Saturday, October 15, 2011

690. Follow up: Oro-nasal fistula in an old Chihuahua

DILEMMA
"The anaesthetic risk is very high in old dogs," the vet says. "Your dog may die on the operating table."




To take the risk and get your dog operate? Or not?

1. Some owners will not take any risk. The dog has a POOR QUALITY OF LIFE IN OLD AGE. Suffering in pain, not active or enjoying life. But she is alive. That is what matters to some owners.

2. BETTER LATE THAN NEVER. Some owners take the risk when the dog has had been sick for a long time and near death's door. Chances of survival are very slim now. Less than 5%. Procrastination has lowered the odds of survival.


WHAT DID THE YOUNG MAN DO?


The son took the risk and took the dog to another vet who would operate on his dog. The dog infected tooth was removed. The dog survived. It was 12 months of suffering and infections. But there was a happy ending.













HAPPY ENDING IS NOT GUARANTEED. BUT THIS STORY HAS A HAPPY ENDING. Part 1 of this story is present at:
http://www.youtube.com/watch?v=5AWHpWYWgy4





7 DAYS AFTER TOOTH EXTRACTION
7 days later, I phoned the son. He was quite grateful and said: "Mum does not need to wipe away the runny nose (left nostril discharge) or clean the tearing eye (left facial wound, dog rubs itchy wound and eye)." PUT THIS TEXT ON VIDEO CLIP

She is now a happy mother and there will be peace in the family after 12 months of worries.



7 MONTHS AFTER TOOTH EXTRACTION
Upper respiratory tract infection - recovered after antibiotics injection. I took some pictures as this old Chihuahua looks so much younger and different.















8 MONTHS AFTER TOOTH EXTRACTION



8 months later. On Oct 21, 2010, the old Chihuahua passed away peacefully at my surgery after 2 days of hospitalisation for not eating, ataxia and severe anaemia. She had an extremely low red blood cell count and a very high platelet count. An extremely high white cell count indicated bacterial infection of the blood. Her liver enzymes and serum nitrogen were elevated. Creatinine was normal

Two blood tests were taken but the second one showed a very high white cell count. The cause of death was hard to say without more tests. The high platelet count was very rarely seen in practice. Could this be a blood cancer or open pyometra?

"Your dog has lived to a ripe old age," I said to the young man and his mother who were called to see the dog to say good-bye on the evening before she passed away.

"I will not be recommending blood transfusion," I said. "The dog is very old as most Chihuahuas don't live up to 11 years old. "The blood transfusion will just kill her."
"Put the dog to sleep now," the mum said during the evening visit. The Chihuahua was unable to stand and her body temperature was dropping below 36 degrees C.

"No, no, no" the young man said. "She may recover." The dog was very weak and pale. She was not vomiting nor did she eat or drink. She passed away around 10 am and I phoned the young man. He came with his mum.

The young man and his white-haired mum were satisfied that the Chihuahua had a good 8 months of high quality life.

After the cremation arrangements and before saying good-bye, the mum hugged me to thank me outside the surgery entrance. I was surprised as Chinese baby-boomer generations seldom hug outsiders or even family members. That is part of my baby-boomer generation's culture. Chinese seldom hug each other as we are not brought up to hug each other.

Then she hugged her son who comforted her. We said good bye. I had a heavy heart that morning as there was nothing I could do to reverse the impending death. Blood transfusions would not work but would just add to my veterinary income. I feel that it is not right to milk my clients by advising blood transfusion when there is no hope of a longer life. I am sure the son would approve of blood transfusions but it would not prolong the dog's life as the kidney and liver disorders were due to old age. The whole body system was shutting down due to old age.



TIPS FOR A LONGER LIFE FOR YOUR DOG OR CAT. An annual health screening with blood and urine test and dental check up is best for older dogs if you want your companion to live longer as many diseases can be prevented. Sterilisation of your dog is advised.



WOULD THE DOG HAVE LIVED LONGER?
YES


Would a spay when this Chihuahua was in her younger days help to make her live longer than 11 years of age? I believe it would.

"Did the dog lose a lot of blood?" I asked the young man earlier after getting the blood test result of severe anaemia. "No," he said. "Was she spayed?" I wanted to confirm as this dog was adopted. I noted a swollen vulval lips of snow white in colour due to severe anaemia. The normal colour should be pink.

Mum said: "The dog is not sterilised. She passed a lot of blood suddenly some months ago and then 1-2 months ago. She had had stopped bleeding previous two years. I did not think there was anything wrong with her bleeding."

"In hind-sight, this dog should have been spayed when she was younger," I told the young man. "It could have lost blood due to open pyometra recently."

The dog was adopted at the 7th year in a bad condition and was restored to good health, till the oronasal fistula affected her 8 months ago for the past 12 months before. Overall, this Chihuahua had been well cared for and Mum took her down three times a day to exercise. The dog was quiet and much loved by all neighbours.

The young man who knew me through surfing the internet texted: "Thanks so much for helping April. Most appreciated! :)". Young people don't converse; they use their fingers to do the talking.


Would she live longer if her infected carnaissal tooth had been extracted as soon as she had the facial wound instead of dragging on for at least 12 months and causing her poor health, stress and bacterial infection? I believe it would. Much depends on the dog owner to seek out treatment early for the sick dog if the illness still persists.

WHY DID I SAY THAT?
If She had been spayed, she would not have developed an infection of the womb. This is called PYOMETRA. It presents as "lots of bleeding 2 months ago and some months back," as told by the mother. She would have had died of septicaemia (high white cell count, high platelet cell count and low red cell count).

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