4/13 Moe: dental today; +9=354;+1.5=271PMPS=350;+9=67;+11=143

[Erin and Moe (GA)]

Good morning all. Today is Moe’s dental and surgery to remove the mass on his lip. His BG this morning is 308, no shot per vet’s instruction.

The vet will call me after examining him, with an estimate of what work will be done, how many extractions, what to do about the mass, etc. I’ll post an update later today.

Good vibes and prayers appreciated.

 

[carfurby (GA)]

Sending dental vines and calming prayers for you.

 

[Sue and Luci]

Sending vetty vines and supportive hugs! I know how stressful this is! I hope everything works out well for you and Moe this morning. Please keep us posted!

 

[Erin and Moe (GA)]

Just got off the phone with the vet and got some good news. The mass on his lip is inflammation from his upper canine super-erupting and poking into his lip. She did a needle aspiration of the tissue. Lots of bacteria and inflammation, but nothing that looks like cancer. Yay! The not so great news is that he has to have five teeth extracted. Both upper canines have root resorption and have to come out. One premolar is loose, another premolar is being resorbed above the gumline, and one lower molar has lots of disease below the gumline. She expects the extractions and cleaning to take about an hour, then recovery for most of the afternoon. I was truly expecting more extractions, so I'm very happy it's only five teeth, but sad he's loosing his upper canines. Poor old boy.

 

[Erin and Moe (GA)]

Just spoke to the vet again (12:30 pm local time). Moe is out of surgery and doing well in recovery. She removed the five teeth and he has lots of stitches there (stitches are dissolving type). She decided not to remove any of the infected tissue at the gum line. She cleaned the area very well and with the removal of the canine that was stabbing into it, she thinks it will heal well without further intervention. Moe will be ready to come home after 3:00 pm. E-collar for 10 days, four days of buprenorphine for pain, plus clavamox for the infection. Recheck in two weeks to make sure everything is healing well and see how diabetes is progressing.

 

[Wendy&Neko]

Poor Moe, he will be a sore little boy. Super happy on the no cancer! I am glad the vet is sending you home with some buprenorphine. If you aren't already, you might want to feed some probiotics to help out the side effects of Clavamox. Feed it at least two hours apart. Antibiotics can kill good tummy flora too.

Why the e-collar?

 

[Erin and Moe (GA)]

Poor Moe, he will be a sore little boy. Super happy on the no cancer! I am glad the vet is sending you home with some buprenorphine. If you aren't already, you might want to feed some probiotics to help out the side effects of Clavamox. Feed it at least two hours apart. Antibiotics can kill good tummy flora too.

Why the e-collar?

I have proviable I can add to his food. Vet wants the e-collar for 10 days so he won't rub or scratch at the stitches in his mouth as they heal. We'll see how he does...I've never left a collar on for that long. I've had two other cats with nearly full mouth extractions (stomatitis); one wore a donut style collar for a couple of days and the other wore a cone for about 10 minutes. Moe's been pretty good the last couple times he's had surgery so I hope he won't need it for that long.

 

[Wendy&Neko]

Sounds like you have other collar options around, that's good. And experience too.

 

[carfurby (GA)]

Great news on the mass on his lip. I hope he heals quickly. Sending prayers.

 

[Erin and Moe (GA)]

Moe is home! Still super wobbly from the anesthesia and extra purry and wanting love.

 

[Erin and Moe (GA)]

I’m just reading his discharge notes. He was given 2 units of insulin at 8:00 this morning. His glucose was 406 at the time, then 511 at 9:00 am and 549 at 11:20 am. They gave me a chart for dosing over the next few days. Pic attached.

 

[Sue and Luci]

Congratulations to Moe for a successful surgery! So relieved to hear it's not cancer!!!

I'm not so sure about the dosing recommendations though...as we dose based on nadirs and not on pre-shot values unless they're really low...I hope @Wendy&Neko or one of the other moderators will stop back in to review those recommendations.

Moe looks precious in his little cabinet...poor little thing. He's had a big day today.

 

[Wendy&Neko]

I agree, ignore the dosing recommendations. Make sure you are feeding just small amounts at once now that he's home, and spaced out in time. Anesthesia can both mess with the GI system, and depending what type of induction drug, can also lower the blood sugar. So get a test sometime this afternoon now that he's home, and then again at preshot so you can see how he's trending. If he's really high you might be able to back the shot time back to as early as 7:00PM tonight, but he's have to be sky high and eating fine. Post here for help on that. You definitely don't want to shoot as early as 6PM as they suggested.

