Juggie went for a dental exam. Expertise with surgery needed

[DenaRox]

so I have been trying to get Juggie in for a dental exam. I was sure he had some issues that seem to have become worse. Sadly I could not take him to appointment (mom did) but talked briefly once exam was over. Conclusion is he needs 14 teeth pulled. I do not have any other real info than that and the cost estimate of between 800-1500 Canadian dollars. I have to call back and book appointment so I’m here gathering all the info I need to be fully prepared and knowledgeable before doing so.

Another thing I know from talking to receptionist is that they will book him when main vet is on shift as she is the owner and the head anesthesiologist .he will be dropped off at 8am and picked up by 230pm. His insulin (2u Lantus) is at 7am. I am to give him last snack at midnight (he normally gets midnight snack) then no food again. They did say I could give 1 teaspoon to help with testing/dosing.(not the vet, still have to speak to her)

So what do I need to know? What should I be asking? What should I avoid/red flags etc.

 

[Larry and Kitties]

That is giving full dose of insulin w/only 1 tsp food in the morning?
That does not seem right, espefcially based on your SS BG and dose.. One vet I have will allow ½ food and ½ dose morning of but dental is started about noon..

For Juggie I would give maybe ¼ dose especially if you are getting relatively high PS BGs like recent entries in your SS shows

 

[DenaRox]

That is giving full dose of insulin w/only 1 tsp food in the morning?
That does not seem right, espefcially based on your SS BG and dose.. One vet I have will allow ½ food and ½ dose morning of but dental is started about noon..

For Juggie I would give maybe ¼ dose especially if you are getting relatively high PS BGs like recent entries in your SS shows

Sorry, I should have clarified (I changed original post) I have not spoke to vet yet, this info was from the receptionist. I will be sure to find out all about eating/dosing beforehand

 

[Wendy&Neko]

Poor Juggie on the dental! I'm sure he'll feel much better with those bad teeth out. The price you have quoted is a very good one for that much work. Are they doing dental x-rays before hand? A post for you to read: Info on Dental Procedures (including pictures)

When you talk to the vet, remind him/her that Juggie is diabetic. Normally they have different protocols for diabetic cats regarding food/insulin. A half dose is a typical amount. Sometimes less.

Based on Juggie's spreadsheet, he has earned a reduction down to 1.75 units since he's been below 90 on this dose.

 

[DenaRox]

Poor Juggie on the dental! I'm sure he'll feel much better with those bad teeth out.

I know he needs it but it sure is scary. They did give the option of doing half now and then the remainder later. I’m just not sure which is the lesser of pain and discomfort for him, having to do it all at once or going through it twice???

The price you have quoted is a very good one for that much work. Are they doing dental x-rays before hand? A post for you to read: Info on Dental Procedures (including pictures)

I really have no comparison, lol, couldn’t imagine affording more. Thanks for the link I will review and take notes lol they do list dental X-ray on the estimate, I will include the paper I received.

When you talk to the vet, remind him/her that Juggie is diabetic. Normally they have different protocols for diabetic cats regarding food/insulin. A half dose is a typical amount. Sometimes less.

I will be having a long discussion when I call to make the appointment. Making my list of questions to ask

Based on Juggie's spreadsheet, he has earned a reduction down to 1.75 units since he's been below 90 on this dose.

I haven’t had a chance to do a curve yet, will do one this weekend when I’m off work

thanks so much for the info, if you can think of anything I should be asking or red flags to watch out for, please let me know. I quickly read something about a medication to avoid because it’s bad for cats but some vets still use it but for the life of me can’t remember the name or find it again

 

[Larry and Kitties]

They did give the option of doing half now and then the remainder later. I’m just not sure which is the lesser of pain and discomfort for him, having to do it all at once or going through it twice???

I would get the removals done at one time. Anesthesia is hard on the cat and i minimise the number of times it has to be done.

Many caretakers do not want to give the one-time injectable antibiotic Conveni, which lasts a week or two. I have used it for an extensive dental since I did not want to risk disturbing the gums using a pillar or dropper for liquids. Also for pain mets Buprenorphine is an excellent one you squirt in on the mucous membrane in the mouth twice or three times daily but a few vets use an injection that last three days. I would not use Metacam

 

[DenaRox]

I would get the removals done at one time. Anesthesia is hard on the cat and i minimise the number of times it has to be done.

