Dental safety for a cat with mild asthma

[baztien]

Hi everyone! Hoping someone can chime in with some thoughts. My cat went into diabetic remission last year after 3 weeks on insulin and her BG levels have stayed relatively stable. Our vet noted that she had teeth that should be extracted and to think about scheduling a dental in the near future, mainly because dental issues can often cause cats to fall out of remission.

(photos of her teeth), (recent lab work)

We currently are scheduled for a dental next Wednesday, but my cat had asthma attacks on 2/16 and 2/29, with some light coughing (4 total small coughs, not a wheezing fit) 2 days ago. We had a check up with our vet yesterday and he seemed a little wary of putting her under anesthesia with the asthma attacks. However, with her history, she's always had an attack here and there since she was young. I'd say she'd have a couple a year. The previous attacks before the February ones were in November of last year. I've brought this up with other vets and none have recommended putting her on medication since the attacks are infrequent.

He gave me two options, we either monitor her for the week and proceed with the dental, or try using an inhaler with her and see if that improves things (although we could potentially have no asthma attack for many more months again without an inhaler if patterns follow how she's always been). Because of her diabetes, we also have to be wary of steroid use, so he'd only recommend the inhaled, low dose steroids.

I'm a bit lost on how to decide. Looking at the photos I took of her teeth yesterday, it does look like she could use the cleaning. I see what looks like tartar/plaque building up on her back teeth and her gums do look inflamed on the top row. Her breath is a bit stinky and she's become a messy eater. At the same time, because she's older, has had the recent asthma attacks, has early CKD, I just feel like a lot of things aren't working in her favor. Reading about anesthesia, people tend to say the risks are so low if your cat is healthy, but what if they're not?

Behavior wise, she's eating regularly, good litter habits, extremely playful. The only thing is she does crouch at times before settling down and I can't tell if she's in any pain from something.

I know everyone says this about their pets, but she's literally my biggest priority in life and if anything happened to her during what's still an elective procedure, I can't tell you how devastated I'd be. If we go ahead with the dental, our vet did offer to do updated in house bloodwork and radiographs before the procedure.

Thanks so much if you've read this. Open to any thoughts or advice.

 

[Furballsmom]

Hi
My angel Poppycat has a lot of health issues going on, --although not asthma, and I kept up with his dental work. To my mind, the risks to her teeth and also other organs are serious considerations, and I honestly have never considered it elective.

 

[baztien]

Yeah I wouldn't have called it elective but that was the word my vet used yesterday! He said her teeth issues aren't an immediate emergency but to me, looking at the photos, they look less than ideal.

 

[lizzie]

My Mystery has asthma.She has always refused the inhaler,so I sneak my nebulizer (albuterol) close to her when I'm taking a treatment and it helps.When it doesn't,off to the vet she goes and gets a depo medrol shot,which works wonders.She too was in need of a dental,and I asked my vet about the asthma.He said he may have to give her another shot during the procedure,we went ahead and scheduled hers and she did great.No shot needed and she's doing great.I just wanted to share with you my girls experience and the outcome.

 

[baztien]

Thanks Lizzie! Lily unfortunately can't have steroids due to her diabetes. Just wondering, what were the symptoms and frequency of asthma that led you to need some medication? It's hard to find info about that! Since she tends to have episodes and then months pass before the next, to me, a non-veterinary professional (and also to her previous vets) it seems like we shouldn't use medication, but I also want to make sure she feels her best.

 

[lizzie]

She coughs,sneezes,breathes hard from time to time and she just doesn't act like she feels well.That's when I know it's time to see Dr. Shawn.Her favorite thing to do is sit in the picture window in the sun and watch the birds,but when she's feeling puny,she stays on my bed. I have copd so I'm using my nebulizer every day.Sometimes she will sit for a few minutes and breathe in the mist and other times not so much,but some is better than none,and I can see the difference.She had her shot about a month ago,and is doing so much better.Her breathing is good as is her appetite and she's out and about the house with my other cats,claiming her spot at the picture window.

 

[silent meowlook]

Hi. Your vet is correct about the inhaler steroids as opposed to systemic steroids ( injectable or oral ).

