Fear Not – Anesthesia

Fear of anesthesia is the most common fear expressed by pet owners when discussing dental and oral care.  Many people prefer to have anesthesia when they have dental or oral surgery for themselves, but those same people do not want it for their pets!  What is the source of this fear?

Anesthesia fear may have originated with a previous bad experience of a pet having a bad reaction to anesthesia, or even death during anesthesia.  It may have originated from stories of anesthesia complications gleaned from the internet, neighbor, or other source.  Whatever the origin, the fear prevents the pet from receiving the treatment it may need to treat dental disease and oral pain.  How then, can a pet owner overcome this fear and move forward with their pet’s care?

It is important to understand that there are many types of anesthesia and that one type of drug or gas does “not fit all.”  Anesthesia protocols should be customized to the health needs and risks of the each patient and the surgery being performed.  This means that the 18 year old pet with heart disease is going to have a different anesthesia protocol than the 7 year old diabetic patient.

Occasionally, conscientious pet owners provide a list of anesthetic drugs that have been given to their pet in the past.  They want me to know that these drugs are “safe” for their pet.  In reality, there are no safe drugs.  The safety of the anesthesia relies on the person giving the drugs, the gas, and all the other aspects of safe anesthesia.  Safety increases and risk decreases if all of the following are provided:  constant vital signs monitoring (blood pressure, temperature, heart rate and rhythm, capnography, etc.), heat support, intravenous fluid support, and a person dedicated to providing all this.  The person providing this care should be in addition to the person providing the dental care – a team of two people.

To summarize, anesthesia safety is less about drugs and machines, and more about the trained person administering the anesthesia.  Statistically, less than 1 in 1000 pets have anesthesia complications.  That number increases to 1 in 70 for those with pre-existing health risks.

Some questions to ask your doctor about anesthesia before proceeding:

  1. What anesthesia do you use? (Correct answer:  The anesthesia is customized to the pet’s needs.  Wrong answer: a list of drugs is provided)
  2. Who monitors my pet’s anesthesia during the dentistry? (Correct answer: A dedicated nurse or Anesthesiologist.  Wrong answer: The person that is performing the dentistry.  Another wrong answer: The monitoring equipment)
  3. Is heat support and blood pressure support provided? Is my pet intubated (breathing tube placed)? (Correct answer: yes and yes)
  4. Are local nerve blocks (pain medication to numb the area of the oral surgery) given? (Correct answer: yes, if extractions or oral surgery are needed.)

If any of the questions are answered incorrectly, anesthesia risk increases.  Decreasing risk involves more time, people, and diligence toward detail.  It also involves more expense.  Cutting corners when providing anesthesia decreases cost but increases risk. For instance, if local blocks are not given to block pain in the area of an extraction, more gas will be needed and that increases risk.  If you are dissatisfied with any answers you are given to the questions listed above, ask for a referral to a practice that can answer them appropriately or to one with a Board Certified Anesthesiologist, especially if your pet has special needs.

Overcoming anesthesia fear is the first step in providing your pet with care that will improve quality of life for both of you.

Fear Not

Fears are common and often immobilizing.  Those with a fear of flying do not travel on airplanes. A fear of drowning prevents swimming.  Many pet owners have common fears when it concerns oral and dental care for their pet:

  1. Fear of anesthesia
  2. Fear of a tooth root being left behind during an extraction
  3. Fear of a jaw being broken during a tooth extraction
  4. Fear of disfigurement if a tumor has to be removed from a jaw with partial removal of the jaw.

Tooth roots left behind or a jaw breaking during an extraction can occur if extractions are performed by someone that has not had sufficient training to prevent these complications and if dental x-rays are not taken before and during surgery.  The best way to prevent these complications and to alleviate fears, is to ask some hard questions:

  1. Will dental x-rays be taken before and during surgery? (Correct answer: yes)
  2. Who performs the extractions or oral surgery? (Correct answer: The veterinarian performs extractions)
  3. Will there be sutures (stitches) at the extraction site? (Correct answer: yes)

If the answer to question #1 is no, then do not proceed with surgery at that clinic.  If the answer to #2 is not the doctor, again, do not proceed with surgery at that clinic.  If the extraction sites are not closed appropriately with sutures, do not proceed with surgery at that clinic.  Seek care where all three questions can be answered correctly.  You may also locate a Board Certified Dentist nearest you by visiting www. avdc.org.

