11/12 Hershey AMPS(300)PMPS(175)+5.5(224)

11/11 Hershey

HAPPY TUESDAY!

Hershey seems to be feeling good today. He was harassing Oreo to the point Jessica had to break it up. Looked like it had gone beyond brotherly wrestling to bullying as I watched Oreo keep trying to find places to hide. Other than that - Hershey's numbers just keep going up. We did the INC from .25u to .3u, but I'm planning to INC to .5u tomorrow, unless Hershey shows us something tonight. He does well with shaves, but when trying to return to the last good dose - it's no longer a good dose.

:?: Working on my list of what to ask about dentals. I know no Convenia or Metacam, so are there particular meds I should ask for?

Also, I'm including the page from the vet I'm going to check out. Would you mind looking it over to see if any red flags go up for you? THANKS!!!

Still watching for those snow flurries. Feral shelter in place and it looks like it's been used already. Now only seeing the mama kitty and TWO kittens.

Have a great day -

Libby (& Hershey, too!)

AMPS (300) +11.5 - Shot .3u at 7:40am + 1/8th tsp Miralax
+2 (327) - fed - Had pretty much finished AMPS meal
+5.83 (259) - INC to .5u tomorrow AMPS unless Hershey shows great things tonight
+7.33 (218) - Debating about INC tonight instead of waiting. Tested to see if dropping. Will give him through tonight.
- Sprinkled treats on food, ate a little more.

PMPS (175) +12 - Shot .3u at 7:40pm + 1/8th tsp Miralax
+2.17 (221) - fed - Had not finished PMPS meal
+5.5 (224)

*******************************************************************************************

Dental Treatment Package Group I / II
Office Visit & Medical Records
Exam: Anesthesia Procedure
Hospital Day Care: Pre/Post Operative
CBC: Feline
Blood Chemistry - Feline: Major
T4 Thyroid / Cholesterol
Acepromazine Inj. Sedation
Butorphanol Inj. Sedation
Anesthesia Support: IV Catheter
Anesthesia Support: IV Fluids
Narcotic Pain Relief Injection
Diazepam Sedation / Induction
Ketamine Sedation / Induction
Isoflurane Inhalant Gas: First 30 Min.
Isoflurane Inhalant Gas: Addition Min.
ECG, Blood Pressure, Temperature Monitor
Staff Monitoring: Anesth. Support
Feline Level I / II: Dental Cleaning
NSAID Pain Relief Injection


Feline Dental Package Grade I / II $155.00 / $185.00

Please see the Estimate Guide page for further information on our dental procedures.

Unless your pet has received a dental evaluation and grading by our Veterinarian, you will need to schedule an evaluation appointment with our office before you may schedule a dentistry procedure.

Care Plan Estimate: Feline Dental Procedure Grade III / IV

Dental Treatment Package Group III / IV
Office Visit & Medical Records
Exam: Anesthesia Procedure
Hospital Day Care: Pre/Post Operative
CBC: Feline
Blood Chemistry - Feline: Major
T4 Thyroid / Cholesterol
Acepromazine Inj. Sedation
Butorphanol Inj. Sedation
Anesthesia Support: IV Catheter
Anesthesia Support: IV Fluids
Narcotic Pain Relief Injection
Diazepam Sedation / Induction
Ketamine Sedation / Induction
Isoflurane Inhalant Gas: First 30 Min.
Isoflurane Inhalant Gas: Addition Min.
ECG, Blood Pressure, Temperature Monitor
Staff Monitoring: Anesth. Support
Feline Level III / IV: Dental Cleaning
Dental Extraction Per Minute
Dental Surgery & Suture Time
Suture Materials, Excess
NSAID Pain Relief Injection
Long Acting Narcotic Pain Relief Injection
Miscellaneous Medications
(Additional Pain Relief / Antibiotics)

Feline Dental Package Grade III / IV
Estimated Range: $ 250.00 - 625.00

Please see the Estimate Guide page for further information on our dental procedures.

Unless your pet has received a dental evaluation and grading by our Veterinarian, you will need to schedule an evaluation appointment with our office before you may schedule a dentistry procedure.

* Please note:
The price range listed for Dental Procedures graded at level III / IV are estimated ranges only. The final fee is based on the amount of time required to perform surgical extraction of teeth and gingival (gum) surgery as well as additional medical materials needed to perform treatment or medications sent home.

There are also specific dental disease issues which exceed the ability of our hospital to treat in a medically appropriate manner consistent with our practice mission and philosophies - such as the option for salvaging teeth via root canals (endodontic) or jaw bone surgical procedures. In these instances clients interested in these advanced care options will be offered a referral to the Board Certified Veterinary Dentistry Specialists at North Carolina State University's Veterinary School.

Re: 11/12 Hershey NSAID/Antibiotic to request??

If Hershey had labs done at the ER, blood work, like the blood chemistry and a T4 are unnecessary if they fax over the results.

There are some items I don't understand. for example:

• Acepromazine Inj. Sedation
• Butorphanol Inj. Sedation

Why are 2 forms of sedation needed? Likewise, why are diazepam AND ketamine both used for induction? One form of induction for anesthesia is sufficient.

