12/2 Loudogg AMPS 280 PMPS 334 - What a nightmare....Response from Vet

[Amanda and a Loudogg]

November 29, 2020 Condo

Good morning everyone,
I feel like everything is spiraling with my buddy Lou, and I am so confused how this all played out backwards. He went lower when he should have gone higher, and now his numbers have gone wildly out of control. It's heartbreaking to see after he's been so steady. And what's worse, I can tell he feels crappy, and I know it's not just healing from the dental. I can tell he feels gross when he's in the higher blues, these yellows and pinks (!) make him feel downright awful. He's even starting to show those initial FD symptoms when he was first diagnosed: starving and scarfing down his food, and I think it's a matter of time before he goes back to trying to dumpster dive into the garbage for scraps.

So the question is, what can we do about it? If things played out normally, if his numbers increased before his dental, I would have gone right back to the 1.5u, no harm no foul. Instead, he had the extended trip in low numbers, which means I've been creeping the dose up, which just leaves the BGs going higher and higher. He actually hit the 300s last night (the 0.75u dose was not even making a dent). So, would it be insane to go back to the 1.5u right now, as a delayed reaction, to get him back to the lagoon? Or do we need to creep up the dose like we would in a normal situation?

I look forward to hearing your thoughts. I hope you have a wonderful day and your kitties surf safely.

 

[Gill & George]

Is he on anti biotics after the dental?
Did they give him AB before?

Something does look off....

 

[Gill & George]

Looking at your ss and notes, he seemed to go start to go off when you stopped the ONISOR, and then a few cycles later when you stopped the bupe, his numbers went higher, could he be in pain? That could mess with his numbers.

I'm wondering if he has an infection, as I understood from my vet, it is usual to give AB after dental surgery to prevent post op infections, especially with the mouth and all the bacteria floating about in there.

I can't make up my mind what to do about the numbers.
With the history of IAA, I would have done what you did this morning and increase to 1u, see how that goes, it is possible to fast track Lou, though it would require closer monitoring.

 

[Amanda and a Loudogg]

Is he on anti biotics after the dental?
Did they give him AB before?

Something does look off....

They didn't give me antibiotics after the dental. I know he was given some at the vet afterwards. They sent me home with two pain meds, which was weird. They only gave me the bup after the first one. This time they had me give him 2 doses of a pain pill (Onsior?).

 

[Amanda and a Loudogg]

Looking at your ss and notes, he seemed to go start to go off when you stopped the ONISOR, and then a few cycles later when you stopped the bupe, his numbers went higher, could he be in pain? That could mess with his numbers.

I'm wondering if he has an infection, as I understood from my vet, it is usual to give AB after dental surgery to prevent post op infections, especially with the mouth and all the bacteria floating about in there.

I can't make up my mind what to do about the numbers.
With the history of IAA, I would have done what you did this morning and increase to 1u, see how that goes, it is possible to fast track Lou, though it would require closer monitoring.

I have wondered the same thing, wondered if I should get him into the vet so they can see if there's something going on. I know it takes time for things to heal, but you'd think it should have been easier this time with only 3 extractions vs most of his teeth last time. There is someone home with him nearly all the time nowadays, so I'm not super worried about monitoring him. I think we could do that easily, but I think it's more how off everything feels. I can't help but worry something else might go wrong while I'm trying to fix his BGs.

 

[Gill & George]

(Onsior?)

it's pain relief a non steroidal anti inflammatory. (you made a note on the ss)

I know he was given some at the vet afterwards

Injection??? could it be convenia? If it was I don't know if it is effective with mouth infections, it's licensed for skin infections.

I would phone and ask what they gave him after and explain how he's feeling, including his BG going off with when the meds were stopped. I think that all indicates to me that there is a problem with his mouth, be that an infection or something else, like they didn't get everything out. (I take it he had an extraction? or was it just a clean?)

 

[Gill & George]

. I can't help but worry something else might go wrong while I'm trying to fix his BGs.

