D. E. Larsen, DVM
I watched Bob and Ellen sitting in the reception room with Ginger sitting on Ellen’s lap. Ginger was sort of a dirty white Shih Tzu who was getting older.
Dixie was just helping Bob up and getting them into an exam room. Bob was suffering from arthritis, and with his advancing age, he had trouble getting around.
When I entered the room, Bob was still trying to get comfortable in the chair. Ellen was standing at the exam table holding Ginger and waiting for Dixies to get a fleece pad for the table.
“Thank you,” Ellen said as Dixie laid the fleece on the exam table. “Ginger hates that cold steel tabletop.”
“Bull!” Bob said. “That damn dog sleeps on the cold kitchen floor and doesn’t say a word.”
“What’s up with Ginger today?” I asked.
“Not much,” Bod said. “She’s just here to spend some more of my hard-earned money.”
Ellen frowned as she looked at Bob, a signal to shut up.
“I thought she died last night, Doctor,” Ellen said. “I was cooking dinner, and she was excited about a possible little tidbit. She was jumping around my feet, then suddenly, she just fell over dead. She just laid on the floor, not moving a muscle. I didn’t know what to do. Then after a minute or so, she just sat and got up, and she was fine, just like nothing had happened. I was crying and swooped her up and hugged her so.”
“And she burned my fried potatoes,” Bob said.
Ellen was back to holding Ginger, hugging her tightly to her chest and glaring at Bob. She gave Ginger a kiss, and Ginger responded by licking her cheek.
“She kisses the dog all the time but won’t even give me a peck on the cheek,” Bob said.
“Let’s set Ginger down, and I’ll get a look at her,” I said.
I grabbed Ginger by her hips; she was thinner than I remembered. Glancing at her chart, I could see she had lost a couple of pounds from her last visit nearly two years ago. That was a substantial weight loss for a fifteen-pound dog. When my hand moved to her ribs, I could feel the vibrations on the side of her chest. Ginger had a pronounced heart murmur.
After listening to the loud bounding murmur on her chest with my stethoscope, I turned Ginger around and looked at her face and neck. I noted that I saw a pulse in her jugular veins. Then I opened her mouth.
Ginger’s mouth was a mess. There was heavy tartar accumulation on her teeth from years of neglect. Notes in Ginger’s chart told of multiple recommendations to have her teeth cleaned, and all those suggestions went unheeded. She literally had teeth that were being held in place by the tartar. With the heavy tartar, there was severe periodontal disease. The gums were receding, and there was exudate around some of the larger teeth in the mouth.
“What is going on with my Ginger, Doctor?” Ellen asked.
“We have multiple problems, Ellen,” I said. “And all of the problems are tied together. The fainting spell you saw last night resulted from congestive heart failure. The heart doesn’t pump enough blood to the brain for a lot of activity, and Ginger faints and falls over for a moment. She was actually close to death. Then blood returns to the brain, and she wakes up like nothing happened. Heart failure is caused by a heart valve that is leaking badly. Ginger has a grade four heart murmur. That is caused by a condition called endocarditis. An infection settles onto the heart valves and causes them to scar in a manner that makes them unable to do their job.”
“Where would she get such an infection?” Ellen asked.
“Her mouth is the source of the infection,” I said. “Ginger has heavy dental tartar on her teeth and severe periodontal disease. That causes bacteria to get into the bloodstream and circulate through the body. The heart valve problem directly results from that infection, and there may also be other problems. The bacteria also insults the kidneys, the liver, and actually, any other compromised tissues.”
“This sounds really serious,” Ellen said. “Can it all be fixed?”
“Sure, it can be fixed,” Bob said. “We will just have to take out a second mortgage on the house, is all.”
“You be quiet!” Ellen said. “You spend enough on yourself. You don’t have any right to make decisions on my Ginger.”
“What do we need to do to help Ginger?” Ellen asked.
“You hit the nail on the head with that question, Ellen,” I said. “If we are lucky, we can still help Ginger. But some of this can’t be fixed. We need to get some blood work and check her liver and kidneys. Then we need to start her on some antibiotics and get her on some medication for her heart. Ideally, we should get a chest x-ray and do an electrocardiogram, but that can be elective. If it looks like everything is good enough for her to have anesthesia, then we need to clean her teeth and extract the bad teeth.”
“Does she have to have anesthesia to clean her teeth?” Ellen asked. “That sounds awful risky with her heart stuff.”
“Yes, she needs anesthesia to do the dental work,” I said. “And, yes, it is a risky procedure with Ginger’s heart issue. But we will do everything we can to lessen that risk. If we don’t clean her mouth up, we won’t be able to buy her any time.”
