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Toby has a bad tooth

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Toby has a bad tooth

Post  MommaJones on 11/14/2011, 10:12 am

Toby's breath has gotten really nasty over the past couple of weeks. I managed to get a quick look in there this weekend, and there is at least one yucky looking tooth. I just called the vet and we have an appt at 10:30 this morning. I'm already in tears. I have no idea if they will decide to put him under to have a full dental and/or pull some teeth. I'm a nervous wreck. Toby is 13, and I'm terriified of anesthesia. And the thought of having to leave him is hurting like crazy. The receptionist assured me that they have 'special' anesthesia they use for older dogs that is not as hard on them. I hope to be more together and ask the right questions when we go in this morning. I requested a vet experienced with working with older dogs.
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Re: Toby has a bad tooth

Post  Rebecca and the Pugs on 11/14/2011, 10:30 am

MommaJones wrote:Toby's breath has gotten really nasty over the past couple of weeks. I managed to get a quick look in there this weekend, and there is at least one yucky looking tooth. I just called the vet and we have an appt at 10:30 this morning. I'm already in tears. I have no idea if they will decide to put him under to have a full dental and/or pull some teeth. I'm a nervous wreck. Toby is 13, and I'm terriified of anesthesia. And the thought of having to leave him is hurting like crazy. The receptionist assured me that they have 'special' anesthesia they use for older dogs that is not as hard on them. I hope to be more together and ask the right questions when we go in this morning. I requested a vet experienced with working with older dogs.
They will most likely not do it today because they are not supposed to have food after midnight before the anesthesia. When Peachy goes in next week for hers, she is only going to be given her thyroid and phenobarb meds with a bit of peanut butter. They will most likely do a senior panel workup on him. I will be keeping both of you in my thoughts, because I know you are worried.
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Re: Toby has a bad tooth

Post  MommaJones on 11/14/2011, 11:08 am

He hasn't had any food since supper last night. I only feed once a day. Don't tell The Jones Boys that most pugs get breakfast AND supper. He also got his usual bedtime biscuit at bedtime around 9:30pm. He did eat a few ice chips this morning that he insisted on while I was filling up Alex's water bottle for school.

What questions should I ask?
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Re: Toby has a bad tooth

Post  puglover22 on 11/14/2011, 12:29 pm

Christy, I'm sending positive vibes for Toby-love

He will be smiling and flashing his pearly whites again soon!
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Re: Toby has a bad tooth

Post  Erin on 11/14/2011, 12:42 pm

Sending good thoughts for Toby, I am sure today will be an exam and then schedule for the extraction.

It is amazing how tough they are, Georgie bounced back after having 11 extractions, he did very well.
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Re: Toby has a bad tooth

Post  thminis on 11/14/2011, 12:43 pm

Dental disease can actually be a leading cause of heart disease, kidney, and liver issues, especially in geriatric pets. Many times the risk of the dental (which is usually very slim) outweighs keeping the icky teeth.

We do dentals on geriatric pets all the time. Heck, we do dentals on pets with seizures and heart murmurs, and they do well, too.

Like Rebecca said, you'll want to make sure they do a full blood panel before he goes under (the morning of is preferred). Also, we keep our pets on IV fluids during all anesthetic procedures to keep their blood pressure up. You can ask if your clinic does that.

It's a good sign that the receptionist said they have a different anesthesia protocol for senior pets. It's probably a difference in the pre med (what makes them sleepy prior to the actual anesthesia). You can ask if they do pain injections or antibiotic injections, and if they'll be sending Toby home with oral pain meds and antibiotics.

