That Old Rockin' Chair's Done Got Dudley.

Veterinarians often find themselves between a rock and a hard place. Or as my cousin Doug used to say, he had his mind in a quandary and his feet in a quagmire.

Dudley, a dachshund, is in his early "rocking chair" years. Like many old dogs, he had serious dental problems. All of his teeth had a lot of tartar. Many had deep infections around the gums and down to the root. Some of them were loose, and undoubtedly painful, though he showed no outward sign of pain. He really needed dental work but in an old guy like Dudley, the risk of anesthesia was a concern.

But there are other risks to consider. Bad teeth often don't seem to bother the dog, and the smell may not bother the owner, but bacteria and bacterial toxins are continually leaked into the blood stream from chronic gum infections and loose or abscessed teeth. The immune system usually fights most of them off, but the heart valves and kidneys are sitting ducks.

The edges of the heart valves don't have much blood supply to bring disease fighting white blood cells and antibodies. But they are bathed in blood with every heartbeat and bacteria that stick to the surface can grow and damage the heart valves. They may start leaking. The heart doesn't work well with leaky valves. Fluid may accumulate in the lungs, the heart may become stretched and enlarged, and the dog may develop the cough of congestive heart failure.

The kidneys are very sophisticated filters. As blood is pumped through the filters, bacteria can get stuck and begin to grow. The resulting damage can destroy the kidney's ability to concentrate urine. As the dog loses more water in the urine, he will pee more often and will have to drink more water to make up for the loss.

So the anesthetic may kill the dog, but not taking care of bad teeth may also kill the dog. You're darned if you do and darned if you don't.

Some blood tests and a urine analysis will tell us how the kidneys, and other organs, are doing. This will help estimate how much of a risk anesthesia is, and what can be done to reduce that risk. Intravenous fluids during anesthesia, and maybe before and after, can make a huge reduction in risk. A high white blood cell count may indicate a need for antibiotics. Early kidney failure can cause a low red blood cell count. If so, drugs for a few weeks before anesthesia can get the blood count up again.

It may be advisable to take chest X-rays, especially if there is a cough, or a heart murmur. Drugs may be needed for a few weeks to get pulmonary edema under control before anesthesia. If a dog is in congestive heart failure, you have to be more careful with intravenous fluids, though it is still very important to have an IV catheter in place.

Dudley's lab work indicated he was in mild kidney failure. We gave him an antibiotic injection and then put him on IV fluids for a couple of hours first and he sailed right through the anesthesia and dental work. We continued the fluids for the rest of day until he went home. When I called a few days later, he was doing great. And in case you're wondering about it, he won't miss the teeth we pulled. A dog with no teeth would have trouble killing and eating a rabbit or deer, but has no trouble eating dog food. In fact, most of them can still eat dry dog food.