02/02 Toeby - Dental today - he's home

Laurasboyz

Laurasboyz

Member Since 2020
Hi!
I haven't posted for months now, but I do check in to read the board time to time.
I changed from TR in September and Toeby's been doing pretty well.
Currently, if his preshots are 144 (8 mmol/L) or less, I proceed with caution - I either give him a minimal amount of insulin, or I skip the dose altogether.
I'm not recommending this to anyone - this is not SLGS protocol, but it's what our vet feels comfortable with, and this explains some of the numbers on his spreadsheet.
Pre-op urinalysis we did this week showed no sugar in his urine, which was good to hear.

He's dropped low into bright green on two cycles since the New Year and I made reductions in his base dose.
He's been doing very well on 1 mg of budesonide every other day for his IBD symptoms.

I had to wait 3 months for a cardiologist to check his heart and make recommendations for anesthetic for possible dental surgery, and having had that appointment 2 weeks ago, he's having a full dental and probably some extractions tomorrow. Today he got some subQ fluids to help protect his kidneys.

I am wondering if board members might have any advice for me on what I might expect as a result of the anesthetic and surgery, as far as his blood sugar is concerned.
I'm sure his appetite will be affected, which will mean perhaps having to be more careful with giving him insulin?
If anyone could give me the benefit of their experience, or advice, I would love to read it.
I hope everyone is keeping well.
Laura
 
tiffmaxee said:
There’s a whole thread on dentals.
https://www.felinediabetes.com/FDMB/forums/health-links-faqs-about-feline-diabetes.14/

Look fir the link there.
Click to expand...

Hi Elise - thank you for that.

With regard to his diabetes specifically, I guess I should just be careful to see that he is actually eating, and not dose him if he is not eating?
I know they are giving him a shot of long lasting pain meds tomorrow, not planning on giving him NSAIDs because he is on the Budesonide.

He is feeling punky tonight, but he had antibiotics and subcutaneous fluids in preparation for tomorrow, so that might be why.
He wasn't hungry, but his PMPS was 11.2, (202) so I coaxed him to eat a bit and gave him his insulin.
I'll have to check him in a couple hours and try to get him to eat some more.
He will have no insulin (nor food or water) in the morning... just his antibiotics.
Laura
 
Last edited:
I skipped Max’s insulin the morning of his dental. He wasn’t eating great so I skipped the night dose as well. The next morning I resumed normal dosing. If he was eating well I would have dosed the night of the dental.
 
Hi Laura, nice to see you :). Good luck with the dental tomorrow, sending vetty vines and hoping all goes well, I'm sure Toeby will feel much better once everything is taken care of.

If he does indeed get some teeth extracted, you might want to have some Tiki cat velvet mousse on hand, in case he's not feeling too keen post op, and not wanting to eating his usual food. Some people here use the Baby Gerbers all meat, but we can't find the right ones in Canada. Positive thoughts for tomorrow, let us know how things go :bighug:
 
What you can expect with his numbers depends on what gets done tomorrow. If he has extractions or otherwise inflamed mouth, his numbers could go up for a week (ish). After Neko's extraction I had to increase for a week then the numbers came back down after the inflammation was down. Let his numbers be your guide.

Another thing you can do is take his BG when he gets home, then again at PMPS time. Some anaesthesia induction drugs lower the BG, though not the one my dental vet used. The two BG's will tell you if he's trending down into shot time. If so, and he's not willing to eat, a skip may be in the cards.

Do you know what foods Toeby is allergic too? Tiki cat velvet mousse may or may not work for him because of ingredients. I just found some Naturo mousse products in the pet food store today (made in Ireland) that don't have fish or chicken. Or you can make your own mousse with water and cat food in a blender. I had a special cheap immersion blender just for Neko's foods.
 
