Sunday, October 11, 2015

Watch Out For The Teeth!

As I said in my first blog post: occasionally, I'll depart from the more humorous aspects of being owned by a cat to bring awareness to an issue I believe is important. So far, I've written awareness posts about going through the identification, removal and recovery from Bear's tumor {HERE} and two "puffier" pieces on cat ladies and cat trees, {HERE} and {HERE}, respectively. 

Who doesn't take a cat's teeth seriously? Oh, yes. The scars. But might there be something else, regarding a cat's teeth, that is just as important? If I had to choose one thing to highlight - it would be, without a doubt, feline dental care. In talking to other cat people, I often hear: "My cat is 8/9/10 and needs teeth removed! I didn't know that was something to worry about!" And recommending one brush a cat's teeth is the epitome of "you want me to do what?" I know, I know. I've heard a variety of comments related to feline dental care: 
"Brush my cat's teeth? Are you CRAZY?!?!" 
"Is it necessary and will I survive?" 
"I can't imagine putting my hand in my cat's mouth! There are sharp teeth in there!" 
Both my cats have suffered dental problems that affected their health. Yet most people don't know that this is possible until it is too late and the cat requires treatment for other, consequential conditions as well. I hope our readers will learn from my (and for Kitty, my parents') lack of knowledge and mistakes.

My first encounter with feline dental care happened when our family vet recommended - at each annual wellness/vaccination visit - for five years, to have Kitty's teeth cleaned. This was news to my parents (who were the decision makers; I was in high school) - so they assumed it was some kind of racket by the vets, to supplement income. Admitting that the internet was not widely available ages me quite a bit but also explains why I didn't just hop on the internet, like I'd do today, and find information to convince my parents to get Kitty's teeth cleaned. It wasn't until years later, after Kitty stopped eating (and threw up a lot), that we found out one of her fangs was really infected and painful and needed to be removed. Unfortunately, with her sudden refusal to eat - which took a while to pinpoint - she developed hepatic lipidosis ("fatty liver") - which is not necessarily chronic - but continued to plague Kitty even when she ate normally again (and the vet had no idea why the inflammation, enlarged liver, and elevated liver enzymes plagued her for the rest of her life). After extraction of the tooth, she took prednisone to decrease the inflammation and stimulate her appetite (fortunately with the introduction of wet food, she started eating again) and switched to a special type of dry food. During a flare-up of her symptoms, we gave her a pill twice a day, but otherwise, just once a day. And that is an experience in itself. I became the designated pill giver - yet really didn't understand the pitfalls of giving a cat a pill. I thought I was doing really well . . . until I found a stash of pills she'd spit out in a corner of the kitchen (actually, in a crack between the linoleum and the wall). She must have spit the pills out everyday for a few weeks judging from the quantity of pills in that stash. And so I became an expert at massaging her neck and watching for the little tongue to come out to confirm she'd swallowed the pill. Still, giving a pill to a cat is NOT fun - for either party.

I suspect taking the prednisone hastened or tipped the balance towards diabetes. One to two years after she was diagnosed with hepatic lipidosis and put on the prednisone, she was diagnosed with diabetes. Kitty had been slightly overweight most of her life - so it's entirely possible this would have eventually happened anyway. But prednisone is known to increase blood sugar in humans and animals. After extensive research (this time on the internet), I found diabetes is relatively common in older cats - and not necessarily cause for alarm. She lived another 5 years - to 15 - so unlike my first reaction of fear to another diagnosis - it certainly wasn't the end. In retrospect, what bothers me most is the seeming snowball of conditions starting with an infected fang that needed addressing and wasn't. First the infected tooth - then hepatic lipidosis - then diabetes. While the link between the infected tooth and hepatic lipidosis is probable (Kitty stopped eating and lost weight rapidly), the link with diabetes is less certain. Regardless, proper dental care (as recommended by our vet - more than once) could have saved Kitty a lot of problems and stress. Because while diabetes in cats is manageable, for Kitty it required daily insulin shots and me closely monitoring her for signs of low blood sugar (and when I saw the twitching whiskers required pouring syrup down her throat which isn't exactly easy). Not to mention that hepatic lipidosis and diabetes interfere with each other: eating to placate the lipidosis (as stimulated by the prednisone) can affect blood sugar (diabetes - not only does the medication increase blood sugar, so does the food) - just as not eating can placate the diabetes (to an extent) - but aggravate the lipidosis. The back and forth between the two became a balancing act that was no doubt as stressful to Kitty, if not more so, than it was to me.

With Bear, I first suspected something was wrong when he was close to a year old (I'd had him a few months by then). He loved chasing string (which he could only have with supervision) - and I noticed a bunch of bloody spots on the string when we were done playing. At first, I convinced myself maybe it was the tug of war or rough play that caused the problem (Bear does nothing else). Why would a cat only a year old have dental problems? But a year later, during a period of pancreatitis, my usual vet noted that Bear needed his teeth cleaned because his gums were inflamed. I'd seen another vet in the same practice 6 months earlier and he didn't say anything to me about Bear's teeth. This bothered me because I didn't even remember him looking in Bear's mouth - and I knew the bleeding occurred before that visit. I also felt responsible for not mentioning the bleeding during the visit - which might have prompted him to look. Bear ended up losing two teeth at that cleaning (~ 2 years old) and has since lost two more (another at a tooth cleaning ~ 4 yo, and another at home ~ 6 yo). The vet explained that some cats are genetically predisposed to dental issues and inflammation. She recommended I brush Bear's teeth daily - to preserve his teeth as long as possible. Unfortunately, as I noted above, he's still lost teeth with daily brushing. Nothing is more frustrating than doing everything you can (like brushing Bear's teeth every day) and then watching your cat lose his teeth anyway. I can only imagine what would have happened had I done nothing. 

