Veterinary care for senior pets

by Christopher Forsythe, DVM

Hello, readers. Welcome to Health Matters. My name is Dr. Christopher Forsythe. I am a small-animal veterinarian practicing in Sonoma. Each month I will contribute a pet veterinary care topic with the hope of tweaking your interest, making you smile, and educating you about your pets.

"You never know until you try.” These are great words to live by, not only in life and in love but also, I’ve come to know, in veterinary medicine. You see, I’m a veterinarian who often gets to see a pet for a condition after two or three other veterinarians have seen her and told the client, “Mrs. Finklestein, Buzby is too old to undergo anesthesia. He probably wouldn’t survive. Let’s just watch the mass and monitor its growth.” Or, “Mr. Terwilliger, even though Paddle Pop has horrible teeth, she is just too much at risk to put under for a dental. So instead, I’m going to give you antibiotics for the abscessed tooth.”

Veterinarians aren’t the only ones who are worried about a problem with a pet. Owners are usually the ones who are most scared and often prevent doctors from moving forward with anesthetic-based treatment. “Oh doctor, I’m not sure about operating on Bubble-cakes. Are you sure he needs anesthesia to fix that wound? Can’t it heal on its own?

But the very best one is the client whose pet had swallowed a three-inch pair of scissors and wanted to know if we could let them pass through on their own. “But I’m just afraid that she could die in surgery,” the client said. “What if something goes wrong? Can’t you make her vomit them up? Or try a laxative? Anything but surgery. She’s 14 years old, and she has a murmur and is on heart medication. Can Miss Marpel even make it through surgery?”

“She doesn’t have any choice this time.” I tried to reassure her restless guardian, and reminded her that Miss Marpel’s AGE was not her illness; it was the scissors in her gut causing the problem.

I’m sorry, I don’t divulge my age

I recently attended a large medical conference in Las Vegas. One of the oncology lecturers from the Bay Area spoke of the success she had had removing tumors from various geriatric pets who had not been treated by other veterinarians due to poor prognoses. She in turn had “stepped up to the plate” to treat these patients aggressively, despite their advanced years, using excellent medical and surgical plans. Of course, their owners were somewhat jaded as they had been reminded by their primary care veterinarians that their pets were very old and had little chance of survival. Well, apparently neither this doctor, nor the pets she treated, had gotten that memo.

Since this particular doctor agrees with me that “you’ll never know unless you try” and “age is not an illness, only a time of life,” she presented a well thought-out surgical and medical treatment plan for those supposedly hopeless, aged pets who were referred to her. Her plans included chemotherapy and, in one case, life-sparing limb amputation. The good news is that the pets not only survived surgery, but went on to live one to two years longer. The owners were elated to have had this extra time with their pets, tail wagging testaments to the fact that you’ll never know unless you try.

Why, sir! Are you not aware of the risks of surgery?

Of course I am aware that there are always risks involved in medicine and surgery, and the risks are elevated in senior patients and those with impaired medical function. What I am saying, though, is that regardless of age, all pets are candidates for life-saving medical interventions.

We do know, though, that seniors are in a higher risk category. That is a fact. But what exactly makes a senior pet more sensitive, and creates those special needs? The woofing and barking AARP set heading into their leisure years are now our fastest-growing pet population, thanks to the amazing quality of medical tools and high standard of care in veterinary medicine.

Our older pet population tends to have less organ reserve, so when they “go under the knife” or, better yet, “go under the laser” they are less tolerant of the physical demands associated with anesthesia and pain. Their respiratory systems tend to be more prone to cessation of breathing and a shortage of oxygen than those of their young counterparts. So while the senior patients are under, veterinarians and veterinary nurses need to be extremely sensitive to any resulting respiratory depression and watch carefully for any change in the pet’s breathing patterns.

The pet’s kidneys “slow down” during surgery. Older pets’ bodies are sensitive to a reduction in oxygen, so if doctors are performing anesthetic procedures on a geriatric pet, they o_ en reduce doses of ingestible sedatives and tranquilizers which are eliminated by the kidneys due to the pet’s reduced metabolic capacity.

Older pets’ livers are different, too. They usually have decreased liver mass as they age, which means less blood flows through the liver, the body’s filter for toxins. If this filter isn’t as expansive, it can’t do as good a job filtering.

Case study: a ravishing creature in basic black

Lavender came into the office a couple of weeks ago as a new client with some big concerns. Number one, she was older than the Sonoma fieldstone behind the hospital. She had a million-dollar smile, but her breath smelled like a truck stop restroom after weeks of plumbing backups. Her eyes twinkled up at me.

The holistic vet from whence Lavender came had given me a problem list and it was vast. She was in her mid-teens. She had developed asthma after having a litter of puppies a number of years ago. Her pneumonitis required her to take daily doses of prednisone, which causes significant side effects to the liver, skin, and general metabolism. She had an ear infection. Her lymph nodes under her chin were swollen. She had thin skin under her tummy and a pot belly as well as an enlarged liver. Her hair was thin at her tail base, probably due to the steroids. Most of all, though, she had very foul breath, the aroma of oyster gone awry. And Lavender, despite all her problems, was a pure and simple delight, a beacon of beauty.

Two of the greatest things about Lavender were her moms. They had been told that Lavender was too old to go through anesthesia. But as sharp, open-minded women who want the very best for their pet, they knew that the risk of not treating with proper dentistry was clearly a much bigger risk than devising a careful, appropriate, safe, yet aggressive treatment plan. After all, they wanted her to play on their farm, not buy it!

We developed a treatment plan for Lavender that kept her senior status in mind. It took into account her special needs, physical condition, her advanced age, and her Cushing’s disease (from the steroids she had been given).

The following Friday, Lavender made her gracious appearance at the hospital for her dental procedure. Her blood work had already been done the week before; her parameters looked pretty good, and her moms were informed about the values. We were ready to proceed.

After a very light dose of sedation, Lavender received an IV catheter in her front leg. She received an ultra-short acting injectible anesthetic that is very safe to use in high-risk patents, as well as preoxygenation to make sure her lungs and internal organs were full of oxygen as she fell asleep. She was maintained on a safe gas anesthetic and monitored with a pulse oximeter and ECG machine at all times. IV fluids with antibiotics flowed into her vein to fight infection, and a medicine called glycopyrrolate helped to ensure her heart rate stayed at 120 beats per minute.

We used a local nerve block to “numb” the pain, and then the teeth were pulled and the gums sewn closed with a flap. All of her teeth were ultrasonically scaled and charted, then polished and sealed as if she were in a human dental office. Before waking up, she received additional NSAID pain medication via injection, to make her recovery less painful and stressful.

Lavender woke up very quickly after the procedure and immediately got to void her bladder (we know that this is what human patients complain the most about after surgery, so we can only assume dogs and cats dislike a full bladder most too!). Then she curled up on her warm blanket and just rested.

Lavender seems like a new dog now, according to her guardians. They now understand that “you’ll never know unless you try.” And guess what, one ravishing creature’s smile and nonstop tail wag is proof positive of that!