The issue of a companion’s age when they are faced with the need for any type of anesthetic procedure is one we face as veterinarians almost daily.
“Isn’t she too old to have surgery?” “I’m afraid because of her age.” These are words we hear fairly regularly when dealing with older companions and their caretakers.
Penny, a 12-year-old miniature poodle, has been diagnosed with congestive heart failure and is currently being treated with two different medications on a daily basis to help control her disease. Maria, her caretaker, reports she is doing quite well. She has lots of energy and goes for walks almost every day. Her only sign of her heart condition is an occasional cough. She does however have what Maria describes as very bad dental disease. Her breath is, to put it mildly, horrible and she seems to have trouble chewing her food. Maria wants to have Penny’s teeth addressed but is fearful of losing her during an anesthetic procedure. She has been told that with Penny’s heart condition and her age, she should not be put under anesthesia because she might die, hence Maria’s fears.
As I have said many times before, old age is not a disease. I hope for lots of us this brings comfort. Yes, Penny is considered to be part of the geriatric canine crowd; and yes, she does have congestive heart failure. This does not mean she can not have her teeth fixed.
Penny needs to have a thorough work-up of her heart condition to access exactly what state her heart is in. This should include a chest radiograph to help check for the presence of any fluid in the lungs from the heart failure. I would also recommend an electrocardiogram (ECG) to measure some of the parameters of the heart. Blood work should also be done as with any patient before an anesthetic procedure.
Another excellent way to access the heart itself is via echocardiography. This involves the use an ultrasound machine which, using high-frequency sound waves, can take moving images of the heart in real time. With this wonderful tool we can check the chamber sizes within the heart, measure the amount of blood being pumped from the heart with each beat and even image the valves themselves. This is an invaluable study, which can greatly assist us in assigning risk to a patient needing an anesthetic.
After Penny has completed her preoperative work-up, an anesthetic plan can be specifically tailored to her physical condition. This plan will take into account both her age and the condition of her heart and allow us the greatest chance at success with her dental work under anesthesia.
The truth about Penny’s dental disease is that the risk from it is likely far greater than the risk from an anesthetic for a dental procedure. Dental disease can lead to severe health problems including liver disease, kidney disease and heart disease. With dental disease, there is a high bacterial load in the mouth, which can lead to bacteria getting into the bloodstream and/or the respiratory tract as the dog inhales bacteria with every breath. These bacteria can cause bronchitis and pneumonia in the respiratory tract and disease in the organs. In Penny’s case, she already has compromised heart function putting her at an even greater risk for further problems with her heart associated with her dental disease.
The good news in all of this is that Penny has a curable disease. Dental disease can indeed be cured and provided her risk assessment is favorable, she indeed can have her dental disease addressed.