Many caretakers do not want to give the one-time injectable antibiotic Conveni, which lasts a week or two. I have used it for an extensive dental since I did not want to risk disturbing the gums using a pillar or dropper for liquids. Also for pain mets Buprenorphine is an excellent one you squirt in on the mucous membrane in the mouth twice or three times daily but a few vets use an injection that last three days. I would not use Metacam

Thanks for the info. I’ve worked it out in my head that I’d rather just have one go of it for that exact reason. Don’t want to put him at more risk than needed. Will be sure to discuss all medications they plan to use.

 

[Noah & me (GA)]

the option of doing half now and then the remainder later

When I had 14 teeth pulled I was told it would be no less painful having it done in two sessions. The differences between feline and human dental surgery are too numerous to mention here. The anesthetic, pain management and the diabetes makes nothing comparable except for what I said about having it done in one go.
Juggie may only be nine but he's still a senior so ask about being under that long.

couldn’t imagine affording more

Where have you been living? We just paid $2,000 for a difficult singular extraction and last year paid $1,600 for just two teeth.

Making my list of questions to ask

There's no such thing as a stupid question. No matter how trivial ask away, it's better than regretting not asking at 3AM.

 

[DenaRox]

When I had 14 teeth pulled I was told it would be no less painful having it done in two sessions. The differences between feline and human dental surgery are too numerous to mention here. The anesthetic, pain management and the diabetes makes nothing comparable except for what I said about having it done in one go.
Juggie may only be nine but he's still a senior so ask about being under that long.

I was told that they aim to do all unless told otherwise. They start with worst teeth and work up that way if they need to stop early they've remove the worst ones

Where have you been living? We just paid $2,000 for a difficult singular extraction and last year paid $1,600 for just two teeth.

We are in Saskatchewan. Here’s the cost given
Dental prophylaxis - 118.50
Dental anesthesia induction +30min - 150.00
Per 30 min - 50.00
Dental catheter and fluids - 81.00
Dental X-ray series - 110.00
Dental nerve block - 35.00
Dental pack - 12.90
Extraction (complex) 4 - 216.00
(Moderate) 2 - 72.00
(Simple) 8 - 144.00
Kennel fee - 18.40
Medication 4 - 94.00
CBC/Chem/usg- 149.60
Blood sample collection - 28.00
Tax - 140.73
total - 1420.13
And this is the estimate so it could be higher or lower depending on what happens when they are actually in there.

There's no such thing as a stupid question. No matter how trivial ask away, it's better than regretting not asking at 3AM.

This is what I’m emailing them then they will call or reply to email their responses.they have been warned I have A LOT of questions haha

Before:

• instructions regarding what to do about food and insulin prior to the visit . 1/2 dose? Skip dose? When can he eat?
• Should I bring his insulin to use if needed?
• Can his ears be cleaned while he is under?

During:

• What kind of anesthetic used?
  • Protocols? (Masking, boxing, injection?)
  • How long will he be under anesthetic?
  • What monitoring will be done while he is under anesthesia?
  • How often will his bg levels be checked?
  • What happens if he drops low?
  • What do you consider "low" BG when it comes to intervening with dextrose or glucose?
• -How will you proceed should jug's BG spike very high?
• - How long will it take for jug to come around?
• Will I receive a phone call / update after the surgery?
• medications used for extractions & post-surgical care
  • What if any antibiotics will my cat be given, before and after surgery?
  • What pain medications will be used and how much to take home? Liquid form?

After:

• What monitoring they will do while he is in recovery
• How can I expect my cat to behave, and for how long?
• How long will it take until my cat completely recovers?

 

[DenaRox]

Just talked to the vet and here’s the info I received:

• he is to have no food after midnight. His normal am shot is 7am, he is to have 1/4 of his normal food and 1/2 his normal units of insulin.( @Wendy&Neko sounds much better than originally told )
• They want me to do a curve this weekend (I already was going to) and send them info to check where he’s at then do a curve again before his appointment date (they also do blood work and all that once I drop him off)
• I am to bring his insulin and syringes
• They will clean his ears and trim his nails while he is under
• Propofol anesthetic Injection + gas
• They have a dedicated anesthesiologist who is there during surgery who checks all vitals and monitors.
• They will call after surgery to update or during surgery if needed re changes of procedure
• They don’t normally give an antibiotic
• They use and give a few days worth of liquid metacam for pain( @Larry and Kitties what is wrong with metacam?) why is bupe better? I will need to research more. Should I be Refusing metacam?

