? 06/21 Butters AMPS 94 - Dental & Echo Tomorrow - Question about aftercare

Butters & Lyla

Butters & Lyla

Member Since 2020
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I hope you all are doing well. Butters is about the same with her itching and mouth pain.

I just got a call that a cancellation opened up for a dental and cardiology appointment tomorrow at the hospital, and they offered it to Butters:cat:. So I accepted it on her behalf. Her appointment with cardiology is first thing tomorrow morning. They will review her medical records, do the echo, call me to discuss (because...still closed to humans) and then decide whether to clear her for the dental.

I'm assuming the echo will go well and that she will get approved. And of course I'm worrying about her already. The instruction for tomorrow is to start fasting her from midnight, and then give her half a dose of insulin with half her normal amount of food. They won't talk to me about aftercare until tomorrow once she is cleared. I'm getting nervous about all of this now.

I was wondering from anyone who has gone through this, can I ask for your help/thoughts/opinions on what is best practice where aftercare and meds are concerned? Butters had a dental in December 2018 at her old vet's office, and she was given a covenia injection and bupe injection at the office but nothing for me to give her at home.

Do I want clindamycin over covenia? She just had a course of clindamycin last month. I don't think there is a problem doing another one so soon, though. I already have buccal bupe from her vet, but what about injectable bupe? Has anyone used that? I'd rather handle her mouth as little as possible. Anything I should watch out for or tell them not to do? I'm worried about her kidneys especially.

Thanks so much for any help.:bighug:
 
Good luck! Given that Butters has CKD, I am wondering if they will perform blood work and urinalysis to see whether she needs to be put on fluids prior to the surgery? (Djoko was admitted the night before but his ckd is more advanced). I think this is something I would ask.
 
Butters & Lyla said:
Last post

I hope you all are doing well. Butters is about the same with her itching and mouth pain.

I just got a call that a cancellation opened up for a dental and cardiology appointment tomorrow at the hospital, and they offered it to Butters:cat:. So I accepted it on her behalf. Her appointment with cardiology is first thing tomorrow morning. They will review her medical records, do the echo, call me to discuss (because...still closed to humans) and then decide whether to clear her for the dental.

I'm assuming the echo will go well and that she will get approved. And of course I'm worrying about her already. The instruction for tomorrow is to start fasting her from midnight, and then give her half a dose of insulin with half her normal amount of food. They won't talk to me about aftercare until tomorrow once she is cleared. I'm getting nervous about all of this now.

I was wondering from anyone who has gone through this, can I ask for your help/thoughts/opinions on what is best practice where aftercare and meds are concerned? Butters had a dental in December 2018 at her old vet's office, and she was given a covenia injection and bupe injection at the office but nothing for me to give her at home.

Do I want clindamycin over covenia? She just had a course of clindamycin last month. I don't think there is a problem doing another one so soon, though. I already have buccal bupe from her vet, but what about injectable bupe? Has anyone used that? I'd rather handle her mouth as little as possible. Anything I should watch out for or tell them not to do? I'm worried about her kidneys especially.

Thanks so much for any help.:bighug:
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Lyla, so happy to hear that. Prayers for tomorrow. The only issue I had with Dolly, it’s been 4 years, but they sent her home still under some anesthesia. It was scary, falling over, walking into walls. I stayed with her and kept her safe. Later came the crying from pain, howling. I don’t remember if they gave me pain meds. They pulled “lots” of teeth. This is all stuff I know you can deal with, you’ve had much worse with Butters not feeling well. Good luck, hugs and prayers. :bighug::bighug::bighug::bighug::bighug: Hope no major work has to be done. Prayers that all goes well with the cardiologist!!
 
