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4520139 tn?1355849169

Cat extraction - decisions to make

Hi everyone,
I've been reading some of the threads on this page and while I have learned a lot I am also very nervous about my 6-year old indoor male cat getting a dental cleaning + extractions under anesthesia. I was hoping for some advice from this community. I apologize in advance for the length but I make decisions based on a holistic assessment of a situation, so I've tried to include relevant information here.

1. 2011 annual appointment: vet noted "very clean teeth". I asked if I should be brushing his teeth - they said no. Exam not particularly thorough. I remember thinking they were talking more to each other than to me or my kitty, which is why I tried a new vet out this year (#2 below).
2. Took my cat for this year's appointment last week (Dec 2012). Vet recommended full blood panel ($189) including urinalysis. Justification: at this age, good to get a baseline on all measures so if he becomes sick at a later date, have something to compare. Also recommended dental cleaning ($200) and extractions (1 loose tooth definitely needs to be removed. Another is a 'maybe'. Was vague about price, but I think it was going to be $50-100 for the extraction of two teeth - said he would give me a minimal charge for the loose tooth which would probably come out easily). Vet was good until it came time for a simple administrative request - letter stating cat is healthy enough to fly in-cabin on upcoming trip. Insisted that he is not a "secretary" and does not write letters because then he would not have time to treat any patients, would spend all his time doing secretarial work. (? seriously?) BUT he was willing to answer my many questions and thorough with my cat (...or so I thought). Got the letter and the cat is on the trip with me now for 2 weeks. Vet said cat is probably experiencing some discomfort, but not to worry. This vet also told me that brushing teeth is unnecessary and Greenies are sufficient for future dental care. No medications given or recommended.
3. Took my cat for a second opinion. This vet found another two teeth to be extracted (root heavily exposed), as well as 2-3 more that might need extraction. Also noted an infection of the gums and recommended administration of antibiotics. Recommended basic blood panel ($90), but not the full blood panel unless indicated. Vet was very patient, willing to answer questions. Charged me for an annual exam in order to provide the consultation, but I don't think he did the part of the exam in which they manually feel the cat's abdominal area and glands throughout the body. Provided a detailed estimate of the costs. However, the cost is significantly higher than the previous vet (#2 above - around $200-300 for 2 teeth, not including blood panel), even if I take into account the different # of extractions (estimate was $580-$720, depending on whether he takes out 3 or 7 teeth, not including blood panel). I looked into the costs of some of the itemized supplies, and on the two I checked, the markup was 4x and 11x. (ex: Lactated Ringers Solution 1L = $22 on the estimate, but I found it for $2 on an online pet med supplies store). My "gut" feeling about the vet in #3 was more positive than about #2, but I am concerned about price gouging. Also, If I get the extractions done with this vet, my kitty will have 10 days to heal before the airline flight back home (which vet said is plenty) - if there are any complications I will have to delay travel. I am staying with my parents for the holidays, so this wouldn't be impossible, but changing my flight would be another expense on top of the already-higher estimate and I can't be gone too much longer. However, if I didn't take into account the much higher cost and the travel issue, I would probably choose #3.

I am a grad student (on financial aid), but will sacrifice other things to keep my cat healthy. However, I'm really torn about whether to do this procedure here (and pay about 2 - 2.5 times more, it seems) while visiting family, or wait another couple of weeks and go with #2. Both vets were kind to my cat. However, I don't know if I can fully trust either...

Please be positive or don't reply (I noticed some responses were very snarky and mainly focused on berating the guardian). I am open to constructive criticism and opinions/information. But I noticed some replies simply lecture or imply the owner is not committed enough. I ask my vet every year what more I can do to keep my kitty healthy. And to be clear, while I've listed prices above, I am in no way implying that price is the main/only factor in this decision.

I am trying to weigh several factors:
-trust in the doctor
-practical issues (I'm not in my own home right now and will need to travel soon. If there are complications like what I've read about, I would have a hard time extending my trip by more than a week or so)
-financial limitations (I will pay interest on this later when I start repayment on my loans, and while I am not 'cheap' when it comes to the important stuff, I strongly resent being 'taken for a ride' to pad the pockets of doctors)
-quality of medical care

Thanks so much in advance. If anyone with a similar question wants more info on the itemized costs (for comparison) send me a private message.
Best Answer
874521 tn?1424116797
ok....
I didn't want to go into this too deeply for starters b/c so many post than never return to read a reply..thus alot of time involved.

