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

9 comments

  1. 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.

  2. 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!

  3. 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.

  4. 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.

  5. 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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