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)
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.
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....♥
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...
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.
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?
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.
I was willing to do the full blood panel (when I go to my human dr, I generally like them to be comprehensive, so I take the same approach with kitty), but I got the basic panel yesterday according to vet #3's recommendation.
I am surprised about the costs of your kitty's dental cleanings. The dental cleaning itself (if my calculations are correct) at vet #3 is $250-300. The extractions are priced out by tooth AND by additional anesthesia costs.
Vet #2 quoted $200 for the cleaning, including costs of anesthesia and additional for the extractions. Why would the price be so different?
Vet #1 never discussed the dental issues with me, but I think you are referring to #2 instead, who I saw last week in FL where I live. He did give me a rough breakdown that it would be under $100 or so for the extractions (he noted 1 definite extraction and 1 possible extraction).
When you say "IMHO I would probably go with #3 if only because you may be able to go longer without kitty having to have another cleaning." ... do you mean kitty wouldn't need a cleaning for awhile because he'll have fewer teeth? Or did you mean that #3 will be more thorough in the cleaning than #2?
By the way, the vet tech told me that the intravenous anesthesia would be Propofol.
propofal...another good choice.
My kitties have both had quite a few teeth pulled. One is 14 and his teeth are going bad and the other was sick when he was little and I think the meds I had to give him may have weakened his teeth. Each time they have had some of the bigger molars removed which are the more expensive ones since they are harder to get out and they usually use a stitch or two to close the gums.
I just remembered that they did xrays which added to the cost, so it would have been less without them.
With the fewer cleanings I meant that the vet would be more thorough and possibly not leave anything that should have been taken out minimizing the risk and uncomfortableness for kitty.
good post ali....thx for the input and info♥
Thanks once again, Opus.
A couple of things:
-the med supplies are several items in the bill (I gave the fluids as an example, but when you add up all the markups I am guessing the profit from supplies alone will be over $100). I realize human doctors do this, but maybe I don't mind it so much then because my insurance covers that but my research on kitty insurance showed it was not nearly as useful. Maybe I just have to accept that they're going to make money off of IVs, fluids, sutures, fluid drip set, anesthesia, etc.
($12.54 for IV catheter, $32.50 for "Catheter Placement, I.V.", $12 for fluid drip set, $12 for "T-Port Connection, I.V., $22 for Lactated Ringers Solution 1L). Also it seems they are charging per tooth for x-rays, is that normal?
-unfortunately (now that I have read your post recommending against this) they recommended an antibiotic injection yesterday, which my kitty DID receive. They said it would cover him for 2 weeks and with the dental discomfort this would be preferable to jamming something down his throat (my words, not theirs).
I am hesitating a lot right now because all the extra charges are making me question whether I can trust the doctor .... is that illogical of me?
I haven't called them yet for the blood test results, which they told me should be available at 10am (it's now 2pm). I was hoping to know whether to take him in now, or just wait to get home (and feed him soft food to keep him comfortable in the meantime). They haven't reached out to me either ...
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.
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. :)
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! :)
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.
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....
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.
You were so right - I was up half the night... part of the reason was that my kitty was hungry and kept waking me up to ask for food.
I'm going to ask about the roots when I take him in this morning. I'll also find out what kind of gas anesthesia - not that I'll have time to research and make any requests, but I like how you and Ali are so informed and would like to keep similar records and post the information here to possibly help a future mommy with a kitty needing dental work.
I am so stressed out - it doesn't help at all that I'm not even at my own home (why did I plan a 2-week holiday visit???). Parents are great, but I'm so used to living alone. They just started an argument with me and I'm thinking about cancelling and heading home early to find a new cat dentist.
Back to square one ... I decided to cancel the appointment and take care of this at home (it's too stressful on kitty and I to do this out of town). I'm going to go for another consultation with a new vet in FL - who will be Vet #4! - so you'll be seeing more of me on this forum.
From what I can tell after a brief call to the office, Vet #4 is all about client education (which I love) but is also quite expensive. I will speak with him personally tomorrow to get a clearer sense of his pricing. I just hope it won't be more than vet #3. Cross your fingers for me!
awww I don't blame you....always best to do what you feel comfortable doing and when things feel right. besides I really do think its best that the convenia clear his system before the surgery!!!
And being back at home kitty will feel more comfortable during his recovery....also the Vet will be right there for follow ups.......you and kitty..btw whats his NAME?? you both have a great Christmas now no stressing for a few weeks :))
Opus, yeah I feel guilty because I think my parents will be upset when I tell them I'm leaving on Xmas. But sometimes we need to accept that some people are not the right ones to support you through something they can't understand (they're not pet people, but they love Professor, my kitty).
I'm going to try to take him in on the 26th so he doesn't have to deal with the discomfort for too much longer.
And now, I'm going to do my own research on everything related to kitty health. I trusted his previous vet about the dental hygiene (the one who said brushing teeth = unnecessary and failed to recognize that a 'snaggle tooth' is a sign of a tooth dropping from the gum) and this is what happened. Time to be proactive! This forum has helped me to see that I need to do more.
I think despite the vet's advice, it's still my fault Professor has to get all these extractions. I could have still brushed his teeth even though they told me it wasn't necessary. Instead, I trusted them completely. Now my poor baby has to deal with my mistakes!
Hope you have a great Xmas too! Thanks for your support. :) I guess I'm a more neurotic kitty mom than I thought.
lol Professor...like that:) you'll have to post photos....
we're all neurotic kitty mom's and dad's on this site so you'll fit right in:)
Merry Christmas and good trip home♥
Hi again, Opus!
Well Xmas is over and I'm back at home and ready to take Professor in for his surgery.
I found another vet (let's call them Vet #4!) and while they're considered one of the most expensive around here, they appear to be more reasonable than Vet #3... how about that!
Here are the drugs they discussed with me:
--Anesthesia cocktail: ketamine, domitor, duprenex
--Gas: isoflourane (spelling?)
--pain: Metacam and duprinex (I remember you said no to Metacam and I brought this up with them. They said they've had a good experience with it, except they wouldn't prescribe it in some cases based on the blood work... maybe they mentioned if there was a liver issue? I can't remember exactly what they said. I also asked if I could request another drug if I wanted. They said that's no problem.)
I will probably schedule for tomorrow morning, although the vet I prefer is not in until next Thursday.