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Paws crossed for success on both counts tomorrow. :bighug::bighug:Too bad they are using an old protocol for fasting. Neko's dental vet let her have up to 1/3 of her breakfast before 6AM. There are new protocols for anaesthesia and diabetic cats. Did you remind the office she was diabetic when they called? Or to check with the vet? I've had them change instructions when I've asked them to do that. Also, if her numbers are at all worrysome, do a token dose or skip in the morning. She will recover just fine. I once gave Neko a token dose and she almost earned a reduction on their AT. :eek:

Speaking of numbers, get a test when she gets home, and then again at PMPS time. Some anaesthesia induction drugs (but not all) lower the BG, so you want to know if she's coming down. That combined with sore mouth/not wanting to eat, can make the PM shot dicey. If you can find it, and it's hard to find in Canada, some all meat babyfood seems to be a fav of kitties after dental. Most ones in Canada have onions or garlic in them, which are no-no's. Or you can make your own, cook the meat, add plenty of water and blend to soft purree.

Clindamycin is a much better AB for the mouth than is Convenia, which is for skin infections. Oral (Antirobe Aquadrops) is easier to give, but tastes awful. I didn't want to pill Neko after she had some major jaw surgery, so she got the oral. Don't forget to start a probiotic, probably today, if she's not on it already. Neko's dental vet also suggested buprenorphine, which she was on already, so we just bumped the dose to three times a day from two. It was oral bupe, injectable subq isn't supposed to be as effective. IV bupe is good, but you won't be doing that. The vet also suggested Metacam for inflammation, which I declined due to her kidneys. More info here: (2015) AAHA/AAFP Pain Management Guidelines for Dogs and Cats
 
Balloon drop & confetti for the appointments :bighug:!

I use subq Bupe & a friend who has had to manage many dental and stomatitis cases also prefers the subq Bupe for the dental cases. Your vet may only be willing to pre fill syringes or depending on how long he thinks she will need the Bupe, he may be willing to write a the prescription for the vials. While the oral/buccal route (along side the cheek) provides a more consistent method of delivery vs subq, any advantage vs subq is essentially removed if you cannot get the proper amount rubbed into the gum line :(. ECID. If Butters is going to have an issue with you rubbing the med on her gum line &/or the dental procedure is going to result in a more painful mouth where the cat is going to be resistant to you messing with her go for the the subq if you can get it. Otherwise, if it isn’t an issue it is totally up to you what you want/feel more comfortable with if the options are given :bighug:!!

The anesthesia is an interesting topic. AAFP & AAHA have both put out Guidelines, but it is still up to your provider. You can have a discussion with them but if you don’t have time, I would not fret too much over it. Most places still do the “no food after midnight” to try to avoid issues and people still forget to pick up the food :banghead: so I think the recommendation has mainly remained because of this issue.

Here are the links for the AAHA chart and the AAFP Anaesthesia Guidelines article:

AAHA:
https://www.aaha.org/globalassets/0...elines_fastingandtreatmentrecommendations.pdf

AAFP:
https://journals.sagepub.com/doi/full/10.1177/1098612X18781391

You will see 1/2 meal 2-4 hours before. One can see where this can become a bit more complicated….& concerning if they are managing multiple cases coming in. It has to be specific.
 
Great that they can get her in earlier than expected! Fingers and paws crossed that everything goes smoothly. (I have no substantial advice to offer... Oberon's dental was uncomplicated and he didn't need any meds afterwards.) :bighug::bighug::bighug:
 
Will be sending vines for Butters and virtual hugs for you tomorrow.

heart-shaped-green-leaf-vines-117539714.jpg

:bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug:
 

