First dental procedure tomorrow - On day 5 without insulin

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Champoux

Champoux

Member Since 2017
Previous thread: http://www.felinediabetes.com/FDMB/...es-in-a-row-amps-6-6-mmol-l-119-mg-dl.178243/

Last Saturday, Champagne went through a symptomatic hypo, induced by a 0.1 u Lantus dose. Since then, I was supposed to reduce his dose to a single drop, but he'd never reach acceptable enough preshots for me to do so. He's now 5 days insulin-free and maintaining himself between 5.2 mmol/L (94 mg/dl) and 8.7 mmol/L (157 mg/dl).

The thing is, his original diagnosis was made during a pre-op blood panel for a dental, where they found his BG at 29.1 mmol/l (524 mg/dl) after a 12 hours fast. Seeing this crazy number, they stopped everything there and Champagne never got his teeth cleaned/removed. The dental was pretty much needed, as Champagne had even started developing an abscess, which had been treated with 2 weeks of antibiotics before the procedure.

Now that he's in good enough numbers, we phoned the vet and she managed to get us an appointment for tomorrow (friday may 26th). She agreed with us that doing it now rather than later would be the best thing to do, as we can't know if either his teeth or his numbers will worsen if we wait too much. Getting rid of the infection and bacteria in his gums could also help him get faster to remission. The vet also allowed us to feed Champagne until 2 AM instead of midnight and to bring him at the hospital at 10:00 AM instead of the usual 8:00 to minimize his stress.

Needless to say that I'm a nervous wreck at the moment. The only time Champagne was under anesthesia was when he got neutered as a kitten. Now he's 15 years old, soon 16, diabetic and stage I CKD and I'm scared senseless he doesn't make it through.

I do know it's the best for him and leaving him with rotten teeth in his mouth could be worse for his health than making him go through anesthesia, but I'll admit I have trouble thinking rationally at the moment.

Did you ever go through this process with your own cat ? If so, how did it go ? Is there something I should know/expect or something I should do to help him recover faster ?

Thanks !
 
Anaesthesia is tough on a CKD kitty and it actually brought on CKD in 2 of my past cats when they went in for a dental when they were elderly (one was 13yo, the other 16). When the one who was diagnosed at 13yo was 17 the vet wanted to do another dental and said she would keep the cat on a drip for 24 hours prior to the surgery to support the kidneys. I got a second opinion from a different vet and he advised against surgery and her teeth weren't that bad at all so we didn't go ahead with it and she passed away 6 months later but she was in a later stage of CKD than your cat. All cats are different though. Maybe ask the vet if if the tooth can be removed with a lighter sedation and does the cat really need a full dental given her age and health? If you decide to go ahead ask the vet about keeping her on fluids for 48 hours (24 preprocedure and 24 post) to support her kidneys.
 
Myrtlesmum said:
Anaesthesia is tough on a CKD kitty and it actually brought on CKD in 2 of my past cats when they went in for a dental when they were elderly (one was 13yo, the other 16). When the one who was diagnosed at 13yo was 17 the vet wanted to do another dental and said she would keep the cat on a drip for 24 hours prior to the surgery to support the kidneys. I got a second opinion from a different vet and he advised against surgery and her teeth weren't that bad at all so we didn't go ahead with it and she passed away 6 months later but she was in a later stage of CKD than your cat. All cats are different though. Maybe ask the vet if if the tooth can be removed with a lighter sedation and does the cat really need a full dental given her age and health? If you decide to go ahead ask the vet about keeping her on fluids for 48 hours (24 preprocedure and 24 post) to support her kidneys.
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The two vets I spoke to said his teeth were in bad shape and he'd probably need a few extractions and those had to be under full anesthesia. It was pretty much non-negotiable. They said they were going to take additional precautions, seen his health issues, such as lowering his drug intake. They also told me they were using gas so if there was a problem, they could wake him up almost immediately. He is going to be on IV fluids a bit before and during the procedure, though not 24 hours before. I'm really scared about the anesthesia part, but the vets told me it could be riskier without... Thanks for your advice though, it's really appreciated !
 
So, everything went well. Champagne woke up from his surgery and got three teeth removed.

