hi kathy. you asked me to stop by to weigh in on the dental...
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.
alex had her predental bloodwork drawn the morning of the dental because a vet visit is such a traumatic experience for her, me, and anyone in the vet's office who has to handle her. i can certainly see a benefit to having them done prior to the morning of the dental.
2. are predental antibiotics required?
No, but they might suggest it based on the pre-dental bloodwork.
if they may suggest predental abs based on bloodwork... the bloodwork would have to be done before the morning of the dental.
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.
i'm not sure if a predental xray of the jaw is the same as predental xrays. just ask. personally, i would want predental xrays done of the whole mouth just so the vet would know what's going on in the mouth before starting the dental. i also asked for postdental xrays to be done just so the vet can see if all the mouth issues were addresses during the dental (eg. no roots left behind).
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?
anesthesia... isoflorane or sevo is what you want.
ketamine... i don't know what to tell you since ketamine has been recalled. i'd ask on health for a ketamine alternative.
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?
having bupe on hand is good if there are extractions. check with your vet about when they should be administered.
6. do they monitor blood pressure?
Yes. They monitor blood pressure, oxygen, EKG, and carbon dioxide.
sounds good.
7. if extractions are required, will they call you first?
I didn't ask, but I will.
not sure why this would matter. when alex had her dental it was understood they would perform extractions if necessary.
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.
all i can tell you is my vet recommended a half dose to no dose of insulin in the morning, depending on the numbers. in other words, if alex was low... skip the shot.
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?
it seems to be a matter of opinion. when alex had her dental jojo didn't think fluids were necessary for alex, but they did have an IV catheter in place just in case. however, since then i've read some things which suggest others may have different opinions. here's a post from dr. lisa on dentals:
Dentals - General comments
Posted by: Lisa dvm (IP Logged)
Date: March 8, 2005 10:32PM
Some thoughts on minimizing any complications from dentistries.
1) I like to have antibiotics on board before the dental procedure ends up showering the body with bacteria. Any cleaning procedure will unleash a lot of bacteria into the system where it can damage kidneys, heart valves, etc. I recommend that the cat get a dose the night before, if possible, but at least an AM dosage the day of the dental. This usually means picking up the antibiotics the day before the procedure or asking your vet to be sure to give the antibiotics upon the arrival of your pet to establish a blood level pre-dental.
2) I recently attended a seminar on Anesthesia and Critical Care where the speaker strongly emphasized the need/benefit of lots of fluids associated with the procedure. I like to start my cats on an IV drip a few hours prior to the procedure, during the procedure and for a few hours after the procedure. Dr. Paddleford also recommended running the fluids at a rate that is much higher than the standard very low rate that most vets run. He stated that "overloading" with fluid was not a factor even at his higher rate.
Anesthesia, dehydration and hypotension results in lowered kidney perfusion and damages valuable nephrons (kidney tissue). Dr. Paddleford stated his opinion that even the most basic of anesthetic procedures can result in nephrons being damaged and could not stress strongly enough that fluids are critical to any anesthetic procedure.
3) Always ask your vet if a catheter is routinely placed. If the answer is "no", I would worry about the level of care being practiced. No cat should undergo a lengthy anesthetic procedure without IV accesss in the event that the animal goes into cardiac arrest.
4) I want to mention also, that any dental done without anesthesia is not only a waste of time, but cruel to the animal. There is no way that an adequate exam/cleaning can be accomplished in an awake animal. In addition to this issue, all an 'anesthetic-free' dental results in is a false sense of security in the pet owner that their pet's dental needs have been adequately addressed which is very far from the truth. The tartar that is seen on the outside of the tooth - that may be removed during an anesthesia-free dentistry - is not a problem with dental health. It is the area UNDER the gumline that is the issue and no awake animal is going to let a human probe under the gumline on the inside and outside of every tooth. Removing the plaque does serve some purpose in that it removes bacteria from the mouth and this is a good thing with regard to seeding the rest of the body with oral bacteria, but this issue is not pertinent to dental health.
Anesthesia-free dentals offered by lay people are illegal in CA and with very good reason.
Lisa, dvm
http://www.felinediabetes.com/phorum5/read.php?8,73506
hope this helps...
