Blk 1002, Toa Payoh Lor 8, 01-1477,
Singapore 319074. Tel: +65
6254-3326,
9668-6468,
judy@toapayohvets.com,
99pups@gmail.com Focus: Small animals -dogs, cats, guinea pigs, hamsters,pet rats and mice, birdsand
turtles
October 29, 2020
Toa Payoh Vets Clinical
Research
DENTAL
WORK WITHOUT ANAESTHESIA IN A VERY OLD POMERANIAN WITH HEART DISEASES Dr Sing Kong
Yuen, BVMS (Glasgow), MRCVS
Written:
29 October, 2020
Can
an old vet (>50 years old) change his mindset of not using general
anaesthesia and sedation for very old dogs so that she has a high
probability of being alive at the end of dental work? The only chances of
her dying would be from fright (heart failure) due to the stress of the
dental work without general anaesthesia. Seldom are such old dogs healthy.
They usually have heart disease and general anaesthesia kills them as they
are also very old.
Is it possible to perform dental extraction with no general anaesthesia
for such very old dogs with heart diseases and a mouthful of decayed
and rotten teeth as shown in the pictures of a case of a 16-year-old
Pomeranian?
If
she survived, her quality of life (no daily oral pain and infection and
hence able to enjoy her food and put on weight). She would be more active
and alert. She might live to a ripe old age the bacteria in her mouth had
been rid of.
Bacteria constantly produce toxins and lower her immune system. In
the above case, the Pomeranian was in good condition for her age. She
looked like an 8-year-old dog rather than an ancient canine. She had no
fever and no abnormal respiratory rate. The pulse pressure was lower. The
dog was on heart medication prescribed by Vet 1 for some years.
However, she was underweight. Her mouth was not smelly despite the
presence of large amounts of tartar.
The owner requested "manual scaling" as she had discovered in the internet
forum that I was highly recommended as I do "manual scaling" (without
general anaesthesia). "I don't do manual scaling," I told her that there
was a mistake in the internet forum she had researched. "How many manual
scaling in dogs have you performed?" she asked. "None," I said. Ultrasonic
dental scaling is the method I use.
However, this old dog needed dental extraction and not dental scaling. The
roots of the teeth were all loose and infected. "Manual scaling" (without
general anaesthesia) would not be in the interest of this dog as the
bacteria still would be multiplying under the roots below the gums. Dental
scaling would be what the lady wanted but this was not the right
thing to do for the dog.
"There is a risk that your old dog may die from fright due to the pain of
tooth extraction without general anaesthesia," I informed the lady. She
was surprised and said, "Let me have some time to think as to what to do."
I expected the lady to go home on this sunny Sunday afternoon of May 3,
2009. I had my hands full on this busy Sunday. However, she returned and
decided to take the risk.
THE PROCEDURE
An I/V glucose drip was given to help to increase the blood pressure as
the pulse was weak. Into the drip set, I gave Baytril antibiotic to reach
the dog immediately to kill the bacteria.
The dog was quite docile and so there was not much worry. Two front
incisor teeth were extracted. The dog started coughing as if to clear
phlegm in her throat. This indicated that the oral heart medication
given to the dog was not effective to remove the fluid in the lungs
(pulmonary edema). What now? Cease operation?
Going back to the basic of veterinary pharmacology, I needed a drug to
clear the water from the lungs quickly. I broke a vial of Lasix and
injected it into the IV drip. The drug would take away fluid from
clogging the airways by taking it into the blood-stream. I waited 5
minutes before continuing dental extraction.
One or two teeth were extracted at 1-2-minute intervals. The teeth were so
loose that most of them could just be pulled out easily. There was little
bleeding. Tissues were used to control the bleeding. When the bleeding had
stopped, the other teeth were extracted.
The dog had not even coughed throughout the process of dental extraction.
He was apprehensive. Suddenly the dog shifted and the IV catheter
came out. Intern Ms Toh had informed me that there was a skin swelling
above the catheter. 3 Elastoplasts strips and a wrap-around bandaged had
been used to fix the catheter in place but we had anticipated that this
would happen. The dog had around 100 ml of glucose and that would be
sufficient.
Since the catheter had popped out of the vein, the rest of the
fluid was given subcutaneously. Caution would be the key and there was
rest in between each dental extraction, dragging the process to over one
hour. Prevention of heart failure due to fright was paramount. After all,
the owner wanted an effective veterinarian who would produce a live dog at
the end of the day, not an efficient one with a dead body.
CONCLUSION
The dog had 23 loose and rotten teeth extracted with little pain and
little bleeding. The lady's eyes brightened when she returned later and
was told that her dog was OK.
The dog was alert and her excellent coat shone golden in the evening rays
of the evening sun as I took her photograph. As the dog was not
vaccinated, I did not want the dog to be hanging around the Surgery. The
lady put the dog in her car while she paid the bill. Well, the dog peed
inside her car, but she was not upset. Her best friend was alive and that
was what mattered to her.
This is the sole case of me doing dental work without general anaesthesia
in my 2 decades of small animal practice. I record this in detail to share
my unusual experiences with other veterinarians. If the dog had kicked the
bucket, the owner would be very unhappy as she had 14 years of
companionship with this old friend after adoption from the SPCA as a
2-year-old.