Only thing is, as Champagne had previously been on Buprenorphine before and badly reacted (was restless, couldn't sleep had poor appetite and still seemed in pain) the Vet prescribed him Metacam in oral suspension. Now I've been arguing with her that Metacam wasn't a good choice for cats, especially CKD ones, but she says there isn't any other option for post-operation pain management. Now I'm torn between giving Champagne just one dose or nothing at all...
 
Long term metacam would be an issue, one or two doses should be ok. The pain would probably be worse on his system than a dose or two.
 
Myrtlesmum said:
Long term metacam would be an issue, one or two doses should be ok. The pain would probably be worse on his system than a dose or two.
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What freaked me out were the reports of people who had cats go in acute kidney injury after one or two doses only. I obviously don't want him to be in pain, but some of the side effects reported seemed painful on a longer time-scale than post-op pain. Though now I did some research and there's apparently less of those cases in Canada than in the US, due to the dosage.
 
I hate these kinds of either/ors. You just want to do the right thing for your little guy.

I don't know anything about metacam, so I can't advise on that, but I'm glad to hear that the risk is lower at "Canadian" doses, at least.

Whenever my cats have had dentals, including extractions, they've gone right back to eating immediately after they get out of the carrier, which either means the pain wasn't too bad, or that they are hopeless gluttons... :)
 
Nan & Amber said:
I hate these kinds of either/ors. You just want to do the right thing for your little guy.

I don't know anything about metacam, so I can't advise on that, but I'm glad to hear that the risk is lower at "Canadian" doses, at least.

Whenever my cats have had dentals, including extractions, they've gone right back to eating immediately after they get out of the carrier, which either means the pain wasn't too bad, or that they are hopeless gluttons... :)
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Exactly. If I could see into the future and just know what the right decision was, it'd be so much easier ! Well, since yesterday Champagne has been eating like he'd been starved (which he kind of has) :) but the drugs he's been given for anesthesia are just starting to wear off. He wasn't able to sleep until 8 AM this morning and his surgery was at noon yesterday. Now he had some food again but he seems more reluctant to eat and hid under my bed, probably the pain meds have stopped being effective. Also he's been drinking like crazy, I suspect it's because the tube might have irritated his throat. I think I'll give him a single dose of metacam today and nothing more. I ended up giving him nothing yesterday as he was already tripping balls, pacing, staggering and unable to sleep.
 
I am glad to hear that Champagne's dental went well and so glad that you took care of it sooner than later as once those AB get out of his system the infection would have brood and could have knocked him out of remission. A bad tooth took Bubba out of remission the first time.

Metacam is not a good choice as it has a black label for cats. Okay for dogs not cats. I wish I could tell you a better choice for pain but don't know of one other the Bup. Also, check but the oral suspension could be sugar ridden and could raise his BGs. So, you are going to want to check into that, and also keep testing his BGs.
 
He's been grooming and eating normally and I've taken him for a short walk outside and he seems okay. Maybe uncomfortable, but still a bit better than yesterday. I haven't given him the Metacam. I feel horrible for not addressing his pain but I guess it'd be even worse to send him into renal failure :( . I am pureeing his food with a spoon so he only has to lap it up and being outside sniffing things seem to distract him a bit from his mouth. I think I'll use it only if his pain worsens... This is a heartbreaking choice.
 
Champoux said:
He's been grooming and eating normally and I've taken him for a short walk outside and he seems okay. Maybe uncomfortable, but still a bit better than yesterday. I haven't given him the Metacam. I feel horrible for not addressing his pain but I guess it'd be even worse to send him into renal failure :( . I am pureeing his food with a spoon so he only has to lap it up and being outside sniffing things seem to distract him a bit from his mouth. I think I'll use it only if his pain worsens... This is a heartbreaking choice.
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Grooming is very good sign. If his numbers spike, it will help you to decide as when they have pain, the numbers rise. When Bubba had his dental extractions he did not receive any pain meds or anti inflammatory, only an AB. Keeping fingers and paws crossed that he won't need the Metacam. Personally, with a CKD kitty, I wouldn't give it.
 
