dental advice on a cat who is not tightly regulated

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donnahc

donnahc

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Hi everyone:
I am hoping I can get some info from anyone who has some experience with this.
My cat Asher and I came here early in January after he was dx’ed with diabetes. I have been helped by all the kind folks in the PZI area with dosing and many questions getting started on this journey.

Asher was doing pretty well but now we can’t seen to get him below yellow numbers. He is currently on 2 units of ProZync BID.
He eats low carb wet food (blue buffalo wilderness chicken) and gets real baked chicken snacks after testing. He is playful and acts like himself and eats heartily (yes he is a hoover kitty). He is 7 years old and about 16lbs.

It has been suggested that maybe his numbers are not good because he has at least one bad tooth that should be removed and needs a dental. My vet told me he needs this but wanted him to be regulated first. I am worried this might be a catch 22 situation if there is an infection or something.

Also since he is not regulated, how risky is this procedure? Is there anything I have to ask my vet not to do or use with him since he’s diabetic and I’m not sure I trust their judgment, like metacam, etc?

Any info anyone has would be so appreciated.

Asher’s spreadsheet is current.

Thanks,

Donna and Asher
 
There would be a lot of cats needing dentals if we all waited till they were "regulated" ;-) Dentals can makes a difference if there is a problem with bg numbers. I just do not give insulin and ask for an early a.m. dental. Mishka gets her dental done in the a.m. and is back home and chowing down by about 3 p.m.
I would make sure the vet knows not to give a Convenia shot or any Metacam.

I remember, few years back, one woman I spoke with said the same thing about her vet not doing a dental till kitty was regulated. My vet did the dental instead and within a few weeks that cat went off insulin. His mouth was that bad and doubt he ever could have been "regulated" with a mouth like that.

I have always said "regulated for today, tomorrow is a brand new day" just because they are cats and like to drive us crazy :roll:
 
agree 100% with Hope. if your vet will not do, just find one that will for this. you can still stick with your reg. vet if you like him. but try again with him first saying, if he has bad teeth, he will never be regulated cause this will increase BG with the pain and possible infection
 
Getting the dental is important and will HELP get closer to regulation. Waiting is not good.

At this point, your kitty has been on insulin for over a month. Discuss with your vet that while his BGs are still not regulated, he is at least pretty STABLE.

Anesthesia can cause their blood sugar to drop -- so Hypo during or right after surgery is a risk. The vet should be aware to monitor this and give glucose if needed.

I've had 3 diabetic cats get dentals -- only my first had a hypo because we didn't know to reduce his shot the night before. He was fine, but they had to give him glucose intravenously when he was waking up from the anesthetic.

so.... because you have to remove food at 12 hours before surgery --- I would give a half dose the night before and none in the morning of the dental.

it is safer to have high blood sugar than low blood sugar.
 
While there have been some notable examples here of vets giving meds without prior consent, its rare. If you trust your vet, have a conversation about the dental including what anaesthesia will be used, what pain meds, whether antibiotics will be used (not necessary), blood pressure monitoring (necessary), IV fluids, etc. Make sure your vet calls you before deviating from the agreed upon plan EXCEPT in emergency situations.

Just an FYI...buprenex and similar drugs are good pain killers but are narcotics. My Squeak tends to try and die on my vet (her words) if they use such drugs so if he needs pain meds, he gets metacam.

Jen
 
Definitely, get the dental done. If there is infection, blood glucose will be elevated. Pain will impact the blood sugar as well.

Also, I don't give a full dose of insulin the night the surgery is done. Depends on the appetite and the PM Blood Glucose.

You will see a totally different cat once the mouth feels good again.

Claudia
 
You may want to discuss giving your cat a round of antibiotics first and see if that will help with the BGs. I've always been told that an infection can make a dental surgery more complicated, whenever a cat of mine has gone in for extractions they always get a round of antibiotics first. If your cat has bad teeth there's no avoiding dental surgery, but since infection can raise BGs, going on some antibiotics first may help regulate your cat.
 
Jen

Antibiotics are not recommended in such a case unless the cat is unable to undergo surgery...it won't make the issue go away and the use of antibiotics unless absolutely necessary is not recommended.
 
Jen & Squeak-

Yeah, I've heard some conflicting opinions about antibiotics for dental surgeries. The last kitty of mine that had teeth removed was in pretty bad shape and his gums were inflamed. He went on antibiotics first, had 14 extractions (poor baby only has 3 teeth left now), then more antibiotics afterward.

Out of curiosity, why is it bad to give a cat antibiotics unless it's totally neccessary? I mean, I know you shouldn't give medicine that's not needed, but is there a specific concern with antibiotics and diabetics? My 17-year-old has bad teeth that should come out, but he's not in good enough shape for surgery and there's a real risk that he wouldn't survive. I've been thinking about getting him antibiotics soon but don't want to do anything harmful (he's been OTJ for 2-1/2 weeks now).
 
In general, over using antibiotics can lead to the bacteria or pathogens becomming resistant to the antbiotics. This has happened to many strains of staph infections that are now resistant to conventional antibiotics. Antibiotics can also kill off the good bacteria in people or pets GI tract that assist in digestion.

That being said, if there is an active infection, it still has to be treated. This would be a judgement call made by your vet or the vet. dentist. My cat had two teeth extracted last month and did OK except his BG went up a few days after the dental about fifty points.

I agree with some previous members. If we waited until our cats were perfectly regulated, then hardly any of them would have dentals or any type of surgery.

