Maui's pre-dental visit - update to the update

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Hillary & Maui (GA)

Hillary & Maui (GA)

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I thought I would start a new thread, as the previous one is quite long.

Last night, I took Maui in for her pre-dental visit. I took the last appt of the night and only had to wait 5 minutes!

So, the vet checked Maui out and was very impressed with her heftiness. She commented, it's not so easy to squeeze you now. This vet saw Maui when she was first diagnosed in March 2009 and hasn't seen her since then.

In March she dropped to 9 pounds and last night she weighed in at 13.4 pounds! Which is only 3 ounces less than her weight prior to the FD.

She got her blood test done (results on Monday).

And I asked all the pre-dental questions. She answered them all and I feel comfortable with her appt on the 15th. And Maui is first on the lineup that morning.

I did need to remind her no pencillin - as she said they would give an AB when doing the dental. I will remind them again, when I bring her in.

She said that the ketamine they have is not part of the recall and since I just don't trust it at all, they will induce with propofonol. There is an extra charge for it - fine, who cares. At least I know it's not questionable.

They don't do dental xrays. They do nerve blockers, so if there is an extraction they will use it.

I asked about warmers - heating pads, bottles, etc. and supervision. She said they have something that is made for this purpose and circulates the warm, rather than concentrates in one place. I mentioned what happened with drooler Chloe and she said, yes she knows how bad that is, they made them see that in vet school and drilled it into them about the danger and need to closely watch.

So, those are the high points of the conversation and overall, I'm comfortable and know Maui will do just fine.

That doesn't mean, I won't be nailbite_smile on that day. And I realized why that is, this is something that is out of my control and I can't be there to watch to make sure it goes well.

Well I guess that is why I asked the questions, feel good about the vet practice overall. I have met several of the vets and had a phone consult with one of the owners last year. The vet we saw, will NOT do the dental, a different vet will (I did meet this vet once) and this vet says that the one performing the dental, has done many of them and has confidence in her.

Overall, I feel good.

We also talked about Sydney and she said the referral she wrote wasn't for the dentist, it was for an internist. I hadn't looked at it, but given all Syd's issues she felt this made the most sense. and I do agree. Again, it'll be a consult and then can go forward from there.

Oh and did I mention, Sydney doesn't think anything is wrong with her. She's acting just fine.
 
Re: Maui's pre-dental visit

I wish I had your vet. I went in for my civvies' "pre-dental" exams, and vet just chipped their teeth and sent me on my way. :?: :?:
 
Re: Maui's pre-dental visit

Hi Hillary,
That last dental post is a really good one. I have to go back to it and copy all the information. I know I should have Sweety's teeth attended to, but I am SO terrified. I think when I bring her in next month I will see how bad they need it and have all the info down on paper and the list of questions to ask.

I'll be thinking of you guys Monday. Of course you MUST keep us updated.

Jayne
 
Re: Maui's pre-dental visit

Jayne,

Here's the funny. I printed all the questions and left them at home. I didn't get far when I realized I forget them and thought do I turn around and get them or go on without them. I decided to get them, as I wasn't sure I'd remember all the questions.

I'm glad I had the paper to refer to. I just went down the list asking the questions and it was quite easy.

So, yeah go back to the other post and print the questions - really is helpful and takes the worry away from forgetting to ask something important.

Good luck when you take her in.
 
Re: Maui's pre-dental visit

The lack of dental xrays would make it a no-go for me. I had several of Dillon's dentals done at work, where we don't have dental x-ray (it's not a GP and we don't have a dentist), and he ended up with a few root fragments that the dentist had to dig out last year. I feel really bad about it. Although going elsewhere for a dental costs me more than triple, I won't do dentals at work any more because of the lack of x=ray capability. I might be able to do it for my dog because his head is so big that regular x-ray might be used in a pinch if he needs an extraction, but if I had a cat with teeth (poor toothless Dillon!) that needed a dental, I'd go someplace that did pre and post xrays. If it's not do-able to get dental x-rays this year, I'd at least make sure the next dental included xrays so you'd pick up on anything missed in the dental before.
 
Re: Maui's pre-dental visit

Oh Jess - now I just don't know what to do. There is no urgency with Maui's dental, rather it's preventative and I figure she could just use a cleaning, I don't expect any need for extraction. Of course no way to know that until they go in.

There is Red Bank that has a board certified dentist. I know they are $$, and haven't called them about what and how they do things. But that would be the only other place I guess I could go. Assuming they do xrays.

So, you think I should not go through with this because they don't xray? I can always cancel if need be. The prelim is done and wouldn't be hard to get a referral.

I want to do what's best for her .
 
