Today, Pinkie arrived for a dental cleaning. Pinkie first came in a few weeks ago for an examination, and in the brief glimpse I got of her bared teeth before having to place a muzzle it was obvious that she had some pretty bad teeth. Unfortunately, when I placed my stethoscope on her chest, in between “grrRRRrrrrRRRRrrr” I heard the classic ‘whoosh-whoosh-whoosh’ of a heart murmur.
Heart murmurs are a common condition in older dogs. There are several causes, but the most common cause in older dogs is a leaky mitral valve. Instead of creating a nice seal between the atrium and ventricle of the heart, the valve leaks a little bit, and each time the heart beats a little bit of blood leaks back into the atrium, creating a distinctive sound that can be picked up on auscultation.
Many times, they are incidental findings. I don’t treat a murmur just because it’s there, unless there is some other identifiable form of cardiac disease that needs to be addressed. When we do find a murmur, though, the course of action directs that I recommend chest x-rays and an ultrasound of the heart. Without that reassurance that the heart is functioning well, I don’t anesthetize pets with a murmur.
“I don’t have the money for x-rays or an ultrasound,” Pinkie’s mother told me. “Can’t you do the cleaning awake?”
I didn’t think we had a chance in hell, but I felt badly for Pinkie and I wondered how much of her nasty view of the world was colored by the chronic pain of her rotting, green teeth. So I tried.
It was a horrible failure, by the way. I mean, I didn’t think it would work- the smallest pressure on her mouth caused her to growl, but I thought I owed it to her to at least try.
So I talked about it with Pinkie’s mom. We had two choices, as we saw it. Do the dental, or not. If we didn’t do the cleaning, she would be guaranteed to continue her life in pain. If we did attempt the cleaning, she might be OK, or she might not. With no x-rays or ultrasound, I had no way to gauge if that murmur was significant or not. So we talked about it in depth, with witnesses, and the owner said, Yes, I want you to try. Her reasoning was, and I quote, “chihuahuas live 12 years on average anyway, and she’s 11 1/2, so I figure it’s about her time soon.”
“I’ll be in and out all day,” she told me when she dropped Pinkie off. “If she dies, leave a message and I’ll pick her body up on the way home.” I replied, “Not if I can help it.”
It was a weird conversation.
We were very careful with the anesthesia, and I did the monitoring while my tech chipped layer upon layer of boglike slimy muck off Pinkie’s teeth. A couple of premolars fell out in her hand. Pinkie was, happily, completely stable under anesthesia and went home alive and well with a much more pleasant mouth.
It’s taken me a long time to be confident enough to take calculated risks. Earlier in my career I would probably have just said, nope, no dental, and left it at that. It takes the right owner, who understands the risk/benefit analysis and trusts you to take the gamble too. I’m glad we did. We are all the better for it.
