That's our internal medicine specialist, Dr. Marielle Goossens of Peak Veterinary Referral Center in Burlington, inserting tongue depressors in Travis' mouth. (Click on photo for larger image.) When I took the photo last Thursday, Dr. Goossens was inserting the 17th tongue depressor. She was on her way to getting 20 in that day, which turned out to be a critical number. First, the background.
When Travis came to us way back in 2005 with a fused jaw from a rare disease called masticatory myositis, we worried about a lot of things -- how to feed him, how to medicate him, and how to keep him from overheating in the summer (because he can't cool off by panting). We also worried about what would happen if he vomited. Also on the list: What if he needed anesthesia some day? And: How would we ever get a dental done on him?
As we explained in our fall newsletter cover story on Travis, we tackled the feeding issue first with a stomach tube, and then he solved it for us by showing he could get his tongue out on one side of his mouth -- just enough to allow him to slurp food on his own.
Medicating has never been an issue because in all these years, even with such a debilitating disease, he has never been sick. (Though if he ever needed it, we could use injectable meds or by dissolving pills in water and squirting them through that gap in the side of his mouth.)
We restricted his activity level during summer months to make sure he wouldn't overheat. Given his high energy level and athletic skills, this was easier said than done.
He has also never, to our knowledge, vomited. This is a potentially very serious problem because if he were unable to expel the vomit, he could end up inhaling it back into his lungs.
The anesthesia issue was always a nagging and unresolved concern, but his health had been such that this was one bridge we'd never had to cross ... so far.
And then there was the issue of a dental. In this we were lucky too, because his mouth remained surprisingly healthy. But in the past couple of years we could tell his oral health was deteriorating significantly. Our local vet tried to do a partial dental on him last year under sedation but of course could only access the exterior of his teeth, which left a lot of the bacteria behind. By this summer his mouth began to smell terrible, his gums were inflamed, and we knew we had to do something.
About the same time we learned there was a veterinary dental specialty, the American Veterinary Dental College. We've worked with many different veterinary specialists over the years but did not know there were board-certified veterinary dental specialists. Fortunately, there was just such a clinic, Veterinary Dental Services, three hours from us in the suburbs of Boston.
On October 8th, I took a few high-risk dental patients to see them (including Wilbur and Sophie), along with Travis for a consultation. Dr. Diane Carle examined Travis and found his mouth was as bad as we feared. He needed a lot of work. The biggest obstacle: How to intubate him? The oral surgery on him would require general anesthesia, not just sedation, and that meant getting him intubated. With a fused jaw, how would that be possible?
Dr. Carle said she knew of two cases of dogs with masticatory myositis having their mouths opened slowly and gradually, bit by bit, with "tongue depressor therapy." This meant starting off by inserting a couple of tongue depressors between his front teeth the first week, then a week later inserting a few more, and continuing weekly. The goal was to get his mouth open enough for intubation. And if it was open enough for intubation, it would be open enough to do extractions and cleaning.
Dr. Carle called Dr. Goossens to discuss her findings and recommendations, and Dr. Goossens agreed to start the process on Travis. For the past couple of months Widget and Travis have made the weekly trip to Burlington -- Widget for her chemotherapy, and Travis for his ... well, his tongue depressor therapy.
I will admit, I think it's safe to say that both Marielle and I were a little skeptical about the approach. But on the very first attempt, she was able to get five tongue depressors between his front teeth, which astonished me. During each procedure, Travis is sedated and hooked up to patient monitoring equipment, with one vet tech focused on monitoring his vital signs and a second vet tech assisting Marielle:
In the photo above Marielle is using a surgical flashlight to look into the back of his mouth to assess the tissue.
The actual process is pretty low-tech: She gently taps a new tongue depressor in between two other tongue depressors, until it slides all the way up and takes its place in the stack.
Here's another shot during the middle of Thursday's procedure:
To keep the myositis from reversing the gains, Travis has been on prednisone since we started doing this. He's also on antibiotics because of the bacteria in his mouth and on pain medication for a few days after each procedure. Every week Marielle begins with the number of tongue depressors she ended with the previous week, and adds a few more -- on average, about three new ones. She uses his heart rate to indicate his level of discomfort, and when his rate elevates to a certain threshold, she stops.
Last week's goal was to get 20 tongue depressors in, but Marielle and her team reached an even bigger goal that day: They were able to intubate Travis! Yes, sooner than we expected, they got his mouth open to the point where general anesthesia is now possible.
His dental surgery was already scheduled for January 14. Until then, we will be doing "maintenance therapy" every other week, just to make sure we don't lose any ground. Travis still can't chew or use his mouth like a normal dog, but he can open and close his mouth. This has made it easier for him to breathe -- he can finally pant -- and it's also made eating easier, too.
He's still getting used to having a mouth that opens -- we now call him "Clickity Clack" because of the odd noises his mouth makes. And we're still getting used to seeing him with his mouth partially open. Still a funny looking boy, just different!
Final 2013 Shelter Challenge Underway
The final round of the Shelter Challenge for 2013 began on October 28th and runs until December 22. You can vote every day here. To search for us, type in our name, Rolling Dog Farm, and Lancaster, NH 03584. We just won another $1,000 in the previous round, so your daily votes do bring in serious money for our disabled animals!
Please note that I cannot help with technical or voting problems. I also do not have an "inside track" to anyone at the Shelter Challenge, and I don't know any more about the contest than anyone else does. So if you find yourself having issues, please consult their FAQ page here and their Rules page, which is a pop-up you can find linked on this page.
Thanks for your votes!