Side note, the moderators job is smooth running of FDMB as a whole, not to comment on dosing, though some of us do that too. There are several additional experienced people here who can comment on dosing.

 

[Erin and Moe (GA)]

I just checked Moe’s glucose at +9 and it’s 354, so about in line with where he’s been lately. I’ll check again closer to 8:00 pm and ask about dosing then. Also, my vet uses an AlphaTrak meter in their practice, so their numbers will be higher than mine.

 

[Sue and Luci]

Side note, the moderators job is smooth running of FDMB as a whole, not to comment on dosing, though some of us do that too. There are several additional experienced people here who can comment on dosing.

I should have said, 'other experienced members' rather than one of the other moderators...sorry I was rushing...as usual...

 

[Erin and Moe (GA)]

Moe’s PMPS is 350, coming down just the tiniest bit from a few hours ago. He’s eaten a couple of ounces since he got home. Vet is recommending 2.5 units for PM shot (based on the little chart she gave me). Any thoughts? He’s still really loopy from the anesthesia.

 

[Sonia & Leo]

I'm so glad it wasn't cancer but poor little sweetie, he went through a lot today. You're an excellent Mama Bean Erin.

 

[Erin and Moe (GA)]

I'm so glad it wasn't cancer but poor little sweetie, he went through a lot today. You're an excellent Mama Bean Erin.

Aw, thanks.

 

[Erin and Moe (GA)]

I decided to be cautious and only gave Moe 2.0 units is tonight. At +1.5 he’s at 271.

 

[Wendy&Neko]

Sorry, I was out pressure washing. Moe's dose is 3.75 units. I would go back to it tomorrow. Looks like the vet gave him the kind of induction drug that lowers the BG so the lower dose tonight was fine.

I expect Moe is loopy because the vet probably gave him some buprenorphine too.

 

[Erin and Moe (GA)]

Sorry, I was out pressure washing. Moe's dose is 3.75 units. I would go back to it tomorrow. Looks like the vet gave him the kind of induction drug that lowers the BG so the lower dose tonight was fine.

I expect Moe is loopy because the vet probably gave him some buprenorphine too.

I’m looking at the vet treatment list. With anesthesia, the following were given: simbadol, alfaxalone and midazolam. Additionally, antibiotic injection (unnamed) with surgery and isoflurane with surgery. Oh, also consil treatment. I have no idea what anybody those things are. She did mention that a long lasting pain med was given but didn’t say what it was.

 

[Wendy&Neko]

Simbadol is injectible buprenorphine. Alfaxalone is the induction drug, and generally doesn't cause the BG to drop. It's possible the pain relief and removal of the inflammation/swelling is helping his numbers somewhat. There will still be swelling from the extractions which will impact his BG for a while until the swelling is down.

 

[Erin and Moe (GA)]

Whoa! I checked Moe’s BG when I got up at 5:30 am and it is 67!! So glad I only gave 2 units last night. I had no idea he would drop so low.

 

[Bron and Sheba (GA)]

Did you offer him something to eat and retest an hour later?
Poor boy has been through a lot today. What a brave fellow.

 

[Erin and Moe (GA)]

Did you offer him something to eat and retest an hour later?
Poor boy has been through a lot today. What a brave fellow.

Yes, I gave him about an ounce of Friskies at 5:30 am and some TikiCat mousse at 6:30. I haven’t tested him again, will do so shortly. His a.m. shot for 4/14 should be at 8:30 am (about an hour and a half from now). I’ll start a new thread for today shortly.

 

[Erin and Moe (GA)]

143 at +11. Getting better.
@Bron and Sheba (GA) any suggestions for dosing this morning? Shot is due in one hour. I have to leave the house immediately after injection but should be home a couple of hours later.

 

[Bron and Sheba (GA)]

143 at +11. Getting better.
@Bron and Sheba (GA) any suggestions for dosing this morning? Shot is due in one hour. I have to leave the house immediately after injection but should be home a couple of hours later.

I think you will have to wait and see what Moe is at AMPS before deciding on dose.
How is he eating this morning?
Does he seem back to his usual self?
Will you be able to monitor the rest of the cycle once you get home again?

