Second opinion] Dear Vet, my 10-years Maltese Sissi passed a minor surgery. Vet did all the necessary tests before the

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Customer: Second opinion] Dear Vet,
my 10-years Maltese Sissi passed a minor surgery. Vet did all the necessary tests before the operation (ultrasound, X-ray, cardiological, blood test). Everything was normal. She only had a diagnosis of a narrowed trachea and a slightly enlarged heart (no heart failure, she didn't need medication). She had a perfect blood test before the preventively operation of a 1-cm skin lump and dental cleaning. She experienced respiratory distress just before the operation, 15 minutes after premedication with Insistor. She received Torphadin and Dexamethasone. From that moment on, we were no longer present during the operation. The operation lasted about 30 minutes. Immediately after the operation, when Sissi woke up, I received a call from the vet that everything was fine with Sissi and that she could go to home care in an hour. About an hour after the operation, she was given to us for home care. Research lately showed the skin growth wasn't cancer (it was benign lipoma of the mammary gland).
After the operation she wasn't feeling good. She got worse day by day. She started vomiting and refusing food. We took her to the vet. Blood test showed acute kidney failure. Vet healed her with iv fluids. She got an ulcer on her tongue. She couldn't even use her tongue to eat. We fed her with a syringe. Vet healed her with antibiotic Convenia and Cylanic and NSAID Ficoxil. After one month of treatment...the blood test showed Urea 90+, Crea 400+. Why does a dog with no prior kidney disease develop sudden kidney failure after minor surgery? What could be the cause?
Reduced blood flow through the kidneys during the operation? If this happened vet will see decreased blood pressure during the surgery, am I right?
Is it possible that the respiratory distress experienced just before the operation affected the kidney failure? Can surgery be performed immediately after respiratory distress?
Is the use of painkillers (Ficoxil) and antibiotics (Convenia, Cylanic) at acute kidney failure appropriate medicine?
Blood test before (date: 2 February) and after operation (13 February and 3 March) in the attachment.
Answered by DrNickiDVM in 19 hours 1 month ago
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Specialities include: Dog Veterinary, Dog Medicine, Dog Diseases, Small Animal Veterinary

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Hello, my name is***** and I'm an emergency veterinarian. I'm here to provide you with excellent service.
I’m very sorry to hear you are experiencing these issues, but I appreciate you reaching out to us for assistance. Hopefully I can help. I’m so sorry Sissi went into kidney failure. You must be so worried. I have some questions I will ask below that will help me to understand what could be going on with her.
Please be aware I am a licensed veterinarian, but I am not your pet’s veterinarian and cannot examine your pet, so I cannot legally provide you with any specific veterinary medical advice such as diagnosis or prescribing medication. However, I can generally speak to help you understand resources that may help you and advise you to seek medical attention.

How long after the surgery was the kidney failure diagnosed? How long was she given IV fluids in the hospital?

Hi, I was just checking in to see if you received my request for more information. If not, here it is again:

How long after the surgery was the kidney failure diagnosed? How long was she given IV fluids in the hospital?

Did her numbers intitially improve after the fluids?

Without the information I requested, I can only give you general advice so I hope this helps.

I am so sorry your dog went into kidney failure. Certainly like you said the blood flow could be less anytime the animal is under anesthesia and we are always fighting to maintain normal blood pressure, but still there is always the possibility anytime and animal is put under that that can happen. I'm not sure how long she was treated on fluids and if they got blood work after the fact that set her kidney values were normal and then made that determination that she could leave the hospital based on that. I am not familiar with the drug Ficoxil But it looks like it is an NSAID. Possibly a

non-steroidal anti-inflammatory can make things worse if there is already kidney disease but it would be completely reasonable to give it if the prenesthetic blood work was normal

I'm not sure what treatment she is on at the moment, if they sent her a home on a special prescription low protein diet and with you giving her fluids everyday under the skin or what the plan is at this point.

I'm happy to discuss this further if you wish. I thank you for reaching out to us here at Just Answer and I sure hope Sissi is doing better soon.
Dr. Nicki

Just checking in as I did not hear back. I sure wish you all the best with Sissi and please let me know if you wish to discuss them further. Thank you again for reaching out to us here at Just Answer.Dr. Nicki

Hello, Thank you for your reply.
About an hour after the operation, the vet sent her to home care. Three days after the operation, her appetite decreased, she vomited several times. We took her to the vet. She received Cerenia. The vet did not check the blood. She stopped vomiting. But one week after the operation, she completely lost her appetite. I contacted the vet. According to his instructions, I fed her with the help of a syringe. Since she didn't have a fever, the vet thought it was nothing serious. After a few days she became very sick, she started shaking. I took her again for a check-up. At that time, the vet checked the blood and found kidney failure (10 days after surgery). She was on fluid therapy for three days. She had her appetite again, and was placed in home care. Three days later, she developed an ulcer on her tongue and lost her appetite. She was again on IV fluids for three days. The blood count has improved. Then the vet sent her home. At that time, she received an injection of the antibiotic Convenia, as well as the antibiotic Cylanic and the NSAID Ficoxil for home therapy. She was sent home without fluid therapy. We fed her with the help of a syringe. After a week, the situation worsened again. Blood values were Crea 400+, Urea 90+.
I have one more question about decreased blood pressure during the surgery. In this case, what could the vet do to prevent further postoperative complications? Should Sissi be on IV fluids for a longer period of time? Otherwise, she was discharged to home care just one hour after the operation.
How common are such postoperative complications? What is the most common cause of such a complication? Based on the example described, what would you say caused such a complication?
Why did they put her on an NSAID?