Other than that, try not to worry! Go with your gut if you trust the vet, but I see Toby doing well. We always joke at our clinic that the pugs are the ones who are laziest about waking up after the anesthesia has been turned off. They never want to give up the machine oxygen, probably because it's the best they've ever breathed! Keep us updated!
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Re: Toby has a bad tooth

Post  MommaJones on 11/14/2011, 1:03 pm

His dental is scheduled for Wed am. I have a couple of questions to ask when I'm not typing on my phone.
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Re: Toby has a bad tooth

Post  Snifter&Toddy on 11/14/2011, 1:30 pm

I'm sure all will go well, but we will be thinking of him on Wednesday.
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Re: Toby has a bad tooth

Post  MommaJones on 11/14/2011, 2:42 pm

I tried to get them to do the bloodwork today, but they insisted on doing it Wednesday before surgery to be sure they have the most current results.

She mentioned "propofol" as a possibility. I did a quick google and it seems it is an injectible and maybe used just pre-anesthesia. Has anyone heard of this? Had it used on their pugs? My only propofol experience is when my dad was in the hospital a few years ago and it made him bat-shit crazy for a few days. I did read something about respiratory depression, so that has me concerned...but I need to read more.

I drop him off at 8:30am. I asked when I can pick him up. She said they usually say around 4:30, but when I started to push that, she said that when he was up walking a bit, she would let me come get him. I assured her that I would be with him constantly as soon as I was allowed to bring him home. She mentioned the possibility of him staying overnight if there were several extractions and he needed narcotic meds. She said they can't send those home??? That seems weird to me. And I'm 99.9% certain that no remains in the clinic overnight, so I'll find a way to bring him home no matter what.

I know I'm probably going to have more questions. Thanks to those of you who are taking time to answer them and hold my hand!
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Re: Toby has a bad tooth

Post  Saira on 11/14/2011, 2:44 pm

MommaJones wrote:I tried to get them to do the bloodwork today, but they insisted on doing it Wednesday before surgery to be sure they have the most current results.

She mentioned "propofol" as a possibility. I did a quick google and it seems it is an injectible and maybe used just pre-anesthesia. Has anyone heard of this? Had it used on their pugs? My only propofol experience is when my dad was in the hospital a few years ago and it made him bat-shit crazy for a few days. I did read something about respiratory depression, so that has me concerned...but I need to read more.

I drop him off at 8:30am. I asked when I can pick him up. She said they usually say around 4:30, but when I started to push that, she said that when he was up walking a bit, she would let me come get him. I assured her that I would be with him constantly as soon as I was allowed to bring him home. She mentioned the possibility of him staying overnight if there were several extractions and he needed narcotic meds. She said they can't send those home??? That seems weird to me. And I'm 99.9% certain that no remains in the clinic overnight, so I'll find a way to bring him home no matter what.

I know I'm probably going to have more questions. Thanks to those of you who are taking time to answer them and hold my hand!

I'm not sure on the other stuff, but Hooli had 9 teeth pulled and they sent him home with me, with meds. Although I can't remember what meds, but I don't see why they would keep him for that.
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Re: Toby has a bad tooth

Post  Renee on 11/14/2011, 2:47 pm

What Bella said. We will be thinking of Toby Love.

Once you get through everything, you will be so glad you had the dental done.

At Toby's age, I would recommend you tell them to take everything out that even half looks like it is going to rot. The goal is to have this be his final dental.
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Re: Toby has a bad tooth

Post  smoochieface on 11/14/2011, 3:09 pm

I can only repeat what Saira, Bella and Renee have said. Better to get the rotting tooth out and take out anything else that looks remotely troubling. Chester had a few teeth pulled at this last dental (age 10) and I hope we never have to do another one. It's perfectly fine for them to run a blood test the morning of - if there are any numbers out of whack, they should not move forward. My vet will run blood ahead of time but he always also runs at least kidney tests the morning of the surgery. No experience with propofol here.

My vet also released Chester to me the day of the surgery. Not sure why they would want to keep him overnight - maybe you can ask whether they have staff overnight. I know that in my vet's office, the last person leaves at 7pm and doesn't come back until 7am so I always bring them home with me and we haven't had anything serious enough yet that has required an overnight stay.