With cats and teeth, it is what you don’t see that is more of the problem. Cats frequently get cavities under the gum line that are painful.

It is best to find a veterinarian that has dental X-ray and is experienced in feline dental diseases. Cats are very different than dogs.

Anesthesia is always a risk. Even for young animals. Mostly it is all up to the equipment and ultimately the person monitoring the anesthesia, not only during the procedure but afterwards. Most anesthesia deaths occur during recovery.

Places vary in their protocols, knowledge, anesthetic agents and personnel. The average general practice veterinary hospital does not have the veterinarian involved in the dental. Usually it is an assistant or two if the place is good, or an RVT if there will be extractions.

Some places just have one person preforming the dentistry and monitoring anesthesia at the same time. This is bad for many obvious reasons. There are hospitals that will have one person doing the dental while another sees appointments. More rare in general practice is a veterinarian also present.

Many things can go wrong and it is important to know that the veterinary team can handle it if they do.

I worked at a specialty hospital where a neurologist had just completed brain surgery on a dog. The dog was left alone a couple of minutes and coded. During a code, everyone should know their job. I immediately started breathing for the dog. The rest of the team scrambled badly. The veterinarian called out for the paddles ( used in CPR to shock a patients heart back into beating) when they finally got the machine out, they couldn’t find all the parts and nobody knew how to use it. The dog died. I think the dog would have died anyway, but can’t know for sure. This was a high priced specialty hospital specializing in surgery, neurology and internal medicine. Everyone could have done better. The sounds of the family crying stayed long after they left. The neurologist quit over it.

So, you just don’t know what you are getting regardless of what you pay. That being said, I would still opt for a dental specialist for extensive dentistry like extractions on a cat.

Ask questions. Ask what their protocol is, and what anesthesia they will use. Ask if the vet will do the extractions or a tech. Ask what monitoring equipment will be used, what parameters will be monitored. If they just say an SPO2, I would look elsewhere. Blood pressure should be monitored throughout any anesthetic procedure. If blood pressure goes too low, the kidneys will be damaged and that is irreversible.

I am not trying to scare you off doing the dental. From the pictures, I would imagine your cat is painful and there is decay and tooth loss under the gum line.

 

[stephanietx]

I have an asthmatic cat in need of a dental and I spoke with my vet about this just a few weeks ago. She told me that she doesn't worry about an asthmatic cat since they are already intubated if something were to happen. She said that she has few issues with asthmatic kitties. She does have concerns for kitties with other health issues, but not asthma kitties.

 

[baztien]

Hey S silent meowlook I appreciate the thoughtful response. These are all things I was thinking about. I had asked my vet about it a while ago and here is what he said:

"We administer IV fluids to every anesthetized patient and take pains to maintain their blood pressure and reduce stress to the kidneys. We also closely monitor all patients while under anesthesia with multiple parameters including: blood pressure, end-tidal CO2, oximetry, ECG, respiration, temperature and more. We keep them under a warm-air heated blanket, as well. For very excited patients, we will also have them on gabapentin prior to coming in.

Dental radiographs are taken during the procedure, but can only be done on anesthetized patients. Of course, we only extract teeth when appropriate. All healthy teeth are left in place. We base the decision on visual evaluation, dental radiographs and probing with dental instruments."

Also I'm almost positive he would be the one performing the dental. And this is at a cat only clinic. I also included the estimate they sent over. Because of her recent asthma attack, he offered to do a chest x-ray the morning of the procedure, in addition to some extra same day bloodwork.

Her December bloodwork included a Cardiopet proBNP test which came back as 76 (normal range 0-100). I guess my big concern is her having some undiagnosed heart issue, but should the proBNP test suffice for catching that? I might make a separate thread for that question.

 

[silent meowlook]

Looks like they are good. So glad it’s a cat only practice, because cats are so different than dogs. The only thing I would question, just looking at the estimate briefly, is why only quantity of one for the pain meds? Other than that, it should be good I think.

I think the Pro- BNP has an 85% accuracy.

 

[baztien]

Yes I've really liked the switch to cat only! What do you think the quantity should be instead? I'm not totally versed on reading these estimates.