Zeke's Stomatits now, High numbers 2 weeks after Dental

It's been a while since I needed you, but now we're on the Stomatitis alert. He had 3 extractions 2 weeks ago and we were sent home after a Convenia shot with 3 day worth of Metacam for pain. His mouth looks better but there is a place that still is healing I think. I also have Clindamycin drops if needed after the 2 weeks, I was told. I know the Con. is controversial, but wanted to try it due to the loose stools he gets on Clindamycin.
I can't get his numbers down. I see no improvement at all after the dental. Last week when I tried to raise his dose he went down to 49 and I had to lower it again.
Should I start the Clindamycin like vet said and leave dose alone, try to raise dose again, or what. I am at a loss. I really hope we won't have to do full mouth extraction! I know it is ok for them, but I'm not ready to go there. Very disappointing. Help.

 

I think I would want the vet to have a look at his mouth to see if clindamycin is needed. I would hate to give it if not needed and chance a tummy upset. With a drop to 49 I would not raise his dose.

 

Maybe I can take a picture for the vet, being there just 2 weeks ago. It is so hard on him, stress-wise. He is 1/2 feral and it's so upsetting for him. I think that is why his numbers aren't moving, yes. Anyone else agree he's probably still got infection?

 

If you give clindamycin, make sure you have a good probiotic on board first. Give the two of them at least two hours apart.

Do you have any other pain meds for him?

 

Do you have a confirmed diagnosis of stomatitis - ie, does the inflammation extend beyond the gumline and into the throat and/or cheeks? If so, unfortunately you really are not going to see oral improvement without at least a partial mouth extraction (all the teeth behind the canines and often times the incisors), if not a full mouth extraction. Unfortunately, extracting teeth here and there doesn't work with resolving or improving true stomatitis. As daunting as these procedures sound, kitties do really well with them (much better than us humans). They are so relieved to have the source of pain gone that once they heal up, they truly thrive! And, fortunately they don't have vanity issues we humans have about having their teeth extracted. As odd as it sounds, they really don't need their teeth!

However, if it's not truly stomatitis, but rather gingivitis or periodontitis (the inflammation is restricted to the gumline and does not extend into the throat and/or cheeks), then extracting just the bad teeth should help improve things - at least as far as oral discomfort goes.

Another thing to be sure of as well, whether the extractions are for stomatitis or other oral issues, is that ALL of the tooth has been removed - that no bits of root have been left behind. This is ensured by taking x-rays after the extractions are done (while the kitty is still under anesthesia). If anything at all is left behind, it will continue to cause problems, especially with stomatitis kitties.

Some stomatitis kitties do need the support of prednisolone, and while this is not ideal, especially for diabetics, it can make a big difference. If things head this way, insulin does can be worked around the steroid. I would only consider steroids if inflammation and pain continue despite a full or partial mouth extraction that has had confirmation that all roots have been removed. I would not jump to steroids if he still has most of his teeth (if he is definitively diagnosed with stomatitis).

At this point, is your only concern that his BGs are staying the same as they were before the extractions? Or is he still exhibiting oral discomfort? Have you had a follow-up appointment with the vet who did the extractions? Personally I would not treat with the AB solely based on his BGs not changing after the dental. I would confirm with an in-person exam at the vet that there is an infection present before doing any more ABs; otherwise you could be opening yourself up to AB resistance, which could cause big problems down the road. Unfortunately some diabetic kitties' BGs do remain the same even after dentals, but even if that is the case, hopefully these kitties feel better after having bad teeth removed.

 

I don’t have any way of knowing if it extends down the throat. To me, his gums look much better, and he doesn’t seem in pain. He’s purring and playing and seems happy to me. I agree about the ab resistance. I guess from what you’re saying , I need to get him back in for a post check.
Yes, I’m just going by his numbers, if you look at his Ss, he has been well regulated for a long time, even remission for a short time. After his last dental 6 mths ago, he was able to get back down. They just started going up a month or so ago. Thanks for all the info. I’ll get him back in and ask for X-rays , I guess. And won’t start the ab now.

 

I would ask the vet if the inflammation extends beyond the gumline. There is a big difference between stomatitis and other dental issues, and the are all treated very differently. Stomatitis is an autoimmune disorder, so it is not like gingivitis, periodontitis, FORL, or other oral issues. The hallmark of true stomatitis is that the inflammation goes beyond the gumline. If your vet isn't familiar with the difference, I would seek out a second opinion, possibly with a dental specialist. If it truly is stomatitis, you really do want to get at least a partial mouth extraction - otherwise problems are going to continue cropping up.

However, given what you are saying, though - that he is purring and playing and seems happy without having had either a partial or full mouth extraction, I would guess that he probably does not actually have true stomatitis, but rather had some bad teeth that needed to be extracted - but of course I am not a veterinary dentist. If his mouth is cleared of infection and bad teeth and all is good there, then there maybe be something else going on that has caused his numbers to go up.

 

Thank you much, sounds like hope, maybe. We’ll see and Ivwill post back what I find. You’re a huge help.

 

Update 47!!! Just now!!! What is going on!!

 

Well, now 56 after extra reg food. ( he zooms with high carb for days). He is purring and content.. I will of course reduce his dose by 1/4u. Could it be that this is just his healing process and he’s clearing the infection slowly ?! I’ll give this a couple of days. Glad I was home !! Off work tonight ! Thanks!

 

60 now at 2a. I wonder if his dose has been too high since he’s healing and he’s now just been bouncing?

 

I usually saw numbers go up after extractions due to inflammation. Once the inflammation died down, the numbers came down. Good catch tonight!

If you are following TR, since Zeke is a long term diabetic, you hold for an under 40. Or if you think he doesn't hold reductions well, wait for 3 times between 40 and 49 on separate days.

 

@Wendy&Neko Thanks!
Sorry? Not understanding ? I just reduced him to 1.25. I just shot . (My sheet says 8 but for me it’s 7)
Did you mean I’m suppose to keep holding at 1.5? Or hold the 1.25 longer?

 

A cat that has been diabetic longer than a year has different reduction points. That would have meant continuing to hold the dose.

Reminder: *earning* reductions and starting OTJ trials

 

Nice to see that green - hopefully he'll settle down now. As Wendy mentioned, it does take some time for them to recover from extractions.

 

Ok, since I gave 1.25 this am, should I go back to 1.5 tonight and continue to hold? I am going to be home tonight, but will not be home the following 3 nights to catch it.

 

Thanks for your input. Glad we are on the mend!
I’m also glad we don’t have to go back to the vet right now!

 

I didn’t remember seeing that in the TR instructions

 

From the Dosing Methods Sticky Note:
Reducing the dose:

The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive. Let's keep all our kitties in the Lantus, Basaglar, & Levemir ISG safe by taking reductions when appropriate.

• If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit.

 

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Yes, I see it now. I’ll go back up to 1.5 for PM shot. Like I said though, it makes me nervous because I won’t always be here at night to catch it if he goes too low. I work at night.
Do you think he has been bouncing? He is often very high when I get home in the AM. There is nothing to do about that.