Possibly still in pain 3+ weeks after tooth extractions? Does anyone else see it or am I just crazy?

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jersharocks

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I am not trying to spend your money, but when my last GSD, who was older and had medical issues, had his surgery for melanoma I did want the board certified anesthesiologist.
I would feel far more comfortable with the anesthesiologist too. I'll gladly pay more for the peace of mind.

I'm also ordering one of those fancy Sleepypod carriers since they're crash tested and I'm nervous about the long drive with her. Better safe than sorry when it comes to my fur babies!
 

silent meowlook

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Definitely, if you can get a board certified anesthesiologist, use them. I hope this cures her pain. I looked at the videos and she looked, to me, painful.
 
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jersharocks

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Definitely, if you can get a board certified anesthesiologist, use them. I hope this cures her pain. I looked at the videos and she looked, to me, painful.
Thank you! I definitely think her teeth are bothering her and her gingivitis has gotten worse. I managed to get a photo today but she was not happy about me touching her mouth. She hid from me for a few hours afterwards. This is just 7 weeks after a cleaning:
PXL_20240612_173810691.jpg

The vet who did her extractions said her mouth looked great when she did the extractions and that was 5 days after the cleaning. When she saw her last week for a follow up, she said the gingivitis was back but "mild" but I think maybe she was downplaying it. This doesn't really look mild to me but maybe my definition of mild and hers are different.
 

Joxer

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Thank you! I definitely think her teeth are bothering her and her gingivitis has gotten worse. I managed to get a photo today but she was not happy about me touching her mouth. She hid from me for a few hours afterwards. This is just 7 weeks after a cleaning:
View attachment 478130

The vet who did her extractions said her mouth looked great when she did the extractions and that was 5 days after the cleaning. When she saw her last week for a follow up, she said the gingivitis was back but "mild" but I think maybe she was downplaying it. This doesn't really look mild to me but maybe my definition of mild and hers are different.
I really hope you and Contessa have a good resolution to this. In my experience, vets are way too eager to pull teeth, especially canines, which are deeply rooted. Multiple vets recommended extracting broken upper canines (the teeth weren't cracked, but were missing their tips) on two of my cats. I declined because of very bad experiences with past extractions, and those canines never caused any problems. One vet even claimed that the root was exposed (based on her reading of an x-ray) and the tooth would surely get infected and cause all sorts of issues. Nope. Not even after ten years.

At my past vet clinic, vets doing dental cleanings charged an extra fee for each extraction. Plus more extractions meant more time under anesthesia, and they charged extra for that as well. The incentive structure was really bad.
 
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jersharocks

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I really hope you and Contessa have a good resolution to this. In my experience, vets are way too eager to pull teeth, especially canines, which are deeply rooted. Multiple vets recommended extracting broken upper canines (the teeth weren't cracked, but were missing their tips) on two of my cats. I declined because of very bad experiences with past extractions, and those canines never caused any problems. One vet even claimed that the root was exposed (based on her reading of an x-ray) and the tooth would surely get infected and cause all sorts of issues. Nope. Not even after ten years.

At my past vet clinic, vets doing dental cleanings charged an extra fee for each extraction. Plus more extractions meant more time under anesthesia, and they charged extra for that as well. The incentive structure was really bad.
I seem to be having the opposite situation at my normal vet clinic. I looked at records for her cleaning in 2021 and they had written down 4 teeth that had problems but they only pulled 2 of them and they left part of one of those (doesn't say exactly what they did just says "closed extraction with division of 108."

Then she had a cleaning in April of this year and they wrote down 6 teeth with problems but only 5 were pulled. I have no idea why they aren't taking all of the teeth that are causing issues. She's diabetic and every painful tooth in her mouth is going to make getting her blood sugar regulated much more difficult.

I don't think there is actually a financial incentive to pull more teeth than necessary because every tooth they pull is a chance for something to go wrong and for them to end up sued. Maybe some vets are cheating their customers but they are the exception and not the rule.

Cat's jaws are fragile and every tooth pulled increases the risk of jaw fracture which is a costly mistake if the vet ends up having to treat it free of charge or pay a specialist to do it. This is why I'm going to a specialist to get the "healthy" teeth removed for her. The specialist has probably done full mouth extractions on hundreds if not thousands of cats so I know that Tessa is going to be in good hands.

What is more likely to be happening with your cat is that visually you can see only a few problems but once they get x-rays they see problems below the surface, just like with human teeth. Ask for copies of the x-rays afterwards and you can double check for yourself or take them to another vet for a second opinion. I can clearly see the issues on Tessa's x-rays that were taken before her extractions.