I think the BG is a reflection of something else being wrong. Especially with how it correlates to you stopping the anti inflammatory and then the pain meds.

When george had his extractions he had 10days ab before and 10days after his extractions, they were an AB specifically for mouth problems. My vet said it was his protocol to do this with extractions, because there is a high risk of infection. Experience on the board tells me not all vets do this, I remember a few cases where this has led to an infection.

wondered if I should get him into the vet so they can see if there's something going on.

I would call them. Tell them what has gone on with the BG and the pain med.

Find out exactly what he was given. I'm wondering if they may have reached for a steroid.

 

[Amanda and a Loudogg]

I think the BG is a reflection of something else being wrong. Especially with how it correlates to you stopping the anti inflammatory and then the pain meds.

When george had his extractions he had 10days ab before and 10days after his extractions, they were an AB specifically for mouth problems. My vet said it was his protocol to do this with extractions, because there is a high risk of infection. Experience on the board tells me not all vets do this, I remember a few cases where this has led to an infection.


I would call them. Tell them what has gone on with the BG and the pain med.

Find out exactly what he was given. I'm wondering if they may have reached for a steroid.

I will call or perhaps email so I can include his spreadsheet. I found the itemized receipt and it looks like they gave him a Covenia and Metacam injection. Other than IV fluids and pain meds, it looks like those are the only 2 other meds he was given. I certainly wish my vet was more like yours. That makes perfect sense to be proactive.

 

[Pamela & Amethyst]

 

[THH & Snowcrash (GA)]

Convenia is sometimes enough to control dental infections, but not always. I've seen at least one cat who had a Convenia injection for a dental end up with an infection, and this cat wasn't diabetic.

Clindamycin is usually the best antibiotic for dental issues. It can cause diarrhea, so be sure to have a probiotic on hand to help prevent that (my cat Snowcrash got explosive diarrhea from Clindamycin after his dental). It can be given in food or liquid by mouth.

 

[Gill & George]

Metacam injection.

That is also an anti inflamatory as I am sure you know.

The Convenia is the AB. I don't know how effective that's going to be with a dental infection, I've seen problems with it here. Has Loudog had that before, there have been reports of cats having adverse reactions with it. It's a long acting antibiotic.
Has he had Convenia before? Zoetis lists diarrhea loss of appy and lethargy as side effects, https://www.conveniafacts.com/top-questions.aspx I do know that Gracie, @Marje and Gracie kitty got very sick with it.

This is what George got it was specific for his teeth/mouth, gave him the runs, had to use a probiotic
https://www.perrogato.net/medicamen...ibiotico-periodontal-para-perros-y-gatos.html

 

[Amanda and a Loudogg]

That is also an anti inflamatory as I am sure you know.

The Convenia is the AB. I don't know how effective that's going to be with a dental infection, I've seen problems with it here. Has Loudog had that before, there have been reports of cats having adverse reactions with it. It's a long acting antibiotic.
Has he had Convenia before? Zoetis lists diarrhea loss of appy and lethargy as side effects, https://www.conveniafacts.com/top-questions.aspx I do know that Gracie, @Marje and Gracie kitty got very sick with it.

This is what George got it was specific for his teeth/mouth, gave him the runs, had to use a probiotic
https://www.perrogato.net/medicamen...ibiotico-periodontal-para-perros-y-gatos.html

I've heard about issues too, ugh, I wish they would have said something. I know he has had it before. I don't have the paperwork handy, but I am pretty sure he had gotten the Metacam and the Covenia injections last time as well. Previously, I don't think he had any lethargy, GI, or appetite issues. This time, he is starving, meatloafing, extra cuddly, but no diarrhea. And unfortunately, it's hard to say whether he's in pain or just feels crappy because of the higher BGs (he's more sensitive to those higher numbers now since he's been regulated). He's staring at his food dish as we speak.

I sent an urgent email off to the vet to see what their thoughts are. I reckon I'll give them a few minutes before calling to urge them on.