Bear's experience taught me to ask the vet to look at Bear's teeth at EVERY VISIT. I also can't help but avoid the vet who didn't bother looking. With Bear, I've also learned that a simple examination at the yearly check-up isn't enough either. During regular check-ups, the vet looks and sees the inflammation - but isn't able to look further. As it happens, Bear develops "pockets" under the teeth that one can't see with a simple examination. With the tooth that fell out at home, the vet noted the inflammation but said it'd be okay and was probably only abrasion from dry food - yet 6 months later, it fell out by itself at home. Again, earlier this year, when I took Bear in for the lump I found on his back, I asked about Bear's teeth. The vet saw the inflammation I pointed out but said it should be okay. Knowing what happened before, and given that Bear needed surgery to remove the tumor anyway, the vet said he'd examine Bear's teeth more closely under anesthesia. After the surgery/examination, the vet conceded that a pocket had formed under the tooth that concerned me and it would need to be removed at some point. But since the tumor was bigger and "nastier" (his word) than he expected, the surgery and anesthesia had already taken double the time as expected and he didn't feel comfortable keeping Bear under any longer to extract the tooth (especially because it's a big, three-pronged tooth). So now I've learned that not only do I need to ask for the vet to double check Bear's teeth at every visit, but that pockets form under his teeth that the vet can't tell by just looking at the inflammation. 

A little caveat to the serious nature of the above: telling other people you brush your cat's teeth. While it's not a subject I bring up voluntarily, sometimes it finds its way in to a conversation without me meaning to bring it up. Half the people think it's some frou-frou psycho cat lady thing along the lines of dressing one's cat up regularly. These people are shocked to discover (and probably don't even ultimately believe), that tooth brushing is necessary for Bear to keep his teeth for as long as possible. The other half are completely surprised that dental care is just as important in cats as in humans. I understand the disconnect because of my past experience and  thinking of the farm cats that lived on my father's childhood family farm that seemed to be fine for a lifetime without dental care. That observation is not entirely fair, because most farm cats won't let people pry open their mouths to check for issues, and outside only cats, on average, live much shorter lives than cats who live indoors (this varies widely with the source of the data, but I believe outdoor cats live an average of 5 years and indoor cats, closer to 15.). I also should confess that there are days when Bear's teeth spend an inordinate amount of time embedded in my flesh . . . and I almost regret my vigilance to preserve his teeth. Bear likes to use his teeth . . . and has no problem using them to provide feedback on my care of him (like most cats, he believes he's mistreated and misunderstood).

There are other alternatives to tooth brushing: sprays and rinses, special treats, wipes and of course, vet cleanings (though, since this requires anesthesia one should be careful about this option). In my experience, the vet always does blood work before the cleaning to make sure the cat is healthy in such a way as to tolerate anesthesia and minimize the dangers of the anesthesia. 

My understanding is that most cats do not suffer from the severity of inflammation as Bear does; though, I've heard of cats that needed all but their little front teeth removed because they have a type of auto-immune disorder which grossly inflames the teeth. Regardless, in taking a lesson from my experience with Kitty, dental care can greatly impact the health of a cat and lead down a road of consequential conditions which might not only make the cat's life difficult, but also end it. At every visit, please be sure to ask your vet to check your cat's teeth - even if your cat is only a few years old. Better to ask than to not and have a crisis later - and in most cases a simple examination is enough (unless you're aware your cat develops pockets, as Bear does - but this isn't common). Also, if you notice bleeding gums, make sure you mention it at the cat's next vet visit - and the vet takes your concern seriously. My vet hasn't taken advantage of my trust - I'd err on the side of listening to their advice, whether it be a cleaning or at home solutions. In Kitty's case, even though the decision was completely out of my control, I regret and feel horrible that the initial issue was ignored and made her life more difficult. A few other close observations would have helped: monitoring her food intake instead of just filling the bowl when it's empty (to establish a baseline - say, she eats a bowl every x number of days . . . so it becomes more obvious when you're filling the bowl more or less often in response to a change in eating habits) and checking teeth and gums for signs of trouble (red, irritated looking gums). In the case of tracking how much the cat eats, you'll also increase awareness of other problems that might affect appetite - in my experience, the sooner you recognize the symptoms, the quicker the diagnosis and the better the outcome. However, while Kitty reacted to her dental problems by not eating, Bear doesn't seem to care and eats the same amount anyway - despite whatever problems he has: so watching intake is not always enough by itself to indicate a problem. 

Note: I am not a vet, nor do I have any kind of veterinary training. I hesitate to provide too much technical information because I can't verify it independently. Any information I provide is from my experience only and devoid of clinical details such as a vet would use in discussing the issue. Finding a vet you trust is worth more than any other resource because he is dealing with your cat specifically. Any concerns, questions or uncertainty should be discussed with your vet - as part of a partnership - with a common goal - the health of your pet. 

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