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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.
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.
Ali, so true about the cost estimate! I looked at it and definitely cringed.
But they did charge me for EVERYTHING, needles, sutures, fluid drip kit, IV tubes, etc. Just didn't charge me for the scalpels, table, and surgical gloves!
If they would have put the real price of the supplies and charged higher rates for the extractions themselves instead... I think I would have had a different reaction. Nobody wants the medical expertise to cost less than the equipment! I'd rather get the equipment on sale and pay a premium for the skills of the vet. You know what I mean?
Thanks for the info about x-rays! Maybe that will be less in the end than they estimated.
I am dropping him off shortly. Will keep you posted. Really appreciate the info and support.
But they did charge me for EVERYTHING, needles, sutures, fluid drip kit, IV tubes, etc. Just didn't charge me for the scalpels, table, and surgical gloves!
If they would have put the real price of the supplies and charged higher rates for the extractions themselves instead... I think I would have had a different reaction. Nobody wants the medical expertise to cost less than the equipment! I'd rather get the equipment on sale and pay a premium for the skills of the vet. You know what I mean?
Thanks for the info about x-rays! Maybe that will be less in the end than they estimated.
I am dropping him off shortly. Will keep you posted. Really appreciate the info and support.
guess our post crossed .....yes indeed we wish kitty good luck and hugs to you!!!
the roots I believe normally come out with the extraction......its only when FORLS are involved and the reabsorption process has begun that it means digging into the calcified bone to remove, some Vets aren't qualified to do this thats why my local Vet sent Sami to a specialist....if root fragments are left it can lead to many problems down the road not to mention the continued pain....
the roots I believe normally come out with the extraction......its only when FORLS are involved and the reabsorption process has begun that it means digging into the calcified bone to remove, some Vets aren't qualified to do this thats why my local Vet sent Sami to a specialist....if root fragments are left it can lead to many problems down the road not to mention the continued pain....
I don't find the prices totally out of line with what i paid at the specialist clinic(in the city)....while the #2 clinic is more in line with what I pay at my regular Vet clinic here. Are the same anesthetic gases and medications being used?. bottom line is I guess you just need to go with your 'gut' feeling on this....if you felt more comfortable with Vet #3 than don't let price be a barrier....but if you'd feel just as comfortable with your Vet at home for less money...((make sure the gas (either propofal or isorflurane) is what they are using.... )) got to compare apples to apples.
And buprenorphine for pain...this Vet is right on with what he uses, other than the convenia injection..I will post a long write up another member just made on convenia on Dec. 16 at the bottom of this page....
there can be side effects from this....and now to be going into surgery with MORE meds added and theres always the chance of side effects with ANY medication....kinda seems like a whole H of alot to be throwing at this kitty all at once...again my opinion.
I tend to trust the #3 Vet the most(other than the convenia) b/c of the more indepth diagnosis he gave you and noticed more issues with your kitties teeth than did either of the other 2. but again if your just as comfortable with one where you live and thats your decision....
I assume you've made your mind up by now given you had to let the clinic know and of course had to take all food and water away from kitty....nothing says you can't phone and cancel in the morning tho if you get second thoughts...just needed to say that so you would lie awake all night thinking and rethinking like I do...lol.
go with your best instincts....let us know what you decided, if kitty does have morning surgery we send our prayers with him...let us know how he makes out ok...♥
angiesmom posted this Dec 16th abt her thoughts on convenia..please read.
My cat Angelina also had a reaction to Convenia, I did a necropsy at Cornell Hospital Pathology Dept. They found that they think she had liver adenoma/ cholangio carcinoma as well as acute myeloid leukemia. In spite of the fact that she had an end stage liver cancer, it seems, nothing to that effect showed up in her blood work until 4 days after the Convenia shot. At that point her AST was elevated but now tremendously and they thought she had an infection. 4 days after that she had become severely anemic, there was no sign of anemia in any of her blood work before this. She also had a 4 minute claw test, which means she took 4 minutes to stop bleeding.
The findings at Cornell said that they did not believe Convenia caused the anemia, not because it wasn't possible, but because Convenia hasn't been reported to cause anemia. This isn't true, read Dr. Pierson's website, read Pfizer's own foreign market results which state it has caused hemolytic anemia- I have also communicated with someone else whose cat developed hemolytic anemia and who passed away after 4 blood transfusions. So this drug does cause anemia as well as many other severe effects.
