10/9 OT: Help with Tobey meds please

[Marje and Gracie]

Morning all.

Tobey had a dental on Sep 20 and they had to extract his two, lower back teeth due to resorptive lesions....a bain of Scottish Folds. They did not put him on ABs which I felt they should have and said so....when you are mucking up with all that bacteria...it's a good precaution.

He seemed to heal really fine and went right back to his Tobey self but I wasn't able to get a peek back there and see how it was doing. He went back last week for his post dental check and one side was REALLY inflamed and very puffy at the extraction site. Our vet (who works Tues, Thurs only) was concerned that he had absorbed the suture and was having a reaction to it but also was concerned that the surgical vet did not give him ABs. She put him on clavamox to which he violently reacted after the first dose. No more of that. I spoke with the surgical vet last Wed and she said if he was eating, didn't have a temp, was not lethargic, and did not have a pus discharge, he didn't need an AB and it would resolve on its own and agreed it was probably reaction to an absorbed suture. Still, I called back on Thurs and talked to our vet who wanted him on an AB. She said clindamycin might have the same effect on his tummy so she put him on metronidazole and said that is a good alternative for extractions....it will get anaerobes. Well.....his mouth looks no different and he's been on the AB since Thurs.

I'm thinking he needs an NSAID or something along that line. Actually...I am sure a shot of dexamethazone would really help but since Gracie is steroid induced.....I'm leery of a steroid.

Does anyone have any ideas on a good anti-inflammatory that he could safely take? I will call vetty again tomorrow. He seems fine....he's eating great, playing, no temp, no signs of discharge, etc.

Thanks!!

 

[Anne & Zener GA]

Hi Marje, I don't have any advice but I hope you find something that will help Tobey. Poor guy. At least he acts like he feels good. I might be in Tucson after Christmas to visit my sister for a few days. Would you be interested in getting together? My sister lives in the Ventana Canyon area.
Liz

 

[Jessica & Boo Radley]

Marje...I'm going to have to side with both of your vets on this one...the surgeon for voting to let him work it out at this point and your vet for putting him on preventative antibiotic.

Here's why...there is a good inflammatory process that we want to happen and then there's a bad inflammatory process that we want to control with meds.

When an acute injury to tissue occurs, the inflammatory cascade begins and millions of different types of specialized cells charge the site to clean it up, to bring it nutrition, to hall off waste and to ultimately begin laying down the framework for new cell and tissue growth. It's a complex, but very straightforward process that usually happens without any hiccups.

Tobey had this type of "injury" when he had the teeth removed and his body began the inflammatory process to heal that up. The hiccup happened when his body absorbed the suture. That suture threw him a curve ball, so now not only does he have to heal that initial incision, but he now has to get rid of that foreign matter (the suture) that was absorbed. All of those same millions of cells are in charge of doing this for him. Because of this, we want to encourage and let the inflammatory process continue to occur. It's his natural way to fighting what ever is going on in there and if we can let the body do it naturally....it's the best way to go. The antibiotic won't get in the way of this process, but helps if it is being caused by bacteria, and it also helps to prop his own immune system up a bit to not have to fight the suture and bacteria at the same time.

In this case, it sounds like the inflammation is being caused by a foreign object...being the suture. The antibiotic isn't "curing" anything because it's not bacterial related. But as mentioned, it's a great thing to have on board to support what Tobey's own system is doing. The sheer fact that he is eating, not running a temp and acting completely normal is a great sign that his body is on board for the fight and doing just what it should. Adding an anti-inflammatory right now would do just want the description says....stop the inflammatory process, which would be counterproductive at this point.

On the other side.....An autoimmune disorder is a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue. These are the "bad" inflammatory processes that we use anti-inflammatory meds to treat. There are more than 80 different types of autoimmune disorders...some common examples are MS, arthritis and AIDS. This is not Tobey's problem - his inflammatory response and system is working perfectly well. With these autoimmune conditions, we give anti-inflammatory meds to stop the faulty inflammatory process.

I'm sorry to ramble, but I wanted to make sure you understood what was going on. You definitely want to keep an eye on him to make sure he's on top of the battle....but letting him do his thing is probably the best thing you can do... ;-) ;-)

 

[Marje and Gracie]

Jessica:

I was hoping you would respond as I know your background and you always have some really great input.

