2/17 Kitty Dental - Resorption, not good, Post anes. concern

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Kathy and Kitty

Kathy and Kitty

Very Active Member
Yesterday: viewtopic.php?f=9&t=6498

Kitty is okay. He is still coming out of anesthesia; I'll be able to pick him up in a couple of hours.

The vet asked me to come to the office to look at x-rays. I don't have a written report, but this is what I heard:

The remaining three front teeth, plus a few other teeth on both sides, have root resorption in various stages. The vet says that this is not uncommon. He felt it would not be right to pull these teeth, because the roots are not available to pull.

There are areas where the gum has...receded? Been damaged? I'm not sure. But it's the roots that are the real problem.

This is what accounts for the "lytic," moth-eaten appearance that was originally picked up by the radiologist last fall.

The plan is to send these x-rays to a board-certified dental vet. We'll get another opinion on how to proceed. I have NO idea what to expect.

The vet doesn't think Kitty is in pain from this. But my heart tells me otherwise. For many, many months, it seems Kitty just moves around trying to find a place to be comfortable.

Anyone with experience with this -- or anyone who wants to send a hug, because I sure need one -- please chime in. :sad:
 
Re: 2/17 Kitty Dental - Resorption, not good report

oh Im so sorry :cry: I don't have any advice on this matter, but I will send you both huge hugs!
 
Re: 2/17 Kitty Dental - Resorption, not good report

:YMHUG: :YMHUG: :YMHUG: :YMHUG: (((Kathy)))
I know you'll get some eyes on this, I'm rootin' for Kitty here!

cat_pet_icon
 
Re: 2/17 Kitty Dental - Resorption, not good report

:YMHUG: :YMHUG: :YMHUG:

It sounds as if you will be getting some good exprt advice. I'm not familiar with this, but if it is not uncommon, there must be a reatively easy solution or you'd be hearing about it all the time!

Good luck and I'm sorry that you and Kitty have to go through this.
 
Re: 2/17 Kitty Dental - Resorption, not good report

Hi (((Kathy)))
You might want to post this on Health, there are a few cats who have gone through this I believe. And always go with your gut. If you think he's hurting, he is.
 
Re: 2/17 Kitty Dental - Resorption, not good report

We haven't had to deal with this ourselves, thankfully, but I'm pretty sure I've read that it hurts - if touched, the kitty may even jump when anesthetized :sad:

Try googling feline odontoclastic resorptive lesions or feline oral resorptive lesions or FORL for more information.

http://www.veterinarypartner.com/Conten ... &A=169&S=2
 
Re: 2/17 Kitty Dental - Resorption, not good report

Thank you, everyone. I've cross-posted on Health, and I'll research those links.

I will ask more about the pain issue when I pick Kitty up. This vet had also mentioned some condition in which cats will react even during anesthesia, so he's aware of that -- and doesn't seem to think this is that condition. I want to know more.

I don't think there is an easy solution. The vet said that this is a problem veterinary medicine is working on, and they haven't figured out what causes it or -- I think -- how to treat it.
 
Re: 2/17 Kitty Dental - Resorption, not good report

Yes, Choy-Foong, that's the name he mentioned during the pre-dental visit! i wonder why he didn't use it today. I will ask him specifically about that. Thank you.

I just read this very quick primer on Wikipedia: http://en.wikipedia.org/wiki/Feline_odontoclastic_resorptive_lesion

I also have just looked at sample x-rays here:
http://vmth.tamu.edu/hospservices/dentistry/FORL.shtml

This is not what Kitty's x-rays look like. It isn't the teeth that have eroded, leavin lesions on the gums. It is the roots that have been resorbed into the jaw.

Since the vet is aware of FORL, I'm going to hope that it isn't that, because there's no good treatment, and it's painful. But I will make sure when I pick him up.

Kitty LOVES to have his jaw rubbed, so that would be a sign against FORL, I suspect.
 
Re: 2/17 Kitty Dental - Resorption, not good report

Hi Kathy

I'm sorry to hear about this complication. My cat Dillon specialized in FORLs to the point where I did take him to a dentist (well, a dental resident) and had her choose whether or not to take all of his cheek teeth [teeth other than the canines]. She did.

