Esophagus — Congenital esophageal achalasia
is also known by many other names such as cardiospasm, mega?esophagus,
dilated esophagus, and ectasia. The disorder appears to be caused by a
simple autosomal recessive in German Shepherds, although it is highly variable
in expression. While reportedly only about one percent of the dog population
may be involved, mortality rate in pups is fairly high. Even when PRAA
has been ruled out as the cause, I believe the percentage in German Shepherds
is quite a bit higher than the reported one percent. Correspondents in
the late 1990s have given me testimonial comments that they believe
the incidence is on the rise, but this, too, may be more a matter of greater
awareness. This abnormally large and flaccid “food-pipe” between the mouth
and the stomach can be found in adults, but the most heartbreaking and
serious cases are in pups early in the weaning and solid-food stage.
GSDs, Goldens, and Irish Setters seem most at risk, and if a pup survives to adulthood, the condition often causes or is associated with other esophagus problems, peripheral neuropathies, gastric dilation with or without torsion and especially myasthenia gravis. Even in adults, many are euthanized or asphyxiate due to progressive malnutrition, aspiration pneumonia, and owner frustration over the regurgitation. Most adult cases that are presumed to be acquired have no cause discovered, which leads me to believe it is simply a milder form of the genetic problem that causes death by starvation in most pups between 5 and 8 weeks of age. A loss of peristaltic action (that contraction that squeezes the food downward like a cow being milked) is probably due to a disorder of the afferent nerves. This is why there is no successful medical, pharmaceutical, or surgical treatment. There may be a connection with other nerve disorders, even giant axonal neuropathy, which mimics HD and GSD myelopathy.
Symptoms include slow or halted growth, weight loss, dehydration, water in the lungs, and persistent and progressively worse vomiting of food minutes after swallowing. The disorder usually is detected at or slightly after the commencement of weaning. As food slightly stretches the esophagus on the way down, an affected pup's muscles apparently fail to contract enough to prevent the food bolus from simply staying in a pouch just in front of the entrance to the stomach. In time, the muscles become weaker and even less able to squeeze the food ball, and even liquid food remains in a hanging “pelican pouch” forward of the stomach entrance and below it. As with PRAA, the pup becomes emaciated and listless, often dying of starvation. In fact, the two conditions may be indistinguishable without autopsy. The accompanying pedigree study gives food for thought.
Congenital pyloric stenosis is a similar disorder but is mostly found in Boxers and other short?faced breeds; it is very rare in the German Shepherd. Spasm of the pyloric sphincter in excitable dogs, especially toys and miniatures, is also uncommon in the Shepherd Dog. There may be several other causes of esophageal dilation, affecting various breeds to different extents. However, German Shepherds have over thirteen times the incidence of esophageal disorders of all other breeds combined, though PRAA may be part of this statistic.
Vomiting and gastritis — Vomiting comes easily to dogs. Grass eating and subsequent vomiting give rise to all sorts of explanations, the most popular being that the dog was sick and ate the grass to help him throw up. Actually, excess grass is more likely the reason for the reflex action. Dogs eat grass because they like the taste of it, just as with the case of garbage. Gastritis, an inflammation of the stomach lining, can be caused by the ingestion of too much grass, garbage, or indigestible materials. It can also be caused by viral or bacterial invasion, but much more common, especially in pups, is the presence of endoparasites: tapeworms, roundworms, hookworms, whipworms, and coccidia. Actually, tapeworms or roundworms can fill up the belly to the extent that they back up and cause vomiting from sheer bulk. The initial treatment for gastritis or vomiting may be withholding food and administering Kaopectate every four hours.
Torsion — Commonly called bloat, sometimes described as gastric dilation/volvulus, this is a terrifying and frequently fatal disorder that German Shepherds and many other deep?chested dogs experience. A twisting of the entrance and exit to the stomach traps the food and gas, and as the stomach swells, the twist is more unlikely to be relieved without veterinary help. Great strides in surgical treatment have been made, but the key to reducing the high mortality is still time. Recognize the symptoms and get the dog to a veterinary surgeon, preferably an emergency or trauma?oriented hospital. Simple dilation (swelling due to gas) may not be serious as long as the dog is able to pass food into the duodenum, but it has been estimated that 80 percent of all dogs that experience simple dilation will someday also have torsion.
