Teeth Extractions - HCM and Lymphoma

Good morning, all!

Sparkle (10 YO, DSH, male) was diagnosed with mild/moderate HCM (stage III or IV heart murmur) about two years ago. This was found through a routine EKG before a regular dental cleaning. I panicked and chose not to proceed with the dental cleaning. He has been on heart meds and shown no symptoms of the HCM over the past two years.

Now, Sparkle has Lymphoma and/or IBD along with the HCM. Diagnosed about one month ago. He's done great on the meds, with the exception of one eye infection, succinctly treated with antibiotics and drops.

At the time of this diagnosis, the vet strongly suggested that he badly needed a cleaning, and probably several if not all of his teeth extracted.

I can tell now that he's in pain from his mouth. Preferring wet food, chomping on kibble and spitting it out, turns his head when I try to scratch his jaws. And, quite frankly, they just look bad.

So, I called the vet this morning to discuss the procedure and she should call me back today.

My question is: Has anyone on TCS put an older cat under general anesthesia with a heart condition and/or cancer?

My concerns: Obviously pros and cons. Risk of infection after surgery since his immune system is already compromised. Risk of not waking up from anesthesia. Quality of life now versus with a mouth void of teeth. (I know that oral health is vital to a cat's wellbeing and health.)

Thanks, y'all!

Lauren & Sparkle

SparkleTheCat said:

My question is: Has anyone on TCS put an older cat under general anesthesia with a heart condition and/or cancer?

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Hi Lauren!

There's a sure-fire way to get answers for all your concerns about this: put Sparkle's story and your dilemma in front of the experts in all-things-heart-kitties.....a group of people numbering 2500 who have been managing their cats' heart conditions collectively for the past 14 years. You'll find them right here: Support group for Feline Hearts HCM. I suspect that group will have dealt with dual-diagnosis cats as well.

IMO, the status quo is just not an option...having experienced dental pain firsthand (and, most people have not), I know just how debilitating it can be. I know I'd be asking whether/not it would be advisable to have a general practice Vet do the surgery or to seek out a specialist, what special precautions should I ensure are in place before/during/after the surgery etc. (You'll find a list of well-established practices for feline dental surgeries here Dental Surgery   and, if you would like a broader coverage of the issue - including the particular type of dental issue affecting cats some of which only detectible by x-ray - that would be here: Dental Problems.) There may be other recommendations to be had from those people, too.

Hope some of that helps.

I am so very sad and sorry to hear of Sparkle's health probems. :rub: This is a very difficult spot to be in. :shame: I think that not getting those bad teeth extracted could be a very painful daily occurrence making his quality of life very poor. I don't know - it is such a tough situation to be in but I am sure there are others' who have been in your shoes - many of them. :nod: I just think at this point, you have to look at the quality of his life and possibly take the risk of the dental in the hopes of him making it through and being pain free in his mouth. Sparkle.

Just spoke with the vet and she feels comfortable doing the extractions. They use gas anestheisa (no ketamine) and local lidocaine. Of course she told me this is more tricky with an HCM cat, but the benefits would out weight the risk at this point. Espeically since he is doing well on his lymphoma treatment. July 1st is the big day. Please send vibes to my little black and white cookie

If Sparkle were my cat, I would opt for the dental surgery. If he is showing such obvious signs of pain, then it's a quality of life issue to me. Yes, there's always a risk with anesthesia, but given that his conditions are known, the risks can be mitigated as much as possible before, during and after. Many vibes for Sparkle on July 1st.

As always, thanks, vball91. I am hoping he doesn't loose too much weight between now and then.

Now that I know he's not happy, I want to get it done ASAP, but currently the vet doesn't have any earlier appointments.

He came through the same cleaning/extraction procedure 3 years ago perfectly fine, so I'm hoping he'll do great this time. I'm going to be a wreck until that afternoon when I can bring him home.

Like I said earlier, he will be boarded at the vet Thursday - Sunday nights while we are out of town and the procedure will be Monday morning around 9:30. Since it will have been 4 days since seeing him, I will go to the vet's early that morning so I can cuddle with him before the surgery. I'm considering waiting at the vets office during the procedure. Just in case. Then come home, get a little sleep and pick him up in the afternoon. . . does that sound too obsessive? I don't think so.

Yay! I got his appointment moved up to June 26th! I used a syringe to feed him last night and he ate so much better - and seemed to enjoy it, he came back for more. So he'll have the procedure next Wednesday morning, come home for one night and then go back to be boarded for a few days. I'll be on vacation on that day, so I can be home all day with him. I'm still very very nervous. . . scared to lose my boy. But I do feel like the sooner he can get his chompers fixed, the better, at t this point.

I think that's great news. I'm glad the syringe feeding helped too. I think you're doing a great job for Sparkle.

Thank you, vball. I've felt so helpless through out this whole ordeal. I am usually the type of person that has all the answers (or does research until I find them!) Friends are constantly asking me for advice on everything under the sun - and I usually have something to tell them! It's been hard for me not having any answers for my Sparkle. But, we do love him tremendously, and I know, in some small way, that helps them feel better.

Picked up Sparkle's refills from the vet today, and she went ahead and gave me his antibiotic and pain meds for the dental surgery. She said we could go ahead and give him pain meds now if we think it will help him. My husband texted me at work to say he had given Kitty his meds. And was so proud of himself - even telling me that he held his scruff - which he has always been hesitant to do. Sparkle definitely felt better. He ate without me encouraging him Still not as much as I would like him to eat - but an improvement.

Also, my cat is addicted to cat wheat grass. . . it's crazy. But he likes it, and it makes him happy

My cat loves cat grass too!

Just a couple of things, I'm glad your vet is working with and being proactive. On the pain meds, I think you've been on this site long enough to know about the dangers of NSAIDs like Metacam. I hope he's getting a safer pain med like buprenex?