So ...

First off, kudos to your vet for being honest and realizing when he's out of his league. He's not sure where to go with a few of those teeth so instead of messing around he's passed the buck to an expert. There is some controversy on tooth removal for cats with FORLs. In the earliest stages, you can and should remove the crown and dig out the root. In later stages you have a weird situation where the root is fading into the jawbone, so there may be some root to dig out but it's not clear cut, or (in rare, advanced cases) you can remove the crown because the root has been replaced by bone. Cats with FORLs can have "crumbly" roots which can be a real P.I.T.A. to get out. You need dental radiographs to check for root fragments and, quite frankly, you can benefit from a very experienced eye to identify how much dental tissue is left (and how much has been absorbed by bone).

As far as the pain goes, for a long time these difficult-to-extract FORL roots were left behind because cats "didn't seem to mind". And to be honest, they really don't seem to feel dental pain to the extent that we do. Dillon --and other cats on the board-- gobbled food as soon as he got home from having the rest of his cheek teeth extracted. NEvertheless, I gave him pain meds for four days afterwards because I think it's unreasonable to imagine that impacted root fragments don't cause pain. I know people on this board who have withheld pain meds, waiting for the cats to "prove" they are in pain, and I usually speak out against it. Dillon didn't seem to be painful, but that doesn't mean he wasn't and pain should not be the "reward" of stoicism.

For Kitty, I'd speak to your vet about pain management for at least the next few days. You'll see if it changes his eating habits and that can help convince your vet to continue pain meds until the dentist weighs in on the next step.
 
Re: 2/17 Kitty Dental - Resorption, not good report

Jess, thank you. I'm sorry you've been through this, but your experience is so helpful. You've said so many things that help clarify the situation.

First off, kudos to your vet for being honest and realizing when he's out of his league.
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Yes, I thought maybe he just didn't know what to do. I'm very glad he didn't plunge in.

In the earliest stages, you can and should remove the crown and dig out the root.
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There will be much time for self-blame, but I am feeling upset that no one has caught this. In retrospect -- Kitty had a broken tooth from the day we found him, and not one single vet ever proposed further dental work. What might we have saved him if they had?

You need dental radiographs to check for root fragments and, quite frankly, you can benefit from a very experienced eye to identify how much dental tissue is left (and how much has been absorbed by bone).
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We were referred to this particular vet because of his x-ray equipment, and I think this is why. He showed me where the roots are just gone, or partially gone. I understand why he wouldn't want to try to dig around.

Jess, having seen those pictures, I'm not sure how they can treat this. How do you ever get those fragments out?

it's unreasonable to imagine that impacted root fragments don't cause pain.
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Right now, Kitty has just had his teeth cleaned. Nothing has been removed. Should I assume he has more pain than he has had all along -- other than the irritation of cleaning? The roots haven't been disturbed today.

Kitty eats soft food well. He likes it a little watery. He was eating hard food with pleasure until last year.

But I'm going to ask for pain meds. Bupe. He said he doesn't think Kitty needs it, but I'll fight.
 
Re: 2/17 Food to feed

Meanwhile... last fall, Kitty didn't really go for the baby food, but he did eat the A/D (?) I got from the vet surgeon. I'm thinking I'll go with that.

And yes, I remember: Test him immediately upon getting home, and feed only small amounts. Maybe a couple of teaspoons at a time? Every half hour?
 
Re: 2/17 Kitty Dental - Resorption, not good report

Kathy and Kitty said:
There will be much time for self-blame, but I am feeling upset that no one has caught this. In retrospect -- Kitty had a broken tooth from the day we found him, and not one single vet ever proposed further dental work. What might we have saved him if they had?
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Unfortunately there is nothing you can do other than extract the tooth once it looks bad. FORLs often don't have symptoms, which is why you hear of cats who seem ok getting a "routine dental" and they have to have five extractions. The x-rays show the extent of the problem.