Symptoms of torsion include a swollen, turgid abdomen; the sluggish action of the dog; his white, frothy, unsuccessful attempts at vomiting; and perhaps his scratching in the dirt to make a cool hole in which to lie down. Also, the spleen will feel like a hard lump. The spleen is normally wrapped around some of the stomach and therefore splenic torsion accompanies gastric torsion. When this happens, the return of the blood that flows through the spleen is shut off causing shock, the “immediate” killer.
The first thing your vet is likely to do is attempt to push a tube down the throat into the stomach so the gas pressure can be relieved. If he cannot get past the twisted part of the alimentary canal, he may opt for immediate surgery so he can untwist the organs. One emergency veterinary service in the Detroit area uses a different kind of lavage tube in their treatment of acute torsion. The large diameter, stiff, black polyethylene pipe has a smaller, flexible tube inserted into it. This smaller tube is for warm water so that the stomach contents can be flushed out of the larger one for about fifteen minutes. In either case, once the dog has been stabilized, decisions can be made about whether to operate, or untwist a stomach or spleen still in volvulus.
Follow?up surgical techniques are numerous,
but the one with the most success in preventing future torsion is a tube
gastrostomy. In this procedure, a rubber or vinyl tube is put into the
stomach through the abdominal wall, and in a week the stomach wall at that
point becomes attached with scar tissue to the peritoneum and abdominal
wall. The tube is then pulled out. The surgical opening seals off in a
few days, and since the stomach is fused to the abdominal wall, it is prevented
from again twisting out of position. Regular gastroplexy, which is suturing
the stomach to
the abdominal cavity, is also widely performed. Because of these and
other techniques, especially the rise of emergency clinics, the mortality
rate among those that make it to the clinic while still alive has plummeted
to about 15 percent. Another 15 percent or so die without being seen by
the vet first.
Groups of scientists at many locations have
been studying bloat for a long time, partly with help from such as Morris
Animal Foundation, the GSDCA, and many others. So far, they have identified
a number of likely causative factors, including behavioral traits.
Breed susceptibility is pretty obvious, with 25 percent or more of Great
Danes, Saint Bernards, Weimaraners, and Irish Setters expected to suffer
from bloat sometime during their lives. German Shepherd Dogs, Standard
Poodles, Collies, and Gordon Setters are fairly high on the incidence lists,
also. Some of the
characteristics seen most often in dogs that had bloated include some
stressful event, even minor, in approximately the eight hours prior to
the incident, a fearful temperament, and consumption of fairly large quantities
of non-food material. The only dogs I’ve had direct contact with that bloated
were of impeccable character, but those may have been in the minority.
Purdue researchers found no pattern in presoaking dry food or not, but
a slight correlation between several smaller meals and less bloat. Others
found no relation to soybean meal in the food, an early target of breeders
looking for a primary cause. Adding vegetables and canned or meat scraps
appears to help lower incidence. Most dogs (60%) bloated not immediately
after vigorous exercise soon after a meal, but in mid- to late evening
when resting or sleeping.
There is a familial element in torsion/volvulus
in many, similar to the way cancer “runs in families”, but most cases don’t
give a clue to hereditary factors. As in “toxic gut syndrome” which is
also seen a lot in some GSD lines, it is almost impossible to tell which
came first, the presence of abnormal bacterial populations and irritated
intestinal or stomach linings, or the bloat itself. Which is cause
and which is effect is not going to be easy or even possible to determine.
Some investigators suspect that breeders may be stuffing their small, young
puppies’ stomachs too
much, with results that show up only later in life. Work goes on.
Less likely are other types of torsion, but they can be as life-threatening. Splenic torsion can occur without gastric twisting, and an even more rare disorder is mesenteric root torsion. The mesentery is the white, fibrous, web-like or film-like tissue that connects the various sections of intestines to each other and to the abdominal wall. Blood vessels travel through the mesentery, and if there is a twisting there, regardless of whether the intestine itself is closed off, the blood supply can be halted and the intestinal tissue can become necrotic. Bloody diarrhea, vomiting, abdominal swelling and/or pain, and shock or general collapse can be symptomatic. It may be the same as what some call “twisted intestines”. So few dogs survive that it is impossible to prevent recurrence or conclusively predict whether those are at greater risk for another attack than any other dog is.
Intussusception — In young pups (and
other animals including humans) the intestine can invaginate (one part
slips inside another).
The condition, also referred to as "telescoping intestines," occurs
in adults, too, but not as frequently. Most common immediate causes include
worms, obstruction by indigestible materials, garbage, or toxic substances.
The German Shepherd seems to experience a high incidence of this disorder
and I believe there is a genetic propensity, a familial trait, in certain
bloodlines.
