Canine Oral Surgery-Dental/Anesthesia Guidelines

Cyd

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Joined
Mar 5, 2019
Messages
17
I believe that things happen for a reason, the effort to get Elliott's cleaning & extractions done as planned, might be delayed for the 3rd time. The good news is that I would be choosing to cancel this week's appt in order to have more time to weigh the various general anesthesia & sedation/pain mgmt options, to have my questions & concerns addressed with confidence & cooperation by the vet. I also want to share that the short 1 month that I've been a part of HA has been very instrumental in shifting my mind-set to understand how essential & important it is to dedicate the time & energy to acquire the knowledge necessary to become an active participant with these types of potentially quality-of-life altering decisions. I came across this very educational article while looking for a printable canine dental chart that I would use for my observations to use as a starting point with the vet who was scheduled to do the cleaning - at previous office visits she was not comfortable looking deep in the mouth or to touch front loose teeth in order to give me a ball-park amt for extractions & I also wanted to create an actual dental condition check-list for my reference. Here is the link Increasing Clients’—and Your Own—Dental Awareness From the Exam Room to the Dental Suite | Today's Veterinary Nurse It's intended to actually teach vets on how to effectively present comprehensive pet dental care to their patient's owners & in my current 1-1/2 year odyssey to get Elliott's mouth safely tended to it served as a very important & useful checklist & guide as to the types of questions to ask. Despite many years of having canine dentals done, I had never requested a written estimate, detailing exactly what the procedure would entail & what types of meds would be used. It has only been 10 yrs or so since I even began asking about the type of anesthesia & that was only because while I was living in Mexico I was told that gas/inhalation types were easier to detox compared to IV delivery & for many years I postponed procedures for those occasions when a vet visiting fm the USA would bring inhalation equipment i.e. for spay/neuter clinic. I'd gone through several procedures when sodium pentathol or ketamine was used & the dogs seemed to really suffer & I was in charge of monitoring the recovery because where I was living, the vet office closes down & everyone leaves for a 2 hour lunch, all animals go home awake or not. I hadn't seen this article a month ago, when I scheduled the firav appt for cleaning, but I did decide it was best for Elliott to have a pre-op visit even though the vet had said the most recent Feb 4 visit would suffice, I felt I needed a calm opportunity to point out other things that might be dealt with during the anesth & to point out some of the problem teeth to get a clearer picture of the cost. I also took the opportunity to ask for a written estimate w/details & am I glad that I did, because despite the vet & I discussing scheduling a cleaning since our 1st meeting back in November, I made the mistake of assuming that the procedure would be done using basic pre-anesth sedative injection & gas anesthesia. I'd made peace with using inject. antibiotic. In all of the previous cleanings which sometimes included multiple extractions involving "big" teeth w/deep roots, extra pain meds, a drug to revive/wake-up, & antibiotic injections had never been used, things were very basic. The 1 recent written estimate which a previous had vet prepared without my requesting only showed Gen'l Anesth/Isoflurane, Pain Med/Carprofen injection & Antibiotic/Penicillin & I'd assumed each quote would be similar except for cost. Dr. E wasn't able to give me the estimate while I was in the ofc, I'd been anticipating a relatively short list of planned procedure meds & was very happy to see the all-inclusive items i.e. Catheter, EKG monitoring, BP monitoring, x-rays, what I wasn't prepared for was the list of 8 various anesthetic/sedative/pain-relief drugs. I had neglected to inquire directly about the Gen'l Anesth being inhalation or IV presuming that would be described. What is prompting this inquiry specifically about the ins & outs of Anesth procedures is that Dr. E isn't as forthcoming with an explanation so that I could perhaps request a reduction in the quantity of drugs to be used. I had thought she totally understood my desire to keep the drug/toxic load & reliance on meds to a bare minimum to get the job done. I hv complete respect for the vet's comfort zone that they need to work with whatever protocol that