Also, just because you don't notice any problems doesn't mean that there aren't any. Cats are the masters of hiding pain. If I wasn't obsessively checking on Tessa since her diabetes went out of remission, I probably wouldn't have noticed that her mouth was bothering her. She LOVES food and will eat every bite of her food even though it hurts her.

I'm not saying that that is the case with your cat because obviously every cat is different and you know your cat but I am saying for anyone else reading the thread that no obvious issues doesn't mean that a cat isn't in pain. Sometimes you have to look carefully to find the signs.
 

silent meowlook

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I can honestly guarantee that vets don’t pull teeth to get extra income. Most vets have their technicians do it. But even so, everyone hates pulling teeth.
With cats, it’s what’s going on under the gum line, the part we can’t see that often is the problem. That is why radiographs are so important.
 

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I can honestly guarantee that vets don’t pull teeth to get extra income. Most vets have their technicians do it. But even so, everyone hates pulling teeth.
With cats, it’s what’s going on under the gum line, the part we can’t see that often is the problem. That is why radiographs are so important.
The one teeth cleaning where I consented to extractions, and there ended up being three of them, cost over $1,000. The subsequent half dozen cleanings where I did not consent to extractions cost around $400 each. Different vets, but same clinic and if anything, the pricing went up over time due to the usual medical cost inflation. I'm not singling out vets. Just saying that most people who bill for professional services are going to pay attention to the extra income potential described above. Auto mechanic, plumber, electrician, lawyer, doctor, or veterinarian. I wish it made a difference but I don't think it does.

There are abundant studies showing that human doctors change their treatment recommendations as a result of factors as trivial as drug industry sales reps bringing them free lunches and pens with the names of prescription drugs printed on them. My last allergist kept a television running in the waiting room that showed nothing but an endlessly repeating stream of allergy medication advertisements.

I have to conclude that if a vet tells me that my cat's upper canine needs to be pulled immediately or terrible things will happen, and I say no, and after a decade absolutely nothing has gone wrong with that tooth or my cat's mouth in general, that vet was incorrect in her diagnosis.
 
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jersharocks

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UPDATE: Tessa went to the vet dentist yesterday. She got all but her incisors removed. The vet did x-rays and cone beam CT to see all of the issues. Initially she was going to leave 2 canines and a premolar in addition to the incisors but there were no guarantees that those teeth would stay healthy so we opted to remove those as well. We opted to leave the incisors because she isn't showing any inflammation there and those are easier for a normal vet to remove if they become a problem. Plus it will allow her to keep her tongue in her mouth a little easier.

Aside from the travel to and from the vet which was stressful and made for a very long day (left the house at 4:50am, arrived home just after 6pm), we had a fantastic experience. We went to Your Pet Dentist in Nashville, TN and I 100% recommend the service. Every person we interacted there was super sweet and you could tell how much they love animals. They kept us informed of where Tessa was in the process with a text saying when she was going under and letting us know to expect a call soon to discuss treatment, then a text when she was out of surgery, and another text to let us know when we can pick her up. They showed us the cone beam CT afterwards which was very cool. They took Tessa's diabetes into consideration with every step they took as well and got us back on the road to head home early enough for her to get her PM insulin shot.

We opted not to use the anesthesiologist because we asked if he was around for emergencies and he was. I felt comfortable enough just knowing he was there and they said that they do consult with him on all surgeries with no additional charge. But using his services for the entire surgery would have been significantly more expensive considering Tessa's surgery was roughly 1 hour and 45 minutes and the anesthesiologist bills by the quarter hour.

The surgery was expensive (just under $4500 total) but very worth it IMO. They do take Care Credit but I will note that the only payment options we were given were 6 months no interest or 24 months 17% interest. We chose the no interest one and plan to pay off as much as we can and then do a balance transfer to a low (hopefully 0%) APR card for anything that is remaining in the last month to avoid paying the predatory 26.99% interest that they charge if you don't pay the balance in full by the 6 month period.

Tessa was stressed when we got home and laid in the litter box for a little bit before feeling up to moving around the house. She ate well - the vet said if she ate well and didn't throw up we could give her more food and we ended up giving her about 75% of her normal food spread over a few meals last night.

Today she seems a little skittish but otherwise okay. She's eating, drinking, peeing, and purring. No poop yet but I don't expect to see that for another day or so.
 

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This is great news! Thank you so much for taking the time to explain everything. It sounds like you made the right decision.
 

