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Should I Have Surgery for My Old Dog?

November 28, 2010
Grey white clown faced long haired red 20-year-old miniature dachshund dog

20-Year-Old Dachshund Granted Several
Miracles

Loss of a Faithful Companion Can Tear
Your World Apart

Shara lost her 12-year-old mini
Dachshund to Bufo Toad toxicity.
Mimi had been a lusty red-headed long haired Dachshund,
and she did what Dachshunds do: Mimi got into everything,
preferably teeth first. The Bufo toad sat in wait in the
leaves at the edge of the patio, and when Mimi lunged for the toad,
her tongue barely touched the poisonous skin. She immediately
started foaming at the mouth and tremors and seizures followed
within two minutes. Even though Shara washed out Mimi’s mouth
with hose water and rushed to the animal hospital, Mimi could not
be revived out of her seizures, even with continuous general
anesthesia. She eventually lapsed into a coma and passed away
later that same night.

“If your dog licks a Bufo Toad, or, if
your dog was in the yard in Florida, and you suddenly notice severe
drooling and tremors, rinse the mouth well, and get to the vet’s,”
says Doc Truli.

Shara was devastated. If
you’ve ever lived with a dog, or especially a Mini Dachshund,
especially since you were a teenager and your dog has been your
only constant companion through school, and moves, roommates, and
love affairs, and even the passing of your father at only 55, you
feel the pain Shara felt when Mimi passed away at only 12 years
old, and so suddenly. We would all understand if Shara felt
depressed or withdrawn or pessimistic. We were all surprised when
Shara returned to the animal hospital the very next week with a
“new” companion!

Love Springs Eternal…At the Animal Rescue
Shelter

Enter Penny. Long red fur, long royal
nose, stubby chubby paws pointing out, feathery long tail waving a
friendly welcome to everyone she met! Shara found a new
companion at the local rescue league. But Penny was no puppy.
She wasn’t even young. She wasn’t even middle-aged!
Penny’s face had a grew laughing clown-like pattern around
her eyes and muzzle. She looked benevolent and smiling all
the time. And she was already 15 years old. “I figured she
needed a good home and I fell in love with her the minute I saw
her,” said Shara. Shara never thought twice about how much time she
and Penny might have together. She only thought about this
loving, beautiful, peaceful, friendly Dachshund and Shara knew they
were meant for each other. Through the years, they weathered
tremendous ups and downs, but mostly “ups.” First, Horrible
Festering Dental Disease at 15
Penny’s previous
family relinquished her to the animal shelter at the ripe age of
15. They stated that their grandmother had passed away, and
as Penny had been her dog, no one in the family had the space or
time to care for her. Imagine! Shara brought Penny for her
fist post-adoption physical examination. Penny was
sway-backed like an old horse, and she had incomplete cataracts, so
she could see okay, but not perfect. Her biggest health
issue, beside some arthritis, was her dental health. Penny’s
incisors were loose and many of her molars were rotten and
infected.

They stated that their grandmother had
passed away, and as Penny had been her dog, no one in the family
had the space or time to care for her.
Imagine!

After dire warnings about older
pets and anesthesia, Shara eagerly signed the dotted line for Penny
to undergo oral surgery. “She deserves to be comfortable,” Shara
said. Doc removed 15 teeth that afternoon. Cleaned
everything, gave Penny some relaxing painkillers. This
amazing little dog was awake and begging for food within 20 minutes
of her surgery! She recovered fully in
hours
– not days!

Penny Faces Adrenal
Carcinoma

Fast forward a year.
Penny and Shara have been constant companions. Shara
noticed Penny was drinking a lot of water, urinating in the house,
and her belly looked large. “These are non-specific symptoms of
over 40 diseases,” warned Doc Truli, “We’ll start with a diagnostic
database of CBC, Chemistries, and Urinalysis and go from there.”
After the basics, an ACTH stimulation test, and abdominal
ultrasound, we found an adrenal tumor inside Penny’s abdomen in
between her kidney and her aorta. This tumor was making
natural cortisone steroid hormones. Even though her body was
making the natural hormone, the effect of too much in this runaway
tumor was the same as if someone fed Penny prednisone or steroid
pills like candy for months. The condition is called
hyperadrenalcorticism (Pronounced
high-per-ah-dree-null-core-ti-sizum), also known as
Cushing’s disease after the doctor
that discovered it in humans. Furthermore, there are two main
sub-types. One type is driven by the pituitary gland in the
brain. This pituitary dependent
hyperadrenalcorticism
accounts for 85% of cases in
dogs. Penny had the rarer, vicious kind of Cushing’s caused
by an actual adrenal gland carcinoma,
a nasty, usually metastatic spreading cancer.