Thanks very much @Christie & Maverick and @Wendy&Neko !
This is exactly the kind of information I was looking for... how the anesthetic might affect him, and what to expect. :bighug:
We're off to the vets momentarily... I will post later with an update.
Cheers for this, I do find this board very, very helpful although I haven't been posting daily.
Paws crossed.
Laura
 
They need to keep him on fluids during the dental and afterwards for a while to protect and flush the kidneys. There are more kidney friendly anesthesia drugs that they can use (some are easier than others on the kidneys). It's very important for them to monitor his blood pressure during the procedure to make sure it doesn't drop too low. Hopefully, they plan to do this.
 
Baby food is also a good option -- Stage 2 of either Gerber or Beechnut. They are all protein and broth, no veggies.

Some cats need "down time" -- being in a quiet room with low light after a procedure. You also don't want to give a lot of food all at once. Anesthesia can stimulate appetite but slow the gut so there's the potential for a cat to vomit if you give in to the "I'm hungry" part of the equation. I've also had a kitty who's mouth was too tender to want to eat much. So, any easy to swallow food is helpful if there are extractions. Some cats are fine with eating their usual food.
 
Christie & Maverick said:
let us know how things go :bighug:
Click to expand...

Hi, nice to see you too, and thanks!

We're home after a long day for him... he was under anesthetic, in surgery, for 1.5 hours and then they kept him on fluids until 6 pm so we just got home a bit ago.
The vet who did his dental said his mouth was bad - the sorest she'd seen in a long time.
She said until they do x-rays, it is hard to really know what is going on with their teeth, which made me feel a bit better, but I do feel bad about his mouth.

He had 5 teeth extracted, and has more that should go - 3 out of his 4 canines are bad too but the vet didn't want to keep him under any longer.
His BP was a bit low at first, but they got it up and then she said he was fine throughout.
There is something going on in his jaw bone - she did a biopsy to determine if he has osteomyelitis or possibly cancer.
The results of that biopsy next week will probably help decide what we do going forward.

He is hungry, which is good.
I did get some Tiki mousse in different flavours; the local PetValu didn't have any Naturo mousse.
He likes it but I am trying to just feed him a little bit every 20 minutes, and I haven't given him his insulin yet until I see he gets some food aboard and doesn't barf it back up.
I took his BG and it is 17.7... which is probably high enough I could give him insulin even if he barfs, but I'm going to wait a wee bit.
His BG was high this morning, but I had given him some treats last night to get him to eat before his food came up at midnight - he felt lousy last night.
His BG was 18 at the clinic this aft.

I have several pre-filled syringes of Comfortan to give him in lieu of Metacam, given that he is on the Budesonide steroid.
We skipped tonight's Budesonide and will start back on Saturday on his regular schedule.
He'll continue on Clinacin antibiotic, with the dose possibly increased if he does have osteomyelitis.

And that's the report on Mr. Toeby.
He seems happy to be home, pretty lively, and a wee bit stoned.
I am relieved that he came through the operation well, and I hope his mouth feels better and that he will maybe put some weight on.
I am also hoping this helps with his blood sugar control, as he was doing very well, I thought, even with what was going on with his mouth.
He was cruising along pretty well in blues and greens with low yellows... I thought we were doing pretty good.
He is very thin... only 4.1 kg, or 9 lbs... he used to be 13 lbs or more back in his hay day, but he is 16 years old too.

Thanks for the good wishes.
Laura
 
Hi Laura! I'm really glad to hear that Toeby is doing well after his surgery! Hope the x-rays and biopsy show nothing to be worried about. Will be thinking of you and Toebs. :bighug: I've missed you around here. :)
 
Suzanne & Darcy said:
They need to keep him on fluids during the dental and afterwards for a while to protect and flush the kidneys. There are more kidney friendly anesthesia drugs that they can use (some are easier than others on the kidneys). It's very important for them to monitor his blood pressure during the procedure to make sure it doesn't drop too low. Hopefully, they plan to do this.
Click to expand...