So how long do I wait? I also forgot to tell you that right now, he is also on famvir anti viral because visits to the vet cause his herpes to break out in his left eye. We started him on famvir (per eye vet instructions) three days before the vet visit and she wanted us to continue it for five days after and today is the last day for that. She said it is ok for him to also be on an AB. The reason she wanted to try five days after is because last time we did four days after and the herpes started but luckily, we saw him start to squint and we got him on the anti viral eye drops. So today is the last day for the oral famvir and the anti-viral drops (idoxurdine).

I can't imagine that would slow up the healing process but maybe it is suppressing his immune system and so the inflammation is not gone yet.....Guess we'll see once we're done with the meds. I hate to have him on so much stuff at once but we can't endanger his eyes by letting him get the herpes ulcers....preventative is best. We don't put him on the famvir unless we know he's going to the vet and we're trying to keep those visits to a minimum. Thus...I don't want to take him back tomorrow......

Thank you so much....

 

[Jessica & Boo Radley]

He must get really stressed out by those vet visits! There's a lot of people who take antivirals continuously to prevent herpes break outs...it's not something that will get in the way of the inflammatory process. This may be completely not done in cats......but have you guys ever tried a kitty Valium (I don't really think it's Valium....but you get the point) or has your vet ever discussed that option? If it's stress related, one small pill may do the trick!

In regards to your question about how long to wait.....I don't have a clear cut answer...but on this path, only one of two things is going to happen.
1. His body is going to win and will destroy and then engulf that absorbed suture. The result will be no more inflammation.
2. His body won't win and will end up with an abscess and the suture will have to be removed surgically. You would know this was happening....Elevated temp, elevated bgs, trouble eating, just not feeling good.

I'm guessing the surgeon sees her share of absorbed suture because of her initial response that they "normally" resolve on their own. If you're still concerned and would just like a better heads up....I think a very reasonable question for her is what is "normal" in regards to time.

 

[Marje and Gracie]

Jessica:

Thanks again for your response. The anti virals like famvir are not recommended long term because they can potentially cause kidney issues. We just started him on a nutritional support that is supposed to help with his immune system and he is, of course, on L-lysine. The nutritional supports don't just kick right in, though. I do give him rescue remedy now before going to the vet. He used to LOVE to go but in July when we had his predental bloodwork, they had problems getting blood from the jugular and he was really stressed out....now he shakes when we take him in. I was really PO'd about it and let them know. He is a very sweet boy who loves people and has never had any issues at the vet and now he is afraid. I am sure that we will have to give him some kind of med to calm him next time he needs bloodwork. Other than that, he doesn't need to go any more than every six months for a checkup. Our long-term vet has a mobile practice but she has been gone alot lately; I'm hoping when she gets back from China, she can come do his routine physicals here.

We'll keep an eye on it and hope his little system can overcome it. It looks really sore but he doesn't act like it is. Thanks again so much.

 

[Jessica & Boo Radley]

You may already know this...but the herpes virus is alive and well at all times on it's host. It just doesn't "come out" unless the immune system is somehow stressed. Stress in an of itself can cause a breakout. It should would be nice if they could give him something to calm his nerves vs. having to dose an antiviral for so many days before and after!

Almost all meds are either process in the liver or kidneys and potentially can be toxic to their respective systems.....the more going on, the bigger risk.

I sure hope Ole Tobey sorts that suture out sooner rather than later. You've had too much on your plate and could use some nice calming waters. BIG HUGS to you!!!

 

[Marje and Gracie]

Jessica:

yes...I know about the herpes virus but good to put it out there for others. I have gotten shingles since I was in my mid-20s. Fortunately, I rarely get them now and only have to pop one or two acyclovir with the episode and then it's gone.

It's interesting because Tobey is pretty laid back and happy. He's never had a problem going to the eye vetty....it's only the other vet where they took his blood so he just associates that with stress. I'm hoping the supplement will help to boost his immune system and keep it at bay. I don't want to give him the anti viral every time he has to go to the vet....he may also get reconditioned to know it's not that bad.

Thanks again for all your help!!