Economic reality may override the moral ethics in a private practice with so much competition and high overheads. The staff and associate vets see what you do if you are the leader in the practice. Do the right thing by asking the owner to seek treatment elsewhere once the owner has had lost the trust in the veterinary-client relationship with the vet. Vets are not Gods. Deaths on the operating table will present themselves and bad-mouthing do spread like wild fire when you handle high risk anaesthetic cases in old dogs as there will always be owners who delay treatment or ignore veterinary advices till they have no choice except surgery.

In this carnaissal tooth case recorded here, I did not phone Vet 1 as to why medical treatment and cleaning of the facial wound were performed for one year for "sinusitis" due to a yellowish nasal discharge from the left nostril for one year. The owner had confirmed that Vet 1 had diagnosed correctly the condition. "He just would not operate on the dog." This was the point of view of the owner whose mother was the one in contact with Vet 1.

The mother would have to visit him many times to seek a cure. Finally, the son took the high anaesthetic risk to get the dog operated.

A blocked left nostril with yellow discharge. A cyanotic tongue indicating a lack of oxygenated blood or toxicity. These symptoms signal high anaesthetic risk. 

These were the pluses but still one cannot be too complacent.

Only 11 out of 42 teeth existed and they were loose ones with tartar built up over the years. Vet 1 had done one dental scaling some years ago. So, there was a good veterinarian-client relationship with the owner's mother

But that facial wound. That rubbing of the left eye. That left nostril discharge. These had gone on for almost 12 months. The mother could be stressed out. In real life, it is the aged parents who feel so much more for the companion dogs since the children have left the nest and have practically no time for the senior citizens. So, it would not be a surprise to me if this case had become extremely volatile and emotional for the mother and family members.

The irony of this case is that surgery would cure. Yet Vet 1 just did not want to do it due to the high risks involved. In such cases, I would pass the buck to other vets. In this case, the son took matters in his hand to seek my opinion. He accepted the high risks. We had never met before. Much was at stake for the mother. If the outcome was good, the mother would be most happy as this Chihuahua is family to her.

I used isoflurane gas anaesthesia with no sedative injections. It was difficult to mask the dog as she had this left nostril discharge. I intubated using a smaller endotracheal tube. This type of cases must be on short anaesthesia to achieve a good outcome. The vet must have all instruments ready. I even had the dental scaling machine switched on just in case it was needed.

The 11 teeth were extracted. It was possible to leave the canine teeth alone to impress or comfort the owner that the Chihuahua had some teeth.

But that would not be in the interest of the dog. They were only slightly loose. But I know that this old dog would get gum diseases later and this would be her only chance under anaesthesia. So, I took out all the teeth instead of doing dental scaling on the canine teeth.

Carnaissal Tooth Abscess in An Old Chihuahua