? 2/23 Dimmu PMPS 553?! Dental surgery update. Dose and medication questions

Yesterday

Long post ahead, I am writing this mostly for my own record, but maybe it'll give some information for other kitties that need to have dental works done.

Dimmu is still at the vet, but we just got a call that surgery went well and he's awake. We can pick him up in a couple of hours!

The dental specialist is up to date, attentive, very patient and clearly has lots of experience with diabetic patients. We especially appreciate that she took time to explain every step and her choice of drugs to us. She did a general exam and noticed Dimmu's left eye socket seem to protrude more then his right one. His left eye has been tearing for months and we couldn't find what's causing it, the vet suspected it could be because of the root left in the gum has changed/inflamed the gum/bone. Dimmu had upper left molar extraction 2 years ago and the vet who did the extraction was not able to get everything out, so he left a small piece of root in his upper left gum.

She then checked his BG before giving him sedatives. Dimmu was given an IV sedative (I think she said diazepam, but will have to double check), and propofol induction after 10 mins, then he was intubated for oxygen and hooked up to a vital monitor. The specialist checked his teeth again and took 10 or so x-ray photos. We were there in the room with him the whole time of the procedure, it's not easy seeing him under, but we had all first hand information of what's going on in his mouth this way, and it's very educative.

The x ray showed that Dimmu has 2 abnormal root formations, which the vet is not concerned about (she also said ECID, meow!), 1 class 1 tooth resorption with cavity on the crown (upper left premolar), 2 class 2 tooth resorption (upper right premolar and lower right premolar), 3 broken front teeth (2 upper incisors and 1 lower incisor) with roots left in, and of course the upper left molar root in the gum.

She decided to extract the class 1 tooth resorption, the roots from the 3 broken incisors, and the left-over molar root, and of course scaling. She said there's no effective methods to treat the class 2 tooth resorption without doing more damage than good, so she'll leave them be, and Dimmu will have to live with it. She also wanted to take out a small piece of bone on his upper left jaw for the lab to rule out any abnormality.

We agreed with most of her decisions but questioned the root extractions of the broken front teeth. She explained if we leave them in, the body will see them as foreign bodies and he will have abscess. So we agreed to have them removed, too.

We were very happy that she could do the surgery right away so Dimmu wouldn't have to go through this again, but of course we couldn't be there with him and I don't know what maintenance anesthesia he had during surgery, but she reassured us she'll monitor his BG and if he's not reacting well to the anesthesia, she'll stop the surgery and do it another time.

I hope he's not in too much pain. I will feed him small watered down meals. Is it ok to keep giving him raw food in the coming days?

 

He's home!!! Yay!!!

Looking spacey because of the pain medication, but seems like he's having a nice trip... Has all motor skills in check, too.

He ate a small portion of food and was wanting more, so that's a relief. The vet said If he eats, I can give him his full shot tonight. Should I do that then? I am gonna feed him 2 more times until his PM shot, so it's going to influence his PMBG, should I still shoot what I see?

He gets antibiotics Amoxiclav (amoxillin) 187.5mg BID for 6 days. He is on Renew life probiotics 15bil, 2/3 cap BID. I want to give him a higher dose of 1.5 cap BID while he's taking antibiotics and continue for another week after finishing antibiotics, will that be enough?

He also gets Metacam as painkiller. Well, it's actually Loxicam, but it's the same thing (meloxicam). The vet prescribed 0.5mg/day for 5 days. @Wendy&Neko warned me about Metacam's black box warning before, but I was so happy to see Dimmu that I forgot to check what it is, let alone asking for another option.... I think it's more widely used/accepted here in Europe. I read through the discussion in the Think Tank and some of the articles online, and mostly it's about the potential danger of using it long term. As I don't have anything other than Loxicom, should I just use it anyways? If not, what are some other options?

I have traumeel at home, but not sure it's potent enough. His previous vet put him on traumeel post dental 2 years ago, but I think there was also a reduced dose of some oral NSAID, but I can't remember which...

 

PMPS 553!!! First black I gave him his normal 3.5U.

I wanted to recheck, but he put up quite a fight, and he's already gone through so much today, so I backed off.... Is this huge rise of BG normal after surgery? He was very very stressed at the vet office, but his BG was at least within his "normal" range then, and while he's so happy and active at home now, his BG reached a new scary high..... Don't know what to make of this

 

Give him time to settle down. He's been on a bunch of drugs that lower BG plus, if Dimmu is experiencing any pain, that will raise BG numbers. Frankly, having numbers running higher, is a whole lot easier than trying to shovel HC into a cat that's just had pretty extensive dental work.

I am not a big fan of meloxicam for all of the reasons Wendy noted. Unless there's a way to contact the dental vet and ask about getting buprenorphine, you may be stuck. Traumeel is homeopathic and I don't know enough about it but I suspect that it is not adequate for dental pain.

 

Hi! So glad he is home and eating and the surgery went well. They did a lot to your boy! Some kitties go lower after anesthesia and some go higher. I would still be checking him through the night even though he is high right now. You want to know if he were to start to drop.

The metacam, I think I remember reading that there is different formulas of it in different countries but not sure about that. Hopefully someone with more knowledge about it weighs in. If it is the same as the US formula, I would request another painkiller.

I don't understand the Class 2 resorption and why it was left behind. Did she explain the potential risk?

I hope that without the infection from the left behind root tip that his numbers will start to improve.

 

I meant to address the Traumeel. I am a huge fan of it. When Bubba had his eye removed in 2015, my homeopath told me to rub it all over the orbital area into his fur prior to taking him to the surgeon. He had absolutely no swelling post operative. Inflammation causes pain , so I would use it to help out.

 

I agree with Sienne. Dimmu's little body has been through a lot today, plus he.only had half a dose of insulin this morning. Pain and inflammation can raise the numbers. After a dental surgery, I noticed it took Neko about 10 days for her numbers to return to normal. I used buprenorphine for pain with Neko.

I would still get a before bed test today, to see if he starts coming down.

 

I compared Metacam (manufacturer only lists info for use on dogs) and Loxicom for cats (which manufacturer claimed it's design for cats), the formulas are different, but the active ingredient, Meloxicom, is the same. The suggested doses are different, too. For Dimmu's weight, he would get 0.6mg/day of Meloxicom according to Loxicom's dosing scale, but 1.2mg/day according to Metacam's. But again, it's comparing cats to dogs. I guess I am stuck, but will try tomorrow to see if I can get another painkiller. If not I will do a combination of Traumeel and reduced Loxicom like our previous vet did.

She said the class 2 resorption teeth are "eaten away" by bone growth, the edges of bone, ligament, and enamel are not well defined anymore, and if she tries to treat it like caries like some other dentist might attempt, it'd only do more damage to the bone. These teeth are still relatively healthy, and the process is slow, so she opted for close monitoring instead of early extraction.

Will definitely do a before bed test. I know I should give him time to settle down, just the black number was very scary. Time to put the Patient Pants on again.

Thank you guys. Have a wonderful weekend!