Kitty is back from the dentist

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kimouette

kimouette

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I thought I might share this experience with you guys...

My 12 year old Titi who has NEVER got any dental treatments had a bad breath and started to show signs of teeth problem (she would masticate her food for so long and spit out everything too "crunchy"). Of course she is OTF now, but still, at the vet I really insisted on not giving any fluids containing sugar or dextrose, and REALLY pay attention to steroids and cortisone medication : my cat got diabetes precisely after an steroids injection (Depot-Medrol)!!

One week before the dental extraction, they asked me to give her antibiotics that I would also need to keep giving to her 7 days AFTER the extractions. They gave me Stomorgyl 10 and the same night she she started having diarrhea. I told them about that problem and they asked me to stop giving Stomorgyl right away and come to the clinic where they gave her an injection of a long term antibioprophylaxy... my cat was fine with it. I also gave her Pro-Kolin (a Antidiarrhoeal Probiotic Paste) that really helped with her diarrhea.

12 hours before the dental procedure I kept her off of her food and she didn't drink during the night either, so I was a little worried. I tested her blood in the morning and it was fine.

The clinic I went to is one of the most high-tech clinic of the region. Since she had to be under general anesthesia (which frightens me since she is pretty old and has the habit of reacting pretty strongly to almost any medication), I asked the vet to make sure they were using the best anesthesia method they could think of and basically just make sure I would get my kitty back on feet as soon as possible

They used :
- a catheter and premedication
- Propofol anesthesia
- plus a local anesthesia (like the one we get when we go to the dentist)
- intravenous fluid
- they monitored her heart and respiratory system the whole time (an assistant was in charge of that)
- they extracted 5 teeth! (they though she needed only 2 teeth extraction before that day!)
- and some kind of periodontitis treatment

Total cost 1000$ : terrible for my wallet, but not that bad considering the quality of the treatment she got.

I now give her Metacam 15ml (a pain killer that contains NO steroids) once a day. When she got back from the vet, she broke my heart! No more Meows, no more purring, she looked skinny, full of dandruff, she could walk normally but still looked soooo tired. She didn't come to bed with me like she normally does, and spent the whole night in a weird place (under my drum stool)... This morning she still just wants to sleep, but atleast she stands up and walks to her food bowl every hour or so ( by the way I added a lot of water to her food, thinking maybe it could help with her dandruff problem).

I hope her gums don't hurt too much! And I cant wait to see her being the cat she normally is!
 
I would be worried about the Metacam, and ask for another pain relief medication. Metacam has a Black Box Warning for cats.
 
Repeated use of meloxicam in cats has been associated with acute renal failure and death. Do not administer additional injectable or oral meloxicam to cats. See Contraindications, Warnings, and Precautions for detailed information.
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It means that if I just gave my cat one normal dose (that lasts 24 hours), she should not receive an EXTRA dose of Meloxicam during that perido right? She gets her weight equivalence of the product and does not receive anything else than that.
 
HI KIm I would ask the vet for buprenex - its a pain medication that is MUCH safer for kitties then Metacam. Jan
 
Kimouette,
My experience with my 17 year old female cat’s dental was very similar to yours. She ended up having 10 teeth extracted. Everyone that I asked told me it takes about 48 hours for cats to return to normal after extractions and anesthesia, but it took my cat more like 5 or 6 days. She was extremely dandruffy the first couple of days and it seemed like the anesthesia took like 24 hours to wear off. She had a different pain medicine than yours. She vomited 3 or 4 times during that first week after the dental. The pain meds and antibiotics made her nauseous. I had to switch antibiotics. She was only eating little bits for several days until her appetite came back. She went hypo 4 days after the dental since she wasn’t eating enough and didn’t need her regular insulin dose. She’s doing pretty good now, but that dental was pretty hard on her. I hope your kitty gets back to normal very soon, but I think some cats recover more quickly than others.
 
