This "Beau". He is thirteen years old, and this picture was taken about 15 minutes after we finished cleaning his teeth. His teeth were really covered with calculus (tartar), and he had a little gum disease. Cleaning his teeth was especially important because of his other medical problems. Not his lower back problems (which have been really bad at times), and not his low thyroid condition (for which he takes medicine twice day), but because he has severe heart problems.
Beau has congestive heart disease. He has been on twice-daily medications for four years. You may not have looked at many chest X-rays, but take my word for it: this is a big heart. It looks like a basketball, double the size it ought to be. It’s not big and strong, either. It’s stretched out of shape and weak and flabby. His cardiac output when he’s wide awake is worse than most dogs while they are under anesthesia. SO… who’s up for knocking him out to clean his teeth? [I can’t hear you.]
Anything you do involves making a decision as to whether the risks outweigh the benefits. When they dropped off Beau, the last thing the owners said was, "Don’t kill him." Hey, no pressure.
First the Benefits: clean teeth, fresh breath, healthy gums… so what? Just don’t look at his mouth and you can pretend he has all those. Then there’s the fact that you get rid of the zillions of bacteria that his mouth is constantly dumping into his bloodstream — bacteria that are clogging up his kidneys and damaging them, and that would love to colonize his damaged heart valves. Okay, that’s a little harder to ignore.
What about the Risks? Well, he’s thirteen years old and has had heart disease for four years and he might die with clean teeth. We could have stopped right there, but we didn’t. We decided to look at his actual risks. First, his bloodwork is good — no problems with liver or kidney function. Second, if you look at that chest X-ray again, you’ll see that the lungs are clear — no fluid and looking good. Third, his electrocardiogram got a pass from the cardiologist at Idexx telemedicine. So…a lot of his "risk factors" are actually not so risky.
We put Beau on I.V. fluids and kept his anesthesia light (with easy-to-adjust Sevoflurane gas), monitored him closely, and I worked at a furious pace. My receptionist wandered back to see how we were doing and said, "Your next appointment has cancelled, so you can take your time." Wrong. No matter how good his labwork was, there’s no point in pushing our luck with that big, weak heart.
The point of the post is this: you folks with your 9-year old dogs with healthy hearts have got to stop using the "he’s too old" excuse for not getting those mouth problems handled.