Bobbie And Bubba said:
Grooming is very good sign. If his numbers spike, it will help you to decide as when they have pain, the numbers rise. When Bubba had his dental extractions he did not receive any pain meds or anti inflammatory, only an AB. Keeping fingers and paws crossed that he won't need the Metacam. Personally, with a CKD kitty, I wouldn't give it.
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I'm testing him at the same times I used to for his AMPS and PMPS and so far since the dental he's had a green number yesterday evening and blue this morning. It could be a good idea to evaluate his stress/pain if he gets a strangely elevated number tonight. He managed to sleep a bit in the afternoon but since he woke up he's very restless and won't stop pacing/trotting around, though he still grooms and eats with appetite. He's clearly bothered by his mouth, but it seems to make him lively instead of lethargic.

Also, concerning the antibiotics : the vet said Champagne got an antibiotic injection before surgery so he won't need any more after. But when he was preparing to get his teeth done the first time, back in April, they'd given him 2 weeks worth of AB + some more for after the procedure. I found that quite strange but they insisted he wouldn't need them. (I never got to speak to the actual vet, only through technicians.) Same tech said the vet didn't need to do x-rays either since there wasn't any "risky teeth", AKA teeth they suspected could hide something else. I found that weird too since the vet, from the same hospital, I had spoken to weeks ago had told me x-rays were essential to determine if some teeth should be removed. All that plus the whole Metacam thing makes the experience much more overwhelming than I'd expected.

Sorry for the mini-rant and thank you for replying :) !
 
You need to find out if the AB injection was Convenia. It is a shot that lasts 14 days ( although studies say it last longer more like 45 days.). It is an injection that last 14 days as told by the vets and if there is a reaction...... the only thing that can be done is to do supportive measures. My Bubba was given it also before I knew any better. He did not have any reaction to it thank God. I am not trying to scare you but, if he starts with any strange symptoms at all, get him to an ER hospital. He might not have any issues at all. A lot of cats don't . But, something that is administered by shot and can't be retrieved and if kitty has a reaction to it, the only thing to do is supportive measures. It is just another drug along with Metacam that I have on my cats charts at the vets to NOT give.

And hopefully if Convenia was the AB shot, there will be no issues. Again, not trying to scare you, just to inform you that if anything out of the ordinary occurs in the next day or two, please don't dismiss it like vomiting, diarrhea, lethargy and decreased appetite, have it checked out ASAP.
 
I also noticed that in the comments of that tramadol article link was someone mentioning a transdermal form and they just rubbed it on the ear. I would think any vet has the ability to write a prescription for you to pick some form of tramadol up at a pharmacy in a dosage that you need.
 
Bobbie And Bubba said:
You need to find out if the AB injection was Convenia. It is a shot that lasts 14 days ( although studies say it last longer more like 45 days.). It is an injection that last 14 days as told by the vets and if there is a reaction...... the only thing that can be done is to do supportive measures. My Bubba was given it also before I knew any better. He did not have any reaction to it thank God. I am not trying to scare you but, if he starts with any strange symptoms at all, get him to an ER hospital. He might not have any issues at all. A lot of cats don't . But, something that is administered by shot and can't be retrieved and if kitty has a reaction to it, the only thing to do is supportive measures. It is just another drug along with Metacam that I have on my cats charts at the vets to NOT give.

And hopefully if Convenia was the AB shot, there will be no issues. Again, not trying to scare you, just to inform you that if anything out of the ordinary occurs in the next day or two, please don't dismiss it like vomiting, diarrhea, lethargy and decreased appetite, have it checked out ASAP.
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Are vomiting, diarrhea, lethargy and decreased appetite the only symptoms I should be looking for ? Or should I jump at any strange behaviour at all ? Because since the surgery he's been restless, a bit jumpy and one of his back legs still seems a bit wobbly. But other than that, he acts the polar opposite of the possible symptoms you listed. I'll look into that tomorrow morning as soon as the vet clinic opens, thanks for the info !

Update: Also PMBG is 7.4 mmol/L (133 mg/dl), so still in Champagne's usual range
 
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Champoux said:
Are vomiting, diarrhea, lethargy and decreased appetite the only symptoms I should be looking for ? Or should I jump at any strange behaviour at all ? Because since the surgery he's been restless, a bit jumpy and one of his back legs still seems a bit wobbly. But other than that, he acts the polar opposite of the possible symptoms you listed. I'll look into that tomorrow morning as soon as the vet clinic opens, thanks for the info !