Geez now I'm scared! It's 9pm now and of course the vets office is closed so I cant talk to anyone but now is also 24 hours after the last metacam dose which means my cat is probably starting to suffer. With no one knowing that medication or with death warnings I don't feel comfortable giving my cat some metacam!!! If I give half a dose will it still relieve her from the pain and maybe avoid the problems that medication can cause?

I'm afraid to give it to her but I just can't stand there thinking she is suffering in silence either!!
 
Kim, find a Veterinary University in Switzerland, hopefully they'll have a 24-hour Emergency clinic associated with it, and telephone them for advice. Failing that, try any 24 hour emergency veterinary clinic and ask for advice. Ask to see if they would telephone a buprex prescription to a 24 hour pharmacy near you. If need be, ask for just one or two pills just to get you and your kitty set for tonight - until you can contact your regular vet.

So sorry you and your kitty are going through this. Best wishes.
 
The closest 24/7 vet hospital is more than hour from where I live.
In the end I decided to give her 75% of the normal dose. This morning she does look a little better (she was definately suffering yerterday before I gave her the Metacam).

It's now 7:30am, in exactly one hour I'm going to the vet.
 
Ok back from the vet...
First of all she (my regular vet's colleague vet) checked my cat's teeth and gums and said she was healing perfectly. She was thrilled to learn that my cat has been eating normally ever since she got back home and never puked, for her this is a very good news. She checked my cat's temperature and she does have little bit of fever 39.5. Then she checked my cat' s skin elasticity to see if she was well hydrated: maybe a little but nothing disastrous.

She said that the metacam should take care of the little gum inflammation and the fever. Then of course I told her about my fear of that product and everything I read about it on the net. She told me that she never would have give me that specific medicine if she had bad experiences with it. Basically she sais that a cat with no creatinine problem that is well hydrated should never have any bad effect if the dosage is carefully respected, and as long as it is for a short period. In my case (and she wrote it on the bottle) its for a 3 to 5 days treatment only and if no signs of injury or fever are visible it can be less then 3 days. When she saw how much I seemed to worry about metacam she told me that there's is absolutely nothing to worry about since my cat didn't have any kidney problem and that she seemed well hydrated and just as a second precaution she hydrated my cat with iv fluids, and said it can't hurt but only be beneficial if for some reason my cat didn't drink and eat enough before the next metacAm intake ( tonight at 9:30pm). She also gave me one of those flexible thermometer so I can take my cats temperature before blindly giving metacam. She said that temperature was a sign of pain and that I should not play around with the dosage if she does have fever.

Then I asked her about buprenex and she said that it's effect was not long lasting and since it's an opiate it's probably not a good solution for a cat that shows signs of fatigue like my cat does .

So tonight I'll take her temperature and give a normal metacam dose to my cat if she does have fever.

It's true though, I mean all the warnings you guys mentioned are really important but from that vet's opinion my cat's specific case I should not worry about a 3 to 5 days treatment. I have an appointment for next week, she'll check her teeth again and run some more blood tests to see bun and cre results

I guess I'll be able to sleep on my 2 ears tonight
 
Hi Kimouette,
Sorry, I didn't mean to scare you. I guess my only point was that some cats heal differently or take longer than others. Your kitty is quite a bit younger than mine and it sounds like she's doing great! Best of luck to you.
 
With younger, healthy cats, it's very unlikely that Metacam will cause problems. Bandit was on it after his first dental, and it worked great. But he was 7 with no other problems besides his diabetes.

However, the thing that worries me in this situation is that you mention your cat is old, and that she was having diarrhea. Metacam should NOT be given to any cat with reduced renal function, or gastrointestinal upset. Most cats over the age of 12 have reduced renal function, but it doesn't show up in a creatinine test until a cat has lost about 75% of it's renal function. That means that the majority of cats with early stage renal disease will NOT show elevated creatinine. Metacam is not appropriate for use with senior cats unless you are using it for palliative care.

The vet is right that ideally, Metacam better drug after dentals because it's a NSAID and reduces inflammation without the woozy side effects opiates have, but it certainly shouldn't be given to cats with the risk factors involved contained in the black box warning--and your cat has TWO of those risk factors. When Gabby had her last dental at age 14, I told my vet that I didn't think Metacam was appropriate because of her early stage renal disease (and she did NOT have elevated creatinine because she still had about 50% of her kidney function left), and the vet agreed. At Bandit's last dental we opted for buprenex as well because he had diarrhea the week before his dental.

