21 March, 2017
When it comes to senior dogs even the simplest of surgical procedures can strike fear in the hearts of dog parents because of the risks associated with anesthesia. Whether it is for diagnostics, a routine procedure or something more complicated, one thing is certain, the possible impact of anesthesia should not be taken lightly, especially when your dog is a senior. However, a wise veterinarian once said that "age is not a disease", so senior dogs should not be disqualified from treatment options solely because of their age. So how do we as dog parents help to reduce the risk of anesthesia in our senior dogs?
Before putting your senior dog through a procedure that requires anesthesia it is very important that you have some testing done to ensure they can handle such heavy sedation. Don't be afraid to ask for tests if your veterinarian is not suggesting them. In addition to a physical exam, pre-op bloodwork is a key diagnostic tool that all parents need to insist on having done.
According to Dr. Jeffrey Levy, DVM, CVA and owner of House Call Vet NYC, "Pre-op blood tests are used to determine the absence of underlying conditions that would make surgery risky or leave the patient vulnerable to the effects of anesthesia. Most important are kidney and liver values, hematocrit (red blood cell count), white blood cell counts, blood sugar for potential diabetes and a heartworm test."
Each bit of information retrieved from the bloodwork tells a story that can help your veterinarian evaluate the overall health and identify any risk factors they need to address.
"Elevated liver enzymes might indicate the pet has Cushing's Disease, liver disease, or a tumor. High or low blood sugar can indicate diabetes or possibly a pancreatic tumor. Decreased kidney function would alter the type of anesthesia used or make anesthesia too risky to move forward. Low red blood cells or platelets could indicate infection, inflammation, or possibly cancer." explains Dr. Judy Morgan, DVM, CVA, CVCP, CVFT, owner of two award winning practices and the Chief Medical Officer for Monkey's House Senior Dog Hospice and Sanctuary.
Additional tests such as an ECG, urinalysis and chest X-rays may also be wise and for invasive procedures with a high risk of bleeding, Dr. Jennifer Queiroz-Williams, DVM, MS, Associate Professor of Veterinary Anesthesia and Analgesia, LSU School of Veterinary Medicine recommends doing a clotting profile as well.
"Chronic anemia, indication of kidney disease, genitourinary infection or systemic infection, abnormal chest radiographs or ECG and abnormal clotting profile, independent of age, would be red flags to not move forward with anesthesia," states Dr. Queiroz-Williams.
When my senior pug Lily was going through her testing to ensure she could handle anesthesia to undergo an MRI, CT scan and the inevitable surgery, she underwent many of the above mentioned tests as well as an abdominal ultrasound. Having so much information available prior to undergoing the anesthesia gave her doctor and supporting team the necessary details to devise a clear plan and made moving forward possible. It was also incredibly comforting to me to know that all her results came in so positive.
Ensuring that your dog is at an ideal weight can make a huge difference in how they respond to anesthesia. Overweight dogs have a much more difficult time breathing and this means their hearts have to work that much harder, especially when under anesthesia. Incorporating a healthy, active lifestyle will keep your dog as fit as possible, reducing risks should they one day need to undergo a procedure requiring heavy sedation.
It is also very important that you discuss any medication or supplements your dog may be taking with your veterinarian prior to any procedure since even a natural remedy can put your dog at risk during surgery.
Dr. Morgan explains, "Some supplements can cause prolonged clotting times and increase bleeding, so be sure to discuss any supplements you are giving with your veterinarian prior to the procedure. Also let them know if you are giving any over-the-counter medications, as many can interfere with anesthetic procedures or surgery. It's amazing how many pet owners give aspirin without a thought; this can cause pets to bleed excessively during surgery. Sedative or anti-anxiety medications may interfere with anesthetic drugs that are used."
Your dog will need to fast prior to the procedure and experts also recommend grooming and bathing your dog prior to any surgery. This will help to keep them clean before and after surgery.