Yes by #2 choice I do mean the last Vet as I didn't even consider the first one as even being in the running, how blind can a person be to not see what you are describing...very incompetent!!!!...

I am like you, money is short however I do not skimp on this when it means the diff between what I feel is the best choice for my kitties:) however the est. Vet #3 gave you is not out of range IMO...except for the ringer sol cost, but thats minimal...

I will try to address all your questions quickly as your decision has to be today and I too have plans for a bit later.

-yes xrays can only be done under anesthesia...and please insist on these being done!! its mainly only with an xray that FORL's can be dx'd..b/c as with my boy they were all beneath the gums and not showing on the surface. thus is why he needed a dental surgeon, and the absolute need to extract the roots and not just the tooth....he had 4 extractions and under gum work done...cost $1800. yikes. but it was done well.

-I agree the cost of the ringer sol. is very high, I would question this, on my bill it was $12

-I am assuming your kitty has extensive gingivitis and this was the case with my boy too...and the forls that were found while xrays were done during an annual cleaning...what my Vet never found and the specialist did is the PERIDONTAL DISEASE that he also had...and thus the need for extensive work on the roots for his front teeth, still need a follow up to see if this worked along with the oral care I do at home(now) if not than he'll need more extractions.

-so be prepared for this as well, b/c its not until a Vet does xrays that the total extent of kitties issues will be seen..if there VISIBLE evidence that he needs that many teeth extracted than there could be many more that are not visible. I would caution that you speak with the Vet and he not do more than whats necessary for kitties comfort at the moment....its a very extensive surgery if forls are present...
but thats up to you and if the Vet feels kitty is healthy and strong enough to have many extractions done at one surgery...

-please please tell the Vet you don't want Metacam (a common anti-inflamatory) used...
NOR any convienia injections....(antibiotic injection that has proven very dangerous) use only ORAL antibiotics and the best one for kitties undergoing dental surgery is ANTIROBE AQUADROPS..(clindamycin hydrochloride)

http://www.drugs.com/vet/antirobe-aquadrops-liquid.html

re: pain med buprenorphine hcl...an excellent choice esp for safety and nerve pain following extractions...good

NO I am not a Vet, only a pet parent like yourself, however have lots of experience the last year with dentals in kitties and spent alot of time researching this recently....so all the suggestions are IMO and always follow what you believe to be right at the time..:)
the research I have done is with holistic cat people, who have dealt exclusively with the care and treatment of cats esp. where medication dangers are concerned.

-
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874521 tn?1424116797
hows Professor doing today??
Helpful - 0
4520139 tn?1355849169
Thanks for your support - it's been a hard process for Professor and I. More so for him of course, and only financially and emotionally for me.

They did do dental xrays. Gave me a printout, but for some reason they only included the bottom xrays in that printout. I asked about this and they said it would be difficult to provide the top xrays (?? no idea what that means).

However, the vet DIDN'T EVEN COME OUT TO TALK TO ME when I came to pick up Professor. Only the vet technician. So I did not get a recap of what happened. All I know is that 6 were level 1 extractions and 2 were level 2 extractions. No info on FORLs, although the doctor discussed them in the consultation before the surgery. I expected her to come out and greet me, but maybe they warned her that I wasn't happy so she stayed in the back room until I was gone. I was 100% polite, but considerably less cheerful and friendly than I had been in previous interactions. Also my eyes are pretty puffy from the stress of the morning and I am sure I looked really anxious while I was handing over my credit card.

Regarding the estimates, I had accounted for 7 extractions at the level 2, which was conservative (vet #2 said 2 maybe 3; vet #3 said between 3 and 7 extractions). Based on the information I had, the eighth extraction should only have increased the price by another $30... so it's the other stuff that they got me on (changing the price of the dental cleaning, the antibiotic gel, and different meds from those in the first estimate). Although I had asked the first tech at this office what other optional meds or supplies might be given, she failed to mention this antibiotic gel. The vet did not say anything about it this and it wasn't on the estimate from this morning either.