However, the biggest transgression I see here is that the vet should have explained these risk factors to you before she gave it to you.

These are listed in the package insert:

Meloxicam is not recommended for use in cats with bleeding
disorders, as safety has not been established in cats with
these disorders. Safety has not been established for
intravenous (IV) or intramuscular (IM) use in cats. When
administering Metacam 5 mg/mL Solution for Injection, use
a syringe of appropriate size to ensure precise dosing. As a
class, cyclo-oxygenase inhibitory NSAIDs may be associated
with gastrointestinal, renal and hepatic toxicity. Sensitivity to
drug-associated adverse events varies with the individual
patient. Patients at greatest risk for renal toxicity are those
that are dehydrated, on concomitant diuretic therapy, or
those with existing renal, cardiovascular, and/or hepatic
dysfunction. Concurrent administration of potentially
nephrotoxic drugs should be carefully approached.
Anesthetic drugs may affect renal perfusion; approach
concomitant use of anesthetics and NSAIDs cautiously.
Click to expand...

No where does it say that it's only a risk if creatinine is above a certain level.
 
However, the thing that worries me in this situation is that you mention your cat is old, and that she was having diarrhea.
Click to expand...
She is 12 years old and it's true she had diarrhea last week because of the first medicine I gave her for the dental procedure (Stomorgyl), but then they gave her something similar but by injection and 3 or 4 days later she did not have diarrhea anymore. By the way she pooped twice since the dental procedure and both times her poop was normal.
Most cats over the age of 12 have reduced renal function, but it doesn't show up in a creatinine test until a cat has lost about 75% of it's renal function.
Click to expand...
Thats definitely something I'm gonna talk to her about next week
However, the biggest transgression I see here is that the vet should have explained these risk factors to you before she gave it to you.
Click to expand...
You are right! And I think she did realize that when she saw how much I got frightened by the notice and different warnings.
Patients at greatest risk for renal toxicity are those
that are dehydrated, on concomitant diuretic therapy, or
those with existing renal, cardiovascular, and/or hepatic
dysfunction.
Click to expand...
She is currently more hydrated then she has ever been becuz of the iv fluids this morning and except for the renal dysfunction (that has never been diagnosed) that might or might not be her case, my cat doesn't correspond to the warning.

I just took my cat's temperature and she is back to normal (38.1), and she looks pretty good (except when she eats, she spits food everywhere, I guess the 5 teeth missing are giving her a weird feeling and probably a sensibility), she meows, she purrs, walks, asks for cuddles, so in other words, she seems to be the way she has alsways been! Which of course means I am NOT going to give her Metacam tonight. I'll take her temperature tomorrow morning and watch closely for signs of pain, and hope i can just keep on avoiding that medicine.
 
Terwilliger1 said:
Hi Kimouette,
Sorry, I didn't mean to scare you. I guess my only point was that some cats heal differently or take longer than others. Your kitty is quite a bit younger than mine and it sounds like she's doing great! Best of luck to you.
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Dont worry it was actually very nice of you to warn me!
:thumbup
 
Something is wrong with my kitty now :

The dental procedure was last Tuesday (4 days ago). When she got back she was eating normally and by the way I never gave her any more Metacam cuz she seems to be healthy ever since that last episode of fever.

Dandruff's gone, she is alert, still likes to sleep a lot but when she is awake I really do think she is fine. But for the last 3 days she has developed a habit that is starting to scare me a lot : everytime she eats, drinks or licks her hair, then she starts to lick her lips and teeth to clean them (she already did that but just not that compulsively) until she ends up like she's about to puke (mouth wide opened and a terrible noise like she's choking or puking). She actually did "vomit" a little bit of saliva this morning.