 

[Wendy&Neko]

This does sound better from the vet. I might accidentally forget his insulin and syringes, did they say why they want them? Otherwise you may find they'll shoot on a schedule that works for you, but not for them. You are giving half a dose so Juggie will have some. Are they expecting he might have to stay overnight?

I don't get why no food after midnight, but OK to feed some food in the AM. If he is staying, or even if not, I might drop off some of his regular food for them to feed. Otherwise they might grab something they have that is not diabetic friendly.

Are they doing dental xrays before hand? I have first hand experience with Neko where a bad tooth looked fine on visual inspection but issue was below gum line which showed up on the xray.

Metacam is an NSAID, which can be an issue for kitty's kidneys. I think in Canada they might be doing the lower dosing for cats (not sure), but previously there was a history of kidney damage to cats with Metacam. Buprenorphine is safer. I refused Metacam cause Neko already had compromised kidneys.

 

[DenaRox]

This does sound better from the vet. I might accidentally forget his insulin and syringes, did they say why they want them? Otherwise you may find they'll shoot on a schedule that works for you, but not for them. You are giving half a dose so Juggie will have some. Are they expecting he might have to stay overnight? I don't get why no food after midnight, but OK to feed some food in the AM. If he is staying, or even if not, I might drop off some of his regular food for them to feed. Otherwise they might grab something they have that is not diabetic friendly.

I asked about insulin but now I don’t remember why lol, maybe if his numbers go too high??? for food she explained that they want as little food in stomach as possible before to prevent puking and all the issues that come with that. She did say they feed him when he wakes after so I will bring a can of his food to give. Assuming all goes well I drop off at 815am and pick up at 445pm.

Are they doing dental xrays before hand? I have first hand experience with Neko where a bad tooth looked fine on visual inspection but issue was below gum line which showed up on the xray.

yes they do bloodwork (have in office lab) and X-rays beforehand, for exact reason you stated.

Metacam is an NSAID, which can be an issue for kitty's kidneys. I think in Canada they might be doing the lower dosing for cats (not sure), but previously there was a history of kidney damage to cats with Metacam. Buprenorphine is safer. I refused Metacam cause Neko already had compromised kidneys.

What I know:

• Canada doses at (.02) and USA at (.03)
• They give iv fluids through surgery to prevent dehydration
• They do blood work and pre op exam to ensure he is healthy enough for surgery and meds

I will ask in more detail about safety in Canada vs using bupe. I am expecting a call tomorrow in regards to safe bg levels to do surgery and a few other things that she wanted the lead vet to answer.

 

[Wendy&Neko]

I am expecting a call tomorrow in regards to safe bg levels to do surgery

FYI - Neko's first dental, her AMPS that day was 452.

Sounds good on the food. I once asked what happens if I had to feed late in the cycle due to dropping numbers, and was told to let them know when and how much. The idea is to minimize food as you said.

Overall, sounds like Juggie will be in good hands.

 

[DenaRox]

FYI - Neko's first dental, her AMPS that day was 452.

I think I would cry, the highest Juggie has been (that we are aware of) was his diagnosis day numbers of 448. I was worried that he’s been bouncing around in the 300’s but I am sure his upcoming curve he will get an increase to 2.25u

Sounds good on the food. I once asked what happens if I had to feed late in the cycle due to dropping numbers, and was told to let them know when and how much. The idea is to minimize food as you said.

thanks for the reminder to bring his food. I know they would feed him higher carb food that was on hand and Juggie is very food motivated so he’s scarf it all down I’m sure.

Overall, sounds like Juggie will be in good hands.

I am feeling as positive as one can in this situation. I am beyond thankful that my pharmacist recommended this new clinic. They are polar opposite of last clinic in every single way. When I told her I had been left in the dark with last vet and that it was this forum that got me through all the fear of new diagnosis and got me to be a confident tester and insulin giver, her reply was that it sounded like an amazing forum and she was proud of how knowledgeable I was and if I was comfortable I could just keep doing my thing. That was the moment I knew we found our forever clinic

 

[Noah & me (GA)]

I have A LOT of questions

That's perfect. Too many owners just drop off their pet, pick it up in a big rush and then wonder why his poop is green and one ear is flopped over on a Sunday morning. It's also a good test for a caring vet. Some just reach for your Visa card while handing you a barely legible set of guidelines.
Skatchewan eh? I'm an Alberta boy but moved from Deadmonton years ago. Ontario is nuts, the house we bought for 215K in 2002 will soon be worth a million and it's only a semi-detached. Try telling someone from Alberta that Saskatchewan has more lakes and more sunny days than Alberta and see how that goes over. Plus no one here knows what a grain elevator is, what 'plugging your car in' or 'can you give me a jump' means. Don't even ask about "The Toon".
"So cold in the Toon I had to wear my toque before going to Timmys for my 4X4". Say what? eh!

