So we've had our cat about three months and it's working out pretty well. She's well behaved, and while not the cuddliest cat in the world, she likes to cuddle up next to us, at least. I probably like her about as much as I could possibly like a cat we've had for three months. She's increased her weight by 50% while living with us, so she seems to be living it up as well.
Anyway, last week my husband brought her to the vet that the shelter recommended. Not because she was sick, but just to establish care and figure out any preventative things we should do. In general, she was fine, but the vet said that her back four teeth didn't look good and ought to be pulled. My husband said sure, then as he was going out the door, they handed him the cost estimate of $1000 for the cat tooth extraction (including X-rays and anesthesia).
Needless to say, I was livid.
First of all, the cat had been to that same vet practice multiple times before we got her, and there was no mention of any tooth issues. Much less any urgent necessary extraction costing $1000. I feel like someone is taking us for fools.
I feel like I sound like some evil person refusing to pay for the cat to have dental work. If she got in some awful accident or developed... I don't know... cat appendicitis, and it cost us that much... fine. But the cat appears totally fine and she's eating up a storm. She had just been to that same vet practice three months earlier and had been fine. I haven't even had $1000 worth of dental work myself, for crissake. And the whole thing will probably make the cat, who barely trusts us already, totally miserable and hate us. God knows how safe cat anesthesia is too.
We're going to another vet to get another opinion, but I'm strongly inclined not to do this to a cat we just got who had a clean vet bill three months ago. Unless there is a very, very convincing argument otherwise. Like that she's in horrible, mind-numbing pain and I'm worse than Trump for not helping her.
While $1000 seems a slightly steep for a dental, that may just be typical in your area. I'm assuming that's the total cost with anesthesia, dental X-rays, and the extractions.ReplyDelete
As for whether or not to do it, if the teeth really are bad, there's two very good arguments for removal. 1) Cats are very stoic and often will not show signs of being in pain until they're pretty sick 2) cats can stop eating for dental pain and a cat that won't eat is a very bad/dangerous thing.
Sounds like a second opinion isn't a bad idea, especially if you're really feeling there's nothing wrong with the cat, BUT contrary to popular belief most vets aren't out to just take your money (though there are some that definitely are...as with any profession).
Depending on the cat's personality, looking in the mouth isn't always the easiest task, so it's possible it was missed before.
PS cat anesthesia is pretty safe in a young healthy cat, though you know there's obviously risks
All this being said, it's possible that there's nothing wrong with your cat and your vet is just a jerk, but let's hope that's not the case...good doctors tend not to recommend procedures just for $$
I just feel that if she had major dental pain, she would stop eating. And all that cat does is eat and beg for food.Delete
I call BS. Extracting 4 teeth should be quicker/simpler than a spay for example. I assume they dont charge $1000 for a spay. Get another price &/or opinion. It's pretty rare for a young cat to need four teeth extracted without some sort of trauma.ReplyDelete
Not true at all. I was a vet tech for 4 years. Spays are easy. Dentals are a pain. First off - access to the area is a pain because you have a freakin tube in the way that provides the anesthesia as well as O2, then cat mouths are small and their teeth can be a royal pain to remove.Delete
... not even close. Dental extractions are a lot of work - it's not just grabbing with pliers. You have to very delicately cut down a flap of gum tissue, burr away bone very gently to avoid causing more damage, get the roots out, re-contour the bone, suture the flap back (Again, very delicate tissue handling required)...Delete
And no, it's not rare at all to have a young cat needing multiple teeth out. Many cats get what are called resorptive lesions (FORL, or feline odontoclastic resorptive lesion is another name) which, so far as we can tell, are basically an auto-immune response against the enamel. They're very painful and extraction is the only effective treatment.
Many cats keep on eating anyway, because they're *animals*. Instinct says "if you don't eat, you will be dead soon". With a nice side helping of "if anyone notices weakness in you, they will eat you".
Done properly, to a good standard of medicine, this sounds like an entirely reasonable quote.