When Angie received Convenia she had what seemed to be a cold which wasn't going away, she didn't seem that ill. She had had some weight loss in July, but her blood work was normal. We did a thyroid panel in September which was fine. Then she had some hair loss for which I never got the results of, an expensive test for ring worm.
After Convenia, she developed a high fever, she became extremely doped, she was hiding a lot and she stopped eating. Throughout this she kept seeming to revive as if her body was trying to fight off the reaction. She was given Orbax and her fever lowered and she ate three dishes of food, but then she regressed and started hiding again.. it was at this point I believe the anemia began... I had given her fluids at home and the next day when I brought her for an ultrasound of her abdomen, they thought from an xray that she had possible pancreatitis and had given her more meds for that, she had a large bruise at the site of the fluids.
That day her dvm told me she was severely anemic and she thought Angie was dying... the dvm was very upset- she was crying. I took Angie to a speciality hospital where she was given iv fluids, pain killers and tested. They told me that night they were considering Convenia as a cause of her anemia, I had just read all about it, not having been warned of any of the severe side effects, and I called them to tell them about that. I decided to take her home and try to treat both the cancer and the FeLV( see below) with steroids and other drugs, but I knew the next day she was in too much pain and I had to let her go.
Now that it has been determined that she had cancer, as well as acute myeloid leukemia, which could or could not have been caused by FeLV, she had one inconclusive and one positive eliza test but no IFA test, which I was finally informed of the day she left the speciality hospital, I fear that both Pfizer and dvm societies will not believe that Convenia played a role in her death.
I still plan to file reports with Pfizer and with the FDA as well as warn everyone I can not to use Convenia. I will never use this drug again- I had already refused it once in July when Angie developed a cold after receiving two vaccinations. I had stopped vaccinating my cats due to health issues and I decided to do a rabies which I was still doing as well as a distemper. I think that was the trigger for her FeLV, assuming she really had this, because it stimulated her immune system too much. Angie was one of two kits of a feral queen who was put to sleep in a shelter, I believe that she may have contracted felv from her mom and then fought it off, but the virus hid in her bone marrow to later resurface.
I had never heard of Convenia before that but I rejected it on the basis that it stays in the system too long. I will always regret giving her Convenia, but had I been warned about the severe side effects reported in foreign market studies I NEVER would have allowed it. I think it is crazy that DVM aren't required to warn us about all of this. Please see my video Just Say NO to Convenia at youtube.
Please inform yourself because no one else is going to unless this drug is removed from the market, which is my goal. Don't risk the health and lives of your beloved fur babies. There are plenty of safe alternatives to Convenia. I would avoid Baytril also as I have read that it causes blindness and possibly other effects.
http://www.youtube.com/watch?v=yk4MnjGUCGo
And buprenorphine for pain...this Vet is right on with what he uses, other than the convenia injection..I will post a long write up another member just made on convenia on Dec. 16 at the bottom of this page....
there can be side effects from this....and now to be going into surgery with MORE meds added and theres always the chance of side effects with ANY medication....kinda seems like a whole H of alot to be throwing at this kitty all at once...again my opinion.
I tend to trust the #3 Vet the most(other than the convenia) b/c of the more indepth diagnosis he gave you and noticed more issues with your kitties teeth than did either of the other 2. but again if your just as comfortable with one where you live and thats your decision....
I assume you've made your mind up by now given you had to let the clinic know and of course had to take all food and water away from kitty....nothing says you can't phone and cancel in the morning tho if you get second thoughts...just needed to say that so you would lie awake all night thinking and rethinking like I do...lol.
go with your best instincts....let us know what you decided, if kitty does have morning surgery we send our prayers with him...let us know how he makes out ok...♥
angiesmom posted this Dec 16th abt her thoughts on convenia..please read.
My cat Angelina also had a reaction to Convenia, I did a necropsy at Cornell Hospital Pathology Dept. They found that they think she had liver adenoma/ cholangio carcinoma as well as acute myeloid leukemia. In spite of the fact that she had an end stage liver cancer, it seems, nothing to that effect showed up in her blood work until 4 days after the Convenia shot. At that point her AST was elevated but now tremendously and they thought she had an infection. 4 days after that she had become severely anemic, there was no sign of anemia in any of her blood work before this. She also had a 4 minute claw test, which means she took 4 minutes to stop bleeding.
The findings at Cornell said that they did not believe Convenia caused the anemia, not because it wasn't possible, but because Convenia hasn't been reported to cause anemia. This isn't true, read Dr. Pierson's website, read Pfizer's own foreign market results which state it has caused hemolytic anemia- I have also communicated with someone else whose cat developed hemolytic anemia and who passed away after 4 blood transfusions. So this drug does cause anemia as well as many other severe effects.
