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

FINAL VIDEO. 

"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.  

BACK TO TOA PAYOH VETS, CONSULTATION IN MAY 2009

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. 

TIPS AND ADVICES

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

 

DETAILS OF THIS CASE AT:
 

https://2010vets.blogspot.com/2014/12/1126-dental-extrraction-of-16-year-old.html

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

 SPECIAL THANKS TO:

 

 FOR MORE INFORMATION:

Narrate the text of the images 

FINAL VIDEO

 

3418. SHYAN KOH. VIDEO 2. Do dogs suffer from toothaches? Periodontal disease treatment at Toa Payoh Vets

 

DO DOGS SUFFER FROM TOOTHACHES?  Yes. Dogs get gum infections and loose and dead teeth if they do not have proper dental work. 

As they can't talk to inform the owner, they tolerate the pain of periodontal diseases. In this video, we discuss some cases of dental diseases in the dogs seen at Toa Payoh Vets, Singapore. 

This is a "Be Kind ........" 

SINGAPORE SETTING.

Video footage.  Singapore scenes - dogs on walks

 

Dogs develop plaque (define) and tartar (define) just like we do. 

In dogs, bacterial infection of the gums and the teeth ligaments is called periodontal disease. There are 4 stages of Periodontal Diseases. 

Periodontal Disease Stage 1
Acute gingivitis. The tooth-bone periodontal
 ligaments are still intact. Dental scaling will save the
tooth

Periodontal Disease Stages 2 and 3

The periodontal ligament connects the tooth to the jaw bone. 
It is infected and loosened, separating the tooth from the jaw bone. The gums recede and the tooth root is exposed. 

See the thick tartar and 
chronic gingivitis (inflamed gums) around the tooth. 

Dental work and scaling is needed before cavities develop.

Periodontal Disease Stage 4 - The periodontal ligament is destroyed, exposing the roots of the teeth. Sometimes, cavities form as shown in the following slide. The teeth are loose or dead. Extraction is the cheapest option as root canal treatment is expensive.

Loose or dead tooth may drop off by themselves.

Dogs do suffer from cavities, also known as tooth decay, like people.  

A cavity is seen (arrow) 

PREVENTION

(Narrate text). Your dog is your best friend, but he can't tell
you he has tooth aches. Check his mouth weekly and help him
to have a good set of teeth to old age!

If your dog eats food on one side of the mouth, snaps at you
when you touch his mouth. If he has cheek tumour, foul breath and is losing weight, consult your vet promptly.

Cheek tumour may be caused by
long-standing dental disease.
. 

3417. SHYAN. Video 1. A rare case of a cheek tumour in the Dog.

 VIDEO 1.  Cheek Tumour in the dog. 

"My dog keeps me company and is a good listener," the young lady said. "He waits beside my study desk patiently while I study for my examination. He waits for me to come home no matter how late in the night." 

"But something is wrong with him, "she continued. "For the past month,  I have to wipe his mouth and clean up the saliva staining my bedroom floor. He has a large lump inside his right cheek. I asked my parents for advice. They were not bothered.."   

I remember this case vividly even though 10 years had passed. The owner was a slim young reticent lady in her junior college. She was likely to be 18 years old. Her eyes were swollen with tears. Her 11-year-old male Miniature Schnauzer had stopped eating and was drooling a lot. 

"This is a gigantic cheek tumour," I told the young lady. "A nasty one of over 4 cm x 4 cm x 3 cm inside the right cheek tissues. It is likely to be cancerous now.  However, the dog has rotten and decayed teeth which needed to be extracted before I can operate on this cheek tumour!"

This is a "Be Kind ........" 

 (narrate)

A rare case of a cheek tumour in the dog

SINGAPORE SETTING.

Video footage.  Singapore scenes - school students - buses in 2010. 
No Covid-19 pandemic/mask footage to be shown.  

ONE WEEK EARLIER, during the first consultation for the cheek tumour,
the Miniature Schnauzer would turn his head away when I tried to open his mouth for a 

physical examination.   

(read text on image)

Intense pain of inflammation of the inside of the cheek. 
Gum infections and loose teeth.
I could see the thick tartar enveloping the teeth

I could smell the bad breath in this small consultation room. 

Back to the case. 

What to do with this large cheek tumour at the least cost to the owner? 

ANAESTHETIC RISKS. 

Two stages of treatment are safer for the old dog.

This is because old dogs are high anaesthetic risks and each stage will require shorter

episode of anaesthesia as compared to one stage.

For Stage 1, I did the dental

work one week earlier. I extracted 15 loose and dead teeth.
Antibiotics and pain-killers were given for the next 10 days
 
For Stage 2, I waited one week to operation the cheek tumour.

I used injectable anaesthetics as it is easier to 
gain access to the mouth to remove the gigantic cheek 
tumour. Domitor and Zoletil were given IV.
Atropine was injected IM. 

 Gas anaesthesia is safer but the endotracheal 
tube obstructs the surgical view. 
. 

ELECTRO-SURGERY

To lower medical cost, the the owner did not want to send the cheek tumour
to the laboratory to check whether it is cancerous or not. 

MEDICAL RECORDS

Anaesthetic and surgical records are maintained
in writing and electronically. Above is an example of Dr Sing's 
illustrations of this rare case of a cheek tumour in a dog in 2010

CREDITS

(Narrate name of surgery and vet surgeons)

(Software used for this video editing by Ms Shyan Koh.  Date)

FOR MORE INFORMATION

-------------------

TIPS AND ADVICES

In this case, the cheek tumour grows again, indicating it is cancerous.  The young lady 
opted for euthanasia as the dog was in great pain and could not eat or drink properly. 

If your dog eats food on one side of the mouth, snaps at you
when you touch his mouth. If he has cheek tumour, foul breath and is losing weight, 
consult your vet promptly.



REMEMBER
(Narrate text in images)


-----------------------------------