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4520139 tn?1355852769

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.
54 Responses
874521 tn?1424120397
COMMUNITY LEADER
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.

-
874521 tn?1424120397
COMMUNITY LEADER
hi and welcome, good for you for searching for some answers before proceeding...I am surprised you are getting such different assessments of kitties teeth, tell me were xrays ever done? why is he needing so many extractions? Were FORL's every mentioned....re exposed root, this kitty is in alot of discomfort. and all of them didn't recommend brushing..that is very very surprising, greenies will NOT keep the teeth clean. I have just gone thru extensive dental work with a cat dental specialist....and what a surprise I got compared to the routine cleanings and findings from my regular Vet...post back if you are still looking for some help with a decision and I will be glad to help...if I understand correctly you are at your parents now and seeing a Vet in that city, when would the procedure be if you decide to have it done there? Is there anyone you know whose used this Vet and is he highly recommended? to tell you the honest truth this second one sounds more competent/caring despite the costs difference...however I will say for that many extractions...it is much better for kitty to be under the care of a dental specialist...but than that raises the cost again...
post back and I'll go  into more detail....♥
874521 tn?1424120397
COMMUNITY LEADER
If possible also tell me what EACH Vet is planning on using for anesthesia and pain control following, that will give me a good indication of which Vet I would recommend...
152660 tn?1291759171
With the blood panel, my vet did the "senior" blood panel which was about $180 as a baseline when they were around 6 or so.  But, that doesn't have to be done now, maybe in the future when you don't have the teeth issue to think about.  

I have had all 3 of my cats in for cleanings and they have been around the $500 - $700 range.  One was more because of the number of extractions they did because the cost of each ranged from $50-$200 depending on the tooth.  

IMHO I would probably go with #3 if only because you may be able to go longer without kitty having to have another cleaning.  

I wouldn't go with #1 just because he wouldn't give you a straight answer on cost.  They should be able to give you a cost breakdown of each tooth that they think may need to come out and all of the anesthesia and equipment costs as well.  He also seemed a little too "I'm too good for that" with your request which would make me think that he may not be as gentle and loving with kitty as he should be especially with him being under anesthesia and vulnerable.
4520139 tn?1355852769
Hi Opus88, and thank you for your quick response to my post from last night.

--When: I need to make a decision TODAY (surgery is tentatively scheduled for tomorrow morning if I proceed with #3). I will call them sometime in the next couple of hours to discuss the blood test results. I can bring up any issues then. Yes, I am in my parents' home now (in CO) - where vet #3 is located. I live in FL, which is where vets #1 and #2 are located.

--Xrays: no, never done by any of the three vets. #2 and #3 said this would be done under anesthesia.

--Why so many extractions: receding gums, gums not healthy. Canines have started to protrude out of the mouth, hanging outside his bottom lip (this actually started more than a year ago, but when I mentioned one protrusion to vet #1 from 2011, they did not see it as a problem. The second canine has started to protrude in the last couple of months or so). Vet #3 says protruding canines due to the extreme gum recession. Infection in gums around molars. No mention of FORL (and from my research, his gums look nothing like the photos I've seen of FORL).

--recommendations from clients of vet #3: I don't know anyone who goes to him. I can ask my neighbors - it is possible they use this dr.

What did you mean by this, Opus88? How were you surprised?
"I have just gone thru extensive dental work with a cat dental specialist....and what a surprise I got compared to the routine cleanings and findings from my regular Vet"

And when you say "this second one sounds more competent/caring despite the costs difference" you are referring to #3 with the higher price? (not #2 that was fussy about the airline note, right?)

I'd also like to hear your opinion about the markups - a sign of the vet's priorities? Correct me if I should not make this connection (but a former teacher of mine used to say, "a person never cheats in just one area of their life") --> Fair pricing and integrity go together. A lot of people would see this price tag and decide not to pay for treatment of their pets. I am not one of those - I see this price tag and question whether it's fair. I can understand charging more for the services rendered (if he is a rock star dental surgeon), but $22 for a liter of saline?
4520139 tn?1355852769
Here is the info you requested on anesthesia and I've included the duration and price if it was listed on the quote. (By the way, are you a vet?)

Pre-anesthetic medication ($26.13)
Intravenous anesthesia ($47.03)
Anesthetic monitoring (electronic) per hour, 45 min ($37.23)
Gas Anesthesia 45 minutes ($66.68)
Gas anesthesia additional minutes, 45-85 depending on final decision about extractions ($59.85-$113.05)
Local anesthesia ($30)

Pain: buprenorphine HCL ($52.50)



Re: Vet #2, I did not get a written estimate from him (and obviously no estimate from vet #1 who didn't even notice gum recession at all). I guess he assumed we'd go over that when I brought my kitty back after the holidays to do blood work. All the info above pertains to the estimate from vet #3.
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