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.
MMANESOLD

23 comments

  1. Jan says:

    We have an (believed to be age-we got her from rescue) Australian Terrier who just turned 12. She is IRIS 2-3 but doing quite well. Her teeth have a lot of plaque buildup. I don’t know that they are bad but they haven’t been cleaned in 2.5 yrs and prior to that were cleaned annually. She was actually at the vet for dental when the bloodwork indicated IRIS 1 CKD in October 2018 and the vet refused to clean her teeth. So far I am at two vets saying NO never let anyone put her under anesthesia and one vet indicating a process of IV fluids before dental, convenia and getting “in and out” as quickly as possible. My real question is about the anesthesia that is used. Does it matter? One vet uses Sevo and the one willing to clean the teeth uses Iso. As I understand it Sevo is a much more expensive anesthetic. In my research I happened onto this article and asked all three vets about it. Not one was familiar with Suprane (desflurane) But we are in OK so not really surprising. I don’t know what to do. I have all her records. The last time we had renal values checked she had improved on restricted protein diet. AND lest I forget she also has chronic pancreatitis and is on twice daily dose of Metronidazole. Despite all this if one had no access to her records and based an opinion entirely on how she looks and acts no one would even suspect she has all this going on. Any insight would be greatly appreciated.

    • The bottom line here is risk-benefit ratio. Two doctors have told you anesthesia is unacceptably risky and the third wants the anesthesia short. Therefore, everyone who has assessed her is in agreement that anesthesia is risky. Let’s say she’s IRIS Stage 3. How much time are we actually going to buy her? You’ve done a great job of keeping her dental health as high as possible, but, now she has this high risk factor, and I believe you’ve done all you can do from an oral hygiene standpoint. The bottom line is that you want to have her as long as you can, and I don’t see taking the risk of cutting that time short. But, then again, she’s not my baby. Thank you for reading, Dr. Randolph.

      • Janice says:

        Thanks so much for your insight and quick response. Not cleaning her teeth runs counter to a lifetime of care for my pets and difficult to overcome. I appreciate you interjecting a dose of reality. Do you have any thoughts on brushing teeth or particular products you feel have value for oral care? I have been brushing daily with Petrodex.

  2. Lee says:

    Thank you for writing this article, it has given me a little hope. I have a 16 yr old terrier/chihuahua cross who has had kidney disease for 2 years now. He is about stage 2 wiht a SMDA of 21 I think but I do need to get some new bloods done. He had really bad breath and the plaque build up on one of his back teeth is so large that he has a lump on his face and his eye weeps. My vet said 2 years ago that the kidney disease would make it too hard to operate on his tooth and gave him antibiotics… but here we are 2 years later and it is just getting worse. The poor little old man also has an incontinence issue which the vet said cannot be treated either… I home cook for him and give him a bunch of supplements and he is doing really well but I think that his tooth must really hurt and he is forever “cleaning up” after himself which cannot be healthy. Any advice gratefully received! (I am in NZ and we do not have fancy vets here that I am aware of).

    • According to the ABVP (American Board of Veterinary Practitioners) web site (click on the link to go to the site), there is at least one ABVP doctor in New Zealand. ABVP practitioners are doctors who are general practitioners, yet, they have additional training and expertise. If you can find him, her or them, you might find someone who can evaluate your baby and tell you whether anesthesia will be safe. Thanks for reading and for writing from so far away!

      • Lee says:

        Thank you Dr Randolph, I had a look and there are 2 ABVP practitioners in New Zealand but unfortunately both are bovine specialists in the South Island where as I live in Auckland! back to the drawing board!

  3. Adrian says:

    Would love some advice on my 12 yearold poodle. About 3 months about he started have what we called spasms. He would scream his neck was stiff and to the side and his right leg was stiff and he he couldnt walk. Painful to watch. Usually ended after a minute. We took him to our local vet and he put him on tramadol and methacarbol for pain. After 2 weeks he was back to his normal self for about 3 weeks. Then we thought he fell off the couch but cant be sure because we didnt see it happen and the spasms started again but were worse in the fact that he was so lethargic and just laid around all day. Peed sometimed uncontrollably, Still are well but we felt something was off. Our vet added gabapentin and meloxicam. After a week he still wasnt better. Started peeing in the bed and still lethargic. We decided to take him to UGA and after blood work found out he was in kidney failure. BUN was 115 but then came down to 88 after fluids and then 65 the next. They said the meloxicam was causing his levels to be high. He seemed to be getting better But today we just found out that his neck and back pain are neurological issues are worse and that’s causing him to not be able to empty his bladder. They want to keep him another day and are having to drain his bladder. They caused his BUN to go back up to 80. They want to do an MRI but I’m so afraid to have him under. We just need some help and maybe someone has been through something similar. He has always seem so happy and healthy up until a few weeks ago. So not only are we dealing with kidneys but now he cant pee and has back and neck problems that they think are several disc. What do we do

    • Sounds to me like he needs a referral to a board-certified neurologist. At age 12, a poodle still has a lot of life to go, and we don’t want those years spent in pain. Thanks for reading, Dr. Randolph.

