As a surgeon, one learns to prioritize problems. What is, at one moment, the issue demanding attention can be suddenly supplanted by a more urgent or serious matter. No case of mine (Henri Bianucci) in recent memory exemplifies this better than Brady.
Brady is a 12-year-old Labrador retriever with severe hip dysplasia. The prospect of hip surgery on a dog this old is a matter that deserves careful consideration. I often tell clients that “age is not a disease.”
Age does carry a greater likelihood of existing, or impending, disease conditions, which may place a patient at greater risk for anesthetic complications, recovery issues and delayed healing.
Advanced age also means that they have used up a greater percent of their allotted lifespan. The problem is that we do not know what that allotment is.
A 12-year-old dog may be near the end or may have another four years.
Brady’s hips were horrid. His pain was overt, difficult to control and seriously impairing his mobility and life quality.
Otherwise, Brady’s health was excellent. His other joints were sound, and he had no other known health issues. After carefully weighing the pros and cons of his surgical options, and agonizing over the decision to do surgery on their dog, the owners decided to go with a procedure called an FHO.
This is a fairly common surgery in which part of the hip joint is removed, eliminating the arthritic joint, and allowing a “false” or fibrous joint to take its place. At peace with their decision, and relieved it had finally been made, the owners called to schedule.
They then mentioned, what they thought was a relatively minor point. In the weeks since our first visit, their vet, Dr. Brian Cribb, had found a very small mass associated with the anal sac. They wondered if this could be removed at the time of the surgery.
In my mind, the brakes screeched to a halt. The mass may be small, but the possible implications were big. Another meeting was in order before any surgery could be planned.
Brady’s hip was as bad as ever. I examined the anal sac and there it was. The mass was no larger than a pea, and I commended their veterinarian for performing an exam so meticulous that something this small was found.
I explained that these tumors were typically malignant cancers, but since it was so small, and if it had not already spread, the prognosis may not be too bad.
X-rays and ultrasound found no evidence of spreading. So, we reaffirmed our original decision to repair the hip, with the addition of a tumor excision. The decision was tough, because not only was Brady older, but now he had the added risk of having malignant cancer. I reasoned that given its size, it was quite possible that Brady’s natural lifespan would be reached before this cancer ever returned, and that a even cure was possible.
Surgery day: Both procedures went like clockwork, and Brady sailed right through anesthesia and recovery. He recovered like a human teenager. The next day he was already using the leg, and eating like a horse, and ready to get home. His owners also were impressed with his ease of recovery and early mobility. They even made a video to show me how well he was walking.
Their glee was short-lived however, because on the evening of his homecoming he suddenly became anxious. He was pacing, salivating and began to wretch. Lots of dry heaving, but no vomit. They called our Mount Pleasant emergency clinic, which directed them to bring him straight in. One X-ray confirmed it. Brady had developed gastric dilatation, and volvulus (GDV).
This is commonly known as bloating, but the stomach not only expands, it twists, preventing the expanding gas from escaping. The pressure builds quickly, and painfully, damaging the stomach wall, and sending the patient into shock.
Death can come in as little as a few hours if this is not treated immediately, and aggressively. The key is recognizing the signs and getting help early. I have seen many cases where the owners left for work, or went to bed, only to find their dogs gravely ill, having suffered, unobserved, for hours.
Large breeds such as great danes and Labrador retrievers are particularly at risk, but it can occur in small dogs, too, including basset hounds. I even treated a dachshund once for this.
Brady’s owners were right on top of this, and surgery, again, went well. The stomach was repositioned, and then tacked to the body wall to prevent recurrence. No serious damage to the stomach occurred, and the next day, he was discharged. Oh, and the tumor; the pathologist’s report said it was completely removed, and not likely to have spread. It was probably a cure.
So what began as a dilemma about whether to do surgery on an aging dog’s lame hip was then complicated by a cancer diagnosis.
These issues were tackled, when out of left field, he bloats! Despite this series of unfortunate events, Brady is on the way to a pain-free hip, his potentially lethal cancer was caught early and removed and he has eliminated the possibility of another GDV.
These are three problems that commonly mark the end of an older dog’s life, and Brady plowed through all of them in two days.
Fate will have to go back to the drawing board because Brady, it appears, is not going easy.
Dr. Henri Bianucci and Dr. Perry Jameson are with Veterinary Specialty Care LLC. Send questions to firstname.lastname@example.org.