Update: Also PMBG is 7.4 mmol/L (133 mg/dl), so still in Champagne's usual range
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Those are the only symptoms I know of but, that is not to say that there aren't others. Any thing out of the ordinary is worth a call or visit. I so hope that there will not be any what so ever. :bighug:
 
Bobbie And Bubba said:
Those are the only symptoms I know of but, that is not to say that there aren't others. Any thing out of the ordinary is worth a call or visit. I so hope that there will not be any what so ever. :bighug:
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I too, deeply hope, there won't be any problem.

I haven't stop stressing for a single day since his diagnosis a month ago and it makes me feel perpetually exhausted. It seems the more time he spends at the vet, the more health issues and complications arise... it should be the other way around ! If I had followed my vet's advice, I would still be giving Champagne 2U SID instead of the 0.1 dose that he needed. She even told me while looking at his bounce-riddled curve that the reason he was "so hard to regulate" probably was because of a pancreatic tumor and that there was no way the fluctuations I was seeing were bounces. I am truly thankful for the existence of this website, it's been the best tool for improving Champagne's health so far.

Thank you for taking the time to reply once again !
 
Champoux said:
I too, deeply hope, there won't be any problem.

I haven't stop stressing for a single day since his diagnosis a month ago and it makes me feel perpetually exhausted. It seems the more time he spends at the vet, the more health issues and complications arise... it should be the other way around ! If I had followed my vet's advice, I would still be giving Champagne 2U SID instead of the 0.1 dose that he needed. She even told me while looking at his bounce-riddled curve that the reason he was "so hard to regulate" probably was because of a pancreatic tumor and that there was no way the fluctuations I was seeing were bounces. I am truly thankful for the existence of this website, it's been the best tool for improving Champagne's health so far.

Thank you for taking the time to reply once again !
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We have all been there with not so good advice from our vets. It is really a shame that they don't get more instruction of FD. It is the equivalent to about 8 hours worth. A lot of beans euthanize their animals when they get the Feline Diabetes DX. Such a shame........ as it is a manageable disease and one that can go into remission as you did discover.

I too am deeply indebted to this forum and I don't know where I would be with out all the great help and advice and time that peeps gave me. :)
 
Grrr, on your vets.

On Convenia, I can add some more reassuring anecdotes-- I had them give it to two of my cats before I found out it was a risk, and neither had problems.

I'm pretty mad at your vet, I have to say, between the Convenia and the Metacam, and then to not take x-rays during the dental?????? For a cat that is a high-risk anesthesia, why in the world would you cut a corner like that? This is probably your one shot to fix any problems, so make sure you fix them! Grrrr. Hopefully, they did indeed catch all of the problem teeth.

Glad he's eating well, even if it does seem like his mouth is bothering him a bit. Hopefully that won't last long....
 
Nan & Amber said:
Grrr, on your vets.

On Convenia, I can add some more reassuring anecdotes-- I had them give it to two of my cats before I found out it was a risk, and neither had problems.

I'm pretty mad at your vet, I have to say, between the Convenia and the Metacam, and then to not take x-rays during the dental?????? For a cat that is a high-risk anesthesia, why in the world would you cut a corner like that? This is probably your one shot to fix any problems, so make sure you fix them! Grrrr. Hopefully, they did indeed catch all of the problem teeth.

Glad he's eating well, even if it does seem like his mouth is bothering him a bit. Hopefully that won't last long....
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My mother and I even made sure to tell them twice that if any teeth seemed a bit off but not necessarily unsalvageable, we preferred them to remove them now as we don't want to put him under anesthesia again at his age.

They do seem to cut corners on things and have been doing so for a while. It's a big clinic and they make us constantly change vets as they're often not disponible (gone on vacation, too many consultations this week). We had one that was very nice, that listened to us and took time to answer questions, but it was back in 2015 and we haven't been able to speak to her since December. Since then they've been transferring us to 4 different vets and I haven't even met the last one, I could only talk to her through techs. When we've asked to go back with the first vet, they told us they'd transfer Champagne's files to her, but it seems they never did.