Jess, having seen those pictures, I'm not sure how they can treat this. How do you ever get those fragments out?
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by digging! and x-raying, and re-x-raying to make sure. Experience helps, though, so if you have a dentist in your area you may want to consult him or her. I also specifically told Dillon's dentist that I was leaving it up to her on whether or not to take out the rest of his cheek teeth -- I told her she had my blessing to take all of them out if she had concerns. (Many people get upset with vets when they take out a lot of teeth--I'm not sure why, but I've seen clients flip out about it before, so I made sure to tell Dillon's vet that she had free reign.)

Right now, Kitty has just had his teeth cleaned. Nothing has been removed. Should I assume he has more pain than he has had all along -- other than the irritation of cleaning? The roots haven't been disturbed today.
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Probably briefly a little more pain just from the probing and digging, but not too much.

But I'm going to ask for pain meds. Bupe. He said he doesn't think Kitty needs it, but I'll fight.
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I would approach your vet with the idea of a "trial" to see if he was in pain, rather than insist that he must be. Ask for a few days of pain meds to see if Kitty seems more comfortable. I'd make a plan with teh vet that you'll give the pain meds as directed for three days then call him with the results of the trial.

I think long-term opioid use is difficult to arrange and difficult for most vets to agree to. If Kitty responds to the pain meds in some way, you should speed up the plans for the extractions, and see if your vet thinks that pain meds are warranted in the meantime.
 
Re: 2/17 Kitty Dental - Resorption, not good report

I would approach your vet with the idea of a "trial" to see if he was in pain, rather than insist that he must be. Ask for a few days of pain meds to see if Kitty seems more comfortable. I'd make a plan with teh vet that you'll give the pain meds as directed for three days then call him with the results of the trial.

I think long-term opioid use is difficult to arrange and difficult for most vets to agree to. If Kitty responds to the pain meds in some way, you should speed up the plans for the extractions, and see if your vet thinks that pain meds are warranted in the meantime.
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Thank you for this excellent approach. I believe he would be resistant if I insisted on it. He's already a little surprised by the home-testing.

From the way you've described it all, Jess, I'm guessing this definitely sounds like FORL to you. I guess it's better to know than to not know.

Thank you so much.
 
Re: 2/17 Kitty Dental - Resorption, not good report

(((kathy)))
we haven't had to deal with this. glad you're getting advice and doing some research...
 
Re: 2/17 Kitty Dental - Resorption, not good report

One last thing about FORL pain ... Depending on the stage and how the resorption is taking place, any single affected tooth might be very painful all the time, or intermittently painful, or somewhat painful all the time, or painless. (If the tooth root is being attacked from the outside to the inside, where the nerve is, it will not be painful at first.) So the presence of a FORL doesn't mean the cat is in pain; it does mean that there is probably more than one FORL, and there is a good likelihood of pain (but no guarantee) somewhere in the mouth if you have a bunch of FORLs.
 
Re: 2/17 Kitty Dental - Resorption, not good report

(((Kathy)))

No advice, just passing on a hug. :) Looks like you have gotten some great advice already. I hope Kitty gets through this as painlessly as possible and comes out the other side like a new kitty. :)
 
Re: 2/17 POST ANESTHESIA CONCERNS

I fed him 2 teaspoons of his FF low carb, with some water in it to make it soupy, heated it. Now he's just lying on the floor. Responsive, breathing, but could he have gotten nauseated? What should I do?
 
Re: 2/17 POST ANESTHESIA CONCERNS

Kathy and Kitty said:
I fed him 2 teaspoons of his FF low carb, with some water in it to make it soupy, heated it. Now he's just lying on the floor. Responsive, breathing, but could he have gotten nauseated? What should I do?
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kathy, did he eat it?
when alex came back from her dental, i was told to put her in a dark room by herself so she'd sleep it off. the only times i went in there was to check her and bring small amounts of food about every hour... a little more frequently as time went on and she became more responsive.

if you have any doubts or concerns about his behavior... call your vet.
 
I don't know, can you call your vet?

Sometimes Jojo says to put them in a dark room for recovery, can you go sit with him in a dark safe place? I don't remember how that is supposed to help, some help I am... And count his breaths and see if you can listen to his heart at all. Was he fairly responsive when you picked him up, or pretty out of it? Is he purring?
 