Hi Suzanne, I missed your post on my first read through - thanks for this, yes, they were careful about his kidneys - he got subQ fluid yesterday prior to the operation, and fluids during and after the procedure today.
As I wrote above, his BP did drop at first, but they were able to get it up and it stayed up, so the vet was happy with how he did.
 
Katherine&Ruby said:
Hi Laura! I'm really glad to hear that Toeby is doing well after his surgery! Hope the x-rays and biopsy show nothing to be worried about. Will be thinking of you and Toebs. :bighug: I've missed you around here. :)
Click to expand...

Hey Katherine - Happy New Year!
I guess we all have our own little tigers for 2022, although some are striped and some are not.
:cat:

I do check in here from time to time...
I stopped posting regularly when I stopped doing TR as there were so many newbies who needed help, and I didn't want to clutter up the place..

As it is, and again, I am not recommending this to any one else, when I stopped TR I actually found it a bit of a relief, given the way he'd drop low on me.
I wasn't constantly worrying about him crashing on me.
As I had said months ago, the vet who is looking after him this past year didn't want me giving him insulin below 144... and at first I stuck to that rule hard and fast.
But I found his numbers have been pretty good, and if I skipped a dose I hated seeing 220's the next day, so I will give a small dose to avoid those higher next cycles.
(Shhh...)
But I do still skip doses at numbers I would give insulin on in TR, or SLGS for that matter.
He seems to be doing okay, and his vet is happier, and so am I.
I record it all on his chart.
He has gone low on me twice this year, which was new - he was good in October - December.
I reduced his dose accordingly.
I am hoping that is a good sign, but I dunno.

Glad to read Ruby is spry and that you are doing well.
Laura
 
I’m very happy to hear that he’s come through this successfully. I hope that he will be much more comfortable now and will heal quickly and be able to eat. It sounds like they were very cautious with him. I have had cats who have had many more teeth extracted at a single time and they did really well. I really hope nothing serious will be found from the bone biopsy. I am glad you have pain medication (not Metacam!). Best wishes!
 
Odd to say I am rooting for osteomyelitis, but I am. Neko also had to have a jaw bone biopsy sent off. It goes to Guelph University lab. Hers was none of the above, but rather a bony growth due to acromegly. However, I did spend a rather nervous week waiting for the results.

I got the Naturo at a small local chain of pet food stores, with more selection than Pet Valu has. Glad to hear the Tiki Cat Mousse worked for him.

tagging @Jodey&Eddie cause she's contemplating a dental but was told it might be 3 hours under anaesthesia! Good to see your vet stopped after a certain point.
 
Wendy&Neko said:
Odd to say I am rooting for osteomyelitis, but I am. Neko also had to have a jaw bone biopsy sent off. It goes to Guelph University lab. .
Click to expand...

I wondered if it would go to PEI, to the Atlantic Vet College, but if yours got sent from BC to Guelph, perhaps Toeby's will too.
Interesting.
I'm rooting for osteomyelitis too, give the choice.

Wendy...
I know I should take things one step at a time and all that, but at some point, could you look at his chart and give me your impression on what he's doing with his insulin?
This may all change (hopefully for the better) if the infection and inflammation in his mouth gets cleared up, or if he does have cancer, I know.
I got the impression that his insulin requirement was dropping over time, with his numbers becoming more regular - less crashes, less big bounces because he wasn't having big drops.
I'm wondering specifically if the fact that he went quite low on me twice since the New Year possibly a sign that his pancreas is producing some insulin?
Or is that just wishful thinking on my part?
Laura
 
I think he's spending a bit more time in green. It's a little hard to tell with the data you've got and not familiar with the dosing method. One comment, if you do a fur shot, could you put FS beside the dose on the spreadsheet. I was wondering why the pink on 1/26 PM. That seems so not like Toeby.

How's his appetite? Is he eating the volume he used to?
 