they have the most experience & confidence using, I am concerned about going through with the cleaning without getting further input on the wisdom of exposing a 9 yr old dog to such a vast array of drugs when I've witnessed bare-bones procedures & 2 other local USA vets seem to employ much fewer narcotic/opioid/local anesth. I also plan to ask Dr. H for a comprehensive written estimate on Mon to accurately compare his approach, it is a shame that this has come up just 5 days prior to the scheduled cleaning, & I am also glad for this eye-opening experience before any potent drugs are administered. I've spent several hours researching the various drugs listed on Dr. E's estimate, it has made a huge difference to at least to hv a basic grasp of the gen'l purpose of each item. I am still waiting for clarification of the actual Gen'l Anesthetic drug, Propofol was listed & I'd concluded that she was using it as the gen'l
because Isofluorane did not appear. I am hoping that Dr. E will explain her drug choices so that maybe I can logically decline things like Buprenex & Marcaine - Wouldn't it be true that Arnica & Hypericum could accomplish the same purpose of post procedure pain-relief without potential unexpected reactions? I hv a definite sense that younger, more recently trained vets believe in the pain-awareness models & it has a direct impact on their preferred protocols. I feel nervous about so many chemicals interacting all at once, especially w/preservatives & additives, I believe my dog 3 yrs ago had a reaction of paralysis flwg a therapeutic aqua-puncture injection of a cocktail of Adequan & Vit B-12, that there was a reaction to the Sodium Benzoate in the B-12. Would it be possible to get your feedback on the proposed meds & basic protocol? 1. Inhaled vs IV Gen'l Anesth - I seem to recall reason it was safer is because by giving O2 could purge out more quickly & I also understand newer products like Propofol are metabolized in an entirely dif. manner. It's interesting to me that 2 local vets clearly indicated that ISO is their preference plus from 2008 there was 1 vet who opened a super modern practice who used Iso & I was able to observe several anesth procedures. I am waiting for clarification on whether Midazolam inj., Torbugesic inj., Dexdomitor Desmedesed are pre-op sedatives or something else. I've ID'd Buprenex inj. & Marcaine inj. as local anesth, I wonder if a local during the procedure is needed if Elliott is 100% unconscious, & hopefully post-procedure Hypericum will resolve extraction pain, I feel Arnica would also help, especially with sore mouth & face muscles being manipulated. Dr. E plans to use Clindamycin inj. instead of Penicillin, it was interesting to learn why it is probably a better choice for this procedure. Dr. E also plans to use Antisedan inj., would this offer a clue to the planned Gen'l Anesth, I don't recall a "wake-up" drug being used for previous work? I am also going to look into using CBD oil after using Arnica/Hypericum during immediate post-procedure period. Does anyone have any personal experience using CBD for this type of pain management + is it best to stop homeopathy before using CBD or are they compatible together? Also, I've been applying PurO3 brand ozonated sunflower oil to previously inflammed spots on gums for about 1 week & I plan to use topically after any extractions. It is supposed to be soothing & promote healing, it is my first time working with this type of treatment & I think Elliott felt relief, it diminished the signs of blood & he reacts as though it feels good. It can be used directly on surgical incisions, the oil acts as a carrier for the ozone. Before I purchased from Amazon I spoke with one of the PurO3 founders, we had a great conversation, he was very informative, PurO3 is very pleased & surprised that the article mentioning ozonated oil has resulted in many people trying out the product specifically for their pet's mouths. Dr. Jeff & Dr. Christina, I know this is very long, I thank you in advance for any input you can provide, I don't want to proceed w/scheduled appt. if there are reasonable, practical ways to reduce the toxic load of this much needed dental procedure. This has been a very intensive learning experience, that I hope others may find useful.
 

Dr. Jeff

Administrator
Moderator
Veterinarian
Joined
Feb 23, 2017
Messages
727
Hiya Cyd-

I'm just seeing your post and would appreciate if you list your specific questions separately, e.g.

1. Should the anesthetic dental even be done...?

2. What about...?

3. Etc.?

We want to be sure that everyone gets their questions answered.

Thanks so much!
 

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