They said they wouldn't charge me for the follow-up. I think this was their last-ditch effort to save face on Yelp. I haven't decided whether I will bring him back again but if I do it would be after discussing these issues with the owner, who is the primary vet (the one I was supposed to see when I came back from my trip early).
Helpful - 0
874521 tn?1424116797
I forgot....did he also get x-rays done? and NO sign of FORL's????
Helpful - 0
874521 tn?1424116797
well this is an unfortunate thing with 'estimates' they are only an estimate and as with all we do need to be prepared for more...however that is quite a jump from $500 to $800...I can't blame you for being upset, when finances are an issue(as with most of us) that is a terrible increase.

but I will say if they did this antibiotic gel...than this Vet must also have done some under the gum work as my Sami had...and thus Professor also has peridontal disease....Sami only needed 4 extractions(thus far) and his bill was $1800. so this Vet is not out of line.

this under gum antib gel that Sami got was to TRY to prevent more root detachment from the peridontal disease, he has to return to see if this gel treatment was successful or not, if not then more extractions will be needed....so as it will be for your kitty.

the specialist also sold me some oral cleaners and told me Sami had to have daily dental care...including a brushing for prevention....so be prepared for that also. also a product called EFAC an essential fatty acid that I was told they've seen great success with.

You tried so hard to find a Vet and a price you were comfortable with and I'm so sorry this had to happen to you. I would ask if this includes a follow up..
main thing now for Professor is that he comes thru the anesthesia fine and heals well with no problems....feed him soft canned food for a few days, he will have a very sore mouth.....thats alot of extractions at one time.

its over!!!! now the healing for both him and YOU...((hugs))


Helpful - 0
4520139 tn?1355849169
Opus,
You won't believe what this vet did to me on pricing today. I got a quote yesterday that put the services (without seeing him) under $500. I padded this estimate based on additional costs I could anticipate. This already felt like a lot (remember, I've already spent $300 on 2 physical exams, antibiotics, and blood work). But I specifically asked for information on pricing so I wouldn't bring him in for another exam and then find out I couldn't afford the services at this facility.
Then this morning I bring him in for the surgery and the estimate they gave me at the last second was $200 more than yesterday. They said the girl from yesterday had made a mistake and was not authorized to price it out the way she did. I asked for a few minutes alone to think about it (in the exam room) and could not get a hold of myself. I had already kept Professor without food for two different nights. And I figured they'd charge me for the (THIRD) physical, even if I took him and left the office. They completely cornered me. An already stressful situation became so much worse when they hit me with a bill substantially higher. It made me more uneasy than I already had been.
Then they called during the surgery to get my approval for an antibiotic gel. The vet said it "would not change the price much" but it turned out to be another $90. So in 24 hrs the bill went from $500 to $800, even though I had accounted for basically the same number of extractions (I thought 7, but they took out 8) and was confident that I had anticipated it properly.
I am so upset at how they have handled the cost. I know they are a business and need to cover their costs, but they should understand that I also have a budget and need to cover my costs too!
On a more positive note, they said he was doing fine and after the antibiotic gel they'd wake him up.

Is this how all vets are? I am so disappointed ...
Helpful - 0
874521 tn?1424116797


so Vet #4 it is....glad this is alll settle and Professor is ready to get this done and over with..

I really don't know much abt Ketamine, other than being told its old school protocol and there are safer drugs available....however IMO also and with my own Vet I sometimes think its safest to go with the drugs they are used to working with and not demand an alternative(some cases)...know what I mean? for instance propofol is a safer induction agent BUT it must be administered by a skilled Vet otherwise if injected too quickly can lead to respiratory arrest.
so if your Vet commonly uses this and is comfortable with it and you trust him....
one word of warning it can cause major hallucinations...so if Professor acts really weird following that is very likely the cause....of course this would reverse when the med has cleared his system.

I am not at all familiar with Domitor,
I think this is medetomidine(?) a pain med. buprenex(bupronorphine) is a safer med. also butorphanal.

duprenex....do you mean buprenex? that is the best choice in pain meds for a cat especially for the nerve pain associated with dentals..
that is absorbed orally via a dropper....and tolerated well.

I'm not sure why 2 pain meds would be required?

for an antibiotic Clindamycin is best for dentals and is very well tolerated by cats. if required.

Metacam is a non steroidal anti-inflamatory (NSAID) and is not a good drug, but from what I've read none of the anti-inflamatories are. they are very hard on the kidneys.....I can't suggest any alternative there. but I would request an alternative if an NSAID is absolutely necessary.

http://www.metacamkills.com/

sorry I can't be a whole ton of help to you. Go with what you've read and your best gut feeling, thats all we as parents can do....I wish you and Professor tons of luck tomorrow...update us afterward okay. sorry but I have to rush off the forum tonight, but will check back tomorrow for an update...♥

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