26/5 Djoko - finally home after his dental!

https://www.felinediabetes.com/FDMB...rust-this-clinic-anymore.247822/#post-2795356

I did not sleep well last night. My boyfriend called the clinic to see how he was doing and to make sure we had been given the right information and he has been called abusive. I was there and there was nothing abusive in the way he spoke. It seems that raising concerns and not taking things for granted is abusive! Oh well - the dictatorship of vets is happening!

This morning, the tech could not make Djoko eat which was surprising. He is normally very hungry in the morning and can eat anything. I had provided them with 4 options (everything specified in the instructions) but apparently, they did not bother reading them. I then asked the admin/coordinator of dental team to open the cans so that he can lick the lid to have couple calories (not too much because he needs to be fasted but his last meal was at 6pm yesterday). He ate very quickly which does not surprise (sincerly hoping that she did not give him too much food) - wondering how hard the tech tried earlier too..

Djoko will spend 3-4 hours under anesthesia which I find a lot. It scares me. He has started 30 minutes ago (at 12 pm eastern time). Very difficult to not be nervous, especially when the procedure last that long.

lets pray!

 

Definitely praying for you and Djoko, these waits can be excruciating. Sometimes I clean house or work outside, or do any kind of busy work to make the time go by faster.
It is also maddening that questioning what is being done, is considered Indecent! It’s happened to me over the years, so I have developed a “student type” of character (who reads EVERYTHING) in a nice enough way that just works. So far.
Grrr about not following your instructions or even reading. I guess they screwed up! Gee.
Not a way to start having your mind at ease right now when it would sure help.
Now, that beautiful kitty of yours is being taken care of - Believe and have faith. I can’t wait to read a happy report from you later!
I’m taking 2 cats in for bloodwork soon.
Your Djoko is just gorgeous!

 

I came on looking for an update. That sounds like a long time but they need to do X-rays and then determine how to proceed so I suppose they give a very long time frame knowing it should not take that long. I hope you will get some updates and hear from the actual dentist when done but not holding my breath. Sending prayers and

 

Sending prayers.

 

I have just been called. Djoko has a tumor (probably malignant) on his neck. The dentist surgeon does not want to remove it but would do a biopsy and then Djoko would need to go AGAIN under anesthesia. I am not sure at 14years and 5 months, with CKD stage 2, I would go through this again. women have lumps in their breast that they do not remove - wondering why it should be removed.
Thoughts? I have 15 minutes to decide!!

 

So I spoke very quickly with the family doctor and she said if they do not want to remove it (they being the dental team) do not bother asking for a biopsy because likely benign. They were wondering why she did not want to remove it because this is an easy procedure apparently but the dentist specialist is a perfectionist so Djoko will be stuck with his itchy tumor .

 

Sending prayers that all goes well with Djoko today.

 

Oh my. Poor baby. I'm praying for him.

 

It could just be a mast cell tumor or something. And you could have your regular vet to a fine needle aspiration of that and it wouldn't require general anesthesia. Then the cells could be examined by a pathologist to see if they are malignant or benign. Praying!

 

You have my prayers, too, Marj. You and your boy are going through a lot right now.

 

Also, Marj, that seems like a long time under anesthesia. What were they doing? I have had cats with full mouth extractions who weren't under that long. Maybe they overestimated on you so that you wouldn't call to inquire how he was doing until they had him waking up and stabilized?

 

Yes, it has been close to 3h40 under anesthesia. I will call now.

 

I hope so. I will call in 15 minutes or less. This is getting long...

 

The admin just had a look and they are still operating on him. Close to 4 hours now. I am getting nervous....

 

I would be jumping out of my skin by now. I understand. Try to stay calm. It should be over very soon. Maybe he wasn't under anesthesia all that time. Maybe they were running IV fluids on him earlier this morning to make it safe for his kidneys. They will need to continue those fluids for hours afterwards as well. Of course, by then he will be in a recovery area. Is anyone going to call you when he is in recovery?

 

She said he as been under anesthetic since 12pm and now it is close to 4pm...I don't know what they are doing...is it risky if he stays under anesthesia too long? They should know that, right? Yes Dr is supposed to call after.