Re: Maui's pre-dental visit

You know, I debated whether to say anything or not but decided to because it's the truth. I was mortified when the dentist pried open Dillon's mouth and showed me the red dots that meant root fragments. Mortified because I should have known better, and mortified that I had allowed him to be in pain for so long. Ugh.

As for what you should do ... I think it's worth calling Red Bank and asking prices -- it might not be so much more since you don't expect extractions. Frankly there are some things that are only diagnosable through radiographs, so I wouldn't consider the dental complete unless it had them. It's possible that a tooth looks good to the naked eye but there is trouble underneath. And if Maui does get an extraction, you'll be left wondering to yourself if they got the whole tooth, if there were other affected teeth that were missed, etc. Dentists are very adamant about the need for radiography -- I've heard the comparison that if your leg clearly looked broken but the doctor said you don't need an x-ray, you're going to surgery anyway ... would you trust him or her?

If you do end up deciding to go someplace with x-ray capability, I think you should tell your vet why (in a nice way of course). She may be trying to convince her boss that x=rays are a good investment, and your testimonial might help.
 
Re: Maui's pre-dental visit

Thanks Jess, I'll give Red Bank a call and talk with them. And I'll be speaking with the vet on Monday, and will tell her that I am uncomfortable with proceeding because they don't do xrays.

My concern is that I'm back where I started, since I don't know the people at Red Bank and the comfort level isn't there. So, now I need to just do this and go see them.

I am glad that you posted this. It's important and I want to make sure that a complete job is done.

Years ago, when Maui had a dental, she had a huge side molar extracted and I didn't ask any questions. I didn't know enough to ask and just trusted the place. I have no idea if they did xrays back then, no idea if they used pain meds and what kind, no idea how anything was done.

I don't ever want to be that ignorant again, nor put my cats through something that with one test or piece of equipment could make all the difference.

I also think about when I get dentals. Once a year they xray me to see what's going on and compare to previous year. They don't do any major procedure without it. So, why should the cat not have same. Totally makes sense.

Thank you Jess.
 
Re: Maui's pre-dental visit

hillary, I don't blame you for not know what to do now. Aren't these dentals so overwhelming? We have yet to schedule mochas even though we know what vet we will be taking her to, and yes they do x rays, and have answered all of our questions, and there were A LOT, but we still have to get the nerve to make the phone call.
 
Re: Maui's pre-dental visit

This is a timely thread, I learned this morning that Pandemonium needs a dental. I did ask about the anasthetic and blood pressure monitoring, but not the other questions. I haven't made the appointment yet, so I have time to check out the other things. Thanks for this thread.
 
OK, here is the update to the update:

I spoke with the dentist at Red Bank (the 24 hour specialty hospital). He was very nice and answered all the questions, with the "correct" answers. I explained my concerns about the current vet not doing xrays and he said that is standard practice with him. I asked who performs the procedure and he said if I want him to do it and not the resident, no problem, just say so. SO I will say! :cool:

I asked about discount being dental month and all. He said if I attend the lecture on Feb 23 at 7 pm, he is offering free consults for all dentals. That is worth $138!

So, I'm going to juggle my schedule, get to the lecture, I was planning to attend anyway and made an appt. for Maui for March 5. Since he doesn't have weekend hours, I figure scheduling a Friday will at least give me the weekend being home, if there are issues.

I briefly talked about Sydney to him and he didn't seem to think it was an issue. He said good idea to see internal med first and they will consult and come up with a strategy for Sydney. He said there are various things he can do to protect the kidneys and take the necessary precautions.

So, without having met him or knowing anything about him, I'm impressed so far.

I see he studied an extra 2 years to get his dental surgery degree and was the vet dentist at the Columbus zoo and aquarium. Wonder if he cleaned lions' and tigers' teeth and if he did then a kitty cat should be a breeze. Of course they have larger teeth so it's easier to work in those mouths. :lol:


Oh and Maui's CBC came back normal and her BG was 108! Of course when I test her she's in the 80's. So all is good from that viewpoint.
 
oh this new vet sounds awesome! I would go to the lecture too, nothing like getting a 138.00 vet visit for free! I know you guys are going to do so well with this dental .. it will be a breeze!

as I'm sitting over here ... nailbite_smile nailbite_smile about scheduling mochas!
 
pardon the pun - but just bite bullet and schedule it. you will be glad that you did that step and then you will take the next and go, and wait and worry and then pick her up and love her afterwards.
 
Hillary, I don't mean to hijack your discussion. I can open my own thread too -- but as you know, we are about to have Kitty's dental done.