 

[Erin and Moe (GA)]

I think you will have to wait and see what Moe is at AMPS before deciding on dose.
How is he eating this morning?
Does he seem back to his usual self?
Will you be able to monitor the rest of the cycle once you get home again?

Appetite is somewhat reduced. He’s pretty nervous right now. I have him isolated in an upstairs bathroom. He can hear stuff but can’t see what’s going on. Still some lingering effects from the anesthesia and pain meds from yesterday - huge pupils and wobbly. He’s also due to get a dose of buprenorphine and clavamox in a little bit.

Yes, I will be able to monitor when I get home, which will be about three hours after injection.

 

[Bron and Sheba (GA)]

Appetite is somewhat reduced. He’s pretty nervous right now. I have him isolated in an upstairs bathroom. He can hear stuff but can’t see what’s going on. Still some lingering effects from the anesthesia and pain meds from yesterday - huge pupils and wobbly. He’s also due to get a dose of buprenorphine and clavamox in a little bit.

Yes, I will be able to monitor when I get home, which will be about three hours after injection.

Yes, sounds like some effects of the anaesthetic and Bupe still lingering.
Will he eat with bupe aboard. I remember when I gave Sheba Bupe orally she was completely zonked for 8 hours.

 

[Erin and Moe (GA)]

He ate about two ounces when he came home last night. I assume he will continue to eat, but not sure. He’s had about three ounces of food in the last three hours.

This morning’s bupe is 4 ml. I just gave him the clavamox...what a struggle!

 

[Bron and Sheba (GA)]

He ate about two ounces when he came home last night. I assume he will continue to eat, but not sure. He’s had about three ounces of food in the last three hours.

This morning’s bupe is 4 ml. I just gave him the clavamox...what a struggle!

That sounds like a decent amount of food, considering he’s just had mouth surgery and teeth out.
I have no idea about Bupe doses in the US. I only gave Sheba it once and she was so spaced out I didn’t give it to her again.
Have you withheld food during the last 2 hours?

 

[Erin and Moe (GA)]

That sounds like a decent amount of food, considering he’s just had mouth surgery and teeth out.
I have no idea about Bupe doses in the US. I only gave Sheba it once and she was so spaced out I didn’t give it to her again.
Have you withheld food during the last 2 hours?

Yes. I’m about to check BG, if I can coax him out of the cabinet one more time.

Okay, AMPS=170.

 

[Bron and Sheba (GA)]

Yes. I’m about to check BG, if I can coax him out of the cabinet one more time.

Okay, AMPS=170.

That is lower than you have shot before. 198 was the previous lowest a couple of days ago, but that was before the dental surgery, bupe and anaesthetic.
I don’t think I would feel comfortable suggesting you shoot the full dose given the current circumstances and I am just about to head to sleep so won’t be around to help.
What are your thoughts?

 

[Erin and Moe (GA)]

That is lower than you have shot before. 198 was the previous lowest a couple of days ago, but that was before the dental.
surgery, bupe and anaesthetic.
I don’t think I would feel comfortable suggesting you shoot the full dose given the current circumstances and I am just about to head to sleep so won’t be around to help.
What are your thoughts?

My vet recommended no shoot if pre shot BG is under 200. I was thinking maybe 1 unit or even 0.5 unit. No way am I shooting 3.75. I will be back in a few hours to watch him.

 

[Bron and Sheba (GA)]

My vet recommended no shoot if pre shot BG is under 200. I was thinking maybe 1 unit or even 0.5 unit. No way am I shooting 3.75. I will be back in a few hours to watch him.

I think you need to shoot what ever you feel most comfortable with because you are there and can judge the situation. The 2 units took him down to 67 last night and it’s hard to judge whether it was the anaesthetic, bupe, or combination of both that took the BG there.
Any history of ketones?

 

[Erin and Moe (GA)]

I think you need to shoot what ever you feel most comfortable with because you are there and can judge the situation. The 2 units took him down to 67 last night and it’s hard to judge whether it was the anaesthetic, bupe, or combination of both that took the BG there.
Any history of ketones?

No ketones. I think I’m going to shoot 0.5. I’d rather he go up than get into a hypo situation.

 

[Bron and Sheba (GA)]

No ketones. I think I’m going to shoot 0.5. I’d rather he go up than get into a hypo situation.

You can always feed him some higher carb food if you need to bring the BG up a bit.