 

They have to operate for another 45 minutes because his teeth are too bad. Wondering if I opened a can of warms and if this was a good decision. How will he recover from that amount of time under anesthesia...

 

this is a nightmare - they need to work another 45 minutes (of course, now the cost is close to 6,000)....
apparently, his mouth is so bad... wondering hos he could eat? as long as he makes it alive, the rest is just money..

 

I am sure they are monitoring everything. He will be on an IV. He will have his blood pressure monitored continuously and his heart rate monitored continuously as well. They are specialists, right? I am sure they will do everything to keep him safe. He will be in pain, of course, but they can give him meds for pain (hopefully buprenorphine -- injectable, which is called Simbadol would be the safe for a cat with kidney disease.) Just make sure they don't send him home with Metacam or Onsior or any other NSAIDS because those will not be good for his kidneys. I'm getting ahead of myself now. I'm sure they are pros and will do it all correctly. I am praying for Djoko!

 

Thank you Suzanne. I will ask these questions to the Dr.

 

Yes. You can just ask what kind of pain control they will be giving Djoko and will they send him home with pain medications, etc.

 

And hopefully no one will say that is abusive!

 

lol

 

So Djoko is out of a 5-hour surgery. She will give him metecam but only for two days - I raised the ckd issue concern but she responded that he had been well hydrated...at this point, what is my negotiating power? He will receive the bupre injection and anti biotics. She was surprised that Djoko BG was regulated with that infection in his mouth and told me to monitor his BG. Now it is to make sure this mess is healing. Apparently, he has a whole in his nose, in his gum, a canine root was infected but the remaining of the tooth was gone (Djoko is missing a canine due to a fall when he was younger).
Of course, they will charge every BG test - no discount at this point eh. The specialist said the dental team would monitor him every 10 min for the 1 hour and then the recovery team (emergency staff) every 30 min unless there is a problem. I was told that Djoko was very special to me but they would treat him as any other patient. I did not recall asking for any privilege other than making sure he is monitored within 2 hours of the procedure which us standard from what I read (my vet did call her abrasive so this is just her being her). Other than that I am wondering if this has damaged his kidneys. Not a fan of metacam obviously. Time will tell. I am wondering how long it will take for him to eat !

My question is: any advice re: recovery? and how much insulin should I give him? I have not him with me now so cannot test him but will update you afterwards.

Thank you for all your prayers and messages today .

 

Oh my goodness - what a long day; so sad for your long wait and the long term anesthesia fear.

I prayed for a better day for you. I see a potential good side. Djoko had a serious problem in his mouth -- and has been treated to the best of the doctor's ability. Metacam IMO is not as scary of a drug as is often believed. When first out, very large doses were given to our pets, causing kidney damage. Now, it has even been shown to be helpful in some cats, in earlier stages of CKD. My Tina was on .3ml Metacam for 2 years, before I found canine Adequan to be like a miracle drug for her spinal deterioration and arthritis.
Her CKD has been stable all along (stage 3).
Still happy to finally be off Metacam for daily use.
It reduces inflammation, therefore relieving pain. Can be great after surgery for short term use.
And all the fluids are great for kidneys. I also have CKD, and know how resilient these precious beans can be, even after taking a hit! I know, I know, I'm not a cat!

 

I am just now seeing this. I wonder why it didn’t show up on my alerts. I checked and was getting worried as so many hours had passed. What a day and I am so sorry he has so much going on. Since his teeth were so bad you had to do this or the infection could have gone to his heart. Stage 2 CKD is not advanced. You started the diet change awhile ago and it’s kept him very stable. I’m hating that dentist and office right now. They know very well he is your baby and they need to learn how to treat family members. The tumor can be easily aspirated later if your vet feels it is a good idea.
I’m not a fan of Meticam either. Why not a opioid patch?
I doubt he will feel much like eating tonight so I would check his bg and decide whether to skip. Max would not eat much the first night after one tooth was pulled and I skipped insulin. I had to skip the morning of the dental as well. So take it a step at a time.

When will you be picking him up?