(((Kathy))))

I hope the vet sent you home with a list of possible warning signs. It's good for your sanity, and kitty's health. Did they tell you what to expect? If it's anything outside of that, I'd call the vet to ask.

I know that anesthesia makes me quite nauseous...I would think it would be the same for the furkids. She does need to sleep it off, but you don't want to miss anything.
 
Re: 2/17 Yes, he is purring

DANG DANG I forgot the dark place.

After reading Jill's message, I picked him and put him in his bed in the darkened room. He is purring. He is still gulping some, but he hasn't vomited. Yes, responsive.

When he came home, he was full of energy, walking, purring -- wanted food, so I gave him the two teaspoons -- I measured! -- he ate, waited for more. Then he sat down, then he lay down and held his head still and was gulping. Like any nauseated being, i guess.

I think he is okay. His breathing seems appropriate -- slow-ish, like a kitty at rest, not shallow or quick.

Don't know what to listen for with his heart, but I'll go have a listen.
 
Jill -- yes, he got .5 (measure??) bupe during the anesthesia. I had to wrestle with them, but I got them to send me home with more.

Yes, it did make him out of it. (what a memory you have) His transition from excited to flat out was so sudden.

It has been 45 minutes since I fed him. Was it wrong to give him the FF? I have the A/D, but it says Feline/ Canine on the can, so I balked.

What should I feed him next, and when? I could run to the store for baby food, but last time, he didn't like it.

p.s. You are all the most wonderful persons in the world.
 
Re: 2/17 Kitty better. He has gotten up - hungry!

About 32 breaths during one minute, with brief pause for gulping. Purring too loudly to hear heartbeat. :)

A little nausea, I guess. He didn't have it last time. He just got out of bed and went to the basement. He's on the prowl!

I think he is hungry. What food do you think I should give him next?

The vet's assistant handed me a piece of paper at check out that says, "follow up for dentals" -- but I was so busy wrestling the bupe prescription, I didn't notice. And it doesn't really say anything much -- just that he will be groggy!
 
you're not wrong to feed him, just keep the portions small. I don't think you need to force him to eat if he's not hungry, though. A/D is ok if he likes that, it's high carb but he'll get over that. Watered down FF should also be ok. When Lucy came home she ate regular FF (she had a cleaning, no extractions and probably not as much digging around as Kitty had).
 
i don't think it was wrong to give him FF. alex won't eat baby food either.
i sent jojo a FB message earlier, but i haven't heard back from her. i sent jess a PM a couple of minutes ago asking her to stop by here if she could. i'm feeling a little bit out of my element. don't want to steer you wrong! my concern is his behavior changing so abruptly. being nauseous could do it. i just don't know if there could be other reasons. if jess or jojo don't pop in here soon... i'd call your vet. i have NO idea if you can give him any pepcid AC right now (maybe someone else does?).

if alex seemed nauseous, i think i'd hold off feeding her for a little bit... and when i did feed her, i'd probably only feed a teaspoon at a time.... but i am not in the veterinary field. these are just things i'd probably do, but i'd call my vet if i thought her behavior was weird.
 
Re: 2/17 Fed one tsp A/D; bupe

He seems to want more, but we'll stick with that. So he has now had 2 tsps FF with water, and an hour later, this tsp A/D.

First he was restless, then he was flat out, now he is up and restless again. He must have been nauseated. If the A/D is higher carb, well, good, I can support his BG with less consumption.

I am sure he had plenty of scraping and digging. The vet was NOT going to give bupe, but I used Jess's strategy and FOUGHT to get some for a trial, until Friday. The vet was already gone, but I pushed the assistant to call him.

So tonight sometime he will need: more food; more bupe; insulin.
 
Re: 2/17 Fed one tsp A/D; bupe

Kathy and Kitty said:
So tonight sometime he will need: more food; more bupe; insulin.
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did vet say when he can have more bupe, and how much? 0.5 ml sounds like a pretty hefty dose, and i think i've read that the larger the dose, the longer the duration. you don't want to overdo it if that isn't close to wearing off.

how much does he weigh?

also, be aware that if he gets too zonked from bupe (if you give tonight), he may not want to eat. you'll have to take that into account when giving his insulin shot. i'm not saying you shouldn't give the bupe tonight if needed - your vet should have told you what to do - just want you to be aware that insulin may (or may not) get tricky tonight.
 
