Thursday, July 1, 2010

Tragedy Avoided- Preventing Surgical Death in Great Danes

Because we purchased both our danes Rozalyn and Lola from reputable Great Dane breeders, they both came with a contract. One of the things in this contracts says we needed to spay them. Neither of them are show quality dogs (not because there is anything wrong with them, but because their specific markings and colors are not recognized by AKC as show markings). Breeding any dogs, especially large breed dogs like Great Danes is a huge responsibility and the breeders want to be sure that only the best quality genes are being passed on and that their dogs are going to responsible pet owners. Great Danes can have a lot of health issues and even though purchasing from a reputable breeder who does health screenings on all their breeding stock can be quite costly, it will normally save you so much heartache and vet bills in the future.

Like our previous Great Dane Sephiroth, Rozalyn and Lola are like our children. They are a very important part of our family and although they can be a lot of work and can be expensive to maintain, they give us something intangible and priceless that nothing else can. Therefore, when it comes to any sort of treatment, we are sure to research everything and check with our circle of trusted dane breeders before going ahead with anything. I tend to be distrustful of doctors and veterinarians....especially ones who are general practitioners and not specialists. I believe they mean well, but if they do not specialize in whatever procedure needs to be done or in that particular kind of animal, I have a difficult time believing that they are experts at what they do.

Anyway, Roz went through her first heat back in February. Our breeder recommends waiting until after female danes first heat cycle and after male danes turn 18 months to spay or neuter them. This is to ensure they reach their full physical potential. Danes who are altered too early tend to be very tall and skinny; they never put on the appropriate muscle mass. It is best to have females spayed 2-3 months after their heat cycle. If you do it to soon after their heat cycle or too close to their next heat cycle there is an increased risk of bleeding out because their capillaries are enlarged. We had hoped to get Roz spayed in May, but then she went through a false pregnancy, began lactating and developed mastitis. Surgery is not recommended until the dog finishes their false pregnancy and the mastitis is cleared up. It took several hundred dollars and a lot of time to get the mastitis cleared up, so we kept pushing the surgery back. Finally last week, we were scheduled to bring her in for surgery on Wednesday. If you read our baby blog, you will know that I was feeling unusually anxious and fearful last week and was having disturbing dreams. Since our last dane Seph died in his sleep and I never really got to say good bye to is now a habit for me to pet, hug, kiss, and tell the girls how much I love them each evening before bed. Last week, I found myself doing this throughout the day with Rozalyn, like I was telling her goodbye, just in case. I know all of this sounds a little silly and somewhat crazy, but I have found that I seem to have an intuition about these sort of things. I don't think I have always had this 6th sense, but since our last dane Seph died, I seemed to have developed this sensitivity. It is difficult to explain. It's like having a pit in my stomach or a gut feeling about something. If you have ever read The World According to Garp by John Irving, it is the feeling described as the lurking "under toad" in this book. It is a horrible feeling, like you know something is out there waiting to pounce, but you can't really put your finger on it, so you don't know how to best protect yourself. Anyway, crazy or not, I felt these feelings last week. I have been very calm and relaxed this whole pregnancy. I am normally pretty high strung and emotional, so Noah just attributed my feelings last week to hormone changes.

I contacted one of our good friends and the best Great Dane expert I know, Seph's breeder from Rainmaster Danes in Ohio. I shared my fears with her and she emailed me a link. It is for the Great Dane Club of America's Surgery Guidelines. She told me to request that all these guidelines be followed by the vet for the surgery. I called our vet up and told her that I wanted to meet before the surgery to discuss the guidelines. Here are the guidelines:

Surgery Guidelines for Great Danes

The following information regarding both routine spay and neuter surgery as well as emergency situations in the Great Dane (such as those involving C-sections) is presented as a basic protocol to help avoid complications such as DIC (Disseminated Intravascular Coagulopathy) which appear to occur in a higher number of giant dogs undergoing surgery than the norm. Therefore, the GDCA offers the following information for owners and breeders of Great Danes.

Several veterinary clinics with regular and extensive experience dealing with giant breeds have developed similar protocols for surgery that can be recommended preferentially for giant breeds. These are techniques that have proven highly successful; both in routine spay/neuter surgeries as well as more critical care situations, such as C-sections. Such a set of protocols is offered below. We suggest you download it and discuss this with your veterinarian PRIOR to any surgical appointment.

Please review the following with your attending veterinarian before deciding to have surgery done on your Dane:

1. First find a veterinarian experienced with surgeries involving giant breeds.

2. All elective surgeries, such as spay/neuter, should be done ideally only on healthy animals. Spays are best planned in anestrous: about 3 months after the last season. Please insure your veterinarian is aware of any health concerns you might have about your dog prior to surgery.

3. Prior to any surgery, request that the veterinarian do a complete physical examination, including a good heart auscultation, and EKG.

4. Ensure that you elect to have the pre-surgical blood work done (CBC and serum chemistry panel) and ask them to also include a CLOTTING PROFILE.

5. If all blood work and the exam are normal, then schedule the surgery and fast the dog overnight. It's not generally necessary to withhold water for 12 hours (simply put the water bowl away at bedtime).