About x-rays, I have had both the surgeon and our regular vet say that x-rays are essential. FWIW. The vet who will be doing the dental for Kitty said that sometimes, cats have a syndrome in which the roots are resorbed into the gum; if I understood, that means the tooth could look okay, but the root would be, well, funky.

Kitty had a fang out last April. I was naive, i didn't know about x-rays, none were taken, and when jaw cancer was considered months later, we had no point of reference.

I have a question about WHO performs the dental. This vet here said that the tech would be the actual tooth cleaning/scraping. Huh? Isn't the vet supposed to do that? I'm worried now too.

I asked the dr. about anesthesia; he said he uses ketamine to induce, but not the wholesaler that was recalled.

I am so with you on the control issue, Hillary. When I don't control things, it seems bad things happen -- but I don't know enough to control this.

:sad:
 
Kathy - not hijacking, just adding to the conversation. Actually, I think I read your post, commented and even included a link to it on Devon's post below. viewtopic.php?f=29&t=3134

So, yes, there have been several conversations going on this subject, and the only reason I started this new one, was cause Devon's post got too long and thought it best to start a fresh one.

We talked about who does dental and options instead of ketamine.

Personally, I don't care if they use the supposed good brand, it's ketamine and given the recall, it's now on my NO WAY list anything called ketamine.

The primary vet, said they would use a different inducer, the iso ---- something, but would charge more for using it. Stupid, I know, but I said fine, do that.

Then when the issue of them not performing xrays came up and Jess and others came on and like you said how important it is, that's when I decided to go to the specialty place.

I spoke with the dentist and he said he uses the iso---something to induce. So that's good.

He also said, xrays are standard - again good - considering the importance of them.

And as for who does the dentals, he said either he (board certified) or the resident does them. I said, well I want you performing it and nobody else. After all, if I'm paying for it and I'm sure he will charge a premium fee for this, then by golly gosh, I WANT what I'm paying for and not some less experienced, person handling it.

This guy didn't seem to think it was a big deal, just tell him and he will do it.

Of course what he didn't say, is that .... nah, nah nah you won't be there, and you won't really know who is doing the dental. I know, I guess this is when one must believe that they will do what they say, etc.

So, since many of us are looking into dentals, all these discussions and linking them together is a great thing, for others who are considering it to see. ;-)

Oh and do read Devon's post, because DR. Lisa updated her 2005 comments in your post on Devon's. She's changed her thinking on AB's and some other things. So, check out the link I provided and you'll see the update to your updates.
 
Hi, Hillary -- Gosh, just spent about 45 minutes combing through all the past threads. I'm beginning to feel confused and overwhelmed (and out of control).

I'll reprint here Dr. Lisa's last word on preventive ABs:

Re: Dental discussion, including Dr. Lisa link
by Lisa dvm » Wed Jan 27, 2010 5:37 pm
No - I do not.

Taking it one step further, I do not necessarily agree with always giving AB's post extractions - per the boarded dentists on VIN and from everything else I have read on this subject.

If the nidus for infection (the bad tooth) had been removed, the ABs are often not warranted.

All that said, keep in mind that NO 100% blanket statements can be made regading this issue. Guidelines can be discussed but this issue still needs to be considered on a case-by-case basis.

The problem is....*generally* speaking....that there is FAR too much CYA ('covering your butt....) going on in this profession with respect to handing out ABs and we need to pull back on handing them out like candy and start to critically evaluate each case more carefully to decide if their use is warranted.
Lisa Pierson, dvm
Feeding Your Cat-Feline Nutrition Basics
Feline Diabetes
Feline Obesity
Feline Urinary Tract Health
Litterbox: Your Cat's Opinion
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Lisa dvm

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Re: Dental discussion, including Dr. Lisa link
by Lisa dvm » Wed Jan 27, 2010 5:39 pm
PS......this will also mean that more re-checks could be needed in certain cases.

In other words, if you and your vet are on the fenceline about ABs and decide not to use them, then it just makes sense to present the patient back for a re-check to make sure the decision was appropriate for the case.

A re-check is a hassle for the client and the cat but it beats abusing their body with unnecessary meds and....abusing the antibiotic with regard to overuse.
Lisa Pierson, dvm
Feeding Your Cat-Feline Nutrition Basics
Feline Diabetes
Feline Obesity
Feline Urinary Tract Health
Litterbox: Your Cat's Opinion
Making Cat Food, Pilling Cats - Do NOT 'dry pill'!, Commercial Canned Food - See catinfo.org

Lisa dvm

Joined: Mon Dec 28, 2009 7:07 pm
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To continue...

Per Dr. Lisa, preventive AB's not necessarily warranted, but depending on condition of mouth, follow-up labs might be indicated.