Gabby weighs 12lbs and was prescribed 0.35 BID of bupe sub-q after her dental. She was a little loopy on that amount but not much. Dilated pupils and a little dreamy. There were no instructions about altering insulin dose with the bupe on board.

Do you know what they used for induction (the meds before they administer the anesthesia) as well as what the anesthesia was?
 
Re: 2/17 energy back, other medical details

He must have been nauseated. He is now not only on his feet, he is on the prowl. He meowed to go into the basement, his idea of outside, or where he hides. He rarely meows. I think he's a little freaked out. But he's purring, and mobile.

Other things:

Anesthesia/bupe: I asked for and got the records. Kitty is 17.6 pounds. They used Ketamine .3 ml and diazepam .3 ml to induce, and isoflurane inhalation gas. Duration of anesthesia: 1 hour.

Fluids: 22ga catheter right front, normosol-r 150 mls overday. [Kitty peed in his carrier on the way home. :sad: ]

BG: was 105 pre-surgery, their scale, when he got there -- I think that's around 70? -- but 134 (their monitor) at 12:25. I tested him before leaving this morning, and he was 90. He was 98 when I got him home.

Procedure notes: These are emotionally upsetting. Some may not want to read this.
"307 mesial root gone, 304 area lytic from tooth loss. Also there is a proliferative area outside of the bone cortex on symphsis, 206 gone, 207-9 ok, 202 broken with root below gum, 203 fragmented dangling ( :shock: ) in exposed gum, 204 root absorption, with blonted root tip. 104 gum recession and root absorption 106 gone, 107-9 o.k. 409 distal root resorbed 404 losts (sic) of bone resorption."

And he didn't think Kitty needed ongoing pain relief?? I don't understand.

Bupe: I was refused bupe at first, but i said I was not comfortable with that, and I was sent home with bupe to manage until Friday, when the vet will be back and we'll talk.

I did not get any instructions really, except .5 two to three times a day. Right now, Kitty is not zonked.

I agree, .5 seems like a lot for him. I gave him less last fall, and it seemed fine. I would welcome thoughts on what I might give him tonight, and when.

BG tonight: I will feed him another teaspoon in about 20 minutes. Not sure when to test him again, or how to decide what to shoot.
 
I think shooting tonight is going to have to be a wait and see thing. If you got a 98 when you got home, I would probably test again a couple of hours after that just to get an idea of whether he is rising, falling, or staying the same. Sorry, I haven't used bupe so no idea on the dosage.
 
Hi Kathy

I haven't read anything too concerning, being that he's had anesthesia today. He could be gulping because his throat is a little irritated from the tube (the breathing tube they have during anesthesia); if it continues you can try to get a little video of it.

From Kitty's pic and his current weight I can tell he's a little, um, portly and sometimes the "portly" animals seem to stay groggier longer (that's not official, just my observation). He's breathing well, he's responsive, he ate well ... I'd leave him be. I, too, have sat and stared at my animals post-anesthesia but as long as they are alert and have no funny goings-on (like vomiting, hyperventilation, inability to walk, etc.), staring at them just ends up making us both a little nuts ;-) Sounds like he's returning to normal so I'd leave him be.

His dose of buprenex is reasonable; I'd hold off on giving him more, though, until you see him completely return to normal, even though that's probably not going to occur until tomorrow morning. If he had had something dramatic happen today (like full mouth extraction, major surgery, etc.) I'd say you couldn't skip a dose, but since all he had was a dental prophy and a major reason for the buprenex is to observe his reaction, I'd hold off. If you give it tonight and tomorrow morning, and he's still "off", you won't know if it's a prolonged response to the anesthesia or the buprenex, KWIM?

The BG/dose/timing advice I'll leave to your LL peeps.
 
wow, 17.6 lbs? he's a big boy! i take back what i said; his bupe dose is within the dose range (albeit on the higher end) for his weight.

diazepam, huh? that's valium. one side effect is it'll make him hungry ;-) go easy on the food, what you're doing - spacing it out - sounds fine to me, but don't take my word for it. i don't know how much food is too much. hope jess or jojo stops in soon.
 