Just a PS about Metacam. I would never give my cats metacam. It can cause liver and renal damage in just a few days in cats. Narcotics have some risks too but I see them as the lesser of the two evils.
 
Jen

Dr lisa did a great post a few months ago about anti-b's and I will find it if I get time

Janelle, about metacam, if Squeak absolutely needs a pain med he gets metacam...ichoose to have him not die from narcotics. I bring his case up because not everyone is aware of the potential risks with narcotics.
 
I support a pre-dental round of Clindamycin for gingivitis. My elder cat, who has a trash mouth, gets it.

I agree that Asher is stable enough for a dental. If his numbers were really bouncing, I could see the vet's concern, but that's not the case.
 
Metacam is currently approved for use in cats only as a one time dose for post-op pain. On October 28, 2010 the FDA made the makers of Metacam (Meloxicam) put the following warning label on Metacam. " Repeated use of meloxicam in cats has been associated with acute renal failure and death. Do not administer additional injectable or oral meloxicam to cats".

The words within the quotes are from the FDA; This is not just my opinion. Some vets in the US still prescribe Metacam to cats despite these warnings. Try and die? I will let other members do their own research and reach their own conclusions.
 
Yes, I am well aware of the warning, as is my vet with whom I have spoken to about this at length. And this warning is not on metacam sold in Europe, for some reason...Squeak is pretty much guaranteed to die on opiates so....

I 100% support informed decisions, I am just trying to highlight that things are not always black and white.
 
I've had many cats over the years, currently have 5. I've always been of the belief that if a cat has infected gums and needs a dental done, it's best to have a 7-10 day course of antibiotics prior to the dental (if doing extractions). No human dentist would do an extraction if there was active infection going on; partly because the infection can spread into the bloodstream, and then to major organs (eg) heart.

When my diabetic cat Taco got his first dental (while newly diagnosed diabetic), he was given a shot of Convenia 2 weeks prior.

Previous cats were given a course of Antirobe (Clindamycin) prior.

Years ago I rescued a very old siamese kitty who had a horrible mouth, and moderate CRF (kidney failure)....and she desperately needed a dental. So she was on a course of Clindamycin prior to the dental. Dental went very well.

As for doing a dental on a diabetic cat.............if your vet is that reluctant to do it until cat is regulated, I'd be finding another vet.......or one that specializes in cat dentistry ..... because if the teeth/gums are that bad and there's active infection going on, it will be next to impossible to really get kitty regulated so then it becomes a vicious cycle.

With Taco, even back when he wasn't yet well regulated (and had his first dental and several extractions), I just withheld food from 8pm onward the night before.....no food or insulin in the morning....and made a request that his BG be checked several times during the dental and if super high, they could give him a dose of short-acting insulin (like Humulin R...though not even sure if they make that anymore?) just to get it under control a bit............and then later that day by the time I got him home, he was starving and would get his canned food and make a slightly smaller dose of insulin......it just depended.........but generally he'd eat like a horse (canned) and he'd get his usual dose and I'd just very closely monitor his BG throughout that first night home.........
 
Lisa,

The vet who often posts here has strong feelings about using Covenia. Here is a quote from her on an earlier thread:


"I am going to try to be tactful here but I cannot express strongly enough just how wrong this is and every boarded dentist on this earth would also VERY strongly disagree with this.

First of all, Convenia is NOT an appropriate medication to be given for mouth problems.

Secondly, Convenia is NOT a 100% safe drug and I almost lost one of my favorite patients to this when a colleague saw fit to give it (unnecessarily) post-dental. The cat's life was saved....$6,000 later after a 1 week stay in a Critical Care unit. I have noted other cats on VIN that were not so lucky having died post-Convenia-induce anemia.

Thirdly, giving antibiotics instead of addressing the 'bad' tooth is wrong on so many levels. If you had a splinter in your hand, would you wait two weeks before removing it ...and just put yourself on antibiotics? I would hope not. I would hope that you would remove the offending agent ASAP.

I come on very strong about this issue because I am sick to death of seeing Convenia mis-used and abuse - with some deaths associated with this newfound 'wonder' drug."
 
viewtopic.php?f=28&t=34263&p=360989#p360989

a discussion on dentals, pain meds and antibiotics

quoting Dr Lisa

You did not misquoting at all and that is an understatement given my frustration with rampant misuse/abuse of antibiotics.

I just spent some time on the VIN Dentistry board with multiple board certified dentists chiming in on this subject with the consensus being that in 99% of cases where pulse antibiotics are being used....it is deemed to be useless/unnecessary "quackery". This issue is a very hot button of theirs and I don't blame them.

Their main complaint is that it is being used when diseased teeth are still present in the mouth. NOTHING is going to be a substitute for a thorough dental with needed cleaning/extractions. Also, pulse antibiotics will not prevent plaque formation.

It was mentioned on the board that ABs are often used when owners are either too afraid of general anesthesia, in general, or the patient is considered too debilitated for surgery. In these cases, they are still very much against the use of pulse antibiotics stating that it is not sound medical practice. To me, this is pretty obvious. You can't expect to throw antibiotics at a diseased mouth with diseased teeth that need to be in the trash can..... and consider yourself to be helping the patient. That would be like pouring a bottle of antibiotics over a painful sliver and expecting it to help....without removing the sliver.

We all want 'quick fixes' but, as with many things in life, if it sounds too good to be true, it probably is. We all really need to think long and hard before we use any drug in any living creature - including antibiotics which are often seen as only 'good' things when there are plenty of 'bad' things associated with them.
 
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