I had an interesting surprise today in surgery. We had an older Staffordshire terrier with a severely fractured tooth. Years ago, the owner had said, the matching tooth on the other side had fractured and had to be extracted at another facility. The dog had had several dental procedures performed elsewhere since then but had never had x-rays done in the mouth. We always do a thorough mouth exam once we have the animal under anesthesia and, in this case, we noticed a small hole in the area of the previous extraction. This is known as a fistula and can be associated with a problem under the gum line. Sure enough, the technician, after taking x-rays, said he saw what looked like a dense, retained root. I thought it looked so dense as to be almost metallic. We opened the area and found a large pocket of diseased, spongy bone surrounding a dark object lodged deep inside. After curreting out the diseased and abscessed material, there was a pocket large enouh to fit a golf ball! Inside this pocket was the tip of a dental instrument, which must have broken off during the original extraction 4 years earlier. All this time it had been reacting with and intoxicating the surrounding tissue. After flushing the area and suturing, the other tooth was properly sectioned and extracted..without breaking any instruments. Although dogs have large, multi-rooted molars which cannot be removed like human teeth, proper sectioning and surgical preparation of the area allows for straight-forward removal without unnecessary force applied, (certainly not enough to break the instrument!), and less soreness for the patient. The dog in this story went home the same afternoon and should have complete healing..4 years later! Careful oral exam and dental radiography were indispensible in this case and a good illustration of why they are important.
Today was an all outpatient day for me. I saw an older cat in the morning, a beautiful 17 yr. old male Siamese. He was a classic siamese, full-bodied, cross-eyed, just like the ones when I was a kid, before the oriental, angular, triangle-headed, (but still very cute), ones were popular. He had been having episodes of what were thought to be seizures and vomiting. Blood work had showed only mild elevations in the kidney values and little else. When I listened to his chest, he had a "gallop" rythm and a slight heart murmur. This he had evidently had for some time. On further listening however, I noticed changes in the rate, like short circuits or skipped beats. One thing which can cause this is an enlarged heart, usually from primary heart disease or from hypertension, not uncommon in older cats. We kept the cat for some tests, which we did right away. Our workup consisted of checking his thyroid, (a high thyroid can cause hypertension and heart disease), a full body x-ray with emphasis on the heart, an electrocardiogram and a blood pressure. He had had blood work done on his kidneys, (which showed kidney issues) and liver the night before. It turned out that the cat had a signifigant electrical short circuit in his heart which was making him faint although it appeared to look like a seizure. His blood pressure was very high. His thyroid was normal. We immediately put him on a hypertension medication and will be closely monitoring him for continued problems. At his age, he is fragile and our goal is for his comfort. I'll keep you posted. It was at least nice to find something we could treat.
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