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My 6 years old DSH neutered male cat underwent a dental prophy

and single tooth extraction in...
My 6 years old DSH neutered male cat underwent a dental prophy and single tooth extraction in the upper right quadrant on Friday. I dropped him off at 8:30am and when I called at 2:30 to check on him was told by the receptionist he was fine and I could pick him up. I immediately drove to the clinic, paid my bill and the receptionist went back put my cat in a carrier and handed him to me. I did not speak to my vet. On the drive home my cat started crying out, head bumping and vigorously face rubbing in the carrier. I thought something was wrong and when I took him out of the carrier at home, his pupils were completely dialated and he was pacing, distressed and disoriented. I called my vet and reported his behaviour and was told, oh its probably just the anesthetic. Wait 24 hours and call us back if you still think there is a problem. Well the next morning the cats eyes were responding normally to light and he appeared improved but I began to suspect deafness. On Sunday his vision seemed better but I knew he was deaf (no response to talking loudly in his ear and shaking a can of coins behind his head and clapping). I phoned my vet on Monday and was told "she is booked" can you bring him in tomorrow. I went to my appointment yesterday and the vet (my regular vet) that did the procedure was on vacation so I saw her associate. She examined my cats eyes and found them normal. I told her he had no menace response and she just said well . . . I then asked her to check his hearing and she responded well you have already done so at home so he likely is deaf. The associate, who had my cats chart (he is a regular patient at this hospital and she herself just saw him for an unrelated issue in February, told me she could answer no questions about how the procedure was done and she was not there. She told me to follow up with attending vet when that vet returned next Tuesday. I also told her I was taking him to an opthamologist but she did not want to write up the referral but had the paperwork put in my cats file for the attending to deal with when she returned. After this long background my questions are:

1) Should not the attending vet known my cat was damaged after awakening from the anesthesia. If it was obvious to me, my was it not obvious to her and should she not have had me bring him back immediately when I phoned the clinic with my concerns after arriving home.

2) How much of my cats damage is due to bad luck and how much is due to the competence of the veterinary who I been seeing regularly for 3 years.

3) I realize my cats blindness and deafness is cortical. My cat does have some vision in that he can navigate the house, find his litter box but there is no response to waving a hand in front of his face or to talking loudly in his ear. What is the liklihood that his vision and/or hearing with return to near normalcy in the future and how long should that take.

He does have an appointment next week with the attending vet and with a veterinary opthamologist in two weeks. My cat is very depressed and most of the time just lays in a lump and stares into space. He is not wanting to eat as the days go on. He was a happy playful loving cat before this disaster and my heart is broken. If he does not recover I am considering euthanization as his quality of life will be zero.
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Answered in 3 minutes by:
5/15/2013
Rebecca
Rebecca, Cat Veterinarian
Category: Cat
Satisfied Customers: 15,764
Experience: Veterinarian for more than 30 years
Verified

RebeccaVet :

Hello JACustomer,

RebeccaVet :

I am very sorry to hear about Misty. You must be devastated.

Customer:

Hello

Customer:

Totally, one of my cats just died a little over a month ago.

Customer:

Misty is my favorite

RebeccaVet :

Thank you for using Just Answer to ask about him. My name isXXXXX am a veterinarian, and will do my best to help.

Customer:

Thank you

RebeccaVet :

Do you know what drugs were used for the anesthesia?

Customer:

No because the associate who had my chart refused to give me any information and the vet that did the procedure was on vacation

RebeccaVet :

All the answers we need would be on the record. What drugs were used, what the blood pressure readings were, what the oxygen saturation readings were.

Customer:

I do know they did no blood pressure monitoring because I asked. I also asked about cardiac arrest and she did say that would have been noted in the chart

RebeccaVet :

You should be able to request his medical records. They can't withhold that from you.

Customer:

Yes but when I pressed the associate for information all she would tell me is that she was not there.

RebeccaVet :

Did they do "Pulse Ox" readings, of his heart rate and oxygen levels
?

