6/24 Zeke AMBG 141 - Home and eating; surgery went smoothly

Good morning LL,

Sending out healthy BG vines to all.

Zeke's last condo

Over the past month or so, I’ve taken a bit of a hiatus from posting but have been checking in now and then to see how everyone is doing. So pleased to see we’ve had a few kitties go OTJ during this time. More OTJ successes for the FDMB – Way to go!!! Well, DH and I have been keeping up with the routine with Zeke. Zeke’s doing well and is still on an approximately 0.1u dose.

On June 5, we took Zeke in for his annual checkout and all BW results came back fine. Unfortunately the verdict on his oral health wasn’t positive. Years ago Zeke was diagnosed with periodontal disease and over the years has had to have many tooth extractions. Well, I think basically all he has left are his four canines but now our vet has determined that they are bad and need to come out. We are very saddened by this.

Zeke is scheduled for surgery on Tuesday. Even though come July it will be one year since Zeke was diagnosed with FD, we’re still holding on to hope that he can become diet regulated. In order to give Zeke the best chance of remission, we’ve had total control over avoiding any un-FD-friendly food or treats, so I’m worried that the vet might do something that could negatively impact Zeke’s progress. Are there any specific concerns we should have or requests we should make as to anesthesia or medication?

The emotional impact to Zeke of not having any teeth is a huge concern to us. I’m curious to know what we could expect as to how Zeke might react. Has anyone dealt with this situation? Was there an adjustment period for your kitty and how did it go? How’s your kitty doing now?

One more thing. Our vet was thrilled with the glucose results of Zeke’s BW. His BG came back at 147 (@+6, though @+3 that morning he was at 75 – poor kitty obviously very stressed by vet visit). Additionally, there was no glucose in Zeke’s urine. Her opinion is BG under 200 is normal and as a result is advising that we take Zeke off insulin, starting with cutting back to once a day dosing of the 0.1u for now. She stated that we should give Zeke’s pancreas the opportunity to function without the aid of insulin, giving Zeke’s body a break from this external insulin, and that by continuing to give him insulin when he’s “normal”, we’re doing more harm than good. Needless to say, DH and I do not feel that (as per the TRP guidelines) Zeke’s BG is normal yet and therefore are not on board with her advice. You can see from Zeke’s ss that he is still going above TRP normal at PS, recently as high as 150. Any thoughts on our vet’s advice?

As always, the advice from LL is greatly appreciated.

Wishing you all a great day.

Re: 6/20 Zeke AMPS 103 - Need advice please.

Morning....

I have experience with what you are facing.
Shadow has feline resporptive lesions and had to have all 4 fangs removed.
( they were cracked)
first of all, Zeke will be okay without them, however, it is something he will likely have to adjust to. It will depend on his personality.

I noticed a large difference in Shadow. She is the alpha in our household .... over dogs and the other cat ( now ga) and when she came
home without her fangs.... she was like a whipped cat. She lost her mojo.
I felt like it was similar to a woman going thru a mastectomy....
it affected her psyche. It took her about a year to strut her stuff again but she did get back to her boisterous self.
She knew she didn't have much defense without her ferocious teeth.... ( even tho' she does have her claws)

It also affected her ability to eat. She is not one to use her tongue to pick up her food. And she had to learn to do that more.
It was an adjustment for her.... you would think those fangs were in the way but it's what they are used to....
suddenly they are gone and they have to use their mouth a little differently.
The first few days after the surgery ( while healing those sutures) I would chop her pate into little balls of food separated from each other
on a larger plate so she could get them in her mouth.


I also see this as very likely to what is holding Zeke back to being diet controlled.
It is very likely his numbers will drop down under the all good threshold after the teeth are out of the picture.
Teeth problems affect cats bg's that much.... any pain does....
I've learned that from Shadow's teeth issue and her arthritis issue. ( Her painful hip kept her numbers in that 120 range until the pain was
addressed....)

I would continue the one drop of insulin .... it's supporting him for now but I bet after he recovers from the surgery that his numbers get better.

Anesthesia will lower bg too....
so you don't want to give him any insulin on the morning of his surgery . I , myself, wouldn't give him that drop of insulin on the night before
surgery either. ( that's what I did with Shadow) I didn't want any insulin influence for surgery since Shadow's numbers were a lot like Zeke's.