When Angie received Convenia she had what seemed to be a cold which wasn't going away, she didn't seem that ill. She had had some weight loss in July, but her blood work was normal. We did a thyroid panel in September which was fine. Then she had some hair loss for which I never got the results of, an expensive test for ring worm.
After Convenia, she developed a high fever, she became extremely doped, she was hiding a lot and she stopped eating. Throughout this she kept seeming to revive as if her body was trying to fight off the reaction. She was given Orbax and her fever lowered and she ate three dishes of food, but then she regressed and started hiding again.. it was at this point I believe the anemia began... I had given her fluids at home and the next day when I brought her for an ultrasound of her abdomen, they thought from an xray that she had possible pancreatitis and had given her more meds for that, she had a large bruise at the site of the fluids.
That day her dvm told me she was severely anemic and she thought Angie was dying... the dvm was very upset- she was crying. I took Angie to a speciality hospital where she was given iv fluids, pain killers and tested. They told me that night they were considering Convenia as a cause of her anemia, I had just read all about it, not having been warned of any of the severe side effects, and I called them to tell them about that. I decided to take her home and try to treat both the cancer and the FeLV( see below) with steroids and other drugs, but I knew the next day she was in too much pain and I had to let her go.
Now that it has been determined that she had cancer, as well as acute myeloid leukemia, which could or could not have been caused by FeLV, she had one inconclusive and one positive eliza test but no IFA test, which I was finally informed of the day she left the speciality hospital, I fear that both Pfizer and dvm societies will not believe that Convenia played a role in her death.
I still plan to file reports with Pfizer and with the FDA as well as warn everyone I can not to use Convenia. I will never use this drug again- I had already refused it once in July when Angie developed a cold after receiving two vaccinations. I had stopped vaccinating my cats due to health issues and I decided to do a rabies which I was still doing as well as a distemper. I think that was the trigger for her FeLV, assuming she really had this, because it stimulated her immune system too much. Angie was one of two kits of a feral queen who was put to sleep in a shelter, I believe that she may have contracted felv from her mom and then fought it off, but the virus hid in her bone marrow to later resurface.
I had never heard of Convenia before that but I rejected it on the basis that it stays in the system too long. I will always regret giving her Convenia, but had I been warned about the severe side effects reported in foreign market studies I NEVER would have allowed it. I think it is crazy that DVM aren't required to warn us about all of this. Please see my video Just Say NO to Convenia at youtube.
Please inform yourself because no one else is going to unless this drug is removed from the market, which is my goal. Don't risk the health and lives of your beloved fur babies. There are plenty of safe alternatives to Convenia. I would avoid Baytril also as I have read that it causes blindness and possibly other effects.
http://www.youtube.com/watch?v=yk4MnjGUCGo
I went ahead and scheduled the appointment.
One final question (and thanks again for all your advice): should I confirm that the roots will come out for every extraction or does this not make much difference?
Wish me luck! :)
One final question (and thanks again for all your advice): should I confirm that the roots will come out for every extraction or does this not make much difference?
Wish me luck! :)
For the x-rays, they charge per x-ray to a point, then just all it the whole mouth which ends up less.
The cost breakdown always makes me cringe, but then I think about the fact that they have to pay for their equipment, staff, rent, their own salaries etc. For example: Lactated Ringers Solution 1L = $22 on the estimate, but I found it for $2 on an online pet med supplies store). We don't think about the tubing and needles etc that go with it. :)
The cost breakdown always makes me cringe, but then I think about the fact that they have to pay for their equipment, staff, rent, their own salaries etc. For example: Lactated Ringers Solution 1L = $22 on the estimate, but I found it for $2 on an online pet med supplies store). We don't think about the tubing and needles etc that go with it. :)
Ali, I 100% agree with you about being more thorough to avoid leaving teeth in that will cause my kitty discomfort. I think we both tend to the safe side!
Do you remember if x-rays were charged per tooth? I know for my human dental x-rays, they do something like 4-6 to to cover the entire mouth.
Thanks so much for your time and advice... I'm hoping I'm nearly there in terms of making a decision.
Do you remember if x-rays were charged per tooth? I know for my human dental x-rays, they do something like 4-6 to to cover the entire mouth.
Thanks so much for your time and advice... I'm hoping I'm nearly there in terms of making a decision.
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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.
-