Hi Fizzy. I'm a vet in Australia, and obviously I haven't seen your cats teeth etc etc, but here's my two cents (I love your blog, btw!!!)ReplyDelete
Teeth in dogs and cats can deteriorate rather quickly, especially in predisposed individuals. Three months for a cat is the equivalent of 18 months wear and tear on a human, and things can certainly change for us over 18 months. Plus, the cat may have seen a different vet within the same practice three months earlier who perhaps wasn't as observant of her teeth (it can also be rather hard to get a good look at the back teeth of even the best behaved dog or cat), and now this possible other vet has noticed it. So, what I'm saying is, I don't think its unreasonable for things to have change with your cats teeth in three months (how old is the cat, btw?). Cats that have previously had calicivirus and other issues that affect the mouth can predispose them to rapidly deteriorating teeth as well - not super common situation, but I removed six teeth from a one year old cat last week, her mouth was terrible!! But so young, and otherwise in very good health.
So, in terms of cost - I'm in Australia, so I don't know exactly how things work in the US, but, a very common thing clients say to us is, but it would only cost x amount for me to have the same/equivalent procedure done, so why does it cost y for my pet to have it done? The answer here, and this may or may not apply for you, is that our health care is subsidised by Medicare, so we just pay the gap, whereas veterinary care is not subsidised by the gov, so the client needs to pay all of it. The client never sees the actual cost of their own procedure - if they did, they would see that it is many many many times the estimate i've just given them for their pet's procedure. A vet hospital is a business, as you would obviously know, so wages, drug bills, rent, water, electricity, continuing education, new equipment etc etc all need to be covered, then profit for the owner to compensate them for the very high stress that comes with owning and running a veterinary hospital.
I say all of the above with the utmost respect, I've been reading you for years!! Just explaining from a vet's point of view.
Take care xxx
Our cat is 5 years old. I do appreciate your opinion… I just know that there are plenty of humans out there with tooth problems and don't necessarily have extractions. For example, my younger daughter has cavities in all four of her back teeth and we haven't taken care of them because she wouldn't sit for it and I don't want her to get put under. I just feel like, if she doesn't have a lot of pain, why would we do this?Delete
It's harder to tell with animals if they're in pain, cats and dogs are so much better at just getting on with things than we are!! They put up with so much more before they go off their food or complain in any other way. Cats and dogs don't get cavities in the way we do, but cats can get cavity-like lesions where there's odontoclastic lesions on their teeth, and they are painful as they expose the pulp cavity. But, yes, many cats will still continue eating. Of course, I haven't seen her mouth, so I just don't know. There is absolutely nothing wrong at all with getting a second opinion, so absolutely do that, see what another vet says. They may agree that she needs extractions, they may say just monitor, but either way, you've got another point of view, which will help you decide what to do for her. Just as an aside, pet insurance is awesome!!!! Although, I have to admit, despite me being a crazy cat lady, we for some reason have insurance for the dog but not the cat??!! We're both vets. Bit silly!Delete
Yes, but none of the insurance would've covered any dental procedures.Delete
Actually, yeah, I think most policies in Australia don't cover dentals as well, come to think of it. Which sucks!!Delete
Trupanion covers dentistry I believe.Delete
I'm a vet in SE Pennsylvania. A feline COHAT (complete oral health assessment and treatment) with 4-6 extractions would probably run around $850-1100 at my practice, depending on the teeth extracted and the difficulty of the extractions. So I don't find that estimate to be that out of range.ReplyDelete
Think of this - what would your bill be if you were a cash pay patient who had:
Pre-anesthetic CBC/chem panel
IV Catheter and IV fluid support for the duration of the procedure
Premedications - probably an alpha 2/opioid cocktail +/- propofol induction
Inhalant anesthesia for 1-4 hours, depending on the difficulty of the surgical extractions
Oral radiographs - full mouth pre and post extraction
Surgical extraction of affected teeth and closure of extraction sites
Regional anesthesia for the extractions
Intra-operative monitoring of vitals, including non-invasive BP, capnography, and continuous ECG and pulse-ox
Post-operative recheck appointment included in cost of procedure
Makes 1k seem like a deal, doesn't it?