Re: 6/20 Zeke AMPS 103 - Need advice please.

there are several kitties that don't have any teeth left. the first one that's coming to my mind is Christie's Willie. She doesn't post much anymore, but i'll send her a msg on FB and ask her to come give suggestions. She had great stories about him - one i got a huge kick out of was that he caught a mouse and brought it to her in bed, but being without teeth he didn't hurt the mouse. i'm not remember exactly who else is toothless, but there are some. i know Willie did fine with it.

Punkin had his canines removed and it wasn't any bigger of a deal than when he'd had back teeth removed earlier. Same post-dental routine.

my next thought is that if he is having tooth problems, that might be the last item on the "how to get Zeke OTJ" checklist. I wouldn't be at all surprised. Zeke's done so well, but has lingered on that last drop .. . maybe getting rid of those last teeth will tip the balance and he'll go OTJ once they are gone.

i'd do what you are doing with continuing the drop of insulin for now. But when the last teeth come out, i'd be extra vigilant watching to see if, by removing that problem, he was then ready to go off of insulin. When Sandy's BK got his last dental, it cleared up whatever was preventing him from going OTJ and he went right off. He's not the only one - it's fairly common.

I doubt the vet could do something to set Zeke back. You could take along the food you want him to have post-dental if they are going to be feeding him. I'd definitely skip the shot that morning and probably that night as well. Anesthesia can drop blood sugar and with his mouth a mess, you don't want to be trying to feed him to pull him up.

great to see you and Zeke, Laura!

Re: 6/20 Zeke AMPS 103 - Need advice please.

Julie is right... Willie is indeed my toofless wonder. His tooth loss wasn't sudden, so I can't speak to any adjustment, but he does just fine today. With no front claws and no teeth, he's got some mighty bravado and can be lightning fast as he is otherwise pretty worthless in a fight and will just cower if he's trying to hold his position. With a neighbor cat that prowls (and an aggressive dog that can jump the fence :evil: :evil: :evil: ), his outdoor time has been significantly curtailed as of late, much to his chagrin.

He is indeed still a prolific mouser, who can manage to massage a mouse into a deep state of slobbery relaxation before bringing it to the humans as a gift and/or demonstration of prowess. :lol: :lol: :lol: (Herbie, otoh, kills them then stashes them in her toy pile!). The worst part was, I'd catch the mouse, set it free outside, and he'd somehow catch it again!!

Feel free to search our old condos for tales of his day to day life. He's 19 now (!!!) and still chases Herbie (now a big girl at 3!!!) around the house, engages in wrestling matches, etc. With FD, dry food isn't on the table, which is good... before I'd definitely have to moisten it because he'd scarf kibble whole, which could lead to pukus issues. With his age, kidney issues and FD, making a soupy food is much better for him, so I add a good amount of water to his meals. We feed Nature's Variety Instinct Raw in the large chubs, and the food can be pretty thick without added water. He can be a bit of a messy eater... I have no idea how that much food ends up on the wall behind the food bowls. :shock: :shock: :shock: :shock:

I'd keep an eye out for any personality changes, and maybe try a feliway if you notice any issues. I'd consider adding fish oil to his food if you're not already doing so (and there are no allergy issues with which to contend). It has a wonderful anti-inflammatory effect that will help with the reducing of post-op swelling.

As for the insulin recommendations, I strongly disagree. Zeke's body will tell you when he's ready to be off insulin. Willie's pancreas is flaky... he'll be OTJ, then something will happen and we'll be back on the juice. I would definitely keep an eye on the numbers after the surgery... this may very well be the boost he needs to get OTJ for good!

Re: 6/20 Zeke AMPS 103 - Need advice please.

Hi, Laura.

Gabby has resorptive lesions and is gradually losing her teeth. The fangs are mostly gone. It hasn't seemed to affect her in the least other than when she goes to eat something and it falls out of her mouth. Gabby, being food motivated, though, perseveres!

Have you thought to share a copy of the tight regulation protocol with your vet? If not, giving her a copy of the actual journal article may help her to understand your way of thinking. I'm always amazed how a vet can say a BG under 200 in a cat is normal but if it were her child, she would think differently. In any event, I don't have the journal version of the TR protocol in the office with me. If you need it, send me a PM and I'll get it to you when I'm home.