Customer:

I have (or had) a good repair with the attending vet and I am sure she will give me the information when she returns. They are supposed to be cat specialists.

RebeccaVet :

He either had a bad reaction to a drug he got ( I would check to see if he got ketamine) or his oxygen levels were too low.

RebeccaVet :

I guess another possibility would be a blood clot to his brain.

RebeccaVet :

If they are cat specialists, they should be monitoring blood pressure during anesthesia, in my very humble opinion.

Customer:

Again, the associate just kept saving she was not there. I did ask her if he was given Ketamine (I was a librarian and have been researching this since Friday). She did not answer one way or the other.

RebeccaVet :

She should know what drugs were given, that should be in the record.

RebeccaVet :

There is a chance he will get better, but it could take one to two weeks.

Customer:

Well they are apparently NOT specialists are they. They are apparently incompetent and I blame myself for taking him there.

RebeccaVet :

I feel so bad for you, and for him. Your description of him is heartbreaking.

RebeccaVet :

It is a good sign that he tracks a cotton ball.

Customer:

Do you think that he will experience recovery in both vision and hearing. He was the happiest little cat running and playing with his ball. Now just lies in a lump.

RebeccaVet :

It is possible, yes.

Customer:

Re the cotton ball, I have heard that with cortical blindess they can sense motion but not really be able to see. What do you know about this.

RebeccaVet :

That is why we use the cotton ball. It is too light for them to hear or feel it. If they track a dropped cotton ball, it should be because he sees it.

RebeccaVet :

If you shine a light in his eyes, do the pupils constrict?

Customer:

If he does not recover in one to two weeks, what are his chances? Yes his eyes respond and look normal upon examination but he is blind. But not completely as he doesnt bump into anything and can navigate well.

RebeccaVet :

If he does not recover in two weeks, I would not be very hopeful. If there is any improvement in one to two weeks, then he may slowly improve, maybe or maybe not fully.

Customer:

Also could his lethargy and unresponsiveness be due also to cognitive deficit from the hypoxia or lack of blood flow to brain.

RebeccaVet :

A consult with a neurologist might tell you more.

RebeccaVet :

He could be depressed about his sudden change in his abilities, or he could be depressed from hypoxia.

Customer:

I tried to make an appointment with the neurologist at veterinary specialists but he only comes in once a month and is booked. I am on a waiting list.. OK re the depression I guess it could be both but you are saying he should recover in two weeks. Why that time frame.

RebeccaVet :

That is just what I have seen, and heard. If you are going to see improvement, it is within that time frame. But without knowing specifically what is wrong, it is just a guess. With cats that got ketamine, you see improvement usually within a week if the cat is going to recover.

Customer:

What does the ketamine do to cause the deafness and blindness

RebeccaVet :

We do not know exactly why and how ketamine works. We do know that it happens, in humans as well as cats. When blindness is due to ketamine, it does usually get better in one to two weeks.

RebeccaVet :

But this could be hypoxia, a blood clot, underlying heart disease or hypertension.

Customer:

What about the deafness why would he experience both and why did they not notice his deficits when awaking from the anesthesia when I noticed them immediately. Why did they tell me to wait and see. And I guess I should not be returning to this vet clinic for anything in the future. Please comment. I know about professional integrity but I have not provided the name of the vets or clinics.

RebeccaVet :

I can't say why they did not notice something wrong when he woke up, since I was not there. I suspect if you noticed it immediately, it was going on at the clinic before you picked him up, but only some one who was there can say for sure how he looked, and how closely he was checked and monitored as he woke up.

RebeccaVet :

I do think that when you called and said there was a problem, they should have told you to come right back immediately, not to wait until the next day, especially since the next day was a Saturday.

RebeccaVet :

And I think the vet who did see him should have been more helpful.

Customer:

What about your personal opinion, base on what I have described, of the competence of this practice. I realize you were not there but what is your sense based on accepted protocols.

