Neither Age Nor Kidney Failure A Factor In Anesthesia
“Dr. Randolph, is she just too old to have surgery?”
Thirty years ago this client’s statement would have applied to any pet over six years of age.
Twenty years ago that age limitation might have been set at age ten.
For the last ten years age, alone, is not a consideration for which patients we will anesthetize and which ones we won’t.
Today we have excellent diagnostic tests, such as the chemistry profile to determine whether kidneys, liver and other blood parameters are in a satisfactory range to ensure safe anesthesia. We have detailed complete blood counts (CBCs) to know whether there are sufficient cellular elements such as red blood cells, white blood cells and platelets for safety. The urinalysis yields data we can use along with the blood test results to know even more about the body’s overall health.
In 2010 we are three generations ahead of inhalant maintenance anesthetics we used in 1980 when I graduated from Auburn University’s College of Veterinary Medicine. Where a pet with a borderline liver or kidneys might not have survived even a short anesthetic procedure thirty years ago, today the same pet might emerge healthy from even a lengthy surgery or dental care.
Which brings us to today’s post about our precious poodle, Pearl.
Recently we noticed that Pearl had lost weight. Perhaps we suspected prior to “recently,” but were in denial. As she grows older and is losing her vision and her hearing, we really aren’t up to more bad news. Frankly, we still haven’t gotten over the loss of her brother, Peyton and probably never will.
Pearl has always been a dietary self-regulator, never eating more than she needs for proper health and nutrition. As a result, she’s always had a trim build, and we are able to just scoop up a bowl of food, put it on the floor while we have supper and pick it up later. We first began to notice that there was more food than usual left in her bowl. She has eaten Prescription Diet t/d in the original size for years and years, but when I accidentally brought home the “small bites” version of t/d we noticed that she ate it better.
Even though her physical examination was mostly normal, just to be sure she wasn’t having any metabolic problems I submitted samples for a chemistry profile, CBC, urinalysis and thyroid level.
Everything came back normal except for her kidney numbers, which are about twice the maximum of normal. As bad as that sounds, it’s really not so bad for a 16-year old dog. Still, it does mean she is in kidney failure, and that will likely be the cause of her eventual demise.
So, what does Pearl’s kidney failure have to do with anesthetizing old dogs? Read on.
After we discovered that Pearl no longer wanted to eat a large kibble like t/d, and we had her abnormal laboratory test results, we decided to change her diet to Prescription Diet k/d instead. k/d is formulated specifically for patients with kidney and liver problems. For some time her breath has been a little objectionable, but I began to notice that there seemed to be “foul” component to it now, which implied infection might be present. Further investigation proved that calculus buildup was substantial, as is common in older dogs, and that infection in the gums was a problem.
After long discussions and prayer, Brenda and I decided to proceed with anesthesia, dental cleaning, polishing and fluoride treatment for Pearl.
The night before her procedure I administered Convenia to Pearl to begin the process of lowering oral bacterial numbers well before the procedure.
We began the day by introducing fluid therapy to flush waste products from the bloodstream that the kidneys were not removing. After an hour on the IV pump we transitioned Pearl to surgery, anesthetized her, and began to remove the calculus above and below the gumline. That part was uneventful and our Cardell monitor assured us that all systems were operating as they should. We polished her teeth, applied a fluoride treatment and woke her up.
To continue flushing out waste products we maintained Pearl on the IV pump for the remainder of the day until it was time for both of us to go home.
The next day Pearl was spry, just as if nothing had ever happened. She is eating normally, jumping on and off furniture like she always does and generally healthy and happy.
The infection smell on her breath is gone.
Convenia will continue to protect her for 14 days from infectious bacteria that might have been released into the bloodstream during the dental cleaning, so that they do not cause problems in the heart, liver, kidneys or other organs.
Removing the oral inflammation and infection will prevent those problems from taking a further toll on her kidneys, a cost she cannot afford.
Having been safely anesthetized and her teeth shiny and healthy, Pearl can expect to survive longer with kidney failure than she would have with ongoing oral disease taking its toll.
More on kidney failure Monday.