Hugs and kisses to Toby!
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Re: Toby has a bad tooth

Post  Maryjo on 11/14/2011, 3:23 pm

MommaJones wrote:His dental is scheduled for Wed am. I have a couple of questions to ask when I'm not typing on my phone.
Thelma had the last of her teeth pulled during a dental when she was 13.5 yrs old. She did fine. My vet always likes to put them on antibiotics first for a few days before the dental.

We'll cross our fingers, toes and paws for Toby on Wednesday.
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Re: Toby has a bad tooth

Post  Renee on 11/14/2011, 3:32 pm

Do not leave him overnight.

I got into a nasty argument with a vet over leaving Ichiro overnight when he had LP surgery. I ended up signing a medical release that I would hold them harmless, and under the glaring eyes of the vet, I took Ichiro home. There is no one there overnight, so there is no way in hell I would leave my baby there alone!

I got a new vet immediately.

I have always done bloodwork the day before any surgery.
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Re: Toby has a bad tooth

Post  MommaJones on 11/14/2011, 3:45 pm

Renee wrote:

At Toby's age, I would recommend you tell them to take everything out that even half looks like it is going to rot. The goal is to have this be his final dental.

That's a great point, and one I will be sure to them when I take him in.

I have absolutely no intention of leaving him overnight. I will fight that tooth (no pun intended) and nail. She did say that they have done hundreds of dentals and she could only remember 3 that required an overnight stay. I will sign whatever I have to in order to bring him home.

Propofol?? No one??
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Re: Toby has a bad tooth

Post  Renee on 11/14/2011, 3:57 pm

MommaJones wrote:
Propofol?? No one??

I was waiting for Blanche to chime in one this one, she seems to have the best knowledge on proper anesthesia induction. I know there is one injection combination that is not recommended for pugs... but, I do not remember what that is.
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Re: Toby has a bad tooth

Post  Renee on 11/14/2011, 4:01 pm

Oh yeah, another comment:

don't let them send you home with just rimadyl for pain, if you think Toby needs something stronger. I see too many poor pugs go through a painful surgery and only get rimadyl. I like to get at least one or two tramadol just in case.

I often wonder if vets under estimate how painful surgery is for dogs?
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Re: Toby has a bad tooth

Post  Pugsaunt on 11/14/2011, 4:15 pm

Propofol is used in both humans and dogs (cats, too) for induction of anesthesia. Technically, it is a short acting hypnotic, which means that it knocks you out for a short while. It is given in the IV, and is known in the medical biz as Milk of Amnesia. It is used for induction of anesthesia - that means it puts you out before they put the breathing tube in - and for anesthesia in short procedures. Onset in about 30 seconds, and lasts about 20 minutes. When I had my carpal/ulnar tunnel surgery, the last thing I remember is the anesthesiologist injecting it into my IV line. The next thing I remember is waking up with a cast on my arm, thinking "What the hell happened?" They probably use it in older dogs because it works well with heart problems and it metabolizes pretty completely, so it is out of the system and the patient is generally wide awake and good to go when it is over. It also helps prevent vomiting.

You will hear that this is the drug that killed Michael Jackson, and, yes, it did. But the problem was not the drug but how it was given. It should never be given outside the hospital and without close monitoring. And given that it wears off quickly, it is a puzzlement to me why Conrad used propofol for sleep. I was on an EKG and had a pulse oximeter (clips on the finger and measures the oxygen level in the blood) when it was given to me, and that is how it should be given. Yes, one of the side effects is respiratory depression, and that is why the patient should be on a monitor. Period. There is no such thing as a drug that is 100% safe (aspirin has a bunch of side effects, and a tylenol overdose is one of the worst). That being said, I'd far rather be given propofol than some of the other drugs that are used.

The bottom line is that you want to be sure that there is someone in the OR while they are doing the dental who does nothing but watches Toby's monitors. With that precaution, and if it were Penny, I'd still be a mess, but I would be more of a confident mess. I know how we worry about our furkids!