 

[DenaRox]

That's perfect. Too many owners just drop off their pet, pick it up in a big rush and then wonder why his poop is green and one ear is flopped over on a Sunday morning. It's also a good test for a caring vet. Some just reach for your Visa card while handing you a barely legible set of guidelines.

got a call from the vet today to talk some more. Was nice to have a follow up, something the evil x-vet never would have done.

Skatchewan eh? I'm an Alberta boy but moved from Deadmonton years ago. Ontario is nuts, the house we bought for 215K in 2002 will soon be worth a million and it's only a semi-detached.

I haven’t been out easy in ages. Love to visit but too big to live there lol, I like toontown well enough.

Try telling someone from Alberta that Saskatchewan has more lakes and more sunny days than Alberta and see how that goes over. Plus no one here knows what a grain elevator is, what 'plugging your car in' or 'can you give me a jump' means. Don't even ask about "The Toon".
"So cold in the Toon I had to wear my toque before going to Timmys for my 4X4". Say what? eh!

Lol I’m just sitting here in my BunnyHug, wishing I would have hopped in the beater and grabbed a 24 of Pil at the LBS before it closed!

 

[Sienne and Gabby (GA)]

I would talk to the vet about the Metacam. If they can see their way clear to give you buprenorphine, I'm a fan. I just don't trust non steroidal anti-inflammatories. My vet is a cat only specialist and won't use NSAIDs.

 

[tiffmaxee]

My vet is a board certified internist and he will not give any cat Metacam either.

 

[DenaRox]

@Sienne and Gabby (GA) @tiffmaxee
I called the 3 vet clinics that were open today and all said metacam is the go to here. I also called the emergency small animal hospital and they too said metacam is their first choice, assuming the cats blood work and pre-surgery exam show the cat is healthy/no underlying issues that would prevent it. The tech I talked to said “those issues aren’t here in Canada” when I asked about the renal damage potential and the black box warning in USA.

I will voice the concerns with my vet on Monday and see what she has to say seeing as I already have to email her with all the info I can gather here on why I refuse to use the Alphatrack. She is wanting me to pay $150 for a fructosamine test because my human meter numbers don’t mean anything to her. Thankfully she is open to hearing info and explanations so hopefully I can transfer all you guys have taught me here lol. Someone really should write up a post to copy paste to send to vets on why human meter testing is good enough and if they can let go of Alphatrack numbers and look at human numbers and patterns all would be happy lol

 

[tiffmaxee]

They do use metacam in Canada but also buprenorphine. Wendy has used bupe. @Wendy&Neko

 

[Bron and Sheba (GA)]

We also use metacam here in Australia. It’s used a lot post surgery.
We haven’t had the same issues as the US has had as the metacam for cats here is a different strength to the metacam they have used in the US which is a strength for dogs. Canada uses the same strength as we do which is 0.5mg/ml
I used metacam for Sheba for a couple of years and it was a lifesaver.

 

[Sienne and Gabby (GA)]

Metacam is used more often outside of the US. However, diabetes is hard on the kidneys regardless. I may be overly cautious but we have had cats here (in the US) who have had acute renal failure as a result of its use.

Re. your vet and the AlphaTrack, ask your vet what meter she recommended 10 - 15 years ago. I bet it was a human meter!

 

[Wendy&Neko]

My vet was using the Onetouch meter in her clinic when Neko was first diagnosed. She found it was pretty close to lab results. And we traded lots of tips on where to get cheap test strips. At the time I was cross border shopping for the Relion. Anyway, a year later she got her first AT. She called said "I don't suppose you want to use the AlphaTrak, now". Umm, no! That was about the time the company was heavily marketing it to vets. Sort of like the "prescription" vet foods, there are alternatives.

Neko's dental vet originally wanted to use Metacam, but with Neko's kidney issues I said bupe please, which she was on already, so it just meant upping her dose. Some previous threads on the use of Metacam:

Metacam/Meloxicam discussions (Strength and Dosing for Cats):

• Metacam ! - Is it safe?
• Bronx's hypo & arthritis thread (begins around Post #80)