Older patients

As vets, we are aware of the increasing number of health problems faced by our patients as they get older. These problems are detected at various stages, depending on their severity, or their owner’s perception of the severity.

This perception is often the key factor in how much treatment or investigation an owner is willing to permit. Times will occur when the vet’s and owner’s perception of the problem do not quite match up. The majority of clients are on board with treating many of these problems, but, occasionally, a client may perceive a problem as too insignificant to warrant treatment. It is our role, as veterinary professionals, to inform clients of the problems and benefits, and guide them towards making the best decisions for their animals.

Sometimes, though, this can be difficult. OA in our older patients is a classic example of this situation. People often mention their dogs are becoming stiff after long walks, or first thing in the morning. However, many see this as a normal sign of ageing and are, therefore, reluctant to start their pet on long-term medication. Once it is explained how uncomfortable their pet will be feeling – and likening the condition to humans suffering with arthritis – more owners seem willing to consider treatment, alongside diet and weight management.

Surgery

At times, however, surgery may be required to resolve the animal’s problem. Over the past few years I have seen a female border collie several times that had a soft tissue mass. Almost three years ago, when she was 11, she presented with a large fluid-filled mass on her flank. The fluid was drained, but it recurred and a central soft tissue area from within the mass was sampled. It came back as inflammatory. After draining, it took another year before the mass had increased in size enough to be causing her a problem.

At this stage we had to decide between additional analgesia or further investigations. After some debate – as she was now 12 years old – we decided to do the latter as the mass was starting to affect her quality of life. We imagined either a foreign body was present or, more likely, a neoplastic process was going on. When we incised around the mass, it became clear neoplasia was most likely, as it was very heterogeneous, with strands of soft tissue surrounded by large amounts of fluid.

The nature, size and mass of the site meant complete excision in a deep plane was not achievable, and histopathology showed it was a soft tissue sarcoma. We kept a close eye on the site for recurrence, aware this would eventually happen. It was a year before the mass had reached a significant size, then we had to make a further decision about whether pursuing a second surgery in a reasonably fit dog – now 13 and showing early signs of arthritis in her hindlimbs – was wise.

She was started on meloxicam for the arthritis, and this improved her symptoms and quality of life significantly over the following month. When the mass started to ulcerate, it made the decision more urgent and we decided to repeat the surgery. The operation went well and, as before, she recovered very well from the surgery. Eleven months later the mass had increased to around 15cm × 10cm and was starting to affect her mobility again. By this stage she was 14 years and 8 months old, but looked amazingly well. Long-term meloxicam was still controlling her arthritic pain and, despite a vestibular episode, she was showing no signs of other health problems.

Based on all this, another surgery was performed. She has since done really well and I have been amazed by how rapidly she recovered. She is a reminder “age is but a number“ – she has tolerated all the anaesthetics very well and has shown, for her, performing all these surgeries was the right decision.

Risk

You’ll find many clients who, once their animal is past a certain age, will not pursue treatment. Cost is one obvious concern, although often it is purely the risks associated with anaesthesia that put them off. A lot of advances have been made in anaesthesia, monitoring and preoperative testing, which have all helped to reduce the risks associated with anaesthesia – especially in older patients. While accepting the risks are higher, the benefits can also be significant.

Dental disease is a hugely prevalent problem in our older patients, and clients can often underestimate how painful this is for their pet. A large number of owners express great surprise at the improvement in their pet’s demeanour after it has had dental work. I have also found many owners subsequently think their pet may have been suffering for longer than they realised with discomfort from this problem. If problems and concerns are fully discussed and considered, and increased precautions taken, the benefits of treatment/surgery can often outweigh any risks. We try to discuss all options with clients, but, often, time constraints become a problem.

A fine line exists between, on the one hand, doing too much and putting animals through surgeries or courses of treatment where we may be prolonging suffering rather than improving quality of life, or, on the other hand, continuing to pursue treatment or surgery, with precautions taken, which have the potential to hugely benefit the patient.

Sometimes it is difficult to judge the outcome and, therefore, decisions are hard to make. However, these few cases have reminded me, frank and open discussion with owners taking some reasonable risks can lead to excellent outcomes for our older patients.