Wendy&Neko said:
tagging @Jodey&Eddie cause she's contemplating a dental but was told it might be 3 hours under anaesthesia! Good to see your vet stopped after a certain point.
Click to expand...

@Jodey&Eddie , I am not sure exactly why his dental vet stopped at the 1.5 hour point but she felt he'd been under long enough at that point, and didn't want to push it.
Toeby is 16.
He has a heart murmur that a cardiologist said wasn't a big deal... it was because of a valve in his heart that acts a little funny, but it doesn't cause him problems.
The cardiologist made recommendations for anesthetics suitable for his age and heart health.
As a 16 year old cat he is showing the first signs of kidney disease, nothing major, so I think the dental vet was being cautious, which I greatly appreciated.
I hope your kitty does well.
I can say this, I regret not having the dental done sooner - I had taken the attitude that it was too dangerous to put him under, but in truth, I think he was safe once we took the precautions first, and his poor mouth is a mess.
When he was younger he had dentals and extractions, but I had no idea his mouth was this bad.
I wish I had done this months and months ago.
I live in a small rural town and was on a waiting list for a cardiologist from our nearest city to come on his rounds, so that added to the delay, but it was worth it.
Good luck and go for it!
Laura
 
Wendy&Neko said:
I think he's spending a bit more time in green. It's a little hard to tell with the data you've got and not familiar with the dosing method. One comment, if you do a fur shot, could you put FS beside the dose on the spreadsheet. I was wondering why the pink on 1/26 PM. That seems so not like Toeby.

How's his appetite? Is he eating the volume he used to?
Click to expand...

I corrected to put FS on the Jan 26th morning shot...
That morning I smelled insulin on my hand after his morning shot so I thought it was a fur shot... and the evening preshot seems to confirm that it was indeed a fur shot that morning.
Also that day, he went for bloodwork at 10:30, and so I figured between the fur shot in the morning, and clinic stress from being whisked off for bloodwork, that created the pink at the evening preshot.
Indeed, he has not been giving me many pinks, thank God.

His appetite has been the same as always - these bad teeth don't seem to slow him down, but he still grazes, which may be because maybe his mouth gets sore, so he stops, then circles back once he feels better?
I would never had known his teeth hurt, but his breath was horrible... every time I'd give him his Budesonide tablet I'd smell it.
The dental vet did say the kind of reabsorptive lesion he had was not a painful one.
He had no appetite last night, but he felt like crap... either the Clinacin he started or the subQ fluids did him in last night.

He has no allergies to foods that I am aware of - we did suspect it, but once he was on Budesonide he has done very well (touching wood)
Laura
 
Yikes...
He was 319 around his normal preshot time... after no insulin this morning, and having his dental this morning.
I waited an hour or so, fed him a small amount every 15 minutes or so, and then gave him his insulin.
Now at +2 hours after he got the insulin, he is at 124!

I may give him some gravy off a high carb can along with the Tiki mousse to bump him up a wee bit.
I will have to keep an eye on him for the next couple hours.
Laura
 
Laurasboyz said:
@Jodey&Eddie , I am not sure exactly why his dental vet stopped at the 1.5 hour point but she felt he'd been under long enough at that point, and didn't want to push it.
Toeby is 16.
He has a heart murmur that a cardiologist said wasn't a big deal... it was because of a valve in his heart that acts a little funny, but it doesn't cause him problems.
The cardiologist made recommendations for anesthetics suitable for his age and heart health.
As a 16 year old cat he is showing the first signs of kidney disease, nothing major, so I think the dental vet was being cautious, which I greatly appreciated.
I hope your kitty does well.
I can say this, I regret not having the dental done sooner - I had taken the attitude that it was too dangerous to put him under, but in truth, I think he was safe once we took the precautions first, and his poor mouth is a mess.
When he was younger he had dentals and extractions, but I had no idea his mouth was this bad.
I wish I had done this months and months ago.
I live in a small rural town and was on a waiting list for a cardiologist from our nearest city to come on his rounds, so that added to the delay, but it was worth it.
Good luck and go for it!
Laura
Click to expand...

