Chapter 28 – Doggie Dental

As I mentioned in previous chapters, I knew others who had dogs that passed away because of anesthesia during routine procedures, specifically a neutering and a skin tumor surgery. The dogs were young and healthy, but after they were put under they simply didn’t wake up. The Internet was filled with many stories similar to this. My own local veterinarian told me the chance was 1 in 400 that Gabby would pass away if they put her under anesthesia, even if everything seemed fine beforehand. Though I wanted to have her teeth cleaned,  the risk did not seem acceptable to me. Instead, I did my best to keep her teeth and mouth clean with brushing and dental sprays such as Leba Labs. We also used pulse antibiotics to control the bacteria.
When Gabby was 13 I had a long talk with my local veterinarian about finally having the dental done. I was terrified of the anesthesia, but her breath and the tartar were getting pretty bad. We discussed the procedure at length. Unfortunately, I wasn’t happy with some of the answers that I got. 
My first concern was with the doctor. Though I knew, liked, and trusted the local veterinarian, they would bring in a specialist to do the procedure. Unfortunately, it was not possible to meet the specialist until the day of the procedure. He would only come if he was going to work, and not for a consultation. I even offered to pay the full fee just to meet with him before we set up her dental. I was still told he would only come if he was scheduled to clean the teeth and do any necessary extractions.
The second problem was the anesthesia itself. I had done a lot of research about veterinary anesthesia and a comment I saw on several websites was they believed the risk would be lower if a veterinarian was assigned only to do the anesthesia, like a dedicated anesthesiologist as found in human medicine. I also offered to pay for a second veterinarian just to act as the anesthesiologist when the dental was performed. Again, I was told this was not possible and a vet tech would work the anesthesia machine.
I wasn’t satisfied. I could not understand why my requests could not be accommodated. They seemed reasonable to me, and I was offering to pay people for their time. I wasn’t comfortable going forward, especially since I could not meet the doctor. My gut just told me no, and I have learned to trust my instincts.
As you will find out as your read future chapters, trusting my instincts here could have very well saved Gabby’s life some time later.
A second opinion
I remembered Dr. Slobody and Meadowlands, where Gabby had her cryosurgery the prior year. I went back to their website and saw they have a dedicated dental suite with special high-end equipment so the procedure could be done more quickly, and the dog would spend less time under anesthesia. I liked the sound of that! I sent Dr. Slobody an email expressing my concerns, and called his office to make an appointment.

Dental suite at Meadowlands Veterinary Center

We met at Meadowlands a week later. Doc started by saying he did not think a 1 in 400 loss rate from anesthesia was acceptable. He thought it should be 1 in 1000s, and he had installed the very best ventilators available to actually breathe for the dogs when they are being operated on. He also told me he would work the anesthesia and do the procedure himself.
I liked the answers I was getting. He then pulled out the optical probe he used to look in her ears and looked in her mouth.  Everything was shown on the small TV in the exam room.
He showed me the tartar covering her back teeth, then he showed me something particularly disturbing.
“Do you see this?” he said. It was a little bit of yellow coming out of one of her back teeth.  “That’s exposed nerve.”
I realize that Gabby winced when I brushed her teeth back there. My poor little dog had been in pain, probably for a long time. I asked why it hadn’t been more obvious. He told me it was because dogs tend to hide their discomfort much better than humans do. It’s instinctive for them.
I was a bit disappointed that my local vet had never found this problem. The dental was definitely going to go forward now. That tooth had to come out.
We set the procedure for the following week. I told him I wanted every possible test that could expose a potential problem before the procedure. Blood work was a given, as were x-rays.
“What about an echocardiogram? ” I asked. “If there are any heart problems, will that expose them?” He replied in the affirmative, so I told him I wanted that too. He suggested we do it the following week, immediately before we actually did the dental. I agreed and we proceeded with the bloodwork and the x-rays.
The bloodwork came out fine, then we did the x-rays.
The x-rays were digital. He showed me them on the monitor. First was a side view.
“Her heart looks enlarged,” he said.  “Notice how it is pushing up on the trachea there.”
My heart sank. I knew an enlarged heart was a very bad thing

Then he showed the top view. “But from above, it looks normal size. I just may have caught it during a beat. We will know everything when we do the echo next week.”

I felt a little bit better after he said that. Still, I was nervous and hoping for good news we did the echo the following week.
The day of the dental
The echocardiogram brought bad news. Her mitral valve was not fully closing, and her heart muscle was twice as thick as it should be in some places. There was no murmur audible with a stethoscope, but things were definitely not as they should be. She had no clinical signs whatsoever, and she was as hyperactive as ever. Unfortunately, problems like this usually lead to congestive heart failure and death over time.
Doc and his staff started to do the dental as I waited in the waiting room. I couldn’t get the news out of my mind. She was 13, fully active and no clinical signs at all, but I was given the very first medical reminder that she was an older dog now and she wasn’t going to live forever. I had always known this, of course, but this was a first.
A vet tech came out to tell me Gabby was waking up and they would be bringing her out soon. A little bit later, one of the techs came out with her wrapped in an orange blanket. It was so funny, she look like a black frankfurter wrapped in the orange blanket!
Gabby saw me from across the room and I saw a little doggie smile appear. She was a little bit sleepy, but she was obviously pleased and feeling good. It must’ve been a relief to have that tooth out. Her dim eyes lit up and she started to wag when she saw me.
“Ohh, she’s wagging! ” the vet tech said. She brought Gabby over to me and handed her to me in the blanket. I was so happy to hold Gabby, and she had made it through the dental OK. But I knew I held a cardiac patient in my arms.
I asked Doc if Gabby was on borrowed time. now that we had uncovered the heart enlargement. He said he didn’t know, and we would treat it, monitor it and go from there. He gave me enalapril pills and we scheduled a follow-up a week later.
The drive home from Ohio was kind of sad for me. I looked at Gabby sleeping peacefully on the passenger seat, and every once in a while she would look up at me. She was obviously tired, but she was fine. I couldn’t help but feel that I had let her down by not having her teeth cleaned sooner.
When I got home I did some research, fearing that not cleaning her teeth caused the heart problem. I found out that it was possible, but also that mitral valve problems are extremely common in dachshunds. I would never really know for sure. Getting the enalapril adjusted was a bit of an event. When I gave her her first dose she became extremely weak.  I took her to the ER and they said it was dropping her blood pressure too much. We cut her back to half a pill, once a day, and that worked much better for her.
The heart enlargement turned out to be a complete non-event for the rest of her life, as you will find out in the next chapter.