Re: 6/20 Zeke AMPS 103 - Need advice please.

Spot has been losing his teeth throughout the years and only has two fangs and his chicklets left. He eats like a champ. I also think that it is a good chance that his teeth removal may result in going otj, but if he doesn't, oh well...at least he will be happy and pain free after the initial surgery.

Good luck Zeke!

Re: 6/20 Zeke AMPS 103 - Need advice please.

Hi Laura!!

Great to see a Zeke condo. He's looking super and I also wonder if those teeth are just what's keeping him from being diet controlled. Here's a great post on Dental Procedures that Sienne did and should provide you with good info. I would check around where you live and see if there is a board-certified anesthesiologist that will go to your clinic and do the anesthesia. Your vet would likely know. We have one here and I know there are others in different localities. My vet loves it because then she can put all her attention on the dental issues and get done faster knowing someone else is monitoring the anesthesia and vitals. The anesthesiologists are also the most up-to-date on anesthesia protocols and pain meds. I would definitely ask about buprenorphine for pain. My vet has me giving Gracie Nordic Naturals Omega 3 Pet due to it's high quality. You can discuss with your vet if she feels it is appropriate and if/when to give it in relation to the dental.

Please let us know how he does with the dental. :YMHUG: :YMHUG: :YMHUG:

Re: 6/20 Zeke AMPS 103 - Need advice please.

Laurie sent me a PM with a few questions.

I spoke with Zeke's vet this afternoon and she was not pleased to learn that we've "dismissed" her medical advice and have stuck with the BID schedule. She proceeded to tell us that since the anesthesia will cause his BG to drop, continuing with the BID schedule could put Zeke in danger during his surgery. She is insisting we reduce his dosing to once a day. Is there really an increased risk as she's stated? How long would it take Zeke's depot to drain to avoid any additional risk? Maybe we could just do the once a day 2 days before his surgery.

Click to expand...

Anesthesia can, in fact lower BG. What your vet is telling you is accurate. However, most vets will suggest you skip the shot the morning of a procedure. I've skipped a shot in the AM and depending on where Gabby's numbers are, if she's eating, etc., there have been times that I've either skipped or reduced her dose for the evening shot. There's also a degree of what's to me, faulty logic with what your vet is saying. If the BG of a nondiabetic cat is in the 50s, isn't there the same risk of BG levels dropping during a procedure? Anethesia doesn't interact with insulin; it lowers BG. Most vets put in an IV whenever doing a procedure. That way, if there's any issue while a cat is anesthetized, they can easily administer a drug or, in this case dextrose, which would raise BG.

Where I see the discrepancy between what your vet is saying and how we view remission is in where the numbers fall. Your vet feels that anything lower than 200 is remission. We look at normal range BG as remission. Most vets want a larger margin of safety because the majority of their kitties' CGs don't home test. These folks bring their cats to the vet once a month or so for a curve. If you're not home testing, it makes sense to let the numbers run higher. In fact, when I travel, I reduce Gabby's dose and she'll be in higher numbers while I'm gone because Gabby doesn't let anyone except me test her. Like your vet, I'm erring on the side of safety. As long as I'm around to monitor, I want Gabby's numbers below renal threshold and as close to normal range as i can get them.

The difficulty with what your vet is suggesting -- the once a day shot -- is that she's not factoring in that Lantus is a depot-type of insulin. Given the duration of a shot, the depot will be draining until what you end up seeing is a response during the cycle you're giving insulin and then numbers rising during the next 12-hour period. You'll potentially see swings in Zeke's numbers. The alternative would be to try to shoot a drop of insulin twice a day.

What we don't know is how Zeke would do without insulin. He does have a few higher than desirable PMPS numbers. In some cases, this could be due to too much insulin.

Re: 6/20 Zeke AMPS 103 - Need advice please.

Laura was going to do an OTJ trial, and skipped the pm shot on 5/8 with a pmps of 97.

He was at 163 the next morning so she picked back up on his shots.

Re: 6/20 Zeke AMPS 103 - Need advice please.

Is it possible your vet is not making the conversion between human meters and the AT? For example, when Zeke is at 70, that is roughly 95 on the AT and 130 is about 176 on the AT.