 

Big hugs to you, Marj. You’ve been through a lot today. Rest up a bit so you will be ready to baby him when he comes home. If he is well-hydrated, and I am sure he is at this point, hopefully all will be well. Maybe she just meant that all of their patients receive the best care when she said that. Let’s hope so. It’s an odd remark. I guess this woman is supposed to be the best dental surgeon, but her people skills are very badly lacking! I am very glad that he has pulled through this. He obviously needed help in his mouth.

 

Totally agree! Why not a Fentanyl patch and not take a chance on the Metacam after a long day of surgery.

 

One more remark on NSAIDS like Metacam. I know it is a touchy subject - I look at it like I look at Prednisolone - (love/hate). Reducing inflammation is important to healing (imagine inflamed gums); not only having pain relief. And inflammation that decreases, automatically reduces pain (somewhat to pretty good). I think the vets I've known where I now live, have all been very hesitant to bring out the "big guns" unless they perceive pain to be severe. Hence, pushing Metacam instead of an opioid. In THIS case, if I were the doc, I'd most definitely offer REAL pain relief . . . I'd think. Then I'm no vet. I just try to understand them. They give a bupe injection, after some surgeries, but don't send opioids home often at all.

Rest and heal baby doll Djoko. Please rest well Marj

 

Oh Marj, what an exhaustingly long and stressful day for you all. My heart goes out to you. Sounds like Djoko had an awful lot going on so I wish for a swift and stress-less recovery. We are all here rooting for you and your beautiful boy.

 

hello,
I am not a fan of the some drugs they gave including ketamine. I have checked each element and most of the were "kidney friendly" except for the metacam and ketamin. I will ask tomorrow if they can provide information on their effects but it is too late. This is a board anesthesiologist so I think I need to trust her with her choices. She knows Djoko has renal disease and maybe it was too painful. 5 hrs under anesthesia after all - he fell when he was younger and the canine root was infected and stuck there. They extracted 14 teeth but they needed to do two flaps due to the fall. Normally, the dentist resident does the job but she needed to take over because it was too challenging for the resident. I am happy I went to see a specialist vs a regular vet. She even mentioned that she did not know how I got Djoko regulated with that infection which tells a lot. (i may be repeating myself but im exhausted.

When I picked him up, he was making weird noise - trying to meow but did not know if his breathing was fine so I asked them to recheck him. The dental team was gone so needed to speak with the emergency team which did not have information on Djoko's procedure.

His BG was 17.6 (316) on AT2 and 11.8 (212) on human meter (tested with AT2 because this is what they used). I assume it was elevated because during the procedure, he went to 4.4 on AT2 so they gave him dextrose. I gave him his full dose as indicated in the instructions. I will monitor him of course. He wants to eat more but they told me to feed him 1/3 of a normal portion.

As per medication, he got the bupre injection, antibiotics, something to rinse his mouth, and metacam for 2 days.

I wanted to send a video but not sure how to do it. I selected "upload a file" and they say I cannot upload it.

I still have to work tonight lol but tomorrow off...

thank you again for your thoughts and advice.

Will monitor the little prince carefully.

 

I’m so glad he’s home with you!

 

Prayers that he will feel better each day, poor baby had a rough day today and so did you. He is so adorable

 

Sending prayers for a quick recovery.

 

Goodness, what a day I hope Djoko feels better each day - wishing him a speedy recovery and wishing you some rest

 

I still don't like the Ketamine. Excreted through the kidneys and there are heart risks. BUT he seems to have come through it just fine!

 

Likewise -I will ask why these products were used for Djoko given his renal disease in two weeks at re-check appointment.
I am wondering if I will see a decrease in his kidneys function next time I do blood test.
He is still acting weird but he is getting. He goes into his litter bow, then gets out, then comes back. Seems like he forgot how to pee.
Very challenging to give him his antibiotics by mouth as you do not want to mess up the work that they did. I am doing my best!
Can't wait to have him fully back.

 

I'm sorry... I seem to have screwed up my post above. I was commenting on your post and I quoted it and my response and it is all bunched up with your quote. Sorry. Please read what I wrote up there!

 

Thank you! He is doing progress but still restless. One day at the time .

 

beautiful BG at least