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I can't see much from the videos but I have one with 14 teeth removed who recovered well in 6 weeks, and one who had a full mouth extraction at the age of 17 and it took him 6 full months for the pain to stop. We needed pain meds and Depo. He had severe stomatitis (outside feral for 15 yrs) and periodontal disease to the point you could smell his breath 10 feet away. Inflammation from the initial procedure and the second one can take a while, and nerves can take a long time to settle depending on how angry they were. Yes it's expensive....sooo expensive! But now the one with no teeth at all is 19, pain free and able to eat happily so in the end that price was worth it for him to enjoy his food now without pain.
 
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jersharocks

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Okay I'm actually going to take back some of my praise for Your Pet Dentist. They are probably fine if you are local but they have not been very helpful for us with Contessa having so many issues after her surgery. They gave us an after hours number to text with questions and concerns. We texted a picture showing how much red is in her saliva and asked if it was normal at this point. The answer was "it may be normal". WTF?!

We also asked if there was anything else we could do to get her to eat and they said "you could get her an appetite stimulant" with no offer to prescribe one. I guess they want us to go to our local vet for that. For how much we paid, you'd think that they'd be willing to send in a prescription for us but I guess not. They got our money and want nothing to do with us now.

They also charged us a whopping $171 for glucose monitoring during her surgery and listed it as AlphaTrak kit x 3. When we asked why we were charged for AlphaTrak kits they said it was how much it cost per test strip which has to be a lie, there is probably no glucose strip on the planet that costs that much. I got them to refund $100 of the $171 but I still think $71 to test her blood sugar 3 times is pretty crazy.
 

FriendofFerals

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Okay I'm actually going to take back some of my praise for Your Pet Dentist. They are probably fine if you are local but they have not been very helpful for us with Contessa having so many issues after her surgery. They gave us an after hours number to text with questions and concerns. We texted a picture showing how much red is in her saliva and asked if it was normal at this point. The answer was "it may be normal". WTF?!

We also asked if there was anything else we could do to get her to eat and they said "you could get her an appetite stimulant" with no offer to prescribe one. I guess they want us to go to our local vet for that. For how much we paid, you'd think that they'd be willing to send in a prescription for us but I guess not. They got our money and want nothing to do with us now.

They also charged us a whopping $171 for glucose monitoring during her surgery and listed it as AlphaTrak kit x 3. When we asked why we were charged for AlphaTrak kits they said it was how much it cost per test strip which has to be a lie, there is probably no glucose strip on the planet that costs that much. I got them to refund $100 of the $171 but I still think $71 to test her blood sugar 3 times is pretty crazy.
OK, I have a diabetic cat and have to do this all the time. The whole AlphaTrak kit for sale with:
  • AlphaTrak 3 Pet Glucose Monitor
  • AlphaTRAK 3 Test Strips, 50 Count
  • AlphaTRAK Lancets, 30 Count
  • Lancing device
  • AlphaTRAK 3 Control Solution
  • Pet Diabetes Diary
  • User Guides and Carrying Case
....is $81.99 online. Test strips sold online are around $1 per strip in a package of 50, Lancets are like $6 for 10 so sounds like you used 18 cents in lancets, $3 in strips and unless they gave you the Alpha Trak device afterward, there is no way the tech pricking the ear and sampling the blood on the test strip in the device costs $171-$3- 18 cents minus tech hourly rate, minus even 100% markup on the strips and lancets. $3.18 in supplies...say $6 total with 100% markup, plus the hourly salary of whoever was working on your cat...$71 is closer to agreeable but probably should be closer to $50 at the most.
 
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jersharocks

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OK, I have a diabetic cat and have to do this all the time. The whole AlphaTrak kit for sale with:
  • AlphaTrak 3 Pet Glucose Monitor
  • AlphaTRAK 3 Test Strips, 50 Count
  • AlphaTRAK Lancets, 30 Count
  • Lancing device
  • AlphaTRAK 3 Control Solution
  • Pet Diabetes Diary
  • User Guides and Carrying Case
....is $81.99 online. Test strips sold online are around $1 per strip in a package of 50, Lancets are like $6 for 10 so sounds like you used 18 cents in lancets, $3 in strips and unless they gave you the Alpha Trak device afterward, there is no way the tech pricking the ear and sampling the blood on the test strip in the device costs $171-$3- 18 cents minus tech hourly rate, minus even 100% markup on the strips and lancets. $3.18 in supplies...say $6 total with 100% markup, plus the hourly salary of whoever was working on your cat...$71 is closer to agreeable but probably should be closer to $50 at the most.
Yeah, I knew the AlphaTrak was expensive but $71 is nowhere near what it costs for them. If I had known they were going to charge that much, I would have put a Freestyle Libre on her (I have a few on hand) and let them just scan it during the surgery. I had another vet look at the bill we got and they were surprised at how high some of the line items were until I said it was a specialist and then they said, "well, it's still on the high side but for a specialist it's not too bad."
 
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