It was fortunate that the old Pomeranian did not die of fright on the
operating table. I don't want to do any more such cases as this will
tempt the God Of Death. This was not a simple case as the dog was
coughing. If the coughing continued, the dog was be stressed out and die
of heart failure. Therefore, the vet must know what to do when things
don't proceed smoothly. Of course, the best way is not to accept such a
high-risk case as deaths of companion animals on the operating table are
never forgiven or forgotten by the owner and her family.
NOTE:
It would be wise for dog owners to get the dog's teeth check every year
and get dental scaling done when the dog is young and fit. Continue with
tooth brushing after dental scaling.
TIPS FOR VETS:
POST-OPERATION PAINKILLERS
I did not give the dog pre-op NSAID pain-killer nor after the dental
extraction as I would do for a younger dog. This is because this dog's
kidneys would not be as good as a younger dog to withstand any adverse
reactions on the kidneys from NSAID drugs.
NSAID drugs are not to be given to dogs with kidney disorders and though
no blood tests to ascertain renal function were taken, I expected the
kidneys and livers of a 16-year-old dog not to be as normal as to
metabolise NSAID drugs without dying of side effects and thereby
distressing the lady owner. As for post-operation sugar paste, this would
be given for old dogs. In very old dogs, it is very risky to use
injectable anaesthesia. In this case, isoflurane gas would be safer but it
was not used as the owner had specifically requested for no anaesthesia.
16-year-old. Home
cooked food. Teeth encrusted with tartar but surprisingly there was no
strong bad breath smell.
An I/V glucose drip
is important for aged dogs during operation. Emergency Lasix was given I/V
when the dog coughed trying to clear her throat.
Dog goes home with
no teeth left. Vet Intern Ms Toh arranged the teeth neatly for
photography. "How many teeth has an adult dog?" I tested Ms Toh who had
great interest to study veterinary medicine. She shook her head. The
answer is 42.
UPDATE IN SEP 4, 2010 FROM
OWNER:
The
dog lived to a ripe old age and passed away in May 2010. The
post-operation feedback from the owner indicated that the dog had oral
pain and low blood sugar.
E-mail to Dr Sing dated Sep 2, 2010
Dear Judy,
I saw the case study on the above website.
I am the owner of this dog. Her name is She. She passed away this year 11
April. It was a Sunday morning.
Please send my regards to Dr Sing.
On the case study, I would also like to update you what happened after I
got home.
The surgery was a success as my dog was indeed alive and well. Just like
any other beings, they need rest after surgery.
However dogs will always attempt to walk or run as its part of their
nature, not knowing itÂ’s exhausting.
One the first night after the surgery, my dog collapsed suddenly and
started to whine. I picked her up and gave her a massage, which she was
able to stand on her feet soon after. This happened for another 2 times in
a day.
I realized it may be trauma and shock, and maybe low glucose level. She is
also not eating well. Where is she going to get the “energy”?
She was already on long term medication for heart, plus after surgery
medicine. I was not prepared for more medication for my little 16+ yr
old.
I brought her to TCM. I think this doctor is the only doctor in SG who
provides acupuncture for dogs. He is (Name given). I asked this doctor to
also do treatment for her appetite, her heart, and other senses such as
hearing and sight. She responded very well after the first treatment. She
was also beginning to eat! And best part is she and I had eye contact, it
shows that sheÂ’s getting more alert.
She continued the treatment for about 1 month, about 5 consultations. She
recovered very well. Soon after she starts to bite all people who attempt
to touch her, including myself. I think itÂ’s the surgery trauma and old
age crankiness. But I also think that if she bites it means she is alert
to her surroundings. I see it as something positive, sometimes, funny.
Because, no teeth still want to bite people?
No more bad breathe and no more toothache. I was not worried about
bacteria possibly worsening her heart condition anymore.
Without teeth, her tongue always sticks out! Amazingly she looked even
younger and cuter!
I wrote this to you because as fate has it, Dr Sing has indeed changed the
quality of her life.
But he is also right, it’s very risky. What if the owner did not take
precaution AFTER the surgery?
I have attached 3 pictures. 1 taken in May 2009, 1 in Sep 2009 and 1 less
than a month before she left in 2010.
She was very lucky, to have met the right people.
Thank you.
Best Regards,
-----------------------------
E-mail from Dr Sing dated Sep 4, 2010
I am Dr Sing and got your good news of
your dog living to a ripe old age. Thank you for your email and
important feedback post-operation as I seldom get any feedback. Most
likely it was low blood sugar as you diagnosed. It could be the
post-dental extraction pain. Your pictures are great. Please give
permission to post the pictures. I hope all are well with you.
E-mail to Dr Sing dated Sep
4, 2010
Hi Dr Sing,
Great to hear from you!
Sorry I would like to rephrase, I meant her
fear and anxiety on the surgery table would definitely caused that
“weakness” which makes her faintish.
Yes, I should write as low blood sugar.
It’s a normal after-surgery process. I remember feeding her sugar/glucose
water.
I am well, thank you. I guess this is one
thing all dog owners have to go thru.
Until yesterday, I could never have
imagined how hard you guys work over the metal table, while I was stoning
in your clinic.
It was a very detailed re-enactment. Thank
you for sharing. It was heartwarming for me.
I hope my feedback could help you and your
furry patients.
Please feel free to use the pictures, it’s
my pleasure.
TOA
PAYOH VETS PTE LTD