Hi Laura, thank you (and Wendy for tagging me) for sharing Toeby's dental story. The one thing I know about surgery length when it comes to the jaw is that the lower canine are part of the jaw and the surgery is quite complicated because there's not just a tooth with a root, so to speak. I don't know if this pertains to Eddie; it was just mentioned to me.

I will be seeking dental work for him as soon as I've found out what the blood panel, which he had last week, has to say.
Thank you again and all good thoughts for you and Toeby!
 
Laurasboyz said:
He had no appetite last night, but he felt like crap... either the Clinacin he started or the subQ fluids did him in last night.
Click to expand...
My bet is on the clinacin (contains clindamycin). Horrid taste, really dose a number on the tummy flora, and fantastic for an antibiotic in the mouth. If you aren't already, I'd be doing some probiotics, given a couple hours away from the clinacin.
 
Wendy&Neko said:
My bet is on the clinacin (contains clindamycin). Horrid taste, really dose a number on the tummy flora, and fantastic for an antibiotic in the mouth. If you aren't already, I'd be doing some probiotics, given a couple hours away from the clinacin.
Click to expand...

Thanks for this Wendy! - sharing knowledge like this is why this board is invaluable to me, really.
We've always given both of them human probiotics sprinkled on meals (Natural Factors Acidophilus & Bifidus) but he is taking the clinacin with his meals/insulin every 12 hours, so I will be sure to give him some probiotics away from then.
I know that probiotic is not feline specific, but I've given it to them for years, as long as I have been taking it.

As far as doing a number on his stomach flora, I noticed he's been passing gas a bit since he's come home, and that is something he used to do a lot before he went on Budesonide.
Now I know why.

By the way, I asked... his sample was sent to Idexx Labs, which is in Markham, ON.
It's not going to a vet school, but to the commercial lab the clinic uses for a lot of testing.
Thanks again,
Laura
 
Oh my goodness, I have taken Clindamycin myself (Augmentin it’s called here for humans - amoxicillin and clavulanate) and it tore me up! I had a LOT of painful stomach acid / heartburn that bothered me all day long. You could try a few days of 1/4 tablet of a 10 mg Pepcid AC (famotidine.) straight Famotidine with no extra ingredients). I would also not give the clinacin on an empty stomach. If you have/or can get slippery elm bark powder to make a solution to syringe in, I think this could really help coat, soothe and protect Toeby’s Gi tract. It works for me, although I usually take it in capsule form.
 
I forgot to say that conventional wisdom says to separate slippery elm bark from pills such as antibiotics by an hour or two - to prevent the medications from being properly absorbed. I don’t think there’s hard data to support this notion, but it seems to make sense since slippery elm protects the digestive tract.
 
Thanks Suzanne, I will look into this... I know for sure I can get slippery elm, and I can check to be sure the Pepcid AC available in Canada has nothing extra in it, and go from there.

He's not hungry this am... but his pain meds may have worn off.
I have to say, I felt bad this morning - when I gave him his pain meds I forgot the volume of liquid is much greater than his insulin and I shoved the plunger home quickly, which made him give me a little "ow".
When he's getting a quarter unit of insulin, I am used to just a tiny motion on the syringe.
Poor guy.

I did skip his insulin this morning as he was 131, with no appetite.
The only two times he's dropped below 50 on me this year was when I gave him insulin on a similar low morning reading, so I am not chancing it this morning, at least not right now.
I will see if he starts to eat soon once the Comfortan kicks in.
Laura
 
Oh wow. So you are injecting the pain meds. I hope he will be comfortable today and will eat some today. He should turn around soon, but yes those antibiotics are so rough on the GI tract.
 
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