During the Procedure
While many procedures are done in your veterinarian's clinic, you can request that an anesthesiologist be present. The more invasive a procedure, the more you need to consider this decision.
According to Dr. Queiroz-Williams, "Best practice is to have an anesthesiologist always present or at least available for consultation. However, specific health conditions (systemic diseases, pre-shock, unstable patients, all very invasive abdominal proceedings, cardiac surgeries, central neurologic patients, and many others) should have an anesthesiologist present. Some breeds can present challenges for anesthesia (e.g., brachycephalic breeds, breeds affected by the MDR1 mutation like Collies and Long-haired Whippets, and many other particularities of specific breeds)."
I have handled things in several different ways for my dogs. My first pug Mackenzie needed dental surgery when he was 15 years of age. Terrified, I made sure we did all the testing that was available and due to the risks, I requested that he have his dental work done by a specialist with an anesthesiologist present. With Milo thanks to his glowing bloodwork and other positive tests I felt that his dental work could be done at my vet's clinic. With Lily, since she was being treated by a specialist, all of her procedures requiring anesthesia had an anesthesiologist involved, especially given the length of time she was under. Now with my Winnie, my 6 year old French Bulldog who has noticeable breathing issues, I am going to ensure she has an anesthesiologist on site for any procedures she may need.
During any procedure requiring anesthesia your dog's vital signs are constantly monitored. I find it comforting to ask exactly what they will be keeping an eye on which typically includes heart rate, blood pressure, body temperature, CO2 and oxygen levels and if necessary, anesthesia may be adjusted throughout.
If you have had a dog undergo a diagnostic or surgical procedure requiring anesthesia then you know how scary it can be waiting for that phone call letting you know how everything went. I remember that feeling of unbelievable relief that consumed me when I received the phone call from Lily's neurologist after her 6 hour back surgery telling me that she woke up like a champ.
Helping our dogs recover begins before the procedure is even completed. From a technical perspective Dr. Queiroz-Williams describes the impact that the proper administration of anesthetics and pain killers during the procedure can have on recovery. "Performing multimodal anesthesia and analgesia, while performing high quality anesthesia will overall improve the quality of recovery. Intense monitoring especially for the first three hours post anesthesia are vital to a safe anesthetic event."
Post-op there are also many things that we can do to help ensure a fast, healthy recovery. Dr. Levy reminds us to use our common sense, "provide a quiet, stress-free recovery area. Make sure the space is well ventilated and the temperature is comfortable. Handle her gently and protect your dog from being annoyed by children or other pets."
Block access to stairs and do not leave your dog unattended anywhere that they could fall or trip. In Lily's case I also needed to restrict her movement so I set up a comfy section in my room on the floor where she would be safe and where she could not move around very much until she was stronger. Some procedures require crate rest so that's something you will need to plan ahead for.
Adjusting their diet can also help with their recovery. "Many pets will be nauseous for a few days post-op. Have a bland diet prepared ahead of time. (I like 3/4 boiled lean ground turkey mixed with 1/4 canned organic pumpkin puree.) Extra fluid intake will help the body flush the anesthetic agents out of the body. Water flavored with a little no salt chicken or beef broth may encourage them to drink more," states Dr. Morgan.
It is important that we keep an eye on any incisions to make sure there are no signs of infection, but we also need to keep an eye on our dog's behavior and report back any signs that your dog is not getting back to their old self. Follow the post-op instructions provided by your vet and ask any questions you may have. Sometimes we are so caught up with the whole process that we cannot think clearly enough to ask all the questions we need to until we have returned home and can catch our breath. Don't be afraid to call your vet whenever you are unsure about anything with your dog's recovery. When it comes to our dogs it is always better to be safe than sorry.
Surgery is never something we wish upon our dogs, but there are steps we can take to reduce the risks as much as possible. Speak with your veterinarian and if needed a specialist, and together you will be able to do what is best for you and your senior dog.
Ann-Marie Fleming is the Founder & CEO of Dog Quality, a provider of products focused on improving the quality of life for older dogs.