“You said some of this can’t be fixed,” Bob said. “What do you mean by that?”
“If you or I have a heart valve that is not working, they give you a new heart valve,” I said. “That is not available in the dog. When we do all of this, Ginger will still have a bad heart valve and congestive heart failure for the rest of her life. We can manage that with medication. And cleaning up her mouth will keep the heart valve from worsening, but there isn’t anything we can do to fix the heart.”
“Ellen, we need to talk about this,” Bob said. “We will spend all this money, and Ginger will still drop dead on us. Just like last night.”
“You’re sort of right, Bob,” I said. “The heart issue is still going to be there. But if her liver and kidneys are okay, we can manage it pretty well, sometimes for several years. But Ginger will lose some teeth, maybe most of her teeth and the risk of the procedure is real. She could die under anesthesia. You will be surprised at how much better she will feel when it is done. And her mouth will not smell like it does today.”
“Doctor, you just do what needs to be done,” Ellen said. “If she dies on the table, so be it. If we are going to help her, we have to assume some risk. So be it if Bob has to sell his truck to pay for it all. He can’t get into the damn thing anymore, anyhow.”
So Ellen brought the discussion to a close. We were going to fix Ginger, one way or another.
“If you can leave her with us for a few hours today, we will get some blood and do her chest x-rays and EKG,” I said. “Then we will get her on some antibiotics and medication for her heart.”
“When will you take care of her mouth,” Ellen asked. “That will depend on how well she responds to the heart medication. But it will at least be next week, I want her on antibiotics for some time to reduce the infection in that mouth.”
Ginger’s bloodwork showed mostly normal values, and that allowed us to get her started on her heart medication and antibiotics.
By the following week, she was feeling better, and her mouth infection was mostly resolved.
“We can schedule her dental work now,” I said as I finished checking Ginger over. “You understand now that she will lose some of her teeth, maybe most of them.”
“I am worried that she won’t be able to eat,” Ellen said.
“If you watch a dog eat, they don’t do a lot of chewing,” I said. “With her heart, she will be on a special diet now. She won’t miss having those teeth. And she will feel much better with them out of there.”
Ginger went home with only her four canine teeth remaining in her mouth. Her mouth had healed well on her recheck, and Ellen was pleased with how well she was doing.
It was another two weeks before I saw Bob again. He came by the clinic with a check for their account and asked to talk with me.
“Doc, I just wanted to thank you for your work on Ginger,” Bob said. “She is almost feeling like a puppy again. We know she lives on borrowed time, but at least that time is good. And you know, Ellen even seems to enjoy life a little more now. We are getting along a lot better, and she even gave me a little peck on the cheek the other day.”
“That’s all good news, Bob,” I said. “Hopefully, we can keep Ginger going for a few more years.”
Ginger did well for a couple of years. The third year was really rough. Her heart had done just about all it could. Bob and Ellen finally decided to put her out of her misery. It was a hard decision. Those decisions are always challenging, and the event is difficult. But most of the time, it is the best thing to do.
Photo by Goochie Pooch Grooming on Pexels.
3 thoughts on “The Ultimate Kiss ”
Well, she had some good time without pain (and those teeth must have hurt badly), so it was worth it! Just like Merlin, who despite his kidney disease had to have 2 extensive dentals (his former owner neglected him and did not let any dentals be done) and has no teeth left. But he has gained weight – from about 6 pounds (3 kg) to 7 and a half (over 3,8 last weighing, and I found kidney diet food which he really likes). But I know I will not have him forever. His kidney damage can already be seen on an ultrasound – that means it must already be substantial.
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Chronic kidney disease can be managed for some time these days. Getting the teeth out probably brought the ongoing damage to a halt. Diet is the key now.
Don’t worry, I’m on it, not on the diet😜, on finding renal diet food he eats. His crazy previous owner gave him NO water, cos he believed as a desert animal cats shouldn’t drink, their kidneys get damaged from that. I shook my head until I got whiplash upon hearing this. The first thing I gave him when at home was some water. He drank. Not excessively, but he drank. Birmans are already prone to kidney disease, but that neglect would have killed him. Three days later we had a date with the dental specialist from that clinic and she was shocked about his state. We got the flea situation fixed, treated the mouth infections with antibiotics, made eating easier on him with painkillers and 11 days later he had his first dental. After 3 hours she had to stop, to get him awake again and she had him in in February for part two. After that his kidney reports got worse, so he got kidney food. But most of that raises the ph-number, and I had to switch to urinal diet. We finally got the ph number down and switched back to kidney food. That’s where we are standing. Must go back to check on him, now that the days got cooler. Were in last time in June. He’ll keep that clinic busy for the rest of his life. He’s 9 and a half.
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