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Wendy&Neko said:
Paws crossed for success on both counts tomorrow. :bighug::bighug:Too bad they are using an old protocol for fasting. Neko's dental vet let her have up to 1/3 of her breakfast before 6AM. There are new protocols for anaesthesia and diabetic cats. Did you remind the office she was diabetic when they called? Or to check with the vet?
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I did. The initial instruction was to fast her from midnight. Then I reminded them she is diabetic and asked if that changed anything. They said yes: they said to still fast her from midnight, but give her 1/2 her meal and 1/2 her insulin dose in the morning. I happen to give butters her insulin and breakfast at 530am anyways, so doesn't it sound similar to what Neko's dental vet allowed for her?
Wendy&Neko said:
Also, if her numbers are at all worrysome, do a token dose or skip in the morning. She will recover just fine. I once gave Neko a token dose and she almost earned a reduction on their AT. :eek:
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Eeeeeek. I do not want to have to worry about that. I'm already worried enough about how the anaesthesia might affect her:nailbiting:. I will definitely get those extra tests, and if it looks like I need to skip the PM shot, I will.
I've never been able to find all meat babyfood in Ontario but I will definitely make some. Butters is on a probiotic. She had a course of the Antirobe Aquadrops last month I think it was, because her vet and I assumed she likely had an infection going on she was pawing at her mouth so much. I doubled the probiotic dose then and will do so again.
Tomlin said:
Balloon drop & confetti for the appointments :bighug:!
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Such a relief! Butters's vet was instrumental in getting her seen so soon. It speaks to how urgently he thinks this needs to get done, of course, but I'm just grateful he is on top of things with her.

Tomlin said:
I use subq Bupe & a friend who has had to manage many dental and stomatitis cases also prefers the subq Bupe for the dental cases. Your vet may only be willing to pre fill syringes or depending on how long he thinks she will need the Bupe, he may be willing to write a the prescription for the vials. While the oral/buccal route (along side the cheek) provides a more consistent method of delivery vs subq, any advantage vs subq is essentially removed if you cannot get the proper amount rubbed into the gum line :(.ECID. If Butters is going to have an issue with you rubbing the med on her gum line &/or the dental procedure is going to result in a more painful mouth where the cat is going to be resistant to you messing with her go for the the subq if you can get it. Otherwise, if it isn’t an issue it is totally up to you what you want/feel more comfortable with if the options are given :bighug:!!
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She has already been fighting me on the oral bupe even more as of last week. It is becoming more and more difficult, which is what I told the vet tech. Thank you for suggesting I discuss subq bupe with her vet:bighug:. He decided to prescribe it for her. I don't know if it's prefilled syringes or vials but I'm just so glad to have options:bighug:.
Tomlin said:
You will see 1/2 meal 2-4 hours before. One can see where this can become a bit more complicated….& concerning if they are managing multiple cases coming in. It has to be specific.
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I'm going to remind them when she comes in in the morning that she got a 1/2 meal at 530am. Her cardiologist appointment is at 830am. If she gets cleared for the dental, it sounds like it won't happen until later in the day.

Thank you Amy and Wendy so much for all of the detailed advice and the links for additional reading. :bighug: It's such a huge help to go into tomorrow armed with some information.
 
Marj & Djoko said:
Good luck! Given that Butters has CKD, I am wondering if they will perform blood work and urinalysis to see whether she needs to be put on fluids prior to the surgery? (Djoko was admitted the night before but his ckd is more advanced). I think this is something I would ask.
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Hmmm. This is a good question. THey didn't mention but I assumed they would do labs beforehand. I'll ask them about that and whether subq would be indicated for her. Thanks Marjorie.
Red & Rover (GA) said:
Heinz by Nature (hard to find). It does contain rice. Walmart might carry it – they show it on their online page.
Ingredients: https://www.heinzbaby.com/en-ca/product/00057000001742/beef-in-broth-puree (there's also a chicken but the page for the chicken isn't working.
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This I have seen at my local Shoppers Drug Mart, I think. I was looking for something back in October when she wasn't eating. I wasn't sure about it because of the rice and lemon juice.
 
Best of luck for tomorrow, it's been a long time coming. Hope all goes well, you really sound prepared. Look forward to hear the post-op report out. (PS I still think of those photos of Butters before/after haircut and smile)
 
You can ask cardiologist to list any anesthesia or meds she should not have on his report.