I absolutely agree with Dr.Bunney (awesome name, btw, I really hope you see rabbits!) that a second opinion is not unreasonable, but I wouldn't be surprised if a second vet recommends a full COHAT as well. Cats do a really excellent job of hiding oral pain. I have cats come in for annual "well" visits with palpably loose teeth, severe periodontal disease, stomatitis, so much dental calculus that you can't actually SEE the teeth, and knock you over halitosis. The owners notice no change in appetite or attitude - until after we remove those little foci of chronic pain, inflammation, and infection. Then their cats feel better!
Oh, and some insurances will absolutely pay for at least some portion of dental care, especially prophylactic care. Look into PetPlan, VPI, and Trupanion.
We just had our cat's teeth done. Just the vet anethesia, IV catheter, Xrays and dental cleaning was $650 or so. Without any extractions. AND the pre-op blood work was an extra $150 or so.ReplyDelete
They did quote about $1000 for up to 3-4 extractions. Thank fully when the teeth were cleaned up, there was no need for extractions.
I feel the pain!
We have had dental work done on dogs and cats, too. It usually runs between $500 and $1000. Our vet will often make a dvd of the procedure to help explain all that was done. The animals have always been better afterward. Yes, it is expensive and you should get a second opinion if you have doubts.ReplyDelete
OMG, Fizzy, I'm sorry this has come up so quickly after your new cat came home. Luck of the draw, I guess (if the 2nd opinion concurs with the 1st).ReplyDelete
I can understand your dismay that this wasn't disclosed at the time of the adoption. I would have been equally suspicious that it didn't develop in 3 months before I read Doc Bunney's reply.
Whatever the outcome, I wish you and cat a medically uneventful future after this issue is resolved.
My vet does a cleaning month discount - not much, but it helps. Dental disease is linked to kidney disease in cats so it's important as they age.ReplyDelete
I guess I need to start teaching my kitten to let me brush his teeth - hahahahaha - that's not going to happen.
I had a cat whose only indication of what was probably severe mouth pain was that he stuck his tongue out almost all the time. He ended up needing all his teeth pulled, for which I paid about $300. It may have been easier because they were all going rather than just a couple. Or it may be that I lived in an area with low cost of living.ReplyDelete
So sorry your cat is having issues! I agree with all the above commenters that cats can hide mouth pain really well. When I was in medical school, my 2 year old cat developed lymphoplasmacytic stomatitis/gingivitis. She was acting like her normal self, eating and drinking fine, but we noticed that she started drooling a little bit. We took her in to the vet, and she had severe dental disease, including several exposed roots, along with extremely inflamed oral mucosa. I can't even imagine the amount of pain she must have been in, but her behavior really hadn't been affected. We were shocked, as she had previously been completely healthy and this came up very suddenly. Treatment included extraction of all molars and pre-molars, antibiotics, painkillers, and a prednisone taper. Seeing what prednisone did to my cat really made me appreciate the metabolic side effects. Same type and amount of food, yet she gained almost 3 pounds and had a total personality change while she was on the highest dosage. At a time when I really couldn't quite afford to spend that sort of money, it was almost $2000 for all of her treatment. However, I consider it the best money I ever spent, and it was extremely high value for the quality and complexity of the work that our vet did. She's now over 6 years old and hasn't had any further dental issues. Having this lovely little cat around got me through some of the most frustrating, stressful, and depressing parts of training, and I am so grateful for the advice and treatment from our vet that gave her all of these healthy years.ReplyDelete
A second opinion is a great idea!ReplyDelete
But, is it even possible to be WORSE than Trump?