I agree with Sienne that your vet doesn't understand how Lantus works. Given Zeke's PSs, I wonder if you only shot once a day, what you'd get......maybe higher PSs? I don't know.

What you can do is not shoot the morning of the dental and if he's still lower in the evening, I'd skip then as well. Then see what his BG does.

Re: 6/23 Zeke AMPS 179 - Update/Need advice please (cont.)

Thank you all for your responses. Sorry I wasn't able to respond sooner. DH, Zeke and I are out of town visiting friends so I've been unable to find time to post. More on how that's gone below.

Rhiannon - Thanks for sharing your experience and Shadow's reaction to his fang extractions. Zeke is the Alpha in the house so I would expect he's gonna have a bit of a time adjusting. As for the eating, I'm hoping that will go a little smother as currently Zeke appears to use his tongue quite a bit when eating and often just swallows his treats whole.

Julie - Well, as Punkin did fine without his canines hopefully it won't be so bad for Zeke either. I too am hoping these bad teeth are the missing pieces of the puzzle. We're cautiously optimistic. Yes, I think we'll skip both shots the day of surgery. Not sure about the night before (tonight) though. Vet wants us to skip PM shot but Zeke's been running higher this weekend so if he's high again tonight I may have a hard time skipping. Do you think giving him a shot tonight (the night before surgery) would increase his risk of going hypo during surgery? Your thought is the vet couldn't do anything to set him back. I thought there are certain meds that aren't FD friendly. Sounds like that's not the case, correct?

Christie - Willie's mouser technique is hilarious. That's wonderful that his lack of teeth hasn't diminished his enthusiasm or joy for hunting. Thanks for the feliway suggestion. I have some bottles on hand so it will be easy to break them out if necessary. We also have fish oil on hand and though Zeke's not real crazy about it, we'll try adding just a little to his food. I hadn't consider the anti-inflammatory aspect of fish oil - good point.

Sienne - Thanks for the copy of the journal article. I will forward to our vet. I'm not hopeful that we'll be able to change her position but hopefully she'll at least agree to not sever our relationship on this issue. We're not about to abandon that which has helped Zeke so much and has gotten him to this point of regulation. Deviating from the TRP is not an option - we will stay the course.

Deb - Aww, that's great that Spot is doing so well with so little teeth. Thanks for the well wishes. Paws and fingers crossed that Zeke will benefit greatly from the removal of these bad teeth.

Marje - Thank you for the moral support, links and suggestions about the anesthesiologist and bupe. I will discuss with our vet. I will also confirm that she is taking into account that we're using a human meter. My impression though is that her insistence that we stop his insulin (starting with once a day dosing for now) is based more on the fact that there's no glucose in Zeke's urine (i.e., he's no longer diabetic).

This weekend: Well, we had already scheduled a road trip (including Zeke) to visit friends of ours way before Zeke's surgery was scheduled so we decided to go ahead with our plans. This trip was meant to be a test to see how Zeke would do. We had hoped that should Zeke do well, we could resume our travels, something that's been on hold since Zeke's FD DX. Well, in some ways he did better than expected but unfortunately due to his uneasiness with the foreign surroundings, he was not willing to eat at times which caused us to have to skip or delay his shots. The result - much higher BGs. Although the stress from a foreign environment and the loud and unfamiliar noises could certainly contribute to the higher BGs, we believe the main reason is the decreased insulin he received the last 3 days - all the more proof that Zeke is not ready to be Lantus free. Once those bad teeth are gone, however, his insulin needs may very well change. Well, guess we'll just have to tighten those patience pants and see what happens.

Thanks again all for your responses.

Wishing you all a great day.

Re: 6/23 Zeke AMPS 179 - Update & Need advice please (cont.)

Hi Zeke and Laura (hope I got that right!). I am VERY new here to LL (day 2) but I actually have something to share! Our Coleman has no teeth at all! When we rescued him about 4/5 years ago and took him to our vet, they said bad dental and that he'd need quite a few extractions. We scheduled him for sx. They called us during the procedure and said that it was so bad (to quote..."looks like ground hamburger in there") they wanted to remove all of his teeth. We said okay as it was best for his long term health. He came home with a Fentanyl patch for pain and antibiotics. He had NO problem at all adjusting, it was as though he was not aware that he no longer had teeth. We actually fed dry back then :sad: and it never slowed him down. We tried canned for him post op, but he insisted on dry (which I now know is kitty crack). His weight has always held good. He is a tall, long, solid cat...usually 12-13lbs. He has no problem smacking anyone who messes with him...and if you REALLY make him mad, he will gum the bejeezuz out of you :lol: And, with no teeth you get a drooler!

