Maybe I am getting impatient as I get on in years of practice, getting older and crotchety myself, or perhaps it is just that after 19 years of hearing the same reservations from pet owners and having the same talk with them to alleviate their reservations over and over and over and over again…that I am just sick of it. Whatever the case, it simply grates on me when I recommend a routine procedure or diagnostic that involves sedation or anesthesia in a senior aged pet that I get the question, “isn’t he too old?”
Ironically this question seems to come most commonly from senior aged people when I recommend a dental procedure, biopsy, colonoscopy, or a whole slew of other diagnostics and procedures that require anesthesia or sedation. They have these instant reservations about a necessary procedure that I am recommending but they have none when it comes to their own procedures that their doctors may recommend. Their logic is like, “Sure I’ll go in for my own colonoscopy despite my advanced age, but my senior dog will die if he does the same.” I wonder how it became a mainstream belief that senior aged dogs are far more likely to die under anesthesia than a senior aged person.
Not to be an ageist, as there are plenty of young people that have the same irrational fears that their senior pet will die if put under anesthesia to the extent that they would preferably let their pet live with a painful or otherwise debilitating condition out of fear of anesthesia.
Case in point, I had a Golden Retriever patient that had a lipoma, a benign tumor that sometimes can become intrusive as they grow large in some patients. When I first noted that the lipoma was getting uncomfortably large to the extent that it was make the dog walk funny and I subsequently recommended surgical removal of the tumor, the dog was just shy of 10 years of age. The owner declined out of fear that the dog was too old to survive the anesthesia, even though he had no cardiovascular or lung issues and his blood work was perfect.
The owner let this thing grow for another 2 years when just shy of 12 years of age and it was literally the size of a watermelon. Between the general arthritis the dog now had and this massive lipoma weighing him down and restricting his movement, the dog could barely get up.
Having no other choice at this point, the owner finally agreed to have the procedure done with euthanasia being her only other alternative. By virtue of waiting for it to get this bad, the owner actually ended up increasing the risk because the surgical time was to be 4-5 times longer than had she done it when I originally made the recommendation 2 years earlier.
Thankfully everything went well and the dog made a full recovery and regained a great deal of mobility back. The tumor ended up weighing 13 pounds.
It is even more frustrating when owners decline much needed dental work on pets. These can be an especially hard sell because in addition to the fear of anesthesia in a senior pet, we also have to contend with pet owners often not taking taking dental health as seriously as they should.
I had an Italian Greyhound patient’s owner put off much needed dentistry for 3 years out of fear of anesthesia. She finally scheduled it when the dog presented looking like an aardvark because the front part of it muzzle was sagging from all of the jaw bone that had rotted out and he could no longer eat. I ended up having to perform an hour and a half worth of oral surgery to extract a full mouth of rotten teeth and surgically reconstruct the upper jaw and leave in a feeding tube for 2 weeks for the owner to feed the dog through while the dog’s mouth healed.
Please be aware, age is not a disease in and of itself. Age is stage of life where we tend to see more disease and it is incumbent upon the veterinarian to rule out underlying disease that may increase the risk of anesthesia prior to a procedure. This starts with a simple physical examination, senior blood work to start, and may also include chest x-rays and an EKG if we suspect any anomalies. Even if there is an underlying condition that may increase risk, we can often adjust our anesthesia/sedation protocols to mitigate that risk.
The reality is that the greater body of anesthetic procedures and diagnostics that we perform in veterinary medicine are in senior aged pets. That is when chronic ailments and injuries tend to be statistically more likely to occur, just as it is in people. If many of them died as the result of anesthesia, that would not reflect well on our profession. The truth is, the vast majority of our senior pets do fine with anesthesia, with anesthesia related death rare with statistical probability rivaling that of anesthesia in people.
What finally prompted this article was a patient I saw yesterday. An otherwise healthy 11 year old Cocker Spaniel presented for a routine well visit and I diagnosed advanced stage dental disease. The teeth were so bad that I saw root exposure with pus and blood at the gum line and the dog was clearly painful for the oral exam.
I naturally recommended a dental ASAP and I was immediately shut down by the owner when I told her the tech would print her out an estimate for cost and she said, “Don’t bother, there is no way I’m doing it, she is too old.” I had a take a few deep breaths as I was feeling my blood rise and I shared with her that the worst pain I have ever felt in my life, even more than the two times I broke my collar bone, was dental pain.
I also told her that living with that level of dental disease would weaken her dog’s immune system, make her more susceptible to cancer, and significantly increase her risk of developing kidney failure. She said nothing just shook her head. I then said that I would have the tech get the estimate anyway, in case she had a change of heart, then proceeded to give myself a time out before I saw my next patient.
Dr. Roger Welton is a practicing veterinarian and highly regarded media personality through a number of topics and platforms. He is the author of The Man In The White Coat: A Veterinarian’s Tail Of Love. In addition to being passionate about integrative veterinary medicine for which he is a globally recognized expert, Dr. Welton was also an accomplished college lacrosse player and remains to this day very involved in the sport. He is president of Maybeck Animal Hospital , general partner of Grant Animal Clinic, and runs the successful veterinary/animal health blogs Web-DVM and Dr. Roger’s Holistic Veterinary Care. Dr. Welton fulfills his passion for lacrosse through his lacrosse and sport blog, The Creator’s Game.