This pituitary dependent hyperadrenalcorticism
accounts for 85% of cases in dogs.

Risks of Adrenal Gland Surgery

The adrenal
tumor responds poorly, if at all, to the medication that works for
the pituitary Cushing’s. Surgery is the best option for many
patients. However, adrenal surgery of this type is extra
dangerous. First of all, the location of the tumor is tricky.
Deep in the abdomen, directly nestled between blood vessels
that supply the kidney and the pipeline to the body, the massive
aorta running under the spine down the back. One wrong move
and the patient dies. If the tumor has spread invisibly and
weakened the structures around the adrenal, the patient dies.
Adrenalectomy is also dangerous because the disease and the extra
steroids in the body have made the body functions deteriorate.
The vital signs – like blood pressure, and heart rate- may
not maintain well under anesthesia and a long surgery. Shara
understood. She also understood that, with a 16-year-old dog,
we had no idea how much longer she had to live anyway. But
here’s the thing that made us decide: Penny had a vibrant glow, a
calm acceptance, a peaceful love that felt strong. She just
felt like she wanted to live a long time. So Shara requested
surgery as soon as possible. Again, Penny cane through with no
complications. “Shara, even though the adrenal gland has been
removed, research shows us that almost all the time, an adrenal
carcinoma has already spread around the body by the time we
diagnose it and remove it,” said Doc Truli. “What does that mean?”
said Shara. “It means the cancer is likely still in her and will
still be the thing that kills her sooner or later,” said the Doc.
“I understand.”

Maxillary fibromatous epulis at 19
requiring hemi mandibulectomy

Penny felt good for 3 more
years! At 19, she was feeling good and going strong.
Doc Truli noticed, at her semi-annual physical, that her
breath was beginning to smell bad again. Plus, there was a
suspicious pink firm swelling on the upper right side of her
gumline just behind the right canine tooth. “Penny needs a dental
cleaning and that lump need to be removed and sent for
histopathology to tell us what it is,” said Doc Truli. “Do you
think it’s cancer?” Penny’s mom asked. “Actually, no,” said Doc
Truli,”But there are these growths that can happen in the mouth
called Epulis (epulidides for plural.)
They technically are not cancer, but the fibromatous kind
invade the jawbone and can make the bone weak enough to break in
the future if the epulis is not completely removed. Plus, epulis
are difficult to remove. They come from the cells lining the
tooth socket, deep in the bone, and they infiltrate along the bony
highways called trabeculae. They can be really far away from
the lump, and you can’t tell. Let’s clean her teeth, x-ray the
bone, and biopsy the lump. If the results come back
fibromatous, Penny will need more surgery to help her. But
there are two other types of epulis that are removable and that
will be that.”

There was a suspicious pink firm
swelling on the upper right side of her gumline just behind the
right canine tooth.

Penny underwent deep
cleaning, x-rays, and biopsy. The x-rays were clean.
The bone was strong-looking. The biopsy said it was a
fibromatous-type lump. The bad kind.

Penny Needs Mandibulectomy Surgery

“Penny really should see the
oral surgeon, but I don’t know if you want to put her through that
at 19 years old, especially because we know these growths usually
are not completely removable, no matter how goods the surgeon is,”
said Doc Truli. Penny’s mom said, “She deserves a chance.
Call the surgeon.” About 6 inches of Penny’s upper right jaw
were removed. The gum tissue was sewn smooth over the spot.
Some jawbone was left for strength. Again, now
19-year-old Penny the wonder Dachshund woke up from surgery and
wanted to eat within hours, not days!

The second biopsy came back “incomplete
excision.” Yet, somehow, 1 year later, there was no signs of
a lump on Penny’s jaw, no signs of Cushing’s disease, and she was
going strong at 20!