I hope that the vet practice doesn't construe your reaction to its estimate as acceptance and then submit an invoice, followed by increasingly threatening demands to submit the cat for the procedure or pay up. I've known worse, though the UK jurisdiction of which I write is, probably, more brutal than yours..ReplyDelete
I don't understand. A veterinary hospital is not going to send you an invoice before work has been done. The last clinic I worked at had a rather strict upfront payment policy, but they didn't expect clients to pay money before the morning of the admission. Who is threatening clients? Veterinary staff will often do follow up phone calls to clients to see how they are going with their decision, especially if they are particularly worried about the animal in question, but I strongly resent the words "threatening demands". We're not the mafia!!Delete
It was certainly not my intention to insinuate that vets were unscrupulous as a breed. In fact there was some poetic license in my comments- not everything on this blog purports to be factual! The threats I had in mind were not of the break your legs or send the boys round variety; rather, of suing. I hope this goes some way to allaying the concern.Delete
If it seems like they're bothering him, get another opinion. I'd be inclined to watch and wait, especially since he's not off his feed.ReplyDelete
Oh, and you might want to do the same for daughter. One of our local dentists has a policy his wife laughingly calls 'Drill, Fill and Bill,' in which he tells clients they have a cavity, drills away perfectly healthy teeth, fills them, and bills the client. They do not comprehend our western ethics, and have made themselves quite wealthy taking advantage of trusting clients.ReplyDelete
I will concur with all the other vets that have posted when I say cats do an excellent job of hiding oral pain. They just swallow their food whole and don't chew... I extracted 7 teeth in a cat today. No signs of dental pain were reported by the owners. In all 7 teeth I saw the bifurcation in the roots and could stick my dental probe through to the other side. Cats are both predators and prey animals- in the wild, any animal showing signs of weakness would be easy picking for a bigger predator.ReplyDelete
5 years, for a cat, with all the teeth squished into a tiny mouth, is a long time. I've met 2 people who regularly brush their pets' teeth. And I'm a vet student! It's entirely reasonable that a cat can have bad teeth at 5. Even though cats can live well into their teens, we start to consider them "seniors" at 7 or 8. If she's never had dental care before, this seems entirely reasonable. I'm serious what your second opinion said.ReplyDelete
As a veterinarian I just wanted to comment on this particular post ( I love your blog by the way - even though not in human medicine I can definitely relate to a lot of what you say!). I think it is absolutely reasonable, when faced with any invasive or expensive procedure, to first seek a second opinion. Keep in mind that an oral exam without x-rays (which unfortunately cannot be done without sedation) can be hugely subjective for us. Some vets are more proactive than others about recommending COHATS - it does not necessarily mean one or the other is wrong or unscrupulous, just that there is a difference of opinion. So you very well may find another vet who is more comfortable monitoring your kitty's mouth for now and holding off on the dental. If you really want to get as close as possible to a "right" answer with this I would recommend you take your cat to a dental specialist for the second opinion (but keep in mind they will likely be more expensive than your primary care vet due to the added expertise).ReplyDelete
However, even if your second opinion also recommends a dental remember that no vet can force you to have this procedure done. If you feel you would prefer to wait, either for financial reasons or to allow more bonding time with the cat (both of which are completely valid reasons and would be respected by most vets) that is completely your decision. As veterinarians (especially primary care vets) we are used to (and usually fine with) presenting other options and finding a strategy and treatment plan that works for everyone.
I can understand you would be upset with this situation - but I hope you are not upset with the veterinarian involved. We are required (medically and ethically)to inform owners of any medical problems their pets have and to explain what we feel the ideal treatment plan would be - we cannot withhold this information because we think you do not want to know or will be unable to do the treatment - that would be us making decisions for you and would be completely unethical.
I wish you the best of luck with your cat and I hope you can all find a treatment strategy that works for you and your new kitty. As the owner you are part of (and quite frankly the most important part of) the care team for your pet. The vast majority of veterinarians will respect that relationship and work with you to make the best decision for your pet, whether that is Plan A or something else. You should not be made to feel bad about your decision - but we just want to make sure you are as informed as possible before that decision is made. So long story short: Don't shoot the messenger and find a vet you trust and are comfortable with so you can work together to keep your cat happy and healthy!
I'ld put the animal to sleep rather than pay $1000.00. If anyone is going to get a thousand dollars from me it would be a human being, not an animal. 5000 innocent children are dying daily from lack of clean water and food .http://www.theguardian.com/business/2006/nov/10/water.environmentReplyDelete
Those of us with pets are responsible for them. We are not responsible for children whose parents decided to procreate in dire circumstances.Delete