Diarrhea and soft stool — Diarrhea can
be a symptom of any number of disorders from cancer to overeating, but
is most often associated with disease or parasitism of the small intestine.
Diarrhea or loose stool is quite common in the German Shepherd Dog, even
when no physiological disease has been identified. However, since this
is not a normal condition, the owner should make a sincere attempt to find
and attack the cause. Some of the causative factors in true diarrhea are:
pancreatic insufficiency, chemical or mechanical irritation of intestinal
linings, parasites,
microorganisms, and a psychosomatic condition related to the "high?strung,"
emotional make?up of the German Shepherd Dog. Foods that can cause
loose stool include milk (if suddenly introduced into the diet), liver,
fats, and those with a high?fiber content. However, simple overeating is
perhaps the most frequent culprit in adults.
Soft to runny stools may be an indication of
a general inflammation of the stomach and intestines known as eosinophilic
gastroenteritis. It is treated symptomatically with something to coat the
lining, plus perhaps a steroid and Kaopectate, until the dog "heals itself."
Many veterinarians administer Pepto-Bismol, also. In the case of young
puppies with watery stool or repeated diarrhea, rush to your veterinary
clinic with the pup and the stool samples. Most of the time the cause of
diarrhea in a young puppy is serious, such as parvo or coccidiosis, perhaps
with hookworm as well.
The Campylobacter bacteria cause some cases of acute or chronic diarrhea,
and most labs would have no trouble identifying this infection. Generally
watery diarrhea is not an indicator of “campy”. Erythromycin antibiotic
is 90% effective, although resistant strains may be evolving.
Toxic gut syndrome (TGS) — This disorder
has been identified as a specific syndrome, with some similarities to other
disorders such as intestinal volvulus, which may have been blamed for death
when TGS was the real villain. The German Shepherd Dog has a higher number
of blood cells per unit of blood than do most other breeds, with 50 to
60 percent compared with 40 to 45 percent. When such a dog becomes dehydrated,
thickened and/or lessened blood supply to the small intestine increases
growth of bacteria that are always present there. These Clostridium and
E. cold bacteria produce such quantities of toxins that the dog is unable
to get rid of them fast enough, and death by poisoning occurs. By the time
owners see symptoms such as discomfort when the abdomen is touched, attempts
to vomit, and excessive salivation, it is probably too late. Prevention
may be accomplished through dietary means (feeding Lactobacillus acidophilus,
yogurt, or cultured buttermilk), or by the same toxoid vaccine that is
given to lambs to prevent Clostridium perfringens types C and D. As research
is done on this recently defined syndrome,
more will become known as to the best treatment.
Other problems — Ulcers have been diagnosed too frequently in German Shepherds and may be related to pancreatic problems or other causes: it's difficult to tell, when several conditions exist at once, whether one is the cause or effect of another. Necrotic bowel syndrome, a disorder of unknown cause, is diagnosed usually on autopsy, when part of the intestine is found to be dead and rotting away. This condition may be synonymous with or overlap intussusception or other diseases. It takes a small toll, mostly among heavily linebred German Shepherd Dogs.
Eosinophilic ulcerative colitis — This syndrome is most common in Cocker Spaniels and German Shepherd Dogs. If your pup or adult has intermittent to constant diarrhea, with or without blood, this disease may be the cause. Initial treatment may include corticosteroids, antibiotics, and antispasmodics to see if the symptoms can be halted.
Irritable colon — Also known as spastic colon, this disorder with mucus in or on the surface of soft or frequent stools may be the result of stress. The best cure is prevention — breed stable temperaments and build confidence in puppies.
Anal glands — Occasionally, anal sacs may become infected, and the dog may scoot along on the ground, rubbing his rump in an effort to relieve the itch. This won't help, but you can easily "express" these glands. Lift the tail high with almost enough effort to lift the dog's rear off the table or floor, and very firmly pinch the sphincter including the sacs. Be sure to use a couple of layers of paper towel or some cotton to keep the liquid from squirting across the room or on you. Most dogs do not need attention nearly as much as owners think they do.
Perianal fistulas — Known by a number
of names, these abnormal passages between two surfaces or an opening to
the exterior, in the area of the anus, is a condition seen more in German
Shepherds than in other breeds. While probably familial or congenital,
the disorder is thought by some to be caused by an injury or an abscess.
More likely, however, it reflects an immune system weakness. Symptoms include
frequent licking or biting at the "vent," and a bad odor and pus may also
be seen. If untreated, ulceration will develop. Only fair results have
been reported with
cryotherapy, which is freezing with liquid nitrogen or nitrous oxide.
