Case of the Month-- Winston

This month we will focus on Winston, a 13 year old Daschund who came to us for a second opinion about a tumor that had been growing near his rectum for 2 years.  The owners had taken Winston to other veterinarians to have the tumor evaluated, but the other veterinarians told them that Winston was "too old" to do the surgery on. 

Winston presented to us in good spirits. After a thorough physical examination, we found him to be in good overall health.  He had two major problems facing him however.  The first was a very severe case of periodontal (gum disease) as shown below. 

The second problem was  a rather large tumor growing near and around the rectum.  

Whenever we approach a geriatric pet with a tumor, we need to do a thorough workup to determine whether or not the tumor has spread throughout the body and if the patient is in good enough shape to withstand anesthesia and surgery.  We performed our "Geriatric Healthguard" program on Winston which consists of the following battery of tests: 

Winston's tests did not reveal any evidence of tumors in the body beyond the visible one. His major organ systems and cardiovascular system were found to be in good shape and so surgery was scheduled to remove the tumor and to clean up the diseased mouth.  The owners were informed of the potential risks involved with the anesthesia and surgery and were happy to do whatever they could to help their "baby". 

When we anesthetize a geriatric patient, we take great care to ensure his/her safety.  First, Winston was lightly sedated with a narcotic to reduce his anxiety and ameliorate any operative pain.  Next, an intravenous catheter was placed to administer fluids before, during and after surgery to help protect the kidneys from the affects of anesthesia.  Intravenous antibiotics were then administered to help prevent infection from the surgery and dental work.  

Winston was placed in an induction chamber and allowed to breath a combination of Anesthetic gas (Isoflourane) and Oxygen until he became unconscious. This form of induction is very gentle and leave little to no hangover.  Then he was intubated (a breathing tube placed in the trachea) and connected to the anesthetic machine directly. 

We attached Winston to our electronic monitoring devices which include:

• Electrocardiogram        
• Pulse Oximetry    
• Blood pressure Measurement    
• Respiratory Monitor 

We then prepared the surgical site by clipping all of the hair in the area and scrubbing the area with antiseptics and alcohol.  Winston was then moved into surgery where Dr. Shufer spent the next 90 minutes painstakingly removing the tumor and attempting to reconstruct a functional rectum.  

After completing the surgery, Winston was moved into our dental suite to begin work on his mouth.  Because the teeth were so terribly diseased, we opted to extract all of Winston's teeth.  The diseased teeth were removed and the gums were sewn over the sockets.  

Winston recovered slowly over about 20 minutes and was placed in an incubator under close observation for the afternoon.  We sent Winston to the emergency clinic for overnight observation and he returned to us the next day.  

Winston did very well post op, but within the first week, the incision site near the rectum began to break down due to the tension exerted on it by the muscles.  In addition some of the oral incisions began to break down due to the infection in the bone.  We repeated surgery at that time and repaired the wound again.  We placed a tube in Winston's neck (esophagostomy) with which to feed him so that the gums could heal undisturbed.  Winston improved over the next week but the wounds began to break down once again.  

Finally we allowed the body to heal the rectal area by bandaging the region twice daily and irrigating it with sterile saline.  Over a few weeks, the wound went on to heal nicely.  The entire healing time took over 6 weeks from the beginning of the first surgery, but Winston is now home with his parents enjoying life.  

The biopsy for the tumor came back from the lab with the report of a malignant tumor.  Odds are that it will recur in the area at some time, but in the interim, we have left Winston a very happy dog. 

The following picture shows the final result of the tumor surgery.