Fear of disfigurement is also common, especially when part of the pet’s jaw will need to be removed in order to remove the cancer in the mouth.  Sometimes, this fear causes the inappropriate surgery decision to “shave the tumor off” repeatedly.  Many tumors invade the bone of the jaw.  By shaving off the tumor at the gum and not removing it completely with 1-2 centimeter margins, the “root” of the tumor continues to grow where it is often unseen: in the bone.  This causes more pain for the pet, and will necessitate a more extensive surgery than if the tumor is removed completely in the beginning.  In many cases, partial jaw removal can be curative, relieves pain, is cosmetic, and the pet eats and plays well, after healing.  Some tumors can spread from the jaw to other parts of the body.  If not treated early in the disease, the pet’s life may be in jeopardy.  It is in the pet’s best interest NOT to shave off tumors, but to have an appropriate diagnosis made with biopsy and x-rays.  Surgery is planned pending the biopsy result.

Questions to ask if your pet has a tumor in the mouth:

  1. Will a biopsy be performed?
  2. Will dental x-rays be taken?

If both answers to these questions are not “YES”, seek care elsewhere (www.avdc.org to locate a specialist) to provide the best care for your pet.

Fear of anesthesia is, by far, the most common fear pet owners share during a consultation.  The next blog post will address fear of anesthesia.

It is important to overcome fears in order to provide the oral and dental care your pet may have.  Being immobilized by fear prevents this care and allows pets to remain in pain, sometimes for years.

“He’s still eating.”

Pets with painful teeth still eat.  Some pets with broken jaws still eat.  Pets with painful cancer in their mouths still eat.

How then, can you tell if your pet is having pain in the mouth or teeth?

Any of the following changes may indicate that your pet is having pain in the mouth:

  1. General malaise, lethargy, acting old
  2. Won’t chew hard food or treats anymore
  3. Swallows hard food whole or chews slowly
  4. Drops food from the mouth while eating
  5. Odor from the mouth
  6. Won’t pick up toys anymore
  7. Red gums instead of pink gums
  8. Head shy (doesn’t want to be petted on the face or have the face groomed)
  9. Less active
  10. Less social (cats)
  11. Discolored teeth
  12. Teeth falling out

The most common phone call we receive is from the dog owner that notices a broken tooth and wants to know if this is a concern.  We are told, “He’s still eating”.  As you know now, this does not exclude pain. Watching and waiting for some “sign” since the dog is still eating, is not in the best interest of the dog.  There is often no “sign”.  In most cases there will be no swellings or drainage.  Antibiotics will not help.

You will not know how much pain your pet is having until that pain is relieved.  The pet that “acted old” prior to treatment of dental or oral pain, begins to act young again.  Pain is debilitating in many ways, but it does not diminish appetite.  If any of the changes listed above occur in your pet, schedule an oral exam with your local veterinary dental specialist.  To find the specialist nearest you, visit www.avdc.org.

 

BDLD

BDLD is an acronym for ‘big dog little dog’.  BDLD cases often present to the emergency clinic.  They are also the most common cause of broken faces and jaws that we see in dentistry and oral surgery practice.  The most surprising incidence of these trauma cases are dogs in the same household that have lived together for some time.  One day the little dog is eating or chewing a treat that the big dog wants and in a flash of teeth, the big dog bites at the little dog’s face and breaks it in one or more places.  Occasionally, the small dog wants the treat the big dog has been given. The trauma occurs over food.  Sometimes there is a new dog in the house, but the competition over food is still the instigating event.

The second most common BDLD trauma case, occurs when a little dog is being walked on a leash and a big dog off leash attacks it.  In some cases, the little dog that has lived next door to the big dog for years, finds a hole under the fence and is met with the big dog’s teeth.

We also see big dog – cat trauma cases.  These are not food competition scenarios.  The cat is bitten in the face by a visiting dog of a family member or a foster dog new to the home.

These trauma cases can be prevented by understanding the instincts of dogs regarding competition for food and the instinct to chase cats.  Small dogs should be fed in separate areas from large dogs so that there is no competition for space around a food bowl or over a treat.  Large dogs visiting a home in which cats live should not be given access to the cats.

We have seen two BDLD cases in one day, and it is not uncommon to see at least one case weekly.  Surgery is always needed to restore comfort and function to the victims. The big dogs are not “mean” or bad dogs, they are acting out of instinct.  Preventing broken faces begins in the home and taking additional precautions when walking a small dog or visiting dog parks.

A World of Veterinary Dental Caregivers

I recently attended the World Veterinary Dental Congress which was held in California this year. Over 900 veterinarians, veterinary dental specialists, technicians, and dentists were there. We gathered to share the most current information on oral and dental care. The veterinary dental specialists at the University of California are using 3D printers to fabricate templates to create implants to restore jaws in dogs that have lost part of their mandibles to trauma or cancer. Stem cell therapy is helping some cats recover from painful stomatitis. Lions and tigers and bears are treated for painful broken teeth by the Peter Emily International Veterinary Dental Foundation.

