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!
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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!
What a wonderful boy you are Travis. And you have so many people who love you!
Your mouth is going to feel so good after the dental work in January.
Posted by: Chloe | December 02, 2013 at 11:17 AM
God is blessing you! You have much to be thankful for this Thanksgiving and each day, especially for Widget and Travis miracles. :-D
Posted by: cgruber | November 27, 2013 at 11:43 AM
Funny, I never noticed that Travis' head was unusual. I always thought of him as the dog with the aerodynamic head. I hope this improves his life. He seems so dear.
I wish you and Alayne a wonderful, happy Thanksgiving!
Posted by: Moon Rani | November 27, 2013 at 10:39 AM
Everyone keep voting! I know the economy still sucks... and if you can't donate $, you can give by voting.
Posted by: Penny | November 26, 2013 at 02:13 PM
All I can think to say is WOW!!!
Posted by: Dawn | November 26, 2013 at 10:55 AM
This is just great! I am amazed at everything we learn from your blogs. Everybody needs to keep voting in the shelter challenge for Rolling Dog Farm!
Posted by: Betsy | November 26, 2013 at 09:42 AM
It's amazing how much I learn from your blog. I never would have imagined that there would be something like this procedure available. I'm so glad that it's helping Travis so much and that he'll be able to get his much needed dental work done. You go, Travis!
Posted by: Ann | November 25, 2013 at 07:40 PM
This is totally awesome and a wonderful gift for the dental college to give Travis a better life. Three cheers to everyone involved, especially Travis!!
Posted by: Gail Thompson | November 25, 2013 at 07:08 PM
Travis, one of my favorite boys! So good to hear this is going to happen. I miss him so much...actually I miss all of you so much. Sending good ju ju to Travis/Widget and the rest of the fur family :)
Posted by: Rosemary | November 25, 2013 at 06:00 PM
Such an extraordinary story!Everyone involved is SO amazing!
Best wishes and luck to Travis with his new abilities, fabulous doctors, and supportive staff!
Posted by: Shirley and dachshund Dieter the Dude, J.G. | November 25, 2013 at 05:36 PM
I'm in awe. This is an amazing story. Love you Travis, god bless Steve and Alayne and to Travis' doctors!!!
Posted by: Penny | November 25, 2013 at 05:25 PM
Who would have thought... that's ingenious. So glad that Travis will be able to get some much-needed dental work. I'm sure he is thrilled with his new freedom to pant and maybe eat a bit more easily.
Posted by: Tonya Allen | November 25, 2013 at 05:10 PM
Ditto everyone's comments as well as queries about life after the dental in January. It is, in any event, amazing!
Posted by: Linda | November 25, 2013 at 04:40 PM
I also adopted a boy with mmm so I find this amazing!!!
Posted by: jane nock | November 25, 2013 at 03:52 PM
Great news! Will this last after the treatment is complete? Will be be able to pant, etc.?
Posted by: Julien Sharp | November 25, 2013 at 03:18 PM
I am so happy for Travis. I hope all continues to go well for this new, drastic proceedure. How clever to put tongue depressors to such good use. With you two helping him and his willingness to work on his situation, who knows how far he can go. Our 2 dogs say to tell him, "Good for him! Keep it up."
Posted by: Phyllis Snow | November 25, 2013 at 02:18 PM
I'm with the others and want to know if this will reverse itself. I'm so glad things like this are now possible. Travis has always been one of my favorites!
Posted by: Lynne Parker | November 25, 2013 at 02:17 PM
Yay for Travis!! He is the coolest! His story and his escapades (climbing snowbanks to run on down the road) have always made me smile. Nice to know he will be smiling pretty here soon. Thank you for taking such good care of this special boy.
Posted by: Anne in FL | November 25, 2013 at 02:10 PM
OMG!!!! That is AMAZING!!! I had to read it and re-read it. When I saw Travis on the table my heart sunk and then to read the blog---WOW!!!
Posted by: Shirley * James/Portland, OR | November 25, 2013 at 01:56 PM
So after the dental in Jan., will he go back to being the way he was, with his mouth being completely closed? I'm assuming the maintenance is what's keeping his mouth open, and once that stops, it will be back to his old normal. Either way, getting the teeth cleaned so he stays healthy and painfree is a big step for him. Better blend up something really special for this guy!! He really deserves it!
Posted by: Barb Ribinski | November 25, 2013 at 01:29 PM
That's amazing! I bet Travis is loving the fact he can open his mouth.
Posted by: MsFitzTX & Andre | November 25, 2013 at 01:25 PM
Just when you think you've heard everything. What an amazing story. Travis probably can't believe how much better life is. The answer was so low tech, no atomic powered jaw synthesizer just someone with an idea that might work. Good for Travis.
Posted by: Bob | November 25, 2013 at 12:58 PM
What a miracle made possible with lots of hard work! Go Clickity Clack! (But you're awfully cute with your gruel "artfully" spread on your face and bib).
Posted by: Kathleen Rivard | November 25, 2013 at 12:50 PM
Yeah Travis! Good for you. I hope your dental goes well in January.
Posted by: Karla | November 25, 2013 at 11:39 AM
We all know this is the season of miracles so it is no wonder that Travis is making such good headway.
Posted by: Kathy Hertzel | November 25, 2013 at 11:30 AM
After his dental surgery, will he retain his ability to open and close his mouth and eat better and feel more normal? It must be a sensational feeling for him! Tongue depressors! Who would have guessed?!
Posted by: Miranda Brooks | November 25, 2013 at 11:13 AM
Unbelievable!! Who knew? With all your veterinary knowledge through coping with all the varied disabilities, who knew it would be a simple and slow prying open of the jaw. Travis is so luck to have a life, because of you, and now, even at this stage in life, more improvement!!
Posted by: Diane Borden, Chehalis, WA | November 25, 2013 at 11:06 AM
wow
Posted by: Lynn (in Louisiana) | November 25, 2013 at 11:00 AM
It's kind of hard to see Travis' smile with the tongue depressors, but I think it's there!
Posted by: Clay Hickman | November 25, 2013 at 09:58 AM
That is awesome!!
Posted by: Laura, Levi & Timmy | November 25, 2013 at 09:36 AM
Wow! Travis must be beside himself with his new found abilities. Hopefully this opening ability won't reverse itself too much over time when he's off the meds.
Posted by: Peggy S. | November 25, 2013 at 08:23 AM