Dental for Overweight Cat

[misty8723]

I'm pretty sure Swanie needs a dental, but he's awfully overweight and I'm concerned about the anesthesia.  How safe is it for an overweight cat to undergo this procedure?  My vet says they are more careful with them because of breathing issues while they're out, and (although I do trust my vet) that doesn't make my confidence level soar.  I love this little guy so much, just thinking about anything happening to him makes it hurt so much I just can't even get a breath.  I know it's not good to let his teeth get bad either, so I feel like between a rock and hard place.  He just had his check up and blood tests.  We are waiting for the results for the blood test, but I thought I'd come see what you guys thought.

 

[vball91]

How old is he and how is his health in general? There are steps you/the vet can take before and during the procedure. Anesthesia is always a risk, but as you said, so are bad teeth.

What steps are you taking to address his weight problem? I'm sure you know that obesity can cause other health problems in cats including diabetes.

 

[alicatjoy]

I work in a veterinary clinic that does a great many dentals on both cats and dogs. And, in the well over 2 years that I have worked at the hospital, I have never seen an animal have complications during or after surgery solely due to their weight. That being said, it is an anesthetic procedure and there are always risks. But, dental disease is also a risk and it can cause severe systemic illness if left untreated. However, it is always wise to determine whether the benefits outweigh the risks of surgery.

First and foremost, it is important to educate yourself. Ask questions - lots of them! I'd rather a client be a pain-in-the-you-know-what than either not care or be ignorant of what their pet will be experiencing when going under anesthesia for a dental cleaning (or any surgery). These are some of the questions I would ask, knowing what I do, if it were my pet:

• Are blood tests and an exam performed prior to surgery...the day of surgery? A complete blood count (CBC), electrolytes, and an internal organ function (IOF) should be run the day of the procedure. I have seen pets have normal lab values one day and then have their labs be off the charts the next. If kidney or liver values are high, I would postpone due to the potential risk. And, there should be no infection or imbalance of the electrolytes. An exam should be done so that the vet can listen for murmurs or respiratory issues prior to the pet being anesthetized. 
• What type of induction agent is used prior to anesthesia? What type of anesthetic is used? And, what type of post-op pain medication (injection) is given, if any? Ketamine is not high on my list of induction agents. I don't even like it as a sedative (DKT), but I find its use more beneficial there and safer than along with anesthesia. Propofol is used widely and is generally safe and I know there are other agents used as well. Isoflurane or Sevoflurane gas should be used to maintain appropriate anesthetic depth. These are human-grade anesthetics and are very safe when used properly. I believe in post-op pain medication for pets. I, however, do not agree with the use of Meloxicam in cats. It can cause renal failure and it is not worth it when there are other medications readily available.
• Who performs the dental cleaning? Is there a nurse monitoring at all times? What are they monitoring and how? Where I work, we have registered technicians who do the cleanings under the supervision of the doctor. The doctor oversees and performs extractions, but not the cleaning. As long as the RVT is trained, there should be no issue. However, the doctor should be present and a nurse should be monitoring throughout the entire process - from induction to when the pet is again sternal. Blood pressure, pulse ox, EKG, pulse, respiration rate, and temperature should be monitored with readings taken every 5 minutes. If the heart rate or blood pressure drops, the doctor can administer medication to assist in stabilizing the pet. There are a multitude of drugs, but any good vet will know what medication is appropriate in any given situation. (You mentioned that your vet would monitor more closely for breathing issues and this is a good thing, not a reason to be more concerned - your vet is taking necessary precautions. I'd be more comfortable and confident in that than in a vet that does too much to allay your fears.)
• What is their policy as far as notifying clients about issues that arose during the procedure or if extractions are necessary? If a pet has a reaction while under, we stabilize the pet and then call the client immediately to let them know. If anything happens, the client should be informed. As for extractions, we tell all clients dropping pets off for surgery to provide us with a number that can be called during the procedure should the need arise. We tell the client that we will contact them, but will need to hear back from them 5 minutes to okay the treatment plan. If not, we will not keep the pet under anesthesia longer in order to wait for their return call. Pets should be under anesthesia only for the necessary time and they should be kept at the lowest anesthetic depth as possible during the procedure. That being said, it should be a given that the pet will be at an appropriate anesthetic depth - not too deep and not in danger of waking up during the procedure. We then call clients as soon as their pet is awake from the procedure. We understand owners worry and want to alleviate that concern wherever possible.

There are other questions to ask as well. Perhaps the vet would prefer some weight loss prior to surgery. And, each clinic monitors differently once the pet is awake and alert. As long as the pet is healthy, being overweight should not be a reason not to do a dental. If there was a heart murmur or underlying disease process (diabetes, hyperthyroidism, renal failure) I would be far more cautious. And, in some situations, performing a dental is not worth the risk. But, your vet should be able to help you decide what is right for you and for Swanie.

If you have additional questions or concerns, please feel free to contact me. I will help wherever I can. But, pending any poor lab results, a dental on an overweight cat is something that can be done safely and without tremendous risk. Good luck and let us know how Swanie does regardless of whether he has a dental or not.