QUESTION: If ABs are needed, which is best? Is Clindomyacin (?) okay?

Fluids: Dr. Lisa does recommend, and she worries about a vet who would do lengthy anesthesia without a catheter in.

Meds: I read the Metacam discussion, and I'm going with Dr. Lisa: NO METACAM. Bupe only.

Anesthesia: Now I see the problem. Two vets here said that ketamine was fine, because they use the non-recalled brand. I didn't realize how recent the recall was. This could be like that melamine problem -- who knows whether the non-recalled brands will be recalled next month, when they finally figure out what the problem is? Right, is that the issue?

The alternatives are a little scary. What if I ask for something the vet isn't used to using, and it ends up badly?? I'm making myself crazy here. :sad:
 
Kathy and Kitty said:
To continue...

Per Dr. Lisa, preventive AB's not necessarily warranted, but depending on condition of mouth, follow-up labs might be indicated.

QUESTION: If ABs are needed, which is best? Is Clindomyacin (?) okay?
Click to expand...

That makes perfect sense and in Maui's case, the thought so far is it is not necessary.

however, not to throw another monkey wrench into things, but my father told me that climdamycin is on the worst pills list for humans. So, while this seems to be the AB of choice for mouth issues, I'm now rethinking it.

Since Maui can't take amoxicillin or clavamox (has amoxicilin in it), I'm thinking maybe azrithomycin may work (will ask vet).


Fluids: Dr. Lisa does recommend, and she worries about a vet who would do lengthy anesthesia without a catheter in.
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Makes sense and seems to be an easy thing to put in and utilize. So, ask the vet if they do this routinely. My two places say yes to this.

Meds: I read the Metacam discussion, and I'm going with Dr. Lisa: NO METACAM. Bupe only.
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Totally agree here. I asked this questions months ago, as I saw both things mentioned and many with adamant NO to metacam. So back then I just wanted to understand and asked the questions.

Anesthesia: Now I see the problem. Two vets here said that ketamine was fine, because they use the non-recalled brand. I didn't realize how recent the recall was. This could be like that melamine problem -- who knows whether the non-recalled brands will be recalled next month, when they finally figure out what the problem is? Right, is that the issue?

The alternatives are a little scary. What if I ask for something the vet isn't used to using, and it ends up badly?? I'm making myself crazy here. :sad:
Click to expand...


My take on this, personally how am I to know which is the "good" ketamine brand and which isn't. It seems to early to tell and given there are many alternatives available as pointed out by Larry in that other post, I would tell them NO ketamine and ask for one of the alternates. Both my places said they can use isoflurane (or whatever it's called).

So, don't make yourself crazy, just ask the vet you plan to take Kitty to. What they use and what alternatives options they have. Like my primary vet, they may say it costs a bit more, but so what, at least you will have peace ofmind and know he is getting the correct stuff.

I mean come on, Toyota is expanding the recall to even more cars now, how do we know for sure what good ketamine is and isn't.
 
Kathy and Kitty said:
This vet here said that the tech would be the actual tooth cleaning/scraping. Huh? Isn't the vet supposed to do that? I'm worried now too.
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This is the equivalent of the dental hygienist doing your tooth cleaning. No treatment decisions are made by the hygienist or the tech, no teeth are pulled, no drilling or suturing, etc.

One other point in this thread, I think there is a mixup about the induction and the gas. The alternative induction drug is propofol, the anesthetic gas is isofluorane (or sevofluorane).
 
Regarding induction, some vets do use gas (iso or sevo) to induce by putting the cat in a tank and admitting a gas/oxygen mixture. After the cat is asleep, the cat in intubated and maintained on the gas/oxygen mixture. Many people say this method is not preferred since the gas is an irritant and the cat frequently becomes very agitated (excitement stage of anesthesia) and moves a lot in the tank.
 
induction

I'm aware that gas can be used to induce.
Let me rephrase and say that I hope there is a mixup, because any vet that has this:

Larry and Kitties said:
Regarding induction, some vets do use gas (iso or sevo) to induce by putting the cat in a tank and admitting a gas/oxygen mixture. After the cat is asleep, the cat in intubated and maintained on the gas/oxygen mixture. Many people say this method is not preferred since the gas is an irritant and the cat frequently becomes very agitated (excitement stage of anesthesia) and moves a lot in the tank.
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as part of standard procedure is one I would stay away from. The situations which call for "boxing" down are very few and far between. The health risks to the cat and to the tech who has to open the box and inhale the iso are not negligible. Another outdated method is "masking down"; the cat is restrained and his/her face is forced into a tight conical mask and they have to breathe in the gas until they fall asleep.