6. Ask that the surgeon insert an IV catheter prior to surgery. Fluid therapy should generally be administered as a safety precaution. Pulse oximetry and cardiac monitoring are also recommended. If blood pressure monitoring is available, consider any extra costs as potentially insuring additional safety margins.

7. Spay surgery in conjunction with C-section is not always the safest option in giant dogs. Be sure to discuss the pros and cons of two separate surgeries vs. doing both procedures at once with your veterinarian.

8. Currently, the induction agent, Propofol (deprivan), and the gas anesthesia, Sevoflurane, are considered the most ideal (safe and effective) anesthetic agents. These agents are not always available and always cost more to use. Valium, ketamine, and the gas isoflurane are widely available and generally acceptable. Due to the variations in physiology in giant breeds, drugs such as acepromazine, rompun and the thiopentals are less appropriate choices. Discuss this with your veterinarian. Also discuss appropriate pain control for your dog when contemplating surgery for your Great Dane.

9. During and after surgery, dogs are highly susceptible to hypothermia (lowered body temperature). The body loses heat directly through the surgical opening; stress and anesthetic agents further impair ability to maintain body temperature. Hypothermia adversely affects the cardiovascular system, coagulation, anesthesia recovery time and increases the risk of wound infection. Preventive measures, including warming of IV fluids, placing the dog on a heated pad (circulating water heating pad or other heating pad set on “low”) and covering the body and extremities with warmed blankets, towels, bubble wrap, or other protective coverings post-surgery are vital in conserving body heat. Temperature monitoring, either via electronic device or rectal thermometer, should be done during surgery and periodically throughout recovery.

Prepared by the Health and Welfare committee of the Great Dane Club of America. Written by Sue Cates, RVT and reviewed by LeAnn Lake-Heidke, DVM.

I am so glad she sent me these guidelines! It most likely saved Roz's life! We took Roz in for surgery and brought the guidelines into our vet and went over each one. I think they thought we were crazy for requesting all the extra stuff including all the extra monitoring during surgery, the CBC blood panel and the blood clotting profiles. All the extras cost about $500 more and they couldn't do the surgery as planned because they had to send the blood clotting profiles out. Although I hated to spend all the extra money on the testing, I didn't feel right not doing it. The vet didn't really seem to think the blood clotting test and all the extras were necessary, but I pressed and I told her that Roz is related to our first dane Seph and when we had Seph's necropsy done at Michigan State, they suspected that he had a blood clotting issue since he seemed to hemorrage and bleed out so quickly with his thymus gland, but they said they could not test for the blood clotting thing post mortem. So I insisted on post poning the surgery last week and having the tests run.

I am so glad that I did! The test results came in yesterday. Everything was normal on the CBC panel and Von Willebrand test, but the blood clotting test came back with abnormalities. They ran a PT Scan to check her prothrombin time (basically how fast her blood coagulates and clots). The vet said the normal range for dogs is between 5-12 seconds. Roz's took just over 100 seconds! She said that Roz's blood does clot, just very very slowly. The vet said that she was so so happy that we had pushed for the tests because making an incision into Roz probably would have been a disaster and most likely fatal! She asked if Roz had gotten into any rodenticide....this is what they originally thought with Seph as well....but when they ran toxicology tests on him, he had no rodenticide in his system. I told her that we are very diligent about watching what our dogs eat and our farm, house, barns, basement, and garage have been thoroughly searched for any rat poisons after our last dane died. The vets recommendation is to give Roz vitamin K for a month and then do another PT scan. If it was due to rodenticide, her PT time should go back to normal. If it is a blood defect, then it probably won't affect the PT number. She said at that time we can decide what to do. She is going to consult with some surgical and internal medicine experts to see what they think. She said that if she does have the clotting defect, then they would either not recommend surgery, or if they did do surgery, it would be with a specialist and they would probably have to do a blood transfusion.

While I am very bummed about Rozalyn possibly having a defect, I am so happy that I followed my gut feeling and had the expensive tests run. It has almost been 6 months since she went into heat the first time, so it could have been really really bad if we had went through with the surgery. I asked the vet if this would have any long term affects on Roz. She said that if she gets a cut or bruise it will take a lot longer to heal, but that she would not bleed to death from it. She said we would just have to be very careful if she ever needed surgery or got a large wound and she would probably need a blood transfusion. I plan to research and see if there is a medication she can take to stop her from going into heat. I would hate to have her develop a false pregnancy and mastitis every time she went into heat. Noah and I are thinking that this is why it took so long for the mastitis to heal and the blood to stop coming from her teats. On a positive note, the CBC panel came back perfect, so the lumps that are still left from the mastitis on her belly must not have any bacteria or infection left.

I am so thankful that I followed my instincts and spent the extra money to have the test run. If I hadn't, we would have lost our darling Rozalyn and this would have been a completely different post. For more information on preventing surgical deaths in danes and other larege breed dogs, check out this article which also contains the surgery guideline link for the Great Dane Club of America.



cara said...

I wish I had such a good 6th sense! You always seem to just know. I get those gut feelings, but I'm always wrong LOL (like I was just sure there was something wrong with Maddie's cria, nope, she's perfect, or other times I'm just sure everything is fine, when it's not).

Anonymous said...

Both your Grandma Nemo and I are proud of you following your gut feeling. Also for all of your research you did. You saved your Roz's life. Love Marm