 

[misty8723]

Alicatjoy -

First off, thank you so much for such a detailed response.  I’ve read it several times already, trying to assimilate everything, and I’m considering getting a consultation appointment with the vet to go over some of the points.  My vet already knows that I’m a pain-in-the-tushy when it comes to my cats, and she is fine with it. She’s really great.

Swanie is somewhere around 8 years old probably, we got him from a rescue and don’t know for sure.  He’s a big cat, in general, solid body type, even without being overweight.  We had a blood test (Senior panel – Antech) done Saturday, and the clinic just called with the results.  Everything is “nice and normal,” with the exception of his cholesterol being a “little high.”

In the past, the vet has recommended we get another blood test the day of the dental, even if we just had one the week before, but I’ll make sure to bring it up if she doesn’t.

I don’t know about the anesthesia, but I will definitely find out.  The last time Swanie had a dental was 2010 and he had a tooth extracted. She sent us home with a pain medication – buphorion (I know that’s not spelled right). I believe they give an Injection there, and then provide the kind you squirt into their cheek area for home use.  Again, I’ll verify that.

There is a visiting doctor who does the dentals, and other minor surgeries, once a week.  If we like, we can actually make arrangements to meet her. 

When you drop off your cat, there is a form you have to sign. The options are that they will either call for your permission before proceeding if anything come up, or you can give them prior permission to do what they need to do in the best interest of the cat.  We always choose that one.  If they call me and tell me that such and so needs to be done, I’m going to say yes anyway, and I trust them, so I give them permission.  Money is not an issue in what we have them do.  Not that money is not an issue in general, just that my cats get preference over anything else we need it for.  We are currently going into debt over Cindy’s cancer treatment and I would do it all again in a heartbeat based on the good results we’re having so far.  I would do no less for my cats than I would for a person – they’re part of my family and deserve the best care I can give them. 

The office does call once the cat is up and alert, let us know how it went, when we can pick them up (usually at the end of the day before they close).

Again, thank you! I sincerely appreciate the information and it does put my mind at ease a bit.

 

[misty8723]

How old is he and how is his health in general? There are steps you/the vet can take before and during the procedure. Anesthesia is always a risk, but as you said, so are bad teeth.

What steps are you taking to address his weight problem? I'm sure you know that obesity can cause other health problems in cats including diabetes.

vball91 - Thanks for respoding! Swanie is around 8 years old (not sure exactly), and generally in good health.

As for the weight issue, yes I know it can cause other problems and it's a constant source of worry for me.  I know it's our fault he's fat, but getting him un-fat, sadly, is not easy

We have not been successful so far based on a number of factors – most of them our fault of course.  It has taken me years to finally get DH on board with not putting food in the bowls all day long.  The original intent of the dry food bowls were for Cindy to graze throughout the night.  When they first came to live with us (2005), she would wake me up several times in the night wanting food. I wasn't planning on giving them dry food, but I caved, and started putting some (carefully measured) out at night

Unfortunately, if it’s down for Cindy, it’s also down for Swanie.  Once the bowls were established, whenever either cat would come around begging, DH (who is home all day while I work) would fill the bowls!  Nothing I could say to him would get him to stop. He truly didn't think it was much.  I finally got him to agree last year to give them canned food instead of dry – and then Cindy got cancer.  She lost a lot of weight and was down to 6 pounds.  Now, when she begs for food, she gets whatever and how much she wants.  We've taken to putting the dry food on a small plate and picking it up when she's done.  It’s a challenge because if Swanie hears food being distributed (which is a given), he’ll be right there. So, we'lll put a few kibbles on a plate for him, and then try to keep him away from Cindy's food  – either while she’s still eating or after she walks away.  Sometimes that's more successful than others, and I just don’t know about DH at all.  I think he's still giving Swanie too much.  They each get about 1 – 1.5 ounces of wet food 3 times a day.  Cindy gets food whenever she asks for it.   I’m less bothered by giving him extra wet food than dry food, particularly since neither of them finishes it all. 

One big problem for me is that I've been unable to get anyone to tell me exactly how much I should be feeding him, based on giving him wet and dry. It's easy to figure out wet OR dry, but what if both? Plus, I have a fear of not feeding him enough and causing him to lose too much or get sick from that.  Basically, I'm a worrier.

So, the weight management issue is a work in progress.

 

[vball91]

I can see the difficulties! A good way to approach weight management is to go by calories. That way it doesn't matter if you feed wet and dry. Just count calories. Most adult indoor neutered cats need about 20 calories per pound per day. The calorie counts should be on the bag/can. If not, you might need to find it online.

Start feeding him the calories for his current weight, then start GRADUALLY reducing his calories each week until he's at his optimal weight. Good luck!

 

[misty8723]

I can see the difficulties! A good way to approach weight management is to go by calories. That way it doesn't matter if you feed wet and dry. Just count calories. Most adult indoor neutered cats need about 20 calories per pound per day. The calorie counts should be on the bag/can. If not, you might need to find it online.

Start feeding him the calories for his current weight, then start GRADUALLY reducing his calories each week until he's at his optimal weight. Good luck!

That sounds like something I might be able to actually figure out! Thank you for the tip!