There are a plethora of injectable drugs which can be more safely used for fractious cats. Besides safety issues, I think that it's better for the cat mentally to experience a brief sting on her hind end (IM injection) than the more prolonged terror of being enclosed in a tight box with smelly air, or having her face pushed into a mask and held there while she struggled.
 
Thanks for the explanations. I would like to say the mixups are all me and my not fully understanding terminology and methodology.

Where this all started was asking if a vet uses ketamine and what alternatives can be used instead.

I got the names mixed up, the isofluorane and propofol (see I can't even spell them). ohmygod_smile

The question asked was what general anesthesia will you use, will it be isoflurane gas or something else. The answer in my case was isoflurane.

then I believe Larry wrote a good alternate to ketamine valium mixture is propofol, which I believe this vet said they use too.

So, for us lay folk - are these the correct answers we want to see?

I think we are just trying to understand what happens when and what each item is used for and why and given the recall, what alternates we want them to say they are using.

For example, one of the questions to ask:

will you use a pulse oximeter or heart monitor? This specialist said both, so I assume that is a good answer.

I also wrote something on my question sheet fetonel patch, I'm not sure what this is for - pain killer I think, but I also wrote buprenex, next to it.

needless to say, When I take Maui in on March 5, I will again ask these questions and hopefully with your explanations, better understand the answers and what it really means.

When I go to the dentist, I just say, please give me happy gas and I'll be good! :-D

Thank you for the corrections and explanations and please, keep them coming, it's the only way we are going to learn and understand.
 
Hi Hillary

I assumed there was a mixup because I can't imagine the dentist saying he boxes down all his patients. Isofluorane and propofol are both good for generally healthy animals. There are alternatives for animals that are in shock, have congestive heart failure, serious blood loss, etc. but iso/propo combo is good for the vast majority.
 
Jess, thanks for adding all of this good info.

Hillary is getting different options than I am.

My vet induces with ketamine + valium, then uses gas to maintain anesthesia. I asked about the recall, and he said, he doesn't used the recalled manufacturer. The discussion here is that is probably wise to avoid ketamine altogether. I think my vet will be willing to use propofol -- but that's a pretty serious drug too. My concern is -- should I be the one to pull him out of his professional routine and tell him to use a drug he doesn't ordinarily use? There are risks that route also.

Am I correct that this is the proper induction -- and is NOT sticking a nasty mask on his mouth? You see, I'm so ignorant overall. I should beware telling the professional what to do.

My vet will give a dose of bupe during the procedure, and will give me some to take home if there are extractions. No patch needed, correct?

Yikes, I am a mass of anxiety. I am trying to control a professional, because I see things that on the surface (ketamine) don't look right. I don't have the language to advise him, and I can't really trust fully either.
 
Kathy and Kitty said:
]
My vet induces with ketamine + valium, then uses gas to maintain anesthesia. I asked about the recall, and he said, he doesn't used the recalled manufacturer. The discussion here is that is probably wise to avoid ketamine altogether.
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Yes and no. We use a lot of ketamine where I work, not for induction but as part of pain management for very painful surgeries (limb amputations, disk surgery, etc.). There is an extensive list of the lots that were recalled and the ketamine we had in stock was checked, and the ketamine coming from our distributor was checked (and rechecked upon arrival). The question is more, do you trust your vet to have thoroughly looked into this to be sure he doesn't have any of the recalled drug?

I think my vet will be willing to use propofol -- but that's a pretty serious drug too. My concern is -- should I be the one to pull him out of his professional routine and tell him to use a drug he doesn't ordinarily use? There are risks that route also.
Click to expand...

I agree. If he said he'd never used it before, or wasn't comfortable using it, I'd be uncomfortable pressing the issue.

Am I correct that this is the proper induction -- and is NOT sticking a nasty mask on his mouth? You see, I'm so ignorant overall. I should beware telling the professional what to do.
Click to expand...
Yes, IV induction should be done.

My vet will give a dose of bupe during the procedure, and will give me some to take home if there are extractions. No patch needed, correct?
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I agree, no patch. Fentanyl is a powerful opioid that should be reserved for major surgeries. Besides that, it is not the most reliable means of administering meds as it can be unevenly absorbed. If there is a choice of medication that can be given in doses (and therefore stopped if there's a reaction), I'm all for it.

I can't really trust fully either.
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This is a problem. You should have a vet whom you trust. Not trust blindly, but trust. I wouldn't continue going to a doctor that I didn't trust, and I wouldn't take my animal to a vet that I didn't trust. I worked for a vet that I realized after a few months was not very diligent and I didn't take my animals to her. I ended up quitting.
 