RebeccaVet :

Even though she was not there, you would understand that.

RebeccaVet :

Well, I do not do dentals without monitoring blood pressure. It could be argued that it may not meet the "standard of care" these days.

RebeccaVet :

Were you offered IV fluids during the procedure, was he on fluids to support blood pressure?

Customer:

I have called the vet that did see him Cruella DaVille. I normally refuse to see her because she is always rude and sometimes rough with the clients..

RebeccaVet :

No one should call him or herself a cat specialist that is rough. Period.

RebeccaVet :

Cats never respond to roughness, manhandling, loud voices, etc. especially when they are stressed at the vet.

Customer:

I was not offered anything. I would have OKd anything to ensure my cats safety. I assumed they could do a simple dental and tooth extraction. She did one before on another cat and saved an absessed tooth.

Customer:

The vet I normally see is very sweet and gentle. I like her personally very much. When my cat died last month, she sent me a personal hand written note. That cat died from acromegaly and susequent kidney failure and was under the care of a specialist when he passed.

RebeccaVet :

I always offer every owner whose cat ( or dog) is undergoing anesthesia the option of doing fluids, pre anesthetic blood tests, etc. and leave it to the pet owner to decide what they can afford or want for their pet.

RebeccaVet :

Acromegaly! I had a cat with that. Pretty rare.

Customer:

He was totally worked up in February because I thought he has something wrong but no one could find anything wrong with him.

RebeccaVet :

It is not an easy diagnosis.

RebeccaVet :

My condolences.

Customer:

Yes, but acromegaly is not that rare. I was on a acromegaly support group on the internet and it is woefully underdiagnosed. My cat had and IGF-1 of over 500 but no imaging. BTW I had to beg my vet to run the test and give her t he information on where to send it, I guess that was very telling.

RebeccaVet :

My cat died at only 10. It was awful to watch, and not be able to help him. He was the best cat I ever had, the one cat I would wish for back of all my cats.

RebeccaVet :

That was 20 years ago, no good testing then.

RebeccaVet :

Yes, a cat specialist should be aware of acromegaly.

Customer:

Now they dont test the growth factor but the IGF-1 i pretty significant. Anything over 100 is suspect.

RebeccaVet :

You are a knowledgeable cat owner.

Customer:

She was aware of acromegaly but kept saying he could not have it as he "didnt have a big jaw". He was on 9 units of Lantus BID and still his BG was not under control. So finally she sent in the test. He only lived a few months after that even though his diabetes like symptoms went into remission. He died of kidney failure. He had three ultrasounds and all his organs were enlarged.

RebeccaVet :

Well, I guess you know a big jaw is not the only symptom. My cat develped brow ridges, like a Neanderthal, but no big jaw either.

RebeccaVet :

As soon as his insulin got up to 10 units, I knew what he had.

Customer:

As I said I was a librarian and I do research. Ashley had a widened bridge and was huge cat. And yes 10 units twice a day would kill a normally diabetic cat.

Customer:

Well OK I guess you have answered my questions and really confirmed what I already know. I am devastated about Misty. If he is left deaf and blind, his quality of life is zero. I believe it will be kinder to ethanize him then.

RebeccaVet :

I would support that decision if he does not get better, if I were your vet.

Customer:

OK Rebecca. Well thank you very much for answering my many questions.

RebeccaVet :

You are so welcome.

Customer:

Good bye.

RebeccaVet :

You have my sympathies for Misty, and for your acromegalic cat.

Rebecca
Rebecca, Cat Veterinarian
Category: Cat
Satisfied Customers: 15,764
Experience: Veterinarian for more than 30 years
Verified
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Mary Ellen,
How are you doing? How is Misty?

Rebecca
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Rebecca
Rebecca
Rebecca, Cat Veterinarian
Category: Cat
Satisfied Customers: 15,764
15,764 Satisfied Customers
Experience: Veterinarian for more than 30 years

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