Please give opinions on 18 year old cat...

[Candee]

My good friend has an indoor only cat (PeeWee) which is 18 yrs old. PeeWee has always been in good health with no problems. Two days ago, the cat suddenly stoped eating/drinking. Peewee also threw up and then continued with periodic dry heaves. She took the cat to the vet yesterday (1 day after symtoms occured) and they underwent a series of blood tests and x-rays. The vet gave her a very small dose of anesthetic before doing the x-rays to keep her from moving around. After the x-rays, she was told that PeeWee has an obstruction of her intestine. The Vet administered IV fluids, an antibiotic shot (baytril) and an injection of reglan (for nausea). He then sent her home with the IV kit (w/ baytril mixed in) to administer 3x per day. Vet also gave her Reglan injections to give 1x per day. Vet bill = $580

I did some researching and found that Bayer, which is the maker of Baytril put a warning out on 7/23/03 that "the injectable form is approved for use only in dogs" and "to restrict the use of Baytril tablets in cats at a dose not to exceed 5 mg/kg/day" due to vision impairments". I also looked up Reglan and found that because it creates contractions to make food go down it is stated that "if stomach obstruction is suspected in a given patient, it is best not to encourage motility and some other anti-nauseal drug is preferred."

Afer the vet visit PeeWee could not walk and was very drowsy which we suspect from the anesthesia. PeeWee remained this way throughout the night and even urinated in the spot she was laying at (15 hours after the anesthesia).

This morning PeeWee can walk but very slowly. Tried to feed her but she seamed as she could not chew and was kind of throwing her food back with a head shake like she was in pain. She also tried but could not lap water. At this time my friend noticed that one of her fang teeth was totally broken and just hangin there.

So now here are my questions...

1) Do you think that maybe the broken tooth was the problem to begin with and she doesn't have an intestinal obstruction. I wonder about this vet because of the fact that both of the injections were not appropriate in the first place.

2) Should she go back to the same vet about tooth or go to a new vet altogether? This vet does do dentistry. But wouldn't he have found the loose/broken tooth to begin with? I suggested to her a new vet... but what do you think?

3) Should she give PeeWee the Reglan injection still or skip it until she goes back to the vet tomorrow morning?

4) Is it normal for PeeWee to be so "out of it" and unable to walk with only a small fraction of anesthetic for such a long time (18hours) or could it possibly be the injections?

5) Obviously the tooth need to be pulled or given a root canal and to do this PeeWee need to be sedated. Do cats have to be totally knocked out to do this?

6) If she goes to a new vet... should she just skip the $60 bloodtest to determine if 18 year old PeeWee can take the anesthetic since the tooth need to be taken care of no mater what. Or is the test still important because it also show things such as amount the can be administered ect.

7) Can vets request records/test results from other vets like how our human doctors do?

Thanks in advance for any opinions, suggestions and help. I and my friend greatly appreciate it.

Thanks again soooooo much,
Candee

[davet]

for sure ewon't remember all the questions but if the tooth is infected it should be gotten out, depending on the degree it might be pulled with out any sedation---agains depends,''depending on the location and type of obstruction...sometime just a glycerin enema works,,would hesitate the regalen again..tis normal for an 18 year oled cat to be out of it but to what degree is debatable'
vets can and do share records, legaly i don't know but most vets have no problem with it so you should be abnle to avpoid pre testing if it was done before but i sure would be carefull of any m ore anesthesia;;i can't see how a broken tooth and obstruction can be confused...again a 1'000 mile opinion...

[Candee]

Thanks for the quick reply. PeeWee is going to a new vet in the morning for a 2nd opinion. Going to try to get his records from old vet also! I will let you know what happens!

[Traci]

First, given the condition(s) of this kitty, I wouldn't wait another minute to get kitty to an EMERGENCY vet, and pronto at that.

The vet diagnosed an obstruction....ok, well, WHAT is the obstruction and did the vet feel an exploratory surgery was indicated to remove it, or just what exactly was his plan of action to treat this kitty? What was noted on the x-rays, inflammation or a clear obstruction?

1) The broken canine tooth should have been noticeable upon exam when your friend first took kitty in. However, depending on the type of anesthesia given, and her reaction upon waking up, she could have thrashed about and broken it on her own somehow. Need to ask the vet about that.

Next, you are certain to find some bits of information on the net about risks, contraindications and side effects of ALL medications. Baytril and Reglan are commonly used drugs for specific purposes. The vet probably prescribed the baytril as a means of combatting intestinal bacteria (based on his findings of an obstruction), and prescribed the reglan for nausea and vomiting, which would be a standard approach based on kitty's signs and symptoms (vomiting). BTW, the veterinary reference letter regarding the baytril use in cats, was actually first sent out a year or more ago, not specifically this year.

2) Yes, get kitty to a new vet, most preferrably an ER vet NOW.

3) If kitty is nauseas and still vomiting after sub-q fluid injections at home and still cannot hold down food and water, then yes, continue the once daily injection of reglan, I'm sure it is a minute amount prescribed. But, repeating again, what kitty needs right now is an ER vet.

4) Depends on the type of anesthetic used. I would assume it was a general anesthetic, and some combinations used can indeed cause a lasting effect. I'd call back the vet and ask the type used, and report an adverse reaction immediately (or, in this case, slow to recover from anesthetic)

5) If it is "just hanging there" as you pointed out, chances are, a vet could loosen it or pull it without anesthetic. However, there may also be another oral condition going on such as a diseased tooth, inflammed gums, ulcers, abcesses, or any other peridontal disease in which a new vet can assess and make the determination if anesthesia is warranted or not to correct the problem.

6) Well, you said kitty underwent a series of blood tests at the original vet visit, so find out just what those tