WWYD regarding vet care decision

[Maxy24]

This is going to be long, I apologize.

My family (I live at home with our parents) owns three pets, Neko, Willie (cats), and Tucker. My parents are in a very bad way money wise. Each month they pick and choose what bills can be paid, we're likely losing our house very soon. Their problems started a few months after we got Tucker. As a result the animals don't get to the vet regularly, they basically go if there's a problem. Up until now I've been unable to help but I currently have a full time job, though a low paying one. So I'm in a stable position at the moment, not a great position, but stable. So I want to start getting the animals to the vet.


All of the animals went to the vet shortly before we got Tucker. Neko in 2009, Willie in 2010, and Tucker in 2010. That was the last time Neko went. Willie went in 2013 because he had a lump I wanted looked at. Tucker went in 2013 as well, I think we wanted his rabies vaccine up to date in case he bit someone.

Neko is now 11 years old, his breath is putrid. Willie is 9, breath is also awful. Tucker (5 yrs old) seems fine but I think he really, really needs to be put on prozac, his aggression is not improving, it seemed to get much worse in the last year, though it's reached a plateau in the last couple of months.

I decided to get Neko in to the vet first since it's been so long and because he's entered senior territory, so we went yesterday. My plan was to get him his exam and shots plus senior blood work. Then I'd get him a dental within the next month or two. I figured I was looking at around $600 for the dental. One of the first things the vet notices is a slight heart murmur, grade 1 or 2 which he did not have in 2009. He says this could make anesthesia dangerous so he will not do a dental until Neko has had a cardiac ultrasound to determine if anesthesia is safe. This will cost around $460. If they find a problem (what exactly that means I don't know...I mean we know there's a murmur, there must be a problem) they will then add X-rays, blood work, blood pressure, and urinalysis which could bring the total to about $850. Then the dental could cost anywhere from $400 to $950 (best case and worst case).

This ultrasound sort of ruins everything. Now I'm probably looking at over $1000 to get his teeth done, possibly closer to $2000. I decided not to get blood work during this visit as I wasn't sure when I'd be able to do the dental and the dental must be done within 2 months of the blood work or else they'll have to redo it.

Now, the vet didn't honestly seem that concerned about his teeth but maybe that's just how he is, he didn't really say much ( I didn't really like him overall, but that's for another thread). He said he was missing two teeth (same one on both sides) and that one side of his mouth looked worse than the other. He said there was no obvious infection or broken teeth. He was sort of talking to himself at this point...he said he couldn't find any obvious cause (I'm not sure if he was talking about a cause for the bad breath or for him favoring one side of his mouth). He thought maybe when he lost a tooth the root could have been left behind and is causing an issue. He didn't really urge me to get a dental or comment on his teeth being bad, he just said he'd get me an estimate for the dental, but he knew I was already considering a dental. So I'm not sure if his lack of urgency was because they're not that bad or because he already assumed I was all on board and didn't need convincing.


So here is where I'm in a pickle. I might be able to afford this dental, I think I'll need to talk to the vet some more to try and narrow down a closer estimate. But if I do this I'll need to put off getting Willie and Tucker to the vet for a long time, at least another year. This bugs me, especially for Tucker who I REALLY want to get on meds. So I don't know if I should push back the dental for another year instead and get Willie and Tucker their exams and vaccines right now. In a year I may very well be in a better paying job (that's the plan anyway) making the dental easier to afford. Or I could also have more bills to pay, who knows.

So what would you do? Take care of Neko's teeth now and wait on the other two animals or take care of them and wait on the teeth?

 

[*blackrose]

I'd get another opinion, honestly.

I'd want to know how bad the teeth actually are and if cleaning them I'd worth the anesthesia risk. I'd also want a second opinion on that heart murmur, as it was such a low grade. I, personally, would not feel the need to do a cardiac ultrasound for a grade one murmur and I'd want another quote on a workup/dental.

Unless his teeth *really* need cleaned and are causing issues, I'd choose getting the other pets evaluated and taken care of before doing just a routine dental prophy. Maybe in the meantime start dental chews/diet/rinses.

 

[BostonBanker]

If the vet didn't seem overly concerned about the teeth, and the cats are eating well enough to be maintaining weight and don't seem to be uncomfortable, I'd put them off and work on the issues with Tucker. It sounds, from some of your posts, as if he is genuinely uncomfortable on a pretty regular basis because of his issues. Plus you have the added risk of him biting someone, although I know you do a lot of management with him.

I'd basically do a triage of whose life is most affected by not having their issue taken care of. It might also be worth it to shop around for prices, if you haven't already. There's a huge disparity in our area for things like dentals and spay/neuters. I'm not generally a big fan of opting for the cheapest care with animals, but in a situation where it might be the only option that doesn't put you in a bad place financially, I don't think it is the wrong answer.

Will the cats let you brush their teeth? Is that even a thing with cats? Meg was looking at her second dental in 3 years about 18 months ago, and instead I got absolutely religious about brushing her teeth Every Single Night, and the vet now raves about how good her teeth are. It's a pain, but I wanted to avoid the dental both because of cost and because I turn into a nervous freak when it comes to putting my animals under. It obviously won't help with something like a broken tooth or a root left behind, if that is an issue, but it might help otherwise.

 

[sassafras]

Personally, given these circumstances I'd accept a slightly higher risk of anesthesia and do the dental without an ultrasound. Those stinky mouths hurt even if the cats are eating.

 

[Maxy24]

Neko lets me brush his teeth, I just started with him too late to begin with, then went to college for 4 years and no one else will do it. I have tried starting up with him again but the brush comes away with blood so I worry I'm causing pain which could make him dislike the process, making him tough to do once he has had the dental. I'm also not sure how much good it could do at this point. They did give me some dental kibble to use as treats, some water additive samples, and some dental gel samples. Willie will not let me brush his teeth.


I have a really hard time saying for sure how concerned the vet was. He never actually SAID anything like "I agree he should really get a dental" or anything to help me gauge how bad he thought it was. He just said said "yes he does have some tartar build up, this side is worse" and showed me (the gums on the bad side were also red), told me about the missing teeth, and then said he'd get me an estimate on the dental. The paper work says that Neko was diagnosed with dental disease and a dental cleaning is suggested. Obviously I should have asked more questions, but the social anxiety kicks in and my brain stops working. I'll be bringing Willie and Tucker to a different vet (well Tucker would have to anyway, it's a cat only vet), I didn't feel like this guy explained things well at all, he didn't ask my permission before giving the vaccines, just told me this is the rabies vaccine (inject), and this is the vaccine for upper respiratory conditions (inject). I mean I could have said "no wait!" if it was something I didn't want but I'm used to vets who go over exactly what they're going to do and confirm everything.

Shopping around for dental prices is hard. I called a couple of places before picking a vet to ask about prices on several things and when I asked about dentals no one was able to give me an estimate over the phone, the cat would have to be examined first. Even with an exam the range is so huge. If I knew the dental would be $400 I'd go right ahead but it could be much higher and I won't know until it's too late to back out.


Neko eats all wet food so even if eating kibble would be painful I'd have no idea. I don't know if I could go ahead with a dental without the ultrasound now. If he died I'd blame myself, as would my entire family. They don't want him to get a dental, period. My dad thought it was stupid to bring him to the vet in the first place because he seems fine. I don't know if I could live with that guilt. Maybe if I got a second opinion and the vet seemed really confident it wouldn't be a problem I might be okay with it. This vet implied that they would not do the dental without the ultrasound. However a second opinion means spending more money, though perhaps it would only be an exam fee.


I was so happy that I was going to get Neko in perfect shape and not have to worry anymore and then that darn heart murmur came and wrecked everything.

 

[Southpaw]

Personally, given these circumstances I'd accept a slightly higher risk of anesthesia and do the dental without an ultrasound. Those stinky mouths hurt even if the cats are eating.

That.

Plus with kitties, if he has missing teeth then I'd wonder about resorptive lesions and I can't imagine any of that is comfortable. But if this vet WON'T do it without an ultrasound then I don't know... like you said getting a 2nd opinion is just more money and maybe you won't come away with a better answer.

That said, I would probably prioritize Tucker and medications since that has a large impact on his and your daily life.

 

[kady05]

Since it hasn't been asked yet, do you have any low cost clinics in your area? Maybe I'm just lucky, but I have access to a few low cost clinics and they are awesome. We have 2 places that are income based for dentals (basically they offer services to everyone but for dentals you have to make less than X amount), and one place that isn't. Obviously to prescribe anxiety meds you'd need to go to regular DVM though.

I just had Piper (who is a dog, cats cost less) at one of the clinics and walked out spending $300 for the exam, dental, one "major" extraction (upper right canine) + removal of hyperplasia around that tooth, blood work, and pain meds. Would've been $450-600 (or more) anywhere else. If the murmur is low grade, I'd really be more concerned about the mouth causing more issues than the anesthesia.

I utilize low cost clinics for basically everything except exams, although the one I use for vaccines & HW tests does a mini exam anytime I go, so that's nice. And for my cats, the only vaccine they get is rabies every 3yrs., I don't bother with anything else (they're 100% indoor). So, if you have those in your area, I'd definitely check into them to see if they offer dentals, and even just for vaccines and such. They save me a ton!

 

[PerformanceDog]

I also would worry more about getting Tucker in and getting meds. Then, if you still feel financially comfortable, ask about getting the dental without the ultrasound.

 

[Maxy24]

Do you think another vet would mind if during Tucker or Willie's visit I asked them about Neko's situation and if they feel an ultrasound is necessary? I can probably get a dental quote if I bring Willie in as his breath is bad too.


Another option is Banfield, I work at PetSmart and think we get a discount. I'm not sure how good they are though.


