Tonka's dental, take 2; and PMBS of 103 (24 april)

So Tonka finally got his extractions done. I'm calling him "Toothless Tonks" now: poor guy is less 3 canines, four molars and one incisor. But he came out of anesthesia well (he was a bit more out of it for longer than he had been for the first dental - which was cleaning and X-rays only - but he was also under for over two hours this time) and is eating fine. He refused to purr for me last night, but I coaxed a few out of him today and he's busily grooming himself as I type.

His sugars were good last night after the dental (79 at +4, after eating a few small meals over the course of the evening), but he's up to 122 tonight at his old shot time (still OTJ). He hasn't been accepting his painkillers or antibiotics (the vet prescribed him liquids - Buprenophine and Metacam (meloxicam) for pain, and Antirobe Aquadrops (clindamycin) for an antibiotic - and he gags and spits them out as soon as they pass his lips). So it could be that he's in pain right now (they gave him a dose of Metacam before leaving the vet yesterday, so he was covered for last night through this morning). Would that be a possible cause of his inflated blood sugars? I know it's not that much outside of the "normal" level yet, but it worries me that he might be creeping up again.

 

Pain and inflammation (both common right after a dental) will definitely increase the BG numbers.

It's important to keep trying to get the medications down him...especially the bupe for pain and Antirobe....You don't want him in pain or possibly getting a secondary infection

The bupe doesn't have to go "down" him....actually it's not supposed to be swallowed. You just try to get it into his "cheeks" and it's absorbed through the mucus membranes

 

Thanks Chris - I figured that was probably the case, since he's been steady under 110 for the past while, but just wanted to get a second (or fourteenth ) opinion

And on that note, does anyone have any tricks to pass on on how to get a stubborn cat to accept foul-tasting liquid medicines? I've done the burrito-wrap, head tilt and blowing on nose. I'm afraid to clamp his poor little mouth shut though, since it probably hurts a great deal right now. I know I'm wearing more of the medicines than he is getting currently (which worries me a tad, since I have to start work in the field in week or so on industrial sites, and random drug testing is always a possibility... having something mildly narcotic in my system from absorbing what Tonka decides to spit out on me will be fun to explain )

My regular vet usually gives him the AventiCLAV which is a pill, but he accepts it ground up and mixed into his food with no issues. His dental vet said that the Antirobe is the best antibiotic for dental surgery recovery, but if he won't accept it, I'm wondering if I should just go to my regular vet and get the AventiClav to use instead...

 

the bupe, you only have to get in his cheek.... hopefully you can sneak that in quickly and get out.

I wouldn't give any more of the metacam,

NSAIDS are known to cause renal failure in cats. This is one of the reasons we inform members about the use of Metacam (meloxicam) for pain management. It has an FDA black box warning (which is just short of the FDA pulling a drug off the market) for causing acute renal failure in cats. Despite the FDA warning, some vets continue to prescribe Metacam. There are some NSAIDS which can be used cautiously if there's no other alternative but I typically will not allow a vet to use one with either of my cats.

 

and if he's hurting his numbers will creep up...
try to get his bupe and his ab ....

I've had to resort to going all in and putting one of our pills as far back as I can and down the throat as fast as I can.....

 

as far as the bupe goes, you don't want to blow on his nose or force him to swallow it...if you can get it in contact with the inside of his mouth, it'll absorb through the mucus membranes.

If he'll take the pill better than the liquid, I'd have no problems asking your vet to change it

 

Thanks folks - good things to know. I just want my little one-toothed wonder to get back to a healthy state as soon as he can. I'll put the Metacam off the list, if it could harm him. I'm not sure why they prescribed two different pain killers in the first place - maybe they're supposed to work in different ways, on different aspects of the pain/inflammation?