Also about the use of antibiotics after dental cleaning/surgery, some vets routinely prescribe antibiotics, but that's somewhat controversial I think. Vets (and people doctors too) use antibiotics too frequently. Given that antibiotics often have adverse side-effects, I am a proponent of using them judiciously, i.e. using them when there is an actual bacterial infection, not just in case. Obviously, it's your choice, but I would discuss it with your vet. It's good to have the antibiotics on hand in case an infection develops after the surgery, but are they really necessary until then?

Glad you were able to move up your appointment.

Ordinarily, I'd advised you to try to get a pet sitter so he wouldn't have to be boarded, especially so soon after his dental.

But given his health issues, I'd probably rest easier knowing he was in a place where he could get the best possible medical care, should the need arise.

(Don't forget to leave with the place you're boarding such essentials as:  his favorite toy, something smelly of yours and your phone number/permission slip to initiate emergency care (if the vet requries this).

Vball - He's definitely not on Meticam. It's the bupro....one. The name escapes me right now. As for the antiobiotics, just like with a human with a heart murmur, they are common before dental work. My mom, for example, has to take Ammoxicillin for 5 days even before a routine cleaning. Also, his immune system is compromised from the prednisolone management therapy for his lymphoma/IBD. So, I don't have any issue with that. But, thanks for the input.

Ritz - Thanks for the tips! He's been boarded before, so we're all OK with it. I don't trust anyone else to give him meds twice per day and keep an eye on him except for the vet techs at this clinic.

Oh good, buprenex/buprenorphine is a good pain med. I'm also glad to hear you are on top of the antibiotics question. I do agree it will be good to have the vet techs watch over Sparkle while you're gone. As usual, you are doing a great job anticipating the possible issues. You are such a good kitty mommy.

Hey y'all... I'm really having second thoughts about this surgery Wednesday. He hasn't showed much interest in food for a few days ( syringe feeding 30cc 3 x day) but I wonder how much of his inappetence is the lymphoma or his teeth. I am worried that this dental procedure won't make him feel better, possibly worse, and won't help his appetite. I just don't know. Should I ask the vet to examine him (with me present) before I make a decision? Should I just let them board him and observe him while we're gone? Maybe fluids and an appetite stimulant would help? I am considering asking to do the Lukeran every 4th day instead of every 3rd day.

Thoughts?

Just FYI, we cancelled the dental surgery. In mu gut I know it was the right thing to do. Wednesday morning he was so lethargic, we had almost decided to let him go. It was an extremely hard conversation for me and my husband to have. He decided it wasn't time for Sparkle to go and he was right. So we went to the vet anyway bc I knew he had to be dehydrated. Luckily we had to see the nice vet. So, 200cc of fluid and one appetite stimulant later, he was back to his old perky, chatty self. What a relief. And what a roller coaster of a day. Hours of crying and wondering and questioning.



I took him in the next morning to be boarded and....he had a 104 fever. I was devastated. And our b!tch of a vet was not kind. She just has bad bedside manner. Anyway the next day his blood work was OK except for his WBC and his temp was normal again. So he's on antibiotic now... Probably a urinary infection.



The vet thinks the Leukeran is not the culprit for his loss of appetite. She said "it's probably just the cancer." (As blunt and cold as possible). However the super nice and wonderful vet on Wednesday said she's seen many kitties go for approximately one month on Leukeran and suddenly lose their appetite. The b!tch vet did decide to take him off the Leukeran for now. And I'm good with that. I would rather him have less time with us and be comfortable than be sick from another drug.



It's been four days since we've seen our boy and we miss him so much. I'm so anxious to see him tomorrow bc the vet is rude and I'm scared she will have more bad news.



Erich and I have now talked about when we will make a decision on letting Sparkle go without suffering, which takes a huge weight off of my shoulders since now we'll be on the same page.



I guess I'll post tomorrow if I have other news or questions. Which, I hope I don't.

The vet did a "free" ($35) ultrasound today, since the radiologist was already there.  (I was SO THANKFUL for that!)  But, his two largest lymph nodes have increased from 2.5cm to 4.5cm over the past six weeks.  He was sent home with basically the same prognosis as before. . . touch and go. . . but he's gotta eat!!!  He has meowed constantly since we've been home from the vet, he's quieted down now, napping.  Not sure if he wants attention, is in pain, is confused, hungry - just like having a baby!  He did eat a tiny bit of moistened dry food. . . but I will probably syringe feed him again tonight.  Without the Lukeran, I'm hoping his appetite comes back. . . but I'm not holding my breath.  I don't know why I was thinking he'd be "healthy" when I picked him up this morning.  I guess I was just so anxious to have him back in my arms that I kind of forgot why he was there in the first place. . .

Thanks for the vibes LDG!  They were much needed.

With a heavy heart, I feel your pain and anguish. I know it all too well as I am sure there are others on site here that know it well too. It is absolutely the worst roller coaster ride on earth - the ups and downs when one of our furkids is sick. Enjoy (as much as possible ) the moments you will have right now with him. Who knows..... every time I thought "this is it" with my :heart3: dog, Wilbur, he seems to rally on. Some say that he has "nine lives" like a cat. They are so much like having a "real" baby. :nod: We love so deeply and wholeheartedly. MEGA, mega, mega vibes for you and for Sparkle.

Oh shoot, I'm sorry about the lymph nodes.

I'm sorry, I've forgotten... is he already on pred? Especially now that you're stopping the leukeran, maybe it'll help him feel better? :dk:

And Lauren really summed it up perfectly. It's such a roller coaster ride: the worrying, the wondering... I hope there's plenty of smiles left in this ride. :heart2: :sun:

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