There is a very low cost clinic in Sterling, MA. Like shockingly low cost. But they wouldn't touch Neko with his murmur, they don't do geriatric animals (although they say they consider that 12 yrs old in a cat), and they don't do x-rays or blood work before hand. They are really for very mild dental issues. Otherwise the only low cost clinics I know of are strictly spay/neuter, though I wouldn't be surprised if there were more general low cost clinics in Boston. Anesthesia just makes me so nervous and I hate going with the cheapest option if it could mean inferior care with his life on the line.


I think I'll call the vet I went to on Tuesday and ask how risky he thinks the dental will be without the ultrasound (if he's even willing to do it) and if he thinks the dental is really and urgent matter for Neko or if he thinks it could be pushed back a year.

 

[crazedACD]

There is a very low cost clinic in Sterling, MA. Like shockingly low cost. But they wouldn't touch Neko with his murmur, they don't do geriatric animals (although they say they consider that 12 yrs old in a cat), and they don't do x-rays or blood work before hand. They are really for very mild dental issues. Otherwise the only low cost clinics I know of are strictly spay/neuter, though I wouldn't be surprised if there were more general low cost clinics in Boston. Anesthesia just makes me so nervous and I hate going with the cheapest option if it could mean inferior care with his life on the line.

Tufts has a community program if you can prove need, if you guys are getting food stamps/WIC/etc!
http://vet.tufts.edu/tufts-at-tech/financial-policies-tuftsattech/

And also Second Chance in N Brookfield, I know it is a ride, but they do a lot of dentals for a reduced price. You can also get lower cost subsidized vet care, they have a full service clinic. I don't think your cost would be anywhere near $600.
http://www.secondchanceanimals.org/pet-wellness/articles/wellness.html

 

[Grab]

Since it hasn't been asked yet, do you have any low cost clinics in your area? Maybe I'm just lucky, but I have access to a few low cost clinics and they are awesome. We have 2 places that are income based for dentals (basically they offer services to everyone but for dentals you have to make less than X amount), and one place that isn't. Obviously to prescribe anxiety meds you'd need to go to regular DVM though.

I just had Piper (who is a dog, cats cost less) at one of the clinics and walked out spending $300 for the exam, dental, one "major" extraction (upper right canine) + removal of hyperplasia around that tooth, blood work, and pain meds. Would've been $450-600 (or more) anywhere else. If the murmur is low grade, I'd really be more concerned about the mouth causing more issues than the anesthesia.

I utilize low cost clinics for basically everything except exams, although the one I use for vaccines & HW tests does a mini exam anytime I go, so that's nice. And for my cats, the only vaccine they get is rabies every 3yrs., I don't bother with anything else (they're 100% indoor). So, if you have those in your area, I'd definitely check into them to see if they offer dentals, and even just for vaccines and such. They save me a ton!

This. I've never been there (I work at a vet, so get a discount) but our local low cost clinic does dentals for $150 (extractions extra)

I don't think I'd do an ultrasound for such a low grade murmur. I know we do dentals on animals with heart conditions all the time and, while we do recommend bloodwork, we don't suggest they go for an ultrasound. (that said, it's about an hour and a half to get to a specialist and....very few....people here are willing to do that in this area)

 

[kady05]

Do you think another vet would mind if during Tucker or Willie's visit I asked them about Neko's situation and if they feel an ultrasound is necessary? I can probably get a dental quote if I bring Willie in as his breath is bad too.


Another option is Banfield, I work at PetSmart and think we get a discount. I'm not sure how good they are though.


There is a very low cost clinic in Sterling, MA. Like shockingly low cost. But they wouldn't touch Neko with his murmur, they don't do geriatric animals (although they say they consider that 12 yrs old in a cat), and they don't do x-rays or blood work before hand. They are really for very mild dental issues. Otherwise the only low cost clinics I know of are strictly spay/neuter, though I wouldn't be surprised if there were more general low cost clinics in Boston. Anesthesia just makes me so nervous and I hate going with the cheapest option if it could mean inferior care with his life on the line.


I think I'll call the vet I went to on Tuesday and ask how risky he thinks the dental will be without the ultrasound (if he's even willing to do it) and if he thinks the dental is really and urgent matter for Neko or if he thinks it could be pushed back a year.

Banfield's are hit and miss. I know a handful of good vets that work at them, but on the other hand I know of many that I'd never consider taking my pets to see. If you get a discount I don't see the harm in seeing if you like any of the vets that are working at your Banfield and going that route.

Don't equate low cost to inferior care. Sure, some low cost clinics are sketchy, but the ones in my area at least are awesome. I'd never take my pets there if I thought anything else. I work for a vet, but since we do all in home services for anything requiring surgery, xrays, etc. I go elsewhere.

Honestly, I could afford to go to my rDVM for whatever, but if I can get my dog neutered (for example) for $100 vs. $400, and have him receive the same exact care, why wouldn't I save the money? Your case is a bit different due to the murmur, so some might not touch Neko regardless. But for the others, it'd be worth investigating IMO.