Had her kidney values I proved before they sent her home from IV therapy? Then got bad again?

I don't know which anesthesia they used and how much fluids she got. Was it a quick procedure?

I apologize I am in and out of appointments today.

The kidney values got better after three days od fluid therapy. They put her on NSAID due to the ulcer on her tongue, they said this medicine will help her with the pain. Yes then god bad again.
During the surgery they used: insistor, isoflurin, midazolam,
propoven, dexamethason, torphadine, cerenia
Operation lasted about 30 minutes-1-cm skin lump and dental cleaning
They sent her home about one hour after surgery. They said it wasn't any complications during the surgery.
When I asked for explanations as to why the kidney failure occurred, they said that they assumed that there was a reduced blood flow through the kidneys. A narrowed trachea and an enlarged heart were said to have contributed to the complication. Do you think this is possible? However, if there was indeed reduced blood flow, the machines would detect the reduced blood pressure during surgery. Am I right? What do you think about it?

Do you know why they used a steroid? For 30 minute operation it's reasonable to send a dog home an hour later in my experience.

What do you mean by respiratory distress?

Did she get IV fluids during the procedure?

Not all clinics monitor blood pressure, you could ask them that but even doing our very best it's inevitable that it happens, by definition in order to put an animal under anesthesia It has to happen and we do our best to counter it.

Sissi was always under a lot of stress when visiting the vets, she was always breathing fast. A year ago, she experienced respiratory distress during a cardiological examination, at which time she almost suffocated. We barely saved her, she was on oxygen all night. She was diagnosed with tracheal collapse a year ago.
She experienced respiratory distress just before the operation, 15 minutes after premedication with Insistor. She began to choke. She received Torphadin and Dexamethasone to manage respiratory distress.
They monitored blood pressure. If there was indeed reduced blood flow, the machine would detect the reduced blood pressure during surgery. Am I right? She was on IV fluids during surgery.

Why would the vet not give her something to sedate her prior to the exam in the future?

When you say respiratory distress what do you mean by that? Was she stable and a candidate for anesthesia? That would be my question. I don't know if they checked blood pressure, that would be a question for them.

Before the operation, 15 minutes after receiving Insistor, she started to run out of breath. She received oxygen, Torphadin and Dexamethasone to manage breathing distress. They claim that they treated the breathing distress and then proceeded with the operation. They also said she was a suitable candidate for anesthesia. They have all the modern equipment in the clinic, so they also monitored her blood pressure during the operation. But they claim the operation went without complications. I wanted an explanation as to why she experienced kidney failure. They say they assume she had reduced blood flow through her kidneys. However, if this really happened, they should detect a drop in blood pressure during surgery, I know they have devices that measure blood pressure during surgery. Am I thinking right?
They were not worried about her breathing given what happened to her before she went under?

I think no matter how much we intervene to keep the blood pressure up it's not going to be normal during anesthesia by the very definition of what b

an ananesthetic drug does.

I don't know, I think it's strange that despite the respiratory distress they still operated on her. Is it possible that the respiratory distress contributed to the reduced flow through the kidneys? Was it appropriate that she was given Torphadin and Dexamethasone before the operation?

You could ask them about that, I'm not sure what they meant by respiratory distress.

I don't see that a little morphine would cause that unless they think her breathing was depressed which morphine can cause. But it wouldn't cause distress, as much as the animal being too sedate.

It's considered very safe and it sounds like they gave the steroid in case there was any inflammation which is something that we often do.

If they gave morphine I'm not sure why they then gave butorphanol or what the time frame is on that. But I don't see that that would cause a problem.

Thank you for the answers. I don't know why the vet claims that there were no complications during the operation. If there was less flow through the kidneys he should see low blood pressure on the machine, am i right?
Are Convenia and Cylanic antibiotics appropriate drugs for healing ulcer at kidney failure?
Not necessarily, there may not be anything obvious even if the blood pressure looks normal, by definition when an animal is sleep secondary to anesthesia, something abnormal is happening to them and acute kidney injury is a known potential risk with any anesthesia. We do our best to mitigate that by checking the kidney function ahead of time and giving IV fluids and trying to use the least amount of sedation we can, but it's not always avoidable.

I would not think the antibiotics are involved, although I don't normally use antibiotics for kidney failure. Unless there was a bacterial component.

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