Yes, he is eating well though ! Yesterday he was emptying his plate in a matter of seconds :) He was gobbling everything so fast I was scared he'd inhale a bit of food and choke.
 
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JanetNJ said:
The pain from the extractions probably isn't much worse than the tooth pain before the extractions.
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That's what I'm hoping. Once his gums recover from the cuts and stitches, he'll probably feel way better than he did in the last years, mouth-wise.
 
Update: Got news from the vet. Antibiotic injection wasn't Convenia, it was Ampicillin. Reading a bit about it right now, it seems safe.

Also Champagne still walks a bit weirdly with his right hind leg only, he sometimes goes in for a plantigrade posture though way less than yesterday, which he didn't do at all before surgery, and vet thinks anesthesia might have caused an electrolyte imbalance. She suggested a BG curve for today.
 
Champoux said:
Update: Got news from the vet. Antibiotic injection wasn't Convenia, it was Ampicillin. Reading a bit about it right now, it seems safe.

Also Champagne still walks a bit weirdly with his right hind leg only, he sometimes goes in for a plantigrade posture though way less than yesterday, which he didn't do at all before surgery, and vet thinks anesthesia might have caused an electrolyte imbalance. She suggested a BG curve for today.
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I recommend b12 methylcobalamin supplements for the leg weakness. Zobaline™ (for Diabetic Cats) 3 mg x 60 tabs https://www.amazon.com/dp/B008G3LI2M/?tag=felinediabetesfdmb-20
 
babyBoo said:
I think tramadol can be used for pain relief in cats. Not sure of the dosage that would be needed.
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The cat dose for tramadol is 12.5 mg (1/4 of a 50 mg tab/caplet). I have used that without problems for several of my cats. However, for some cats tramadol spaces-out a cat
 
Champoux said:
Since he also has CKD, I'll wait to see with my vet if it could be related to calcium or phosphorus imbalances first.
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Also check the potassium numbers.

I am glad that Champagne came through the dental fine. I did notice your comment on the SS "re-introduced a bit of dry food as occasional treats.". Once a diabetic, a kitty is always a diabetic, even in remission. We have had way too many cats come out of remission due to dry food. Give away the dry food, don't be tempted to give it again if you want him to stay off of insulin.
 
Nan & Amber said:
How is Champagne doing?
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A lot better. He did sleep a lot after his two initial post-op days, probably recovering, but now he's got energy again. He started playing with his toys and doesn't seem bothered by his mouth anymore. He rubs on branches outside, bites on his furry toys and eats normally. The wobbliness in his gait gradually ended up going away on its own after a few days. I walked him outside today and he sprinted twice, running at full speed like a young cat, which he hadn't done in a while.

Thank you for asking :) ! I'm sorry for not having updated sooner.
 
Wendy&Neko said:
Also check the potassium numbers.

I am glad that Champagne came through the dental fine. I did notice your comment on the SS "re-introduced a bit of dry food as occasional treats.". Once a diabetic, a kitty is always a diabetic, even in remission. We have had way too many cats come out of remission due to dry food. Give away the dry food, don't be tempted to give it again if you want him to stay off of insulin.
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Vet ended up calling on tuesday, by when Champagne had already started getting a lot better. Since he was improving, she said it was probably due to him recovering a bit slower than younger cats, seen his age. The plantigrade walk on his right hind leg has completely stopped and his usual energy seems back. He did drink a lot in the days following the procedure too, but that's also gradually calming down. For now the vet has ruled out electrolyte imbalances, though I'd still be curious to have a blood analysis to see how he's doing 1 week after the surgery (it is expensive though, and stressful for him).

As for dry food I know we shouldn't, but it's one of the rare low-phosphorus treats he can enjoy. We're not giving him a lot, only a few pieces at a time, but we noticed it did help putting back a little bit of weight onto him (gained 3 ounces in two weeks). I'm still looking for low-phosphorus treat options to replace the dry food. But thanks for the info.
 
Champoux said:
He started playing with his toys and doesn't seem bothered by his mouth anymore. He rubs on branches outside, bites on his furry toys and eats normally. The wobbliness in his gait gradually ended up going away on its own after a few days. I walked him outside today and he sprinted twice, running at full speed like a young cat, which he hadn't done in a while.
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Love it!!!!! That's great to hear!
 
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