Consider the Love an Older Pet Can
Share!

Next time you think you must have a puppy, think
of Penny. She’s the most loving, sweet, patient being Doc
Truli has ever met. If Shara rested her decision purely on
age, we would never have known Penny. Not Shara, not Doc, and
not you through this story. Think about it. VirtuaVet
provides

food for thought regarding the ethics and morality of advanced,
invasive medical for older pets.

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5 Comments leave one →
  1. Shannon Dobson permalink
    August 14, 2013 2:52 pm

    Doctor,
    I know this is an old post for your group but I had to share a comment anyway. I have no idea if you will ever see it, but it was important to me.
    I have a sugar-sweet, soft-as-silk, 14 year old Beagle named Max at my home in Colorado. He has always been happy, health and sweet but stubborn every day of his long, long life until…
    We found a lump on the thyroid 2 days ago and brought him for diagnosis. The oncologist diagnosed adenocarcinoma of the thyroid. The oncologist offered surgery to remove as much of it as possible and I have been struggling for two days because Max has had multiple surgeries in the past 2 years (one TPLO, one lateral suture repair and removal of a carnassial with a slab fracture) and with the exception of the slab fracture healing has been difficult and long and painful for him. (After the TPLO we seriously considered euthanasia because his pain was so immense.)
    And so I have struggled for 2 days, wondering what the right course of action is for a dog who is otherwise in excellent shape but is very old regardless. I can give him the surgery, but should I?
    And so I found your story about the little Dachshund. Then I found your self-reflective questions to ask. Then I found your quality of life scale and I read every word. And what I found out is that Max is really STILL the same happy, healthy, sweet but stubborn Beagle he has always been. He just needs to have this tumor removed.
    So I was able to reflect on my situation and his – and I made a good decision that surgery is in his best interest, not just mine. A week or two of pain and healing should bring maybe a year or two of good quality life. A far better thing than watching my sweet old guy choke to death on that rotten tumor.
    I thank you Doctor Truli for offering food for thought that helped me to make the best decision for a well-loved, precious dog.

    • August 14, 2013 5:47 pm

      Dear Shannon,
      Thank you for your feedback. I’m thrilled that the tools I provided worked for you the way I imagined they would help someone. May your Beagle friend have many happy years!
      -Doc Truli

  2. December 11, 2010 1:50 pm

    Oh…this warms my heart and reinforces that there is ‘good news’ and ‘love’ out there, not all bad. A few years ago, I got a 14 year old cat back from it’s home as it was ‘fighting with the new wife’s cats’ (guess, what…the marriage didn’t last either) and thought she would be with me for the rest of her years as she had severe untreated HCM. But a lovely family met her and wanted her to be able to sleep in bed with them, and be treated like a queen…for however long she had (she was aggressive with my cats, too so she was a ‘guest bedroom cat’). They loved and cared for her for over a year, before the found her dead one morning at the bottom of the stairs. But neither of us regret the time and love she was able to share with them…and I think of it as a very happy ending.

  3. December 2, 2010 12:54 pm

    What an inspiring story! Especially since my beloved Maggie is 11-ish now and I can’t help but worry about what lies ahead. Penny is a true survivor and Shara is a wonderful wonderful human being for adopting her and loving her and caring for her so well.

  4. December 1, 2010 2:23 am

    This was a wonderful story!

    Speaking of dachshunds, I got the email below. Didn’t know if you knew about it or were interested. You don’t have to include this in the comments.


    Subject: in case you know people with dachshunds

    The American Veterinary Chiropractic Association doctors is starting a study
    on DachshundsÂą common back/spinal problems. They would like to have 400
    dogs in the study. The results of the study will be published.

    The Chiropractor I use on my dogs is taking part of the study and sent this
    information to me today. So if you have or know of someone with a Dachshund
    who’s having some back issues/rear leg weakness, send an email to Natasha
    Jaskiewicz at her email address: info@theanimalchiro.com

    To see if your dog qualifies, please visit Dachshund Study

    http://burger-buddies.com/m_7.asp?g=4

    PLEASE CROSS POST TO OTHER LISTS!!!

    Thanks!

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