Post dx, we now feed all wet...which he is perfectly okay with now...and we feed 4xday. For Coleman, his BG gets worse if he goes long periods without food so we feed ~every 6/7 hours, small meals for all. He recently reverted back to diabetes, but I know for sure we can rule out dental issues :lol: FYI, his gums checked out great at the vets last week.

I know this seems scary, but cats can do great with no teeth. I also think that our attitude has a lot to do with it. If you treat him as weaker or needing more help he might act that way. Take the necessary precautions post op, but otherwise treat him as you always have. He'll be gumming you in no time.

Good luck with the procedure, we'll be sending purrs and hugs.

Re: 6/23 Zeke AMPS 179 - Update & Need advice please (cont.)

Hi Laura!

I love all the stories about how well cats have done with no/minimal teeth. it's good to hear positive outcomes!

i should clarify what i meant - i don't think BGs are known to be increased by any of the typical anesthesias. Typically, depending on what they use, it will either be unaffected or it may decrease BGs. I would ask for bupe for post-surgery pain. I would double-check any antibiotics to make sure they didn't have added sugars.

I would reiterate with the vet that I did not want metacam or convenia given to my cat (metacam is FDA-allowed for cats for one shot post-surgery; the risk with convenia is if he is allergic to it, it remains in the body for 2 weeks.)

As far as tonight - I haven't heard of people skipping the night before. The Lantus you shoot tonight will have mostly worn off by the time surgery comes around tomorrow. You might want to decide based upon what the BGs are at pmps tonight. If it were me, i'd probably go ahead and shoot tonight and plan to skip am and pm tomorrow. Especially since you know he's having multiple extractions. His eating may be iffy tomorrow if his mouth hurts, or if he's nauseated, and gut motility can be slowed down with anesthesia so you can get vomiting. You wouldn't want to run into having low blood sugar and an iffy appetite situation.

We have gone slow with food post-surgery. Give a teaspoon of watered food and wait 20-30 minutes to make sure it's staying down. Keep repeating that process until you feel pretty confident that he's not going to vomit, and even after that go light on the food.

We'll be thinking of Zeke tomorrow - i hope you can open a condo and let us know how he's doing. Big hugs! :YMHUG:

Re: 6/23 Zeke AMPS 179 - Update & Need advice please (cont.)

My vet always says to feed half their normal amount of food after a dental and resume the regular amount the next day. Good luck.

Re: 6/23 Zeke AMPS 179 - Home and eating; surgery went smoot

Zeke's home!!!! He did great. He has a healthy appetite and would prefer we not be dragging out this feeding business. I'll post a more thorough update tomorrow. Right now I just want to love on him and feed him his dinner slowly so as not to upset his stomach.

Thank you again for the support. DH, Zeke and I thank you from the bottom of our hearts.

Re: 6/24 Zeke AMBG 141 - Home and eating; surgery went smoot

Great to hear he's home and has a healthy appetite!!

If he does ok with the small feedings for awhile, you could probably go ahead and give a bigger amount if he's really hungry. It's best not to rush it too much though.

Looks like he's figuring out how to do without those toofs too!

Now the toof fairy has to come and leave him something special!

Re: 6/24 Zeke AMBG 141 - Home and eating; surgery went smoot

I'm so glad his surgery went well cat_pet_icon
:YMHUG: to you.

Re: 6/24 Zeke AMBG 141 - Home and eating; surgery went smoot

glad to hear things went well and Zeke is wanting to eat.

we'll look forward to a new condo tomorrow with the story. enjoy your time with him tonight.

Re: 6/24 Zeke AMBG 141 - Home and eating; surgery went smoot

'I am so glad to hear that Zeke's surgery went well. I am sure you are happy it's over. That's great that he wants to eat.

Re: 6/24 Zeke AMBG 141 - Home and eating; surgery went smoot

I know how relieved you are that this is over. I hope it helps also to get Zeke into remission for real!! No glucose in this urine is great. Our last vet visit Max's BG was 144 but urine was +3.