need advice regarding vet treatment

[melysion]

When I first adopted Toby, I went to a vet that I now know did all sort of unnecessary and expensive procedures. I changed vets to one at a teaching college and have been pretty happy with it, other than the fact that you cant chose which vet to see - which means no continuity with treatment.

Anyway.

I've been considering this place - Kitten to Cat - Cat only Vet in Richmond, West London - for some time and since Toby had symptoms of a sore mouth (and I had a voucher for a free consultation) I took him there today.

Poor Toby-puss has a nasty mouth infection at the moment and is on antibiotics.

He has had dental issues since the day I brought him home (he has FIV for anyone who doesnt know). He has had several dentals and nasty mouth infections so this is definately an ongoing problem.

Anyway, to cut a long story short, the vet today suggests I take out all his back teeth. In the long run, it will save on a lot of dental work and would make Toby much more comfortable I'm sure.

So, I dont have a problem with that. However, she also suggested that Toby has a grade 3 heart murmur. This has been picked up before, ages back, at his other vet but only once and it hasnt been detected in subsequent visits. It certainly wasnt mentioned the last time he had a dental (Feb this year). She did say that heart murmurs can 'occur' due to stress but wants to do an ultrasound before she considers surgery. She also wants to take x-rays of Tobys mouth to make sure that there arent any broken fragments of tooth left from previous extractions.

All of this - including the dental - is going to cost a fortune - about £1,200. Thankfully, I only have to pay half of that as my flatmate will be picking up the other half. Its a lot of money, but I am happy to pay it if its necessary for my Tobe.

But my question is - do people think its necessary to have the heart ultrasound or even the tooth x-rays? I like this new vet and Toby was so much more relaxed in there than at the one I usually go to. However, I'm very wary of vets now 'testing' when perhaps its not needed. I know darn well that if I asked the vet college, they would not do any tests that they deemed unnecessary and I suspect they wouldn't do the ultrasound (they didnt before). He has had several dentals since the 'murmur' was first reported and is obviously fine.

So, what do people think? Shall I go with the recommendations of the new vet or ask for a second opinion at the vet college?

[doodlebug]

On the ultrasound I would ask what information the test would give them and how it would affect treatment or his life in general.

On the tooth x-ray I would ask why they think there would be slivers (is it normal to leave pieces behind? probable?). And what happens after they do the extractions of remaining teeth? Do they do an x-ray to make sure they didn't leave slivers? It seems like they're assuming that the previous vet did a bad job....

Basically I approach suggested tests by saying what is this test going to tell me? What treatments would be indicated by the various possible results? Would I do those treatments?

[Heather102180]

Probably best to ask the "so what?" question when they are telling you Toby needs this and that. Like Doodle said, find out what the test is going to tell you and if there is anything you can even do about the results.

If it's an consolation...I had a check-up to see how a root canal was doing and the x-ray showed there are still pieces of a wisdom tooth stuck up in my jaw that must have broken off when they pulled it. I would have never known it was there unless they told me so it's never bothered me. Maybe the fragments left in Toby, if there are some, don't even bother him.

If they pull his back teeth, he'd have to be put to sleep so is that what the concern is over the heart murmur? Is it risky to put him to sleep when he has that? I think the xray of the heart might be a good idea.

[melysion]

Originally Posted by Heather102180

If they pull his back teeth, he'd have to be put to sleep so is that what the concern is over the heart murmur? Is it risky to put him to sleep when he has that? I think the xray of the heart might be a good idea.

Yep, thats exactly it. He would obviously have to be put under for the op. But he had a dental earlier this year - in which he was knocked out obviously - and was fine and has had at least one other dental since the 'murmur' was originally picked up - with no complications. When the vet college picked it up, it was as part of a pre-op check and they didnt suggest an ultrasound at all -they didnt seem remotely worried and just did the dental. And I guess thats why a little flag of concern has come up regarding the new place.

The tooth xray would literally just be to see whether any fragments of tooth have been left behind. As Toby is FIV+, any remaining fragments might cause an infection which would not occur in a non-FIV cat apparently.

Please dont get me wrong - if Toby needs something done, he needs it done. I'm just very wary of vets doing unnecessary things - you know what they say - once bitten and all that.