And I'll say a prayer for Toby on Wednesday. Hugs to you, too.
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Re: Toby has a bad tooth

Post  Tyson&LuLu'sMom on 11/14/2011, 4:30 pm

I would second Nancy's suggestion of making sure someone is there to monitor his vital signs (I may have had to pay extra for this when Tyson had his dental), and I also had them do an IV in case they had to administer anything quickly (this was on the suggestion of a lady who has been very helpful to me in dealing with Tyson's Addison's Disease).
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Re: Toby has a bad tooth

Post  MommaJones on 11/14/2011, 4:41 pm

Pugsaunt wrote:Propofol is used in both humans and dogs (cats, too) for induction of anesthesia. Technically, it is a short acting hypnotic, which means that it knocks you out for a short while. It is given in the IV, and is known in the medical biz as Milk of Amnesia. It is used for induction of anesthesia - that means it puts you out before they put the breathing tube in - and for anesthesia in short procedures. Onset in about 30 seconds, and lasts about 20 minutes. When I had my carpal/ulnar tunnel surgery, the last thing I remember is the anesthesiologist injecting it into my IV line. The next thing I remember is waking up with a cast on my arm, thinking "What the hell happened?" They probably use it in older dogs because it works well with heart problems and it metabolizes pretty completely, so it is out of the system and the patient is generally wide awake and good to go when it is over. It also helps prevent vomiting.

You will hear that this is the drug that killed Michael Jackson, and, yes, it did. But the problem was not the drug but how it was given. It should never be given outside the hospital and without close monitoring. And given that it wears off quickly, it is a puzzlement to me why Conrad used propofol for sleep. I was on an EKG and had a pulse oximeter (clips on the finger and measures the oxygen level in the blood) when it was given to me, and that is how it should be given. Yes, one of the side effects is respiratory depression, and that is why the patient should be on a monitor. Period. There is no such thing as a drug that is 100% safe (aspirin has a bunch of side effects, and a tylenol overdose is one of the worst). That being said, I'd far rather be given propofol than some of the other drugs that are used.

The bottom line is that you want to be sure that there is someone in the OR while they are doing the dental who does nothing but watches Toby's monitors. With that precaution, and if it were Penny, I'd still be a mess, but I would be more of a confident mess. I know how we worry about our furkids!

And I'll say a prayer for Toby on Wednesday. Hugs to you, too.

Nancy, So you are fairly confident with them using the propofol? (I do realize that nothing is 100% safe. I'm just trying to make sure they are doing the best thing for him.) The respiratory depression scared me, but if he's intubated and being monitored, that shouldn't be an issue. Correct?

And yeah, the Michael Jackson thing doesn't faze me at all. In fact, after my dad's propofol experience, we kind of had a laugh when all of that came out.
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Re: Toby has a bad tooth

Post  Pugsaunt on 11/14/2011, 4:49 pm

MommaJones wrote:
Pugsaunt wrote:Propofol is used in both humans and dogs (cats, too) for induction of anesthesia. Technically, it is a short acting hypnotic, which means that it knocks you out for a short while. It is given in the IV, and is known in the medical biz as Milk of Amnesia. It is used for induction of anesthesia - that means it puts you out before they put the breathing tube in - and for anesthesia in short procedures. Onset in about 30 seconds, and lasts about 20 minutes. When I had my carpal/ulnar tunnel surgery, the last thing I remember is the anesthesiologist injecting it into my IV line. The next thing I remember is waking up with a cast on my arm, thinking "What the hell happened?" They probably use it in older dogs because it works well with heart problems and it metabolizes pretty completely, so it is out of the system and the patient is generally wide awake and good to go when it is over. It also helps prevent vomiting.