Olive got half dose insulin morning of. I don't remember if she was fed before. I was told to bring her insulin in and they could give her the rest later. I did NOT do that. I reminded them the type of insulin isn't given like short term. I could take care of her insulin when she is home. Maybe switch fluids to non dextrose if it gets to high. Ollie ate as soon as she got home. She had ab and pain meds.
 
Our Dolly Girl said:
Lyla, so happy to hear that. Prayers for tomorrow. The only issue I had with Dolly, it’s been 4 years, but they sent her home still under some anesthesia. It was scary, falling over, walking into walls. I stayed with her and kept her safe. Later came the crying from pain, howling. I don’t remember if they gave me pain meds. They pulled “lots” of teeth. This is all stuff I know you can deal with, you’ve had much worse with Butters not feeling well. Good luck, hugs and prayers. :bighug::bighug::bighug::bighug::bighug: Hope no major work has to be done. Prayers that all goes well with the cardiologist!!
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Awww poor Dolly:(. I've seen Butters have the same reaction from being on too many pain meds:nailbiting:. I'll be blocking off the stairs to the basement and am probably going to have to stay on the couch with her tomorrow night:rolleyes:.
 
Olive & Paula said:
You can ask cardiologist to list any anesthesia or meds she should not have on his report.

Olive got half dose insulin morning of. I don't remember if she was fed before. I was told to bring her insulin in and they could give her the rest later. I did NOT do that. I reminded them the type of insulin isn't given like short term. I could take care of her insulin when she is home. Maybe switch fluids to non dextrose if it gets to high. Ollie ate as soon as she got home. She had ab and pain meds.
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Thank you for the suggestion. I'll do this. That's scary about the insulin. You knew better. Others may not. It's nice when they eat right away. Butters ate after her last dental. She ate everything. But that was 2.5 years ago, before all of her illnesses.
What is going on in Butters's mouth is a bit of a mystery. She has gingivitis and a fractured canine but that tooth doesn't seem to be bothering her. I won't know how bad (or not) things are until the dentist gets xrays.
 
Butters & Lyla said:
Awww poor Dolly:(. I've seen Butters have the same reaction from being on too many pain meds:nailbiting:. I'll be blocking off the stairs to the basement and am probably going to have to stay on the couch with her tomorrow night:rolleyes:.
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Like I said, hope she just gets a cleaning and no teeth have to be pulled. I hope things are okay with the cardiologist. I will be sending lots of prayers for both appointments. Poor Butters has been through a lot, hope and pray tomorrow goes well. I didn’t mean to scare you but our vet did it twice to me, no forewarning that she was still sedated. It was scary to watch, I just kept her close. Sending lots of loving prayers for sweet Butter ( my favorite kind of butter:p) and you. :bighug::bighug::bighug::bighug:
 
I hope I won't be repeating what everyone else has said. I will be thinking of you and Butters tomorrow and praying for a good outcome. Clindamycin is definitely the drug of choice for any bacteria in the mouth. It is frequently given prior to a dental procedure and also after. Simbadol is the injectable form of Bupe. It is good, but is not especially long lasting (about the same as regular Bupe -- Darcy just had a Simbadol injection on Saturday and I was instructed to give oral bupe about 8 hours later ... although I never did because he ended up at the ER). Many of my cats have had Simbadol and never have had any problems with it. However, at home, we are given oral liquid Bupe to use. I understand your concern about getting near her mouth though! I usually just try to work really fast. I am excited about this getting done sooner... rather than your expected time frame before this cancellation. Paws crossed for tomorrow!
 
I hope you will be able to get some sleep. Good luck to you and Butters. I will send you good vibes. Go Butters - you can do this!
 
I just hope that the source of the swelling and pain is found so she feels well again. You won’t need by antibiotic if no teeth are pulled and there’s no sign of infection. The only times Max received antibiotics was after a tooth was pulled. :bighug:
 
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