Risk of dental procedure for a 12 y/o yorkie poo

I need help making a decision. My otherwise healthy yorkiepoo Obie has developed an epulis, and has a heart murmur (detected about 1 year ago). When discussing removal of the epulis, I think the vet said it was a grade 3 murmur. This puts him at risk for anesthesia complications. The vet is more than willing to do the procedure and he has other dental issues that need attention. But she referred us to a cardiologist for an ECG as an option to get 100% "gold standard" seal of approval for the procedure . She said it's not necessary, though, and she can do an x-ray of his heart the day of the procedure to make sure there's no immediate problem. The cardiologist is far, the visit and the ECG will cost about $1,000 more than the dental procedure itself. All just to get cardiology to say "yes he can have a procedure." I'm reluctant to do this, since the vet said it's not fully necessary.  My question is this:  with a grade 3 murmur is there a chance the cardiologist will not clear him? The epulis for now just makes him drool more and his breath is awful even with regular teeth brushing.  Seeing cardiologist just seems excessive at this point. There is also the 3rd option is not doing anything, since the epulis doesn't seem to bother him.  Any advice is MUCH appreciated. If it weren;t for the murmur there would no question or dilemma. Please help!

Hello - I empathise very much with your and your vets' dilemma.  Of course, the best thing to do depends on a unknown factor - what is actually causing the sound (the 'murmur'  over the heartbeat) - but you can't know what's causing it for definite without having the scan, so it's a bit of a catch 22 situation.   Of course, you can always ask the specialist 'what is the most likely cause of a persistent murmur of this type in this aged Yorkie' and if one possibility is much more likely than the others, then you might choose to make that assumption without going ahead with the scan and then act accordingly.  A good follow up question would be, 'okay so what's the chance of a dog with that disease making it through the anaesthetic if I do no further work up.  What drugs did I ought to use?'. The referral cardiologist might (and in my opinion, ought to) charge the vet for this conversation, but it could prove very useful and less expensive than doing the tests to find out exactly what the problem IS.   Obviously there is risk attached to making this assumption (what if it's something else entirely?) but it's a good middle ground.

The specialist might wish to impart this information in a consultation, on the understanding that you can't afford a scan. Another way of looking at the dilemma would be 'see here- my dog cannot have a good quality of life without having the procedure.  Therefore let's take steps to have the anaesthetic as safe as possible and accept that there is going to be a risk.' I think that the key is to minimise it (eg by using certain drugs / monitoring blood pressure) and accepting that risk, whatever the outcome.  This can be emotionally very tough, especially if things don't go well.  To me that mouth sounds stressful and uncomfortable, so the risk may well be worthwhile. Unfortunately, there's always a chance that you might turn out unlucky, in which case you would have to remember the extremely valid reasons for which you went ahead.

Whatever you decide, best of luck.