[melysion]

Originally Posted by doodlebug

On the ultrasound I would ask what information the test would give them and how it would affect treatment or his life in general.

It would be checking for primary heart disease. But Toby shows no symptoms of any of that. Admitedly he does nothing that could ever be described as 'exercise' .. .. but all the same.

[Kobster]

Yes and yes. Dental xrays are vital. If you haven't had them before, then they are doubly important. Your vet will be using them during the procedure to make sure all bone fragments are removed. And it is very common for root tips to be left behind during extractions causing chronic infection later on. It doesn't necessarily mean your prior vet did a bad job by any means.
Heart echo is invaluable in determining the nature of your cats heart disease. What is causing the murmur is really something you want to know before you put Toby under anesthesia. Also, when you know what you are dealing with, you know how to handle it. Old school is just wait until they go into heart failure then put them down. Its possible, with a cardiac echo, to be pro-active. Ninja had one at age 6 months when he demonstrated exercise intolerace and was diagnosed with DCM and wasn't expected to live to one year. He's now 14 months and going strong due to early detection and appropriate management of his condition.

I don't think either test is un-necessary by any means. It's good medicine. Go for it.

[Gabby169]

Considering Toby's FIV+ status I think both tests are very reasonable. I understand more about human health (10 years in the hospital and clinic) than kitty health but I know in a human both of these would have to be done before they were allowed to undergo anesthesia.

[melysion]

Originally Posted by Gabby169

Considering Toby's FIV+ status I think both tests are very reasonable. I understand more about human health (10 years in the hospital and clinic) than kitty health but I know in a human both of these would have to be done before they were allowed to undergo anesthesia.

Well, I'm not at all convinced that a heart murmur has anything to do with Tobys FIV status. I dont really subscribe to everything automatically becoming more expensive just because Toby is FIV+. Other than his dental issues and being hyperthyriod Toby is a very healthy (if slightly plump) 9 year old cat. But, yes, little fragments of tooth in Tobys gums would potentially cause him more trouble than in a non-FIV cat. Having thought about it, I can certainly see the argument for the tooth xrays.

Anyway, flatmate and I had a chat about it last night. Poor flatmate almost passed out when he saw the estimated bill - - but he was looking at Toby very fondly and stroking him by the end of the evening so I don't think I'll have too much trouble getting his half of the bill out of him

I think what I'm going to do is ask the vet college for a second opinion on the heart murmur. Its not spending the money I have a problem with - I'd eat toast for an entire month if I had to rather than have Toby go without treatment - its wasting money on unnecessary treatment. Its happened before at another vets and I refuse to go down that route again. The dental stuff is fine, that can go ahead no problem including the xrays, I'm just wary of him needing the heart ultrasound.

Thanks for all the feedback so far. Much appreciated.

[praline]

Heart echo is invaluable in determining the nature of your cats heart disease.

Extremely so and you have a very good vet if they want to do one.

My Golden has VSD (hole in the heart) so I am very familiar with heart echos, EKGs and all of that good stuff. Even when we got him fixed we were extremely careful with the operation.

One of the big things the Heart Echo can do is let the vet know how much and what kind of meds to use to knock him out. They did this very same thing with my dog. Not all drugs are the same and they have some out there safer for heart murmurs.

they could also do the test and tell you flat out that the risk for the surgery is too great and find another method of dealing with his teeth.
This is much better then sending him in the operating room and finding out while he is under that his heart can't take the surgery =(

when it comes to murmurs ~ you don't want to fool around with surgery until the vet knows what is causing it. Knowing can also (as was stated) make you informed and proactive in treating it. This is the route I took and my dog's hole has lessened a great deal. I was extremely careful about diet and fitness when he was young and continue to do so. I would have never taken these steps had I not found out about his condition.

So yes, get the testing done on the heart. Very important stuff!

[RachandNito]

Does Toby have stomatitis because of his FIV? We've dealt with a couple cats at my shelter who deal with these nasty mouth infections- stomatitis is an immune condition where the body attacks the teeth and causes the infection. Removing the teeth in the case of these cats has put a stop to the infection and improved the quality of life for these cats tremendously. So maybe it IS something that can help Toby.