Several veterinarians were awarded the American Veterinary Dental College diploma after many years of study and examination. There are now just over 150 Veterinary Dental Specialists in the world that are certified by the AVDC. Wherever you live, you may locate the specialist nearest you by visiting www.avdc.org.

It is comforting to know that this worldwide team of amazing people is making great strides and efforts to provide the best and most current oral and dental care for the animals we live with and work with daily.

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New Home for Christmas

Tis the Season of celebration; a time of parties, shopping, cooking, company, caroling, and cats. Yes, cats. My favorite cat rescue group, Cat’s Angels, creates an annual calendar featuring their cats up for adoption. This is a fund raiser in which amateur photographers volunteer to contribute their time and talents toward this project. Hundreds of photographs are submitted for the 12 coveted calendar pages.

002I decided to donate some of my time, between seasonal obligations, toward this worthy project. Seated on the floor in the cat adoption center with my Nikon in hand, some of the many cats in the room decided to adopt me. A couple came to bat at the camera strap and lens cover dangling from its bungee. Another settled into my lap. Some cats entertained with cat toys strewn about the room. Others watched from perches or slept in selected soft places on various levels. A few cats came and went through the cat door that led to the wonderfully designed outdoor cat run. It was grand central station and I had been royally welcomed as if I were Queen Cat.

There was no shortage of pictures taken that day. As personalities were digitally recorded, I began to learn the names that went with the faces. Boeing, a young orange tabby, was found at the airport. Archie, young gray cat with a half tail and full of confidence, was rescued from a dump. Smiley, white and orange long haired cat had been a colony cat. He was soft, gentle, and full of joy.

Cats at playI left that day with plans to return for another photo shoot and more cat therapy. I had been so touched by Smiley, that I could not stop thinking about him. Thoughts of adoption danced through my head. I have two eight year old cats. How would they be with a young kitten? Back and forth went those thoughts. Should I or shouldn’t I adopt?

Two days later I returned to Cats Angels to take more pictures, with hopes that Smiley would still be there. Archie was first to greet me. Lots of activity in the adoption room that day. Children and parents visited the cats. Many heads were petted, purrs exchanged, and precious cats all vied for attention. Photos were taken of cats in all sorts of poses, postures, and playful antics. And yes, Smiley was still there. I took home the adoption paperwork.

Back and forth those thoughts went again. Smiley? Archie? Boeing? Any more cats? What would happen if my two forever cats were not kind to the new guy? Two people, two laps, three cats? The most important thought was giving a cat a new home for Christmas. So home we went, Smiley and me.

I have not finished taking photos of the cats waiting for homes for Christmas or any other day of the year. There are so many waiting, as many as the photos needing homes on the calendar pages. I will return to the adoption floor to cherish each cat, learn their names, and capture their personalities, in hope that each precious cat finds a forever home. Will I again be tempted by soft fur, gentle purrs, and another loving cat that wants a forever home?

Consider giving a cat a new home for Christmas. Visit your local SPCA. You may also visit www.catsangels.com.

 

Mojo

Simple Pleasures

MojoSome of you have inquired about my cat, Mojo (see Blog entitled Life Lessons). Mojo had a tumor on his forehead that was unsuccessfully removed with repeated surgeries. He was being treated with chemotherapy and strontium therapy. He had difficulty with the chemotherapy and we had to discontinue it. Several weeks after the strontium therapy, Mojo’s tumor is gone. It has not recurred.

Mojo teaches us life lessons every day, especially during his cancer treatment. Here a few for all of us to practice:

  1. Seek comfort in familiar places. A soft sofa, sunspot, or cool place in the shade will do just fine.
  2. Take time to be still. You will be restored.
  3. Stretch daily. Do this between seeking comfort in familiar places and times of stillness.

Focusing on simple pleasures daily is essential for those moments of happiness that are ours to enjoy, for we never know how many more moments we may have with our beloved pets. We are looking forward to many more special moments with Mojo. We give thanks for each and every one of them.

 

Goofy oral exam

Goofy gets an oral exam

Goofy oral examI had an opportunity to teach dentistry at a conference near Disney World recently.  On Sunday morning (yes, veterinarians attend conferences on Sundays), we were joined by Goofy, Pluto, Donald, Mickey and Minnie.  Children posed with the famous five while parents and grandparents took pictures.

My presentation topic that morning was the oral exam.  I could see Goofy’s teeth from across the room.  I waited my turn in line to visit Goofy, who by the way is much taller than I am.  I told Goofy that I was a veterinary dentist and would examine his teeth.  He stood very still while I did so.  I found something in Goofy’s mouth that I have never seen before.  EYES!

