Monday, September 24, 2007


His name was E.J. I never asked what it stood for... only now does it occur to me to wonder. He was a middle aged cat. A gray tabby with longer fur. He started off beautiful, but days of hospitalization, eventually with an e-collar, caused his coat to become grungy and gross.

He had bladder stones that he couldn't pass. And when he tried, they got stuck in his urethra, and he became blocked. A week ago, he presented to the emergency clinic for this problem. It was the first time it had happened to him. His owners weren't properly educated on what this meant in terms of lifestyle changes, diet changes, and survival time. Bladder stones are managable, they can be influenced by diet and water intake. They can be removed with surgery. They can be an incidental finding that will never affect the health of the animal.

But E.J. had problems from his. And each time the stones reentered his urethra, he had to be anesthetized again. He blocked 4 times in the last week. Yesterday, we did a cystotomy. That's the surgery where we go into the bladder through the abdomen and scoop out all the stones. It was like picking grains of sand out of a beach blanket. The stones were tiny, most of them. Many he could likely pass on his own. But two were larger, round stones that were small enough to enter his urethra from the bladder, and large enough to not be able to pass all the way through. We took out 30+ stones. Carefully flushing and flushing and flushing until we were convinced that the larger stones were all gone, and anything too small for us to remove would probably be able to be passed on his own.

We closed the abdomen. We took a radiograph that showed a nice bubble of air in his bladder, but no remaining stones big enough to be spotted. We placed an indwelling urinary catheter, because his urethra has been traumatized so many times in the last week that we wanted to relax it while the inflammation died down. Amy went to make some phone calls. The technicians were placing a new IV catheter, because his current one (though working well throughout surgery) had been in for 4 days and was at increased risk for infection.

They walked away for 10 seconds. Both new catheters were in, he was still on the table on anesthesia. The pulse-ox slipped off his tongue and the alarm went off. Gail went to replace it, and noticed he was very pale. Then she noticed he wasn't breathing. We located doctors, three of them.

We did CPR for almost 10 minutes. We used epi, atropine. We ventilated him at 40 times per minute, we pumped his heart as fast as we could (you try making a heart beat 150 times/minute). We watched the ekg each time we paused. He didn't make it.

A week ago, before first going to the emergency clinic because he couldn't pee, he was a healthy cat. Whatever stones may have been present were not affecting his life at all. Yesterday, he died. The owners elected a group cremation, with no ashes returned.

Ethical Dilemma

S is a 11 month old Doberman Pinscher. She is not spayed. She is purebred with papers. She has a class III malocclusion, an anterior crossbite (example in picture below), and "rostral flare" of her lower incisors.

A class I malocclusion is just when the front teeth (between the canines) don't quite meet the way they're supposed to. It is presumed to be some combination of factors including environment, congenital, genetic, and dumb luck.

A class III malocclusion is when the mandible is just a little bit too long, and rather than the top teeth fitting nicely and prettily over the bottom, instead they either meet straight on (try it, you can see how it would hurt after a while) or have the "bulldog look". Class III's are considered to be a genetic skeletal deformity, where the pre-molars and molars are involved to some degree as well as the more obvious incisors.

(For reference, a class II is when the maxilla is waaay to long, and a class IV is severe skeletal deformities like where the teeth don't even meet in the front, or one side of the mandible is longer than the other.)

Dogs that are shown are typically in the highest demand for breeding and continuing the lines of the breed. As a result, they need to be the best genetics available, and breeding dogs with cranial skeletal deformities is not in anyone's best interest.

S's owner came to the dentistry clinic when she was about 6 months old. In hand, he had an article written by the AKC for judges about how to spot (and disqualify) dogs who have had orthodontic work to correct malocclusions. The article had a picture of a dog with an expansion device, which many people I know had as children in conjunction with their braces. The expansion devices angle the teeth outward appropriately so that the skeletal abnormalities are disguised and the dog has a normal bite.

He pointed to the device in the picture and said "I want that for my dog."

After many hours of ethical discussions amongst themselves and with the owners, my clinicians ultimately decided to use the expansion device to correct S's malocclusion and crossbite. The owner desires to show this dog, and insists that "no other dogs in the line have any teeth problems".

I have several major ethical issues with treating this dog and working with this owner, which I will briefly highlight, along with some pertinent facts.

1) The dog is in no pain and has no quality of life issues with her current bite.
2) The dog is an intact female that may be bred in the future, potentially to relatives.
3) The dog is intended as a show dog, and judges are clearly *taught* to look for these changes.
4) There is no real way for us to "report" this owner to the AKC.
5) In order to become board certified in veterinary dentistry, a resident must perform and document two orthodontic device fitting and placements.

Personally, I have decided to not treat an animal when placed in this situation. While I would be happy to place the device, I would do it on contingency of spaying the dog. As a student, I abide by the choices of my attending clinicians.