1/25 Kitty AMPS 95 - Dental questions again!

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Kathy and Kitty

Kathy and Kitty

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Yesterday: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=3872

Finally got to speak with the vet who will do Kitty's dental+xray followup. Before I hyperventilate, could someone help me understand whether the answers I got are good ones?

Here's the other info:

1. is predental blood work required?
They would like to do bloodwork on Kitty the morning of the dental.

2. are predental antibiotics required?
No, but they might suggest it based on the pre-dental bloodwork.

3. will xrays be done first?
Yes. We need a digital jaw x-ray to follow up on the possible cancer we saw last fall.

4. what kind of sedative and what kind of anaesthesia are used?
For anesthesia, they used ketamine and valium to induce sleep, then gas to maintain it. I asked if there was an alternative to ketamine; he said they sometimes use mostly gas with patients they have reason to be concerned about.
Isn't ketamine a no-no?


5. what pain killers will be used and at what point?
They send kitties home with bupe after extractions. I think I could get some bupe in any case, but I didn't ask that specifically.
When SHOULD painkillers be started?

6. do they monitor blood pressure?
Yes. They monitor blood pressure, oxygen, EKG, and carbon dioxide.

7. if extractions are required, will they call you first?
I didn't ask, but I will.

8. what is their procedure for diabetics; ie should insulin be given in the am and if so just partial dose or ? and will they monitor bgs at all?
When I asked about their protocol, he suggested no insulin the morning of the procedure. I told him I might adjust the evening dose as well, since there would be no food after midnight.

I asked about checking Kitty's BG during the procedure, and he said they could run a catheter and give fluids, and be ready to provide glucose drip if warranted.
But fluids aren't necessarily required, right? Only on as-needed basis?

This dentist is the only one in the area with the digital x-ray equipment we need, so I want to make it work. How does it sound to others?

By the way: When I told him we home test, he was surprised that I was able to poke successfully -- said they have a couple of people who are trying to home test but not having success poking. (I will bring FD resources with Kitty, for sure!) He said that they also are working on getting a couple of their patients off insulin.

Thanks, everyone. Otherwise, things are fine in Kitty-land. AMPS a little higher -- but I won't worry about that, because my worry machine is busy working on the dental issues. :mrgreen:

p.s.

For anyone who missed it, Monique (&Spooky) wrote a wonderful explanation of why our kitties have varying BGs, and why we wean them slowly off insulin. Would be a great stickie! :mrgreen:

viewtopic.php?f=9&t=3808&p=37734#p37734
 
Hi Kathy

when is ur dental for?

Kitty doing ok today? Had a good start for the day, hope he keeps it up :mrgreen:
 
I need to schedule Kitty's dental for the next week or two. I asked about February pricing specials, but he said they specialize in dental all year -- no sales! :YMSIGH:
 
1. is predental blood work required?
They would like to do bloodwork on Kitty the morning of the dental.

If they are going to do this, they should do it at least a couple days before dental, this gives time to get back from lab and to be aware of anything they may need to be aware of. Doing it morning of dental, sounds a little too late and a waste of money.

Do it, if it's been at least 6 months since last BW, but do it BEFORE dental day.

2. are predental antibiotics required?
No, but they might suggest it based on the pre-dental bloodwork.


Again, another reason why to have BW done before dental day. And depending on age and other conditions, it is sometimes recommended to do a 5-7 day course of AB prior - but check with others on this (even ask on health Dr. Lisa) as she has issues about AB's being given at all.


4. what kind of sedative and what kind of anaesthesia are used?
For anesthesia, they used ketamine and valium to induce sleep, then gas to maintain it. I asked if there was an alternative to ketamine; he said they sometimes use mostly gas with patients they have reason to be concerned about.
Isn't ketamine a no-no?

Ketamine is recalled, along with several others.
Ketamine et al recall

5. what pain killers will be used and at what point?
They send kitties home with bupe after extractions. I think I could get some bupe in any case, but I didn't ask that specifically.
When SHOULD painkillers be started?

My vet gives prior to and during dental. Depending on if extractions, etc. will be sent home with bupe.

7. if extractions are required, will they call you first?
I didn't ask, but I will.

They should let you know, especially if more than 1 or 2. As that will jack up the price and could be extreme.


I asked about checking Kitty's BG during the procedure, and he said they could run a catheter and give fluids, and be ready to provide glucose drip if warranted.
But fluids aren't necessarily required, right? Only on as-needed basis?


You want them to give IV fluids, to protect kitty's kidneys. The anesthesia can be harsh on them and you want to protect them.

Take a look at general health section and the post from peterdevonmocha on dental - I listed the things the estimate and what's included for Maui's dental.

That may help.....plus the post in general about what to ask, etc.
 
Yes predental bloodwork is a good idea..Moonie did get it at time of her 1st dental (she has had 2 in 2 yrs) She had ab's last time 2 days before.
Yes monitor BP,Heart,intubate,yes IV fluids, Moonie got isoflourene gas for anesthesia, and for pain buprenex..
They can monitor BG's & You should get AB's after, as when they work in the mouth, any bacteria & infection causing stuff can be released. Most give Clavamox...
They should call you to tell you if extractions are needed, and call you after it's done to let you know Kitty is alright!
The anticipation is worse than the actual dental, but it makes a great difference to the health of your Kitty!
 
Re: 1/25 Kitty +5.5 69, PMPS 79

Kitty's last bloodwork was in October, before his biopsy. It probably wouldn't hurt to have it done, though I really, really hate to put him in his carrying case twice.

I'm very concerned that this vet uses ketamine.

I'd also like to hear more about whether preventive AB is recommended. My sense from reading other posts is that it is not.

:roll:

Hillary, I saw the peterdevonmocha string that day, thanks.
 
Hi Kathy,

Wish I had some words of wisdom for you...but I can bump you up!

Have you tried posting on health too? Might get additional eyes for you. Good luck!
 
Thanks, Nancy. I'm bummed about this, because he is the only vet around with this fancy digital x-ray.

Kitty sure seems to be doing fine. I half wonder if this x-ray is really needed. The surgeon who was supposed to do a biopsy in October recommended it -- but he didn't even see anything to biopsy!
 
I agree with Hillary. If they need to make a decision about ABs in advance of the dental, then they need to run labs ahead of time. My vet is not a big proponent of giving ABs pre-dental unless they know there is an infection present. She does give ABs at the end of the procedure and did not send me home with any since there was no infection. In retrospect, I'm not sure I agreed with her.

I think you can ask that Ketamine not be administered. I would write this on the informed consent in very big letters and ask to speak with the vet or the tech that will be assisting to make the point.

My vet's practice gives 2 estimates for a dental. One is an uncomplicated procedure with no extractions. The other is their "high" estimate that included potential extractions.
 
I should be more focused on cost! Right now, I'm just concerned about his safety.

The vet said he uses valium plus ketamine to induce anesthesia, then gas to maintain it. I don't know whether that's sufficient.

Kitty shows no signs of any infection. He is doing great. Is ruling out infection the only reason to get labs in advance?
 
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