Re: 2/17 Nom Nom Effect - BG 81

Down from 98 upon arrival home, which was a bit over 2 hours ago.

I fed his 3rd tsp of A/d. Food so far:

5:15 2 tsp LC FF, he got nauseated but did not vomit
6:15 1 tsp A/D
7:15 1 tsp A/D
7:30 t txp A/D

He's hungry, and BG is lower. Not sure how to manage this. No visible nausea on the A/D. He is active and up - maybe a little nervous, but fully alert.
 
WCF and Meowzi said:
wow, 17.6 lbs? he's a big boy! i take back what i said; his bupe dose is within the dose range (albeit on the higher end) for his weight.

diazepam, huh? that's valium. one side effect is it'll make him hungry ;-) go easy on the food, what you're doing - spacing it out - sounds fine to me, but don't take my word for it. i don't know how much food is too much. hope jess or jojo stops in soon.
Click to expand...

He is very LONG too. :smile: He is a large animal in all regards, though, yes, way too portly. He has gained a pound since his procedure last October. Someone must be feeding him to make sure he doesn't go too low. :roll:

Gosh, he's hungry.

He seems pretty normal. But we'll see how he is tonight. I wonder, can one give a small dose of bupe? Like, .1?
 
Kathy and Kitty said:
I wonder, can one give a small dose of bupe? Like, .1?
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Hi Kathy

I'm not sure if you're asking this of me? I still hold the same opinion as I did one post ago ;-) Besides that, you'd be giving a sub-therapeutic dose if you gave 0.1mL and there's not much point in that ... it'd be like you taking 1/3 of an ibuprofen.

If he's hungry, and hasn't vomited, I don't see why he can't eat his regular meal. If you're asking about it in terms of your shooting schedule, I'll pass that question on to your LL beans. If you're asking if it's harmful, no, he's kept food down for a few hours now so I'd give him the rest of his dinner.
 
(((Kathy))) (((Kitty)))

I haven't been on here all day except just now and when I saw this I had to come give you and Kitty BIG HUGS ♥ I don't know anything about the after anesthesia stuff but I know plenty about HUMAN root resorption as I have it in many teeth and it came out of nowhere and I'm trying to figure out how to proceed with this for myself. Only way I found out was because all of a sudden a bridge came loose and the x-rays showed why... when amazingly 6 months before things looked fine.

I can tell you this...I am not in pain from it. I know this is not true for everyone(EBID), and probably not for every cat(ECID), but I am not in pain at all. Just something to make you feel a little positive. :-D

Give Kitty and you big hugs from Alex and Jackson and of course, me. We are thinking of you ♥
 
Jess, sorry to be confusing. I've been trying to post and take care of him.

He is holding food down, and he is hungry, so I will give him a little more A/D.

Normal shooting time is in around 2 hours from now, which will be +24.

I will hold off on another dose of bupe until the morning.

THANKS, everyone.
 
kathy, will you please post the number before shooting? if there's not a significant rise... i don't think i'd shoot tonight. that's NOT the normal recommendation, but kitty is so tightly regulated. "IF" he experiences the nom-nom effect... he doesn't have a whole lot of room to drop.

i can make sure i'm here in 2 hours if you want a second opinion as whether to shoot or not...
 
Re: 2/17 Food and shot

Jill, thanks. I plan to test him in about 5 minutes, and I DEFINITELY want your opinion!

He has eaten altogether about 2/5 of the large can of A/d -- all in two-tsp. lots stretched out since 6:15. He's alert, walking around, maybe a little confused. This is higher carb, I guess.

As an aside, he did "use" the box, KWIM? :-D Just wanted to share.
 
Re: 2/17 +23.5 66!

I would be very comfortable skipping his shot. I'm pretty tired and would have a hard time staying up all night to monitor.

In fact, I would like to give him some HC gravy.

Jill, your thoughts?
 
that's what i was afraid of. go ahead and give him a little hc gravy (don't overdo it). you'll want to keep his numbers up now.
skip the shot tonight. you can start fresh in the morning.
 
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