effect of a dental

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Just-As-Appy

Just-As-Appy

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I am trying to screw up the courage to have Tony's teeth done. I am worried about the effect of the anaesthetic on him, esp the diabetic aspect. What has been the experience? His gums are ok, but he does have some buildup on the teeth. I want to eliminate anything that might be contributing to his not-so-great numbers, but am a little (ok big) chicken.
 
Part of it is trusting your vet. I'd want the vet up to date on procedures, with access to a variety of anesthetic agents and knowing when to use what. Some anesthetics are better than others when there may be issues with the kidney and/or liver function. Does the vet also use local nerve blocks in addition to general anesthesia before doing any extractions? Using local in addition to general anesthesia may prevent wind-up, a type of pain response which can be difficult to manage. Ask ask for a complete description of what is to be used - IVs, general anesthetic, and local anesthetics, tools/machines/X-ray, recovery area, expected time under anesthesia, whats available for resucitation if there should be an arrest, blood pressure, etc.

Another part is the cat's current general health - stable on medical management? Evidence of kidney disease? Liver disease? Both the kidney and liver should be working fairly well; this may be assessed, at least partially, with blood tests.

And finally, what do you want done if there is a problem - if the cat has an allergic or atypical response to the anesthesia, do you want to resucitate?

The vet I use in Columbus, OH stays very current on veterinary knowledge and I've not had a problem with any of my civvies (including the seniors I've had), nor the 1 diabetic I currently have, in having a dental performed.

Observation - wow, is he ever on a lot of insulin. I searched your posts, but didn't see whether he'd ever been evaluated for insulin auto antibodies, or for acromegaly. I may've missed it, but if not, that may be something to investigate after the dental.
 
I understand your fear about the dental on your kitty .. I was a big chicken too, and it took me a lot longer to get it done then it should have .. I thought mochas teeth/mouth area looked pretty good as far as I could tell (but what do I know?) Anyways, I researched dental vets in my state and went to a board certified vet about two hours away. In the end, mocha needed 8 teeth extractions :o But her recovery time was minimal, I would say by the time we got home she was pretty much back to her old self. Of course, peter had to take care of her since anything like that makes me very nausea's but it really wasn't that bad. If we ever get money to do it again, I would take her to our local vet only because we have been through it before and it's not as bad as we thought it would be.

On a side note, I really thought mochas numbers would improve greatly with all those bad teeth out of her mouth. Well it's soon to be a year since her dental and she is still bouncing from high's to lows, but at least we have peace of mind knowing her teefers don't hurt her!
 
My FD cat Leo had a dental in October, and I wish I'd known about this board before I made some decisions regarding his care, particularly about IV fluids during the surgery. I declined them; now I wouldn't go without them, diabetic or not.
viewtopic.php?f=28&t=33132
He had severe gum disease and five tooth extractions, so he was an extreme case.

There's some good info and links to other posts here:
viewtopic.php?f=28&t=32057&p=333034&hilit=ketamine#p333034
You might want to do more research on ketamine as an anesthetic. Many cat lovers aren't big fans of it.

Metacam after the surgery for pain relief is to be avoided as well because it stresses the kidneys. Leo got oral Buprenex in a syringe twice a day, very small squirt near the tongue so easy to administer, worked well.

Good luck--I know dentals are unsettling, but managed right, they can make a huge difference in your cat's health. I regret that I didn't have Leo's done three years earlier when I first learned he had gum disease. I was a stupid human...
 
You might also want to read my post on Feline Odontoclastic Resorption. When I found Nomad a year ago he only had two teeth left. They had recommended removing them but I put it off thinking "what could go wrong with two teeth?" I looked in his mouth over the weekend and he had bleeding indentations around both of his remaining teeth Cats sometimes get a weird disorder where they're body reabsorbs their own teeth. I wish. I had done this months ago before it turned into this complicated expensive ordeal. If your cat can tolerate the dental procedure you are probably better off doing it now. With diabetic cats things can become complicated very fast. It was your post plus an earlier one about dentals that prompted me to bring Nomad in today. That is one valuable of this board it reminds us of things we might have otherwise overlooked :-) !
 