You never know what you may find in the mouth until you look.  Looking in the mouth of my patients requires anesthesia.  I must also look under the gum with dental x-rays.  This is where we often find painful periodontal disease. Periodontal disease is the most common reason for tooth loss in our pets.  Fortunately, if found early with dental x-rays, treatment can be started to relieve pain and help prevent tooth loss.  Left untreated, periodontal disease can lead to jaw fractures.  I have seen many  small breed dogs with this complication.

Teeth cleaning without anesthesia does not allow for dental x-rays unless you are a dolphin, person, or Goofy.  If you pet has bad breath, an oral exam and dental x-rays under anesthesia are needed.  There are often no outward signs of periodontal disease and clean teeth may have severe periodontal disease under the gum.  To find a Veterinary Dental specialist for your pet, visit www.avdc.org.

Life Lessons

Long time, no blog. Sometimes life gets in the way of blogging or anything else that we have good intentions of performing. As a part time blogger, it is encouraging to receive feedback or comments from readers.

Most of the time, my job provides relief from pain and improves the quality of life for pet and pet owner. Occasionally, I have sad news to deliver. The sad news could be that the pet has cancer in the mouth and that it is inoperable. Sometimes, oral cancers can be treated with radiation and we are
fortunate to have an oncologist locally to provide that service. Most of the time, I deliver happy news and there are many happy endings.

Recently, my own cat Mojo, who I have blogged about previously, was diagnosed with a very aggressive tumor. Mojo has a fibrosarcoma. It is not in his mouth. It is on his head. When a cat has a fibrosarcoma on a leg, treatment involves amputation of the leg. I obviously cannot amputate his head. He has had three surgeries, but the tumor persists. He can have radiation treatments. Unfortunately, Mojo is not a good patient. He is very frightened when away from home, will not let anyone restrain him, and will bite out of fear. He has frightened doctors and technicians. Radiation requires many treatments, each one involves restraint by people Mojo does not know, and a reputation as a difficult patient precedes him. He may hurt someone in the process. We are considering other options. We are hoping for a happy ending.

I look at Mojo daily and see his beautiful face, now with many of the striking tabby stripes missing from his forehead in an effort to remove all the tumor. He does not know he has an aggressive tumor. I wonder how much more time we will have with Mojo. He does not wonder about tomorrows.

This is what Mojo teaches me:

  1. Put one paw in front of the other and go forward.
  2. Begin each day purring.
  3. Enjoy the moment.

These life lessons, taught by a seven year old orange tabby Maine Coon cat, are timeless lessons for us humans. Stay tuned.

BEWARE of “Natural”

We find the word “natural” on many food items for our pets and for ourselves.  “Natural” connotates safe and helpful things for us and our pets.  Or does it?  Natural may mean free of by-products, additives, processing, or artificial anything.  Some natural products are organic, some are not.  Some items that may be natural are fresh foods, vitamins, supplements, or in the case of dogs, chew items.

While “natural” items make us feel like we may be doing something good for our pets, BEWARE.

One of the newest “natural” items being highly marketed as chew for dogs, are antlers.  Purveyors of  antlers market them as being “natural” and even better, from the USA.  I prefer to buy USA products and especially local whenever available.  I enjoy whole foods and avoid processed foods.  But there is more you need to know about antlers.

Antlers break dog’s teeth.  Broken teeth are a source of pain and infection.  Your dog will not tell you his tooth is broken.  He will still eat and chew but he is likely to avoid the side of the broken tooth.  Broken teeth can sometimes be saved with root canal treatment.  If the damage is too severe, the tooth must be extracted.  Either option is not without expense.

Why then are antlers sold?  Besides being promoted as “natural” and a USA product, they are marketed as being “tasty”.  Everyone with a dog that likes to chew knows that taste is not necessarily a factor in what he selects to chew.  For instance, are shoes tasty?  Are fences tasty?  What about the dog that chews items from the cat litter pan?  Perhaps” taste” is truly a matter of taste.  No, antlers are not tasty.

Why do people continue to buy antlers for their dogs to chew?  Some dogs love to chew.  They would be happy to chew on something 24/7.  Some are aggressive chewers and destroy even the toughest Kong toy or other firm rubber toy in a day.  The pet owner is looking for the indestructible chew.  There are several.  While the antler may me indestructible, the teeth (in particular the back teeth) are not. A chewing obsession needs to be replaced with another physical activity that will not harm the pet.

Natural bones, raw or cooked, and antlers are two of the “natural” chews that are not safe for any dog. Veterinary dentists in the US, and now in England, are seeing many more dogs with broken teeth from antlers since they have become more available and the marketing hype has gone viral.

In addition, there are many things that are “natural” but also toxic.  A few that come to mind are: arsenic, botulism, and snake venom.  Natural does not mean safe.  BEWARE.