Jess, heartfelt thanks for dealing with this so patiently.

I will have one more conversation with this vet about the ketamine, to be sure they have carefully excluded the recalls.

I will also ask how often he uses propofol. I'm inclined to leave the choice to him, pending the answer to the question above.

I have found it hard to trust any vet since Kitty became diabetic. His first vet treated him with one shot of lantus daily up to 10 units for four months, which nearly killed him. I finally got wise. I get different advice about food and diabetes from every vet I've seen since, and in most cases, I know as much about feline diabetes now as they do.

This particular vet has the best equipment, and two other vets referred me to him. Including him, that's three vets thinking he does the right thing! I will have to try to have faith in that.

Thanks again.
 
Jess, thank you for the explanations. I have never heard any vet talk about boxing up a cat or any of the barbaric induction methods you and Larry mentioned.

If I did hear something along those lines, I'm sure I would be aghast at it and come running here asking WTH did I hear and did I misunderstand?

Kathy, I know it's hard to decide what to do and whom to trust. But like Jess said, you need to decide if this vet appears to be honest, open and gives you the comfort level you need to trust. No, NEVER blindly, never again. I believe we have all learned that lesson, some of us the very hard way.

I took Syd to Red Bank today, to see the internist. He reviewed Syd's records, ultrasound and basically confirmed what we already know - early kidney disease, bronchial issues/possible asthma, or could be something more.

To do the bronchial wash - just to tell me specifically what the bronchial issue is - to me is a waste of my money and unneccessary stress on Sydney. Same with the FPLI test to tell me if she definitively has pancreatitis. Especially when she shows no symptoms and eats well and the treatment is what I'm doing already (minus pain meds).

So, onto the real reason for taking her, DENTAL - he said, that he agrees with primary fluids day before dental (kidney protection), in addition he wants to do:

C&S, kidney test, another U/S all prior to dental - cost for just this $1K. And he'll want to do follow up kidney test to make sure no damage from the anesthesia.

Then he will coordinate with the dentist (board certified) - same guy I'm taking Maui to, and will be there when they intubate and excabate - to make sure about her breathing as that is a concern.

The internist did say that given her conditions complications (think that's code for possible death) could occur. I kind of knew this and it's why I'm so concerned and unsure how to proceed and took the baby step of this appt.

The dentist, I will speak with when I take in Maui and have him consult with the internist and work up a strategy for his part and a cost estimate.

Then, I'll need to get up the nerve, make the appt and do it. I really think Sydney needs the dental and it will be better for her overall health.

So, that's where I am with everyone.

I'll be very interested to learn what difference there will be in process/procedure for Syd and Maui. (And yes, Maui has a whole other set of issues, I will need to inform him about). Thank goodness the FD is in remission! At least that is one less worry.

Jess - if you have any additional thoughts or questions I should ask regarding Sydney, please let me know as I proceed with her.
 
Hillary & Maui said:
To do the bronchial wash - just to tell me specifically what the bronchial issue is - to me is a waste of my money and unneccessary stress on Sydney. Same with the FPLI test to tell me if she definitively has pancreatitis.
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I agree with some important caveats. If you have a cat who has trouble breathing, has no cardiac problems, has not blood-tested positive for infectious disease, and has not responded to empirical therapy, I would do a BAL (bronchial wash) in a heartbeat. It definitely has its place in diagnosing and classifying diseases of the respiratory tract.

For the fPLI, if I had a cat with symptoms of pancreatitis that could be attributed to other (scarier) things like fluid in the abdomen or chest, I would definitely do it. Personally I'd do it anyway but then again I get a discount :) and am generally a fan of the "easy" (simple blood test) diagnostics.

C&S, kidney test, another U/S all prior to dental - cost for just this $1K. And he'll want to do follow up kidney test to make sure no damage from the anesthesia.
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Has Sydney had a C&S? When was her last ultrasound, and was it done by an internist or radiologist?
Then he will coordinate with the dentist (board certified) - same guy I'm taking Maui to, and will be there when they intubate and excabate - to make sure about her breathing as that is a concern.
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I have to confess that I don't remember Syndey's breathing issues? Does she frequently have trouble breathing?
The internist did say that given her conditions complications (think that's code for possible death) could occur. I kind of knew this and it's why I'm so concerned and unsure how to proceed and took the baby step of this appt.
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Death is unfortunately a possibility with any anesthetic procedure. A congressman just died from gall bladder surgery (last week, I think it was). The internist might have been referring to kidney issues or something, though. Anyway I think you've done everything you can to look out for her -- you have experts doing the procedure, so it should be done quickly and efficiently, you have been assured of close monitoring during the procedure, and are giving the kidneys a good flush before and after.
 