Thanks for the points that each of you made. I do trust his vet, especially as it is an exclusively cat practice. However, I am also a little protective of him, and value the experience of those on this board.

IV fluids are on the estimate. WRT kidney and liver fcn, he is having blood work done next week so that we can decide about the dental. I hadn't heard of windup, so that's a good one to ask about. When my other cat had all his uppers extracted, he was on a liquid pain med for several days. I don't recall the name. I don't know if he'll be on antibiotics after, but I do know that it won't be convenia. Xrays are another good one to check about - there are none listed on the estimate.

Yes, he is on a lot of insulin. I haven't had him tested for acro or antibodies b/c I don't see that it will make a difference in management. If I have to choose between buying insulin or paying for a test, I choose the insulin. I've been reading about Levemir, and may talk to his vet about trying it after he settles down from the dental. Lantus didn't have any effect on him we started this diabetic journey.
 
Definitely consider changing to Levemir -- at high doses, Lantus stings.

Please go to the Acromegaly / IAA / Cushings Insulin Support Group forum and read the sticky posts at the top -- and post if you have any questions.
 
Testing DOES make a difference - if there is a positive result, you know you are looking at a functional pancreas as opposed to one that is not working well as with the regular DM kitty.

Testing won't really change how you treat, but will let you know that you may not want to get to numbers lower than 100 for acro, and you may want to be much more aggressive and with a longer lasting insulin if IAA positive.

The reason you may have had no results form the Lantus could be due to resistance.
As Phoebe stated, Lantus stings at high doses, so best to switch to Lev and Tony will have much better and level numbers.

If you have the tests done, and have a positive result for IAA, you can treat much more aggressively and possibly beat the condition and be insulin-free. IAA can be temporary.

If you get a positive result for acro, you have to know that you do not have a diabetic kitty, but rather have an acro kitty with the DM as a result of acro condition.

Caninsulin is not long lasting enough; I started on that insulin with my first acro, Shadoe.

If you need the info on the tests, please let us know.
I had to take printouts to my vet and push them to arrange for the testing.
They did not think Shadoe was acro so discouraged me. The positive result for her shocked them. They did not argue when I requested Oliver be tested because he LOOKS like an acro kitty.

For dental, there are points which are important if you have an acro kitty. The important one that comes to my mind is to have the vet use kitten size tubing because of possible soft tissue in the throat with acro kitties. Normal sized tubing should not be used, just in case.
The choice is not between testing or insulin; the picture changes for Tony if you get a positive result.

Please have a look at the info in the HD group and ask all the questions you may have.
 
could you elaborate a little regarding the time lantus was used? how long? what unit amount was cat started on as well as amount of units used when lantus was discontinued?
 
I'm embarrassd to say that I didn't keep very good records early on, and I recall just giving a few pages of data to the vet b/c I was so discouraged. That said, I'll piece together the picture from the bits that I still have and add it to his profile. He has been checked by ultrasound, and has 'evidence of chronic pancreatitis'. He also has thickening of the small intestinal wall which has improved since starting Leukeran. Off to work on history.
 
After reading this whole tread, it seems like there are definately some other issues that need to be addressed before you do the dental. However it is probably good you posted here because some of the other issues were raised . Your post and another one about dentals prompted me to look into my cat's mouth. He had two whole tooth extractions and also had several reminants of roots that had to be removed. X-rays are a good idea because the teeth can break off at or below the gum line and the roots still left can still become infected or problematic. They took a bioposy of the surrounding bone to rule out osteomyelitis.

Nomad has made a fairly good recovery and is eating more than he did before. The only complication was his BG ran about fifty points higher for a few days but it is slowly stabliizing again. I would definately encourage you to do the dental after you have the other issiues addressed.
 
His dental is booked for late January - lots of time for me to work myself into a complete lather! I'll post here after, when I return to a sensible state.
 
I just realized that I hadn't responded to Gayle's comments about testing. His vet talked about testing for acro early on when the glargine was not making a dent. I asked how it would change management and given that it wouldn't (at that time anyway), I opted to use the $$ elsewhere for him. Believe me - the picture was pretty grim in the spring and summer. With his other issues becoming more clear and somewhat managed, I may revisit this idea when the money well fills up again after the dental.
 
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