transfusion may be necessary.
If HGE is related to a more serious cause (e.g. pancreatitis), further treatment is necessary.
All dogs with HGE are advised to go on a bland diet for approximately a week following discharge from hospital. This can be made at home or purchased from the Vet. Our homemade diet has been boiled chicken breast and white rice, minced in a food processor - served periodically in small amounts, cool/cold with a dash of water. It's really important that you use human-grade meat, within date, and make fresh batches every 2-3 days maximum (i.e. it should be fresh enough for a human to eat). If you don't have time to concoct this recipe, you will need to purchase special wet and/or dry food from your clinic. Generally dogs need to be reintroduced to their regular food slowly after an episode of HGE.
Prognosis for HGE is good if treated early, and dogs who receive appropriate medical care can expect to make a full recovery within 1-2 weeks.
WHAT DOES THE TREATMENT COST?
It's difficult to say how much treatment for HGE will cost. It largely depends on how dehydrated your dog is before they get to the Vet. Generally, the earlier they are seen to, the less treatment they will need, and the lower your Vet bill will be.
Your treatment cost may also be affected by whether your dog is treated at a regular Vet clinic or a 24 Hour Emergency Centre with specialised facilities and round-the-clock medical attention. We have always felt more comfortable with the latter option (particularly overnight) as we prefer our dogs to be under constant supervision.
As a ball park figure, our own experiences with HGE have cost between $1500 - $7000 (AUD) per episode. In the more severe cases, surgery was required to rule out foreign body ingestion (as the imaging was inconclusive).
If affordability may be an issue for you, there's a few things you can do to manage this:
1. Consider using a regular Vet clinic for treatment during the day, and transferring your dog to an Emergency Centre at night (only if your dog is stable enough to be transported - speak to your Vet).
2. Ask your Vet for an upfront estimate before any care is provided. Most clinics will provide this to you automatically. Ask the Vet to call you if your dog's needs increase while they are in the clinic (and make sure your phone is set to ring loudly overnight so you don't miss their call).
3. Be totally upfront with your Vet about your means - they may cater to some kind of payment plan such as Vet Pay or Gem Visa.
4. Investigate alternative Vets in your area - in Melbourne, Lort Smith Animal Hospital never turns away a pet in need of emergency treatment. On top of being very affordable, Lort Smith also offer certain discounts and payment plans for those who need them.
5. For future, look at taking out an insurance policy - but be sure to query whether HGE will be permanently classified as a pre-existing (non-covered) condition.
Whenever querying Vet fees, please bear in mind that it is genuinely expensive for Vets to provide treatment - just as it is for human doctors and hospitals. The difference is that there is no government-funded healthcare program for pets like there is for people (i.e. Medicare). Generally Vet charges simply reflect the honest cost of proper medical care.
HOW CAN I STOP MY DOG FROM GETTING HGE IN FUTURE?
The million dollar question!
Sometimes HGE is unavoidable. Further research will hopefully shed more light on how to prevent dogs from developing this nasty disease. In the meantime, you can reduce your dog's risk by taking the following precautions:
- Give timely parasite treatments, ensuring your treatments cover ALL parasites (this normally requires 2 separate products)
- Don't give your dog your food scraps, and swap "junk" treats for healthy treats such as pieces of apple and carrot. If you prefer to buy pre-packaged treats, look for top quality natural products. Treats should be fed sparingly.
- Don't feed raw meaty bones; look for alternatives such as high-quality chews (not rawhide), frozen mince blocks, occupier toys etc.
- Don't feed your dog raw chicken due to high risk of bacterial overgrowth.
- Don't allow your dog to scavenge on the ground, particularly when it comes to animal faeces (such as possum poo). Some studies suggest the faeces of small, rodent-like animals may be responsible for severe gastric trauma in other animals.
- Don't change your dog's diet overnight. If you are looking to swap foods, you need to do this over a minimum of TWO weeks, but four if you want to be careful (this is often understated on dog food packets).
- Remove the temptation for your dog to ingest dangerous foreign bodies and substances. Put away all socks/stockings/underwear. Don't leave your dog with access to soft furnishings such as blankets, towels, string/dental floss, soft toys etc. if he/she is prone to chewing and eating them. Throw away food packaging, skewers, corn cobs, fruit pips/pits, and broken toys. Minimise access to sticks and stones. Never, ever leave your butter on the bench unattended (pancreatitis risk)!
LET'S SEE THE PHOTO ALREADY!
Below you'll see two snapshots of the case we encountered earlier this week. We're glad to report the patient is making a full recovery, and that the root cause was not a contagious one.
You'll notice in the below photo there appears to be a lot of jelly-like mucus, which is a common sign of gastric upset.
Following this episode, several more followed which had the appearance of slightly watery, brighter-red blood, in vast volumes.
If you've read this far - your dog thanks you!
Knowing this information and responding to HGE early can make a huge difference to the final outcome.
Got friends with Labradors, Golden Retrievers, or other dogs that hoover? Don't forget to share this with them... you could be saving a life!