Hillary, that was helpful. I'm going to trust the vet. I did like his interest and approach. I will send many vines for you and both your babies.

Jess, you rock. Thanks.
 
Jess & Earl said:
Hillary & Maui said:
To do the bronchial wash - just to tell me specifically what the bronchial issue is - to me is a waste of my money and unneccessary stress on Sydney. Same with the FPLI test to tell me if she definitively has pancreatitis.
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I agree with some important caveats. If you have a cat who has trouble breathing, has no cardiac problems, has not blood-tested positive for infectious disease, and has not responded to empirical therapy, I would do a BAL (bronchial wash) in a heartbeat. It definitely has its place in diagnosing and classifying diseases of the respiratory tract.
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Sydney's issues actually started in October. I noticed her breathing heavier/louder and that she lost weight - getting back down to what I know for her is normal weight, but with muscle loss. Which had me worried. She also sounded congested and has a questionable tooth.

I took her to the vet - turned out to be a big mistake (was trying to save some $) and took her to vet 1. He only wanted to treat her for a possible ear infection (which she didn't have. Then when I went back to the vet. He was nasty, rude and got angry when I asked questions, and in the middle of drawing blood, told us to get out and never return.

I called vet 2 (Maui's new vet) and took Sydney there. We went over her history, current issues and they came up with ideas to figure out what was going on.

They first did xrays, (didn't show much) - no surprise, then ultrasound (which I asked them to do first), then they sent it all to a specialist, who supposedly had nothing to add (waste of money).

The xrays showed lungs hyper inflated, pushing on kidneys. No growths or anything, but they wanted US to be sure. US then said possible pancreatitis and no growths.

Then in order to do Syd's dental, wanted her there overnight, unsupervised - giving fluids the whole time. I said no and this was before I asked dental questions and learned they do not do dental xrays.

So, vet said, go to Red Bank, see the internist and get their opinion.

In the meantime, I gave some AB - congestion noises went away and came back - can't keep her on AB indefinitely.

I got aerokat and am using flovent and albuterol - to help with the breathing. I did notice improvement.

For the fPLI, if I had a cat with symptoms of pancreatitis that could be attributed to other (scarier) things like fluid in the abdomen or chest, I would definitely do it. Personally I'd do it anyway but then again I get a discount :) and am generally a fan of the "easy" (simple blood test) diagnostics.
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I understand, my only thought is, she doesn't have other issues or fluid or anything and has no signs of this. SO, I opted not to do the test. It was partly money and that ok if it does come back positive, then I'm doing what is needed anyway and if it doesn't then what. She's 14/15 and I don't want to get invasive with her. I don't think she can handle it.

C&S, kidney test, another U/S all prior to dental - cost for just this $1K. And he'll want to do follow up kidney test to make sure no damage from the anesthesia.

Has Sydney had a C&S? When was her last ultrasound, and was it done by an internist or radiologist?
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She hasn't had a C&S, her ultrasound was done in October by the regular vet - actually the owner of the office. He performs them routinely and gave his opinion, then had me send it out to a specialist as they wanted confirmation of what they saw and the answer came back with the same information from the regular vet.

I think this internist is "being thorough"? He kept using the word base line to refer from. Honestly I thought the October US is a baseline, but what do I know.

I even have the US on CD and gave it to the internist - I think he viewed and printed it.


Then he will coordinate with the dentist (board certified) - same guy I'm taking Maui to, and will be there when they intubate and excabate - to make sure about her breathing as that is a concern.

I have to confess that I don't remember Syndey's breathing issues? Does she frequently have trouble breathing?
Click to expand...

The breathing is a new thing.

The internist did say that given her conditions complications (think that's code for possible death) could occur. I kind of knew this and it's why I'm so concerned and unsure how to proceed and took the baby step of this appt.

Death is unfortunately a possibility with any anesthetic procedure. A congressman just died from gall bladder surgery (last week, I think it was). The internist might have been referring to kidney issues or something, though. Anyway I think you've done everything you can to look out for her -- you have experts doing the procedure, so it should be done quickly and efficiently, you have been assured of close monitoring during the procedure, and are giving the kidneys a good flush before and after.
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I understand, which is why this makes the whole thing that much scarier to deal with.

I do feel confident that they will do everything possible to keep her safe and having the internist involved with the dentist to oversee the "danger" parts is a good thing. I'm not taking this lightly, which is why I've been agonizing over this. Even I, a lay person can look into her mouth and see that the tooth looks really questionable (meaning I don't know if it can be saved) and I do understand the importance of having good clean, healthy teeth. That if I don't treat this, other worse things can develop.