 

The Metacam is often given as an anti-inflammatory (so maybe they're thinking it will keep any swelling down) as it's NSAID based, but the bupe is opiate based so I think purely pain relief. Rosa was given Metacam for a few weeks about 7 years ago as I was told it was the only thing available as an anti-inflammatory even though there were known issues with it even then. I was assured by my vet at the time that a very low dose was safe (I'm not convinced he really knew - I think he was just hoping it would be OK as they didn't know what else to give) - she survived, but if you can do without it, I'd suggest not giving it.

 

Well, he just got the Bupre today, and a fraction of his antibiotics (heading to the vet shortly to pick up some of the AventiClav that he is more tolerant of. It may not work as well for dentals, but at least it'll get into him, so it's got to be better than nothing.

His blood sugars are up to 130 now , so I'm really hoping they get back to where the belong soon. The vet only prescribed him 4 days worth of painkillers, so I'm hoping that means that the pain/inflammation tends to be down to a more tolerable level after that long. But he's not getting the anti-inflammatories now, so maybe it's worse?

How long above 130 might he stay for this without losing his remission? I'm heading out to the field soon, and I'm terrified of leaving him if I have to start him up on insulin again, because he won't get tested regularly enough while I'm away. Hypoglycemic episodes weren't an issue last fall because he was pretty well chronically high.

 

Poor Tonka - at least the dental is done now!

Clindamycin is also available in pill form. If you know he'll go for pill pockets, you could ask about getting that instead. For liquid meds, I do a quick scruff grab and head tilt then squirt in the liquids. For buprenorphine, I find it easier to give from behind/beside Neko. I put the syringe at the corner of the mouth and squirt into the cheek pocket. But she gets chicken flavoured bupe so it's easier to give.

I wouldn't worry about the BG numbers for a while yet - pain can cause higher numbers. I noticed about 10 days after Neko's extraction her numbers went back down.

 

Okay - that's a relief. I'll probably worry incessantly while I'm away until I can get back and test him again.

Funny thing about the pill pockets - he used to take them just fine. Then one day the last week that I was away one of the cats (and I suspect Tonka) got into the package of pill pockets on the counter (and half a loaf of bread!) and now won't even touch them. Too much of a good thing? We've been grinding up his antibiotics and adding them to his food: one of the nice things about the AntiClav is that it has very little taste, so I can get away with that. I'm getting a bit better with getting the Bupre into his cheek, but he still freaks out each time. It's the Antirobe that he positively despises though - he actually spits it back out. Didn't know that cats could do that but I shouldn't have been surprised, because he used to be a master of spitting out individual kibble that he didn't like when he was still eating dry and I was mixing it with a new type.

 

The Bupe is tasteless too, to get it into Vyktor after a dental I don't let him see the syringe then I sit right in front of him yawning until he does too and kaboom in it goes.

Glad Tonka's dental went well. I'm with the others on the metacam and also wouldn't be concerned about the numbers yet, Vyktor got up to about 150 around his dental after more than 2 years OTJ but it all sorted itself out without intervention

 

If you're not already refridgerating the antibiotic, you could try that. It should reduce the taste some.

 

Hee hee. Sadly, I am not terribly co-ordinated and would probably miss him entirely if I tried a sneak attack like that

I hadn't been, but will try that. Thanks for the suggestion. He objects rather violently to the whole process, but the favour of the Antirobe was especially offensive to him. He's quite unhappy about the "mouthwash" (antibacterial rinse) they also gave me to try to get into his mouth, but I was told that if that one was a losing battle, to not worry about it.

Tonka's back down to 103 tonight. Whew. I had a bit more luck getting the Bupe into him this morning (on the second last day of his prescription - sigh) thanks to the hints about just getting it into his cheek, so maybe it's finally helping him. He's also getting more and more back to himself. Still hasn't forgiven me enough to snuggle up to me yet, but he's chirping (he's normally a very vocal cat, so his silent treatment the last couple days has been rather alarming) and chasing his toys around again, so that is a good sign.

 

Ha ha I'm pretty unco too and must confess that most of his final dose ended up on his face rather than in his mouth!

Glad to hear Tonka's feeling better, hoping for snuggles for you post haste