You will hear that this is the drug that killed Michael Jackson, and, yes, it did. But the problem was not the drug but how it was given. It should never be given outside the hospital and without close monitoring. And given that it wears off quickly, it is a puzzlement to me why Conrad used propofol for sleep. I was on an EKG and had a pulse oximeter (clips on the finger and measures the oxygen level in the blood) when it was given to me, and that is how it should be given. Yes, one of the side effects is respiratory depression, and that is why the patient should be on a monitor. Period. There is no such thing as a drug that is 100% safe (aspirin has a bunch of side effects, and a tylenol overdose is one of the worst). That being said, I'd far rather be given propofol than some of the other drugs that are used.

The bottom line is that you want to be sure that there is someone in the OR while they are doing the dental who does nothing but watches Toby's monitors. With that precaution, and if it were Penny, I'd still be a mess, but I would be more of a confident mess. I know how we worry about our furkids!

And I'll say a prayer for Toby on Wednesday. Hugs to you, too.
Nancy, So you are fairly confident with them using the propofol? (I do realize that nothing is 100% safe. I'm just trying to make sure they are doing the best thing for him.) The respiratory depression scared me, but if he's intubated and being monitored, that shouldn't be an issue. Correct?

And yeah, the Michael Jackson thing doesn't faze me at all. In fact, after my dad's propofol experience, we kind of had a laugh when all of that came out.
Yes, if he is intubated and monitored, the respiratory depression shouldn't be an issue. And if it were Penny and they told me that they were going to use propofol, I would be ok with it. Now would I be a quivering nervous wreck until I knew she was out of the anesthesia and ok? Of course. Just more confident of a nervous wreck.

And Renee is absolutely right on the pain med issue. And Becky on the IV.
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Re: Toby has a bad tooth

Post  thminis on 11/14/2011, 6:47 pm

Echoing Nancy here on the use of Propofol. I'm 99.9% sure use it for all of our surgery pets. They get a combo of pre meds about 30 mins before we aim to intubate. The propofol is drawn up to the max dosage, but the pet does not usually receive it all. It relaxes them so they can be easily tubed, and then the pet is immediately hooked up to oxygen and isoflurane or sevoflurane.

If a pet becomes bradycardic (where their heart rates drops too low) during the procedure, there are multiple drugs that can be given IV to increase the heart rate. I know for a fact that when Reggie had his dental that lasted at least an hour, he needed 2 doses of these drugs (meaning it's fairly common). So as others have said, as long as they monitor him closely (which I am positive they will), he should do just fine.

I agree that you shouldn't have to leave him overnight. I would let them keep him during the day as long as they want. Basically as soon as they think it's safe to pull his catheter and his temp is high enough is when it should be safe for him to go home. Just keep him away from stairs and jumping, and also don't fill his water bowl high.

Ask if they can maybe give an injection of pain meds if that means they'll let him go home and not stay the night? We've done dentals with 11 or 12 extractions and sent pets home with adequate pain medication.

Sorry for all the random comments. I'll pop back in if I think of anything else. You've been given great support and advice from Nancy and everyone. I'll keep you and Toby in my thoughts these next few days! Let us know if you have any more questions.

Edit to add: We put an IV catheter in every pet during any anesthetic procedure (even cat neuters!). Granted we keep all pets on fluids, but everyone's right that it's a direct line for any needed meds, so request one if they don't do it automatically!
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Re: Toby has a bad tooth

Post  MommaJones on 11/14/2011, 6:53 pm

Nancy and Theresa, I feel better about the propofol after hearing what you've had to say. I'm still a nervous wreck, but at least now I know what they are doing is not some off the wall thing!



thminis wrote:


Sorry for all the random comments. I'll pop back in if I think of anything else. You've been given great support and advice from Nancy and everyone. I'll keep you and Toby in my thoughts these next few days! Let us know if you have any more questions.


Please, keep the 'random' comments coming. I love having your perspective on this. It is a great help (and comfort).
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Re: Toby has a bad tooth

Post  LisaIzzyAggy on 11/15/2011, 7:46 am

Think of you and Toby Love. I'm praying that all goes well.
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Re: Toby has a bad tooth

Post  ayleash on 11/15/2011, 9:31 am

paws crossed... watching for an update.
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