Tuesday, October 27, 2020

3419. No anaesthesia to extract 23 teeth in a very old heart-diseased dog.


"I was referred to you from an internet forum member," the owner of a 16-year-old female Pomeranian consulted me in May 2009. "The member said you perform tooth extractions in old dogs without using anaesthetics. My Pomeranian has heart disease and will die of heart attack if her rotten teeth are extracted under anaesthesia. " 

* Images of Toa Payoh Vets in 2020...Covid-19 pandemic, some 11 years later

"I have not done any dental work without anaesthesia," I replied.  "Tooth extraction is painful! It's just not possible to expect a dog to let any vet do extraction without biting the vet or running away!" 

reception area

waiting area

waiting area 

(*SINGPORE scene. Singapore daily housing and people walking/working scenes video footage as you narrate the following). NO FACE MASKS. Scenes in 2009). 

Singapore is a city state with a population of around 4 million people in 2020.  It is a popular tourist destination --- Merlion and Chinatown are some of the major attractions.

Singapore flag

 Durians are popular fruits, but some expatriate and a few locals cannot stand the pungent smell of durians.  


Small breeds of dogs are the most common as around 90% of the residents live in apartments. Pomeranians were the favourite gifts some 20 years ago. They are well cared for and live as long as 17 years as in this case study.

Ms Tan, the Pomeranian owner knew her dog would not live past one month as the dog simply would not eat.   

"My Pomeranian has difficulty breathing. The heart medication reduced her frequency of coughing. But her paws are stained with her saliva drooling from her mouth daily. She will die soon as she has stopped eating. Please help her to live longer!"

"Any dental extraction might cause her to die from fright as her heart could not take the stress and pain too," I explained. 

The owner understood the high risks involved. She consented to the dental work on condition that no sedation and anaesthesia be used. 

This was the first time in over 30 years of practice at Toa Payoh Vets to encounter such a request. 

Her dog was all bones under the thick coat. Emaciated. Malnourished. Death was at the door step. 

I took the chance to help this dog.  This is my "Be Kind To Pets Veterinary Story......(read text in the image below).

Extraction of the bad dead and loose teeth would get rid of the bacteria in her gums and mouth. She could eat and live longer too. 

16 MONTHS AFTER DENTAL WORK, the owner contacted me. Her dog was active, eating, drinking and had no drooling. She had passed away around November 2010. The owner emailed to me the following two images of a much younger-looking old dog.  

*(Narrate text, elaborate on the bright eyes, pink tongue...good health signs...)

The lady owner, in her mid-thirties, had done her internet research well. She was very happy that her dog had lived for some 16 months. 

The internet connected us, as many vets would not want to tarnish their professional reputation should the dog die during surgery. 


For very old dogs undergoing anaesthesia, the following practices are used by me:

1. IV DRIP.  Dextrose saline or 5% glucose for 5 minutes followed by Hartmann's Solution pre- and post-surgery. Baytril and tolfedine are given via the drip which has added multivitamins.   

2. IV frusemide for dogs with heart disease before the operation. 

I gave the frusemide during the operation when I noticed that the old dog began to cough. Her heart disease medicine was not 100% effective.

The IV frusemide stopped her coughing episodes. I extracted the 23 loose teeth slowly. There was no more teeth left as the other 19 teeth had dropped out over the years. A normal dog has 42 teeth. 


Active, eating and drinking. (narrate text in image). 

3. IV pain-killer like tolfedine post-op if the dog has no kidney or liver disorders (the vet ought to do a blood test).  

4. Gaseous isoflurane and oxygen anaesthesia, without injectable sedatives, is my anaesthetic of choice. It is much safer for old canines as they recover fast. 

Endotracheal tube intubation is needed.  What is the endotracheal tube?


Narrate text in image



(Research how to hyperlink the above link in the video so that the viewer can click to go direct to the webpage...)




Narrate the text of the images 



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