 

[carfurby (GA)]

Sending prayers.

 

[Olive & Paula]

Maybe having him rechecked to make sure nothing was missed.

Wish I had copy but some time ago I was reading a paper on pets and antibiotics. What stuck out at me was it specifically said diabetic cats needed longer than normal course of abs. I ask ed my original vet about it and he agreed. I asked Ollie's vet what she thought and she said she does 3 week treatment on diabetic cats and dogs.

I also have on all my cats records at vets, NO convenia, metcam, at any time. Clavamox, steroids to be discussed with me first. We have discovered 2 of my civvies do better on smaller dose of clavamox given every 6 or 8 hrs instead of larger dose every 12 hrs.

 

[Gill & George]

@Olive & Paula
Human diabetics have an increased risk of infection post op. It wouldn't surprise me if the same were true for cats.

Amanda if he didn't have an issue with convenía the first time it's less likely that the problem.

I hope you get to speak to the vet, I would want them to take a look at his mouth again.

 

[Amanda and a Loudogg]

Well, this vet absolutely sucks. I finally got a response back, and I couldn't be more shocked, appalled, and downright disappointed in their response to me:

"Good Afternoon,
Yes, Lucius was given a 14 day long-acting injectable antibiotic called Convenia on the day of his surgery. We did indeed take x-rays of his teeth before and after extractions. The buprenex he was receiving could possibly have caused his glucose readings to be lower than normal.
The other questions we have are if he is getting his insulin and food (same amount/kind) at the same time each day? What dose of insulin is he getting? Is he getting 0.75 units twice a day? According to our records, his prescription is for 2 units twice a day. If he is not consistently receiving this prescribed dose, we recommend returning back to the 2 units twice a day. After 2 weeks of being on the prescribed dose, we recommend performing a full day curve here in-house at the clinic and see where his glucose numbers are at. High glucose numbers may explain why he is not acting like himself as it affects the body in many ways. Please let us know if you have any other questions or concerns."

I have not discussed insulin dosages with them in at least 2.5 years, probably 3. They didn't even discuss the possibility of infection. Just treating me like I don't know what I'm talking about and having the frickin audacity to tell me to come in for glucose curves. Like I haven't kept my cat alive for 3.5 years with almost no help from them. I'm bloody steaming right now.

So I think I need to focus on getting his numbers down I think. Should I stick with the 1.0u right now or do you think I should go back to the 1.5u to see how he fares? Lou is only home by himself up to 2 hours a day, so monitoring him closely would be easy.

 

[THH & Snowcrash (GA)]

Woooooow

 

[Wendy&Neko]

Every time any of my kitties have had a dental extraction, the vets have suggested a followup one week later (no charge at any of the 3 vets) to make sure the mouth is healing fine.

Remember patience and NDW? Plus holding a dose at least 6 cycles - especially with blue nadirs.

 

[Ella & Rusty & Stu(GA)]

Just checking in to say that I hope that Lou will get back to normal soon and find a good dose. I never had a problem with Convenia; Rusty tolerated it well, much better than Clavamox. I remember all sorts of controversy with regard to Metacam back when I joined the board. It is a potent painkiller and was considered potentially harmful if not administered with care.

I'm sorry that your vet is so uninformed about his feline patient. Sending lots of healing, feel-better vines for Lou.

s for you.

 

[Gill & George]

I can understand your frustration. I wonder if their records show when they last reviewed his dose?

Have you asked them if they would do a follow up appointment as part of the dental, to check his mouth after the op?

Good luck with the dose increases.

How has he been?

 

[Amanda and a Loudogg]

I can understand your frustration. I wonder if their records show when they last reviewed his dose?

Have you asked them if they would do a follow up appointment as part of the dental, to check his mouth after the op?

Good luck with the dose increases.

How has he been?

I doubt it. They thrive on doing the bare minimum. Which is why that response is so shocking. Other than sleeping more and being more cuddly, he seems perfectly fine, just has high BGs.