I'm concerned that there are no pre- or post-procedure x-rays. There's no way to really know what's going on beforehand without an x-ray and if there are extractions, there's no way to know if a root is accidentally left behind without an x-ray.

Metacam is an NSAID. Make sure that NO form of NSAID is given since they all have the same risk for renal failure. Most of us ask for buprenorphine for pain management.

If they are saying that what the total bill is, it's way cheap. Granted I live in Chicago and Gabby usually requires several extractions due to her having resorptive lesions, I usually end up spending over $1000.

Re: 11/12 Hershey NSAID/Antibiotic to request??

Thanks, Sienne. This is just from their website. Thanks for giving me some questions to ask. Thanks for mentioning no NSAID's, too. I was wondering when they all have possible side effects.

Re: 11/12 Hershey NSAID/Antibiotic to request??

hi libby. regarding the questions sienne raised:

there's a website i've often referred to when i've had questions about anesthesia: Veterinary Anesthesia & Analgesia Support Group: Practical Information for the Compassionate Veterinary Practitioner.

description:
"This site is maintained by veterinary professionals who have made a commitment to anesthetic and pain management excellence. We want this site to be a centralized resource for our colleagues engaged in small animal private practice.

Our focus is on practical guidance; on clinical relevance; on the evidence informed perspective. Our goal is improved patient comfort and safety.

The VASG is about colleagues helping colleagues. We want to help anyone that has an interest in advancing veterinary anesthesia and pain management at the primary care level anywhere in the world."

i think you'll find answers there as to why your vet is using the drugs in question.

re: diazepam and ketamine for induction (scroll down to #4): Anesthetic Induction Protocols

There are some items I don't understand. for example:

Acepromazine Inj. Sedation
Butorphanol Inj. Sedation

Why are 2 forms of sedation needed?

Click to expand...

the explanation can be found here: Balanced Anesthesia


hope this helps.
have a good day and good luck with the dental!

Re: 11/12 Hershey AMPS(300)+2(327) +7.33(218)

- Hey, Jill - Thanks for the links. I'm trying to learn so much new stuff that I think my ears are bulging! :lol: Not unlike when I first found this site...

+5.83 (259) - INC to .5u tomorrow AMPS unless Hershey shows great things tonight
+7.33 (218) - Debating about INC tonight instead of waiting. Tested to see if dropping. Will give him through tonight.
- Sprinkled treats on food, ate a little more.

Re: 11/12 Hershey AMPS(300)PMPS(175) Yippee Skippy!

PMPS (175) +12 - Shot .3u at 7:40pm + 1/8th tsp Miralax

Yippee Skippy for a BLUE preshot!!

Re: 11/12 Hershey AMPS(300)PMPS(175) Yippee Skippy!

Yippee Skippy for a BLUE preshot!!

Click to expand...

Boy can I relate to that! Well done Hershey - let's see some that Hershey green mints tonight please!

Looking at the dental questions, the only possible red flag for me is

NSAID Pain Relief Injection

Click to expand...

I'd ask what NSAID they use. If it's melixicam, that's the same as Metacam. I saw that same phrase on a quote when my civie had one of his cystitis episodes and had to insist twice on something else. As others have said buprenorphine is good. Another more recent drug is Onsior, which is OK for short term use only (3 days) for pain relief.

Re: 11/12 Hershey AMPS(300)PMPS(175) Yippee Skippy!

Hi Libby,
It looks like you have lots of reading to keep you busy! I hope you'll find a dental vet with whom you are comfortable. Nice that Hershey has decided to come down a bit with his bgs.

Have a good evening and don't spend the whole night reading!

Ella & Rusty

Re: 11/12 Hershey AMPS(300)PMPS(175) Yippee Skippy!

Good luck with Hershey's dentai

Re: 11/12 Hershey AMPS(300)PMPS(175)+2.17(221)

- Hey, Wendy - Sure was tickled to see a little blue, even if it was short-lived. Hoping it returns soon!

Wendy&Neko said:

Another more recent drug is Onsior, which is OK for short term use only (3 days) for pain relief.

Click to expand...

I hadn't heard of that one, thanks, Wendy.

- Hey, Ella - Good to see you. It is a lot of reading, but I think it's starting to sink in. Looking forward to having a vet where I can feel like we're a team. Know what I mean?

- Hey, Kat - Thanks! Kind of dreading it, though.


**+2.17 (221) - fed - Had not finished PMPS meal

Re: 11/12 Hershey AMPS(300)+2(327) +7.33(218)

Doug N Libby said:

- Hey, Jill - Thanks for the links. I'm trying to learn so much new stuff that I think my ears are bulging! :lol:

Click to expand...

you're welcome!
there's always new stuff to learn! i don't think a day has gone by since i joined this board that i haven't learned something new! :mrgreen:

+5.5 (224) - Hadn't eaten much of +2.17 meal, so sprinkled treats on top and he ate ~1/2 of it. Oreo came sniffing around, so I went and got him a turkey treat. As I was feeding it to him with my left hand, Hershey kind of bit my right index finger. I didn't realize there was chicken treat dust under that nail, but he did! :lol:

Going to bed feeling a little discouraged with him in these numbers we don't like. AMPS INC to .5u

Goodnight and thanks for hanging out with us today!