Syd is now a complicated matter and I need to be sure it's done correctly. Which is why the vet said, they would not do the dental and I needed to take her elsewhere. Of course, her reason was more that I wouldn't leave her overnight unsupervised and they insist on the fluids prior. Whatever, the reason, I think for this, she needs to see the specialists who will be with her the whole time and have 24 hour monitoring and care.

OK - what else do you need to know that I failed to mention. I'm sure there is something.

 
Hillary. My goodness. I can't believe what you went through with that vet. What an angel you have been, and a ferocious mother -- the highest compliment! -- to boot. Hats off to you, and how about (((hugs))) too. :YMHUG:
 
Thanks Kathy.

My cats are my family. I am the only one who can speak on their behalf, look out for them and love them.

This former vet office, I used for about 5-6 years and while I thought the one vet was pretty good, when she wanted to treat Maui newly diagnosed FD with 2 shots in less than 12 hours and no overnight supervision, I realized, I needed to find a new vet office and quick.

She also instead of helping me figure out the cause of Maui's skin issues, threw AB's, steroids and shampoos at it. With her liqui poo problems - she said, we would just have to live with it.

All (well most - she still gets occasional liqui poo) stopped when I stopped the dry food. Such a simple fix.

I also brought my Jake to her, when he got ill. keeping this story very short - they performed surgery, I spent the next day visiting him and then cause it was a holiday weekend, was planning on bringing him home 2 days later. (This was not a 24 hour care place) I get a call the next morning telling me Jake died. They claim it was an embolism - I wasn't allowed to come over and see him (holiday weekend - and vet on duty wouldn't allow me to come), they put him in freezer and then I had to call when they re-opened - they didn't call me. I never saw him again. They never told me what the underlying problem was, not until I went to pick him up and the blanket I left for him. And then they were cold about it. He was only 6.

Then I bring in Sydney and get treated like crap by another vet there that I went to before all because he didn't like that I was asking questions (guess he felt I was questioning his abilities). I wrote about this on community in October when it happened and that was the last straw for me. Yes, I filed a complaint with the state vet board - it got dismissed, but I filed anyway.

So, after all this pain and heartache with one vet office, I am now even more diligent than ever and have learned to ask a lot of questions and honestly if a vet doesn't like that - then tough, I'll find another one to work with. The new vet office I'm using, the vet actually is very kind, quiet and answers all my questions and doesn't seem at all put off or angry about it. I've said to her, that we need to work together and I'm not questioning her abilities, rather I want to better understand and do what is best for my cats.

If surgery or overnight stays are required, never again will they go to an unsupervised facility. While the two 24 hour places are a bit further away and more $, I'd rather have the peace of mind that they aren't alone and are being looked after constantly.

Regarding Jake, it may have happened (ok it probably would have happened) even if he was monitored and supervised overnight, but the difference is - I would have been allowed to get over there, I would have received the call at 3 am not 10 am and he wouldn't have been alone and I'm no expert, but maybe they could have done something to help him - it's one of those things that I will never know.

It's also why I sometimes come on a bit too strong on this board in suggesting that people ask questions, make sure they know where their 24 hour place is and seek second opinions.

Which reminds me, I need to phone the primary vet and give her a Sydney update. And make sure she gets copies of their notes and the treatment plan when it's finalized.
 
(((((Hillary))))) How many hugs can I send? As for your sweet Jake -- I guess no one understands better than people here.

We have to learn to stand up for our furbabies. It's something many of us have begun to do for ourselves, but for me, it has been harder with vets, because feline health has been so mysterious to me. All we can do is learn, and as you say, ASK, and if we don't get answers, leave.

Human doctors are beginning to encourage patients to ask questions. Maybe we can help more vets do the same.
 
Thanks Kathy - and I'm fine. I miss him yes, but I'm fine. I've come to terms and moved past the grief and all that.

But holy cow - the things you're dealing with from your dental! I'm stunned, but like you say, ASK! and keep asking until it makes sense to you.

hugs to you too!
 
Hillary, check out my update on Health. I feel MUCH better than Kitty is not in severe chronic pain.

Why do I feel better? Because I ASKED. The vet didn't answer my questions. He said Kitty wasn't in pain. No explanation. But the vet tech took the time to explain, and now I understand.
 
exactly - just read and responded on it.

and it really makes you feel better when you understand. I got what you wrote (ok I thought, ugh, yuck and ouchie) but I understood it and it makes sense to me. Glad it does to you and puts you more at ease.

:mrgreen:
 
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