Since some veterinarians prefer to use familiar surgical procedures rather
than cryosurgery, ask for a second opinion if you aren't sure, especially
at a veterinary college clinic. Frankly, the prognosis has historically
been very poor; there has not been a high satisfaction rate regardless
of treatment method. But a pharmacological approach has come to the foreground
in the late 1990s, that being the use of the immuno-suppressive drug cyclosporine
in an oil base, fed twice a day for as long as 5 months. It has had some
success so far, though researchers warn that remission of symptoms may
not be permanent in all dogs (nor is it in the case of surgery), and this
immunosuppressive treatment is extremely expensive, thanks not only to
the drug but also to close monitoring by the veterinarian. However, even
in those dogs not “cured” by the drug alone, it improves the condition
of the lesions enough so that surgery is much less extensive and has a
better chance of success.
Polyps — Rectal polyps are little round
or teardrop shaped red to purplish balls. Sometimes they are clustered
like tiny grapes, and are found very close to the anal opening or further
inside the rectum. They should be surgically removed, since they rupture
easily and are a potential site for infection. A drop of bright red blood
recurring on the end of stools is a sign that you should have the dog examined
for polyps.
The Pancreas
The pancreas is a rather long, V?shaped gland
that aids the digestion of food. It has two major types of cells or tissues.
One group is endocrine in nature, which means it secretes hormones into
the circulatory system, which in turn transports them to other glands and
body parts; the other group empties into the digestive tract. Located near
the stomach, it produces enzymes, bicarbonate, and hormones; the first
two are delivered to the intestine, the third is secreted into the bloodstream.
One major enzyme, amylase, breaks down the long starch macromolecules,
while others break down fats and proteins. The endocrine (glandular) portion
of the pancreas, which does not excrete into the alimentary canal but rather
secretes into the circulatory system, functions in control of blood sugar
level, and when defective, results in diabetes. Most GSD people, in America,
at least, are concerned more with the digestive function than with diabetes.
Just before publication, I also heard from fanciers in England who are
concerned about pancreatic insufficiency, and since many of their lines
are from recent German imports, this is possibly a more widespread
problem than I had earlier suspected.
Clinical pancreatitis — The word clinical
may be used to mean “frank” or “obvious”, at least to a veterinarian with
the training and equipment. Most causes of this disorder are of unknown
origin. Adult clinical pancreatitis is not tremendously common in the German
Shepherd Dog, but when it does occur it is usually the middle?aged, obese
bitch on a fatty diet that has it. Chronic pancreatitis symptoms include
emaciation, dull dry coat, and high appetite with poor digestion as seen
by fatty, loose stools containing undigested starches. Treatment is accomplished
mainly
by correcting the diet.
Pancreatic atrophy — On the other hand,
German Shepherd Dogs seem to have a considerable predisposition to pancreatic
atrophy, also known as juvenile atrophy or pancreatic insufficiency, and
certain bloodlines have been much more associated with it than others.
For years I have referred to it as subclinical pancreatitis, because people
who are not familiar with familial and breed tendencies are likely to miss
the subtle signs. The disease usually starts before the dog is one year
old, though many are three before symptoms are noticed. When lack of "drive,"
less coat
lustre, coprophagia and/or poor weight are seen, have the stool examined
by your veterinarian for abnormal fat level and absence or low level of
the trypsin enzyme. If the problem is discovered before it becomes severe
and chronic, Viokase™, a brand of powdered raw pancreas, added to the food
half an hour or more before feeding usually produces good results. Another
similar product is called Pancreazyme™. Getting enough to do the job without
making the owner go broke is a tough balancing act, though. By the way,
these types of preparations are also good for non?specific diarrhea. Some
owners with access to slaughterhouses claim some benefit from feeding raw
pancreas, but there is not enough data with scientific controls to consider
this anything more than anecdotal testimony. I believe there is a strong
possibility that subclinical pancreatitis can worsen with neglect into
an acute attack by enzymes on the pancreatic and surrounding tissues themselves,
and that this condition may be the cause of many instances of diagnosed
perforated ulcers. Texas A&M vet school is trying to get AKC and GSDCA
funding to study and possibly identify a genetic marker for pancreatic
acinar atrophy in the breed.
Fred Lanting
***Want to learn more about canine health and GSDs in particular?
Read “The Total German Shepherd Dog” by Fred Lanting, published by
Hoflin and sold wherever good books are found. ***