Now I use a mixer to transform her food into this easily-lickable texture but she still does that thing.
Everytime she eats or licks her coat, I pet her and talk to her to stop her from starting that frenetic mouth cleaning and it works! But i cant always be there and I think she is starting to associate eating with puking or something cuz she doesn't eat as much as she normally does.

My next appointment at the vet is supposed to be next friday, what should I do?
 
Kimouette,
My Timmy did a lot of extra teeth cleaning for the first week or two after her dental. She also did some salivating and spitting up the first few days, but I thought that was from the antibiotics and pain medicine (the vet gave me liquids which I had to squirt in her mouth, and she hated it, so I switched to pills and pill pockets). Since Timmy had 10 teeth extracted including one canine, I assumed that it was taking her awhile to adjust to new feeling of her missing teeth and gums, and thought there was probably a little swelling for awhile too. I know she chewed mostly on one side of her mouth for many days until she got the hang of it. And she still curls her lip up on one side where the top canine is gone (like Elvis). My only reference point was when I had wisdom teeth pulled and how my mouth felt weird for a couple of weeks until everything healed. I know people have some major nerves in their gums, and that the mouth can be sensitive for quite awhile after teeth pulling. I don’t know about cats. She ate pretty well the first day home, and then not as much. I think the pain meds were in full swing that first day and it didn't bother her to eat. After the pain meds wore off, she started noticing the discomfort and missing teeth. Having said that, if she keeps spitting up or is throwing up, I would call the vet. When I talked to my vet about all my concerns, he was mostly concerned about the vomiting and told me to call him if she vomited. Timmy only threw up cat food once, and the few other times it was just saliva. Sorry to be so graphic but thought you might want to compare notes.
 
When I talked to my vet about all my concerns, he was mostly concerned about the vomiting and told me to call him if she vomited. Timmy only threw up cat food once, and the few other times it was just saliva.
Click to expand...
It's exactly the case of my cat too! No food, just saliva. So your vet said that if it's just saliva then there's nothing to worry about and that you just have to wait, is that is? Do you remember how long it took before your kitty stopped "over-cleaning" his mouth and "over-salivating"?
 
Kimouette,
The salivating lasted about 5 days, but like I said, I don't know if it was all the medicine (antibiotics and pain meds). She was only on pain meds for three days, and then I switched to pill antibiotics after 3 days as well. The overcleansing kind of tapered off after a week to a week and a half. She didn't vomit any more after 5 days I think. I, too, pureed her food in a food processor or added some water to the patte style canned foods so she wouldn't have to chew for about a week or so. Since it's been about a week, I would think your kitty should be starting to feel a little better now. How is she?

Erin
 
Also, the vet didn't exactly say that saliva-only vomit was okay. I think he was concerned about nausea in general. He said that the anesthesia can stay in their system awhile. I know after my mom had two major surgeries, it seemed like she was kind of loopy from the anesthesia for several days. Of course, she was on pain meds too. She said the anesthesia left a weird taste in her mouth, and nothing she ate tasted normal for several days. I don't know if you can compare humans and kitties, but I'm wondering if there are similarities.
 
Actually, except for that saliva thing, she is fine. She doesn't take any meds and looks and acts completely normal. I'm starting to think she has "simply" developed a bad habit from that previous anesthesia and pain feeling. I hope she forgets all about it and gets used to her "new mouth". It's really like a reflex she has developed and not like a symptom.. but of course I can be wrong. I'll call the vet tomorrow but since we already have an appointment this friday, I might just have to wait until then and hope she gets better by then ! cat_pet_icon
 
My vet says that it's hard to tell anything without looking at the cat's teeth... so I'll wait until my next appointment on friday.

But in the meantime I decided to put a video on Youtube showing what she does... in the video she doesn't puke at the end, but we can clearly see that something is bothering her!

Here's the link : http://www.youtube.com/watch?v=6jovJ81Dy9E
 
Hmmm. . . that's more excessive than what I saw with my cat. It almost looks like she's trying to get something cleaned out from the back of her mouth. Did she have any molar's removed? If so, could she be getting any food caught back there? I'm definitely no cat dental expert, so just throwing out thoughts.
 
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