  4. Jamie Fiste says:

    Thank you for your helpful article! I was encouraged to read it! We have a 15 year old Sheltie with one kidney who is otherwise healthy except for a tumor in her leg around her ankle (if that’s the correct terminology). It’s gotten pretty big and the vet said the skin is getting kind of thin. As far as I know, her blood work is normal. The vet even said she is a very healthy 15 year old sheltie. She’s still playful, sees well, barks at the cats in her yard (haha), and can even hear a little. But the vet said because of her age and one kidney that they can’t do surgery to remove the tumor. The vet suspects the tumor is benign. She said eventually the skin will probably rupture and we would have to seriously consider putting her down at that point. It seems wrong to put down a dog that is otherwise very healthy and completely alert over this tumor. Have you ever successfully put an elderly dog under anesthesia with one kidney? It seems there must be something that can be done. Any thoughts?

    • I would ask for a referral to a surgical- or multi-specialty practice where a board-certified surgeon can evaluate her candidacy for anesthesia and surgery. A practice that includes a board-certified oncologist would be ideal. Your local doctor can set up the referral. I’m with you … let’s give her every chance for a long survival! Please write back and tell me what you learn and how she progresses. Thank you for reading, Dr. Randolph.

  5. Rachel says:

    Hi,
    My 8yr old dachshund just had blood work done before having a dental scheduled. It came back normal liver but slightly high globulin and slightly low albumin. The urinalysis came back high white cells, normal kidneys. She’s on antibiotics and tests are being repeated next week. We are hoping urinary tract infection and when the antibiotics get that everything else will get back to normal. If that doesn’t happen is there any way to know what the probability of the anesthesia having a bad effect on her kidneys could be? I’m trying to decide between having the dental or not, she really needs the dental. My vet would rather do lots of further tests ( if needed) but I can only afford one or the other.
    Thanks for any thoughts.

    • If the laboratory tests did, in fact, show her kidneys to be normal, there should be no renal issues with the anesthesia. After the suspected urinary tract infection is resolved, it will be important to follow up with testing to be sure the infection is completely resolved. Please don’t skip this step. Any inflammatory process in the body can be hard on kidneys, and oral inflammation is high on that list of possibilities. IF your pet’s doctor feels your pet is safe to proceed to anesthesia, she should have healthier kidneys after. Thanks for reading, Dr. Randolph.

  6. Sandy says:

    I have a 15 year old jack Russell. Bad breath, took him in to do blood work and urine.?rusults were not good! His kidneys and liver enzymes were up quite a lot. Gave me 3 different pills and I’m supposed to go in as much as possible for fluids.?have tried multiple ways to give him pills but I truly believe he can’t chew well because of his teeth. My vet said it’s not a good idea to put him out because of a chance he might not wake up. I want him to be comfortable for how ever long he has. I want his tooth pulled. Need some advice, please. Sandy

    • If the lab test numbers are so bad your veterinarian doesn’t feel comfortable anesthetizing him, you have two choices: 1, follow his advice, or, 2, seek a second opinion. If there is a board-certified veterinary dentist near where you live, you could ask for a referral. Thanks for reading, Dr. Randolph.

  7. Steph says:

    Hi,

    Not sure if you are still answering questions. I have a 14 year old pup with stable stage 2 kidney disease. She has been stable since diagnosis 6 months ago. She has a connective tissue tumour in her groin that has gotten to a size her vet now thinks is bothering her. I want to make her as comfortable as I can for as long as her old body wants to be in this world. Our Vet seems fairly confident he can safely do the surgery and I trust him. I’m just curious how risky it is to put older pets with ckd under? With all the new drugs and pro-cautions you can take for ckd pets, is there a much greater risk than with healthier pets? I know there are always risks of complications in surgery, just wondering what your opinion/ experience is with success rates in dogs with ckd. Thanks!

  8. Scoots says:

    Our cat is 8 yrs. old. This is the second time he has had crystal & bad kidney levels. Last time they lowered his levels & he had surgery to remove some crystals. This time he is much worse & his kidney levels are not coming down. We don’t know if we should keep him on an IV & cathator or go ahead with surgery to remove his penis & make the pee hole bigger to help with the crystals while his blood work is out of whack.
    Any suggestions?

    • Your local veterinarian is in a much better position to make this judgment call. Ultimately, if he has post-renal uremia, he’s not going to get better until the urine comes out. In some patients, perineal urethrostomy is the only way that will happen. Thanks for reading MyPetsDoctor.com.

  9. Bindu says:

    Thanks for your reply, Dr. Randolph.

    Yes, sorry, they were bags! Krish weighs about 65 pounds. And he had close to 750 ml of RL altogether; 500 ml was given to him either during or right after dental cleaning and the rest, while I was sitting with him after the procedure.

    He’s been coughing.. almost like he’s trying to get something out of his throat. He used to do do this a while ago when his kidney numbers were highest, so is it acidity perhaps? Other than that he seems okay.

  10. Bindu says:

    We had my 13 year old canine companion’s teeth cleaned today since his breath had been foul for a while. His kidney numbers were bad a few months ago and didn’t improve much despite daily fluid therapy. His numbers did come down impressively after a 3 week herbal treatment! It’s been good for about 3 months now, so we thought it might be an ideal time to tackle the bad breath which had, predictably, gotten worse. And his blood work seemed to be more or less normal (BUN was 15! But creatinine was 2.3) But after the cleaning, he was only given one and a half bottles of fluid. Is that sufficient?

    • Congratulations on success in getting your aging friend doing better. To answer the question about quantity of fluids administered I would have to know your dog’s body weight and the size of each container. Bottles have been out of vogue for several decades, are you sure they weren’t bags of fluids? In any case they come in 100 mL, 250 mL, 500 mL, 1000 mL and larger bags. The type of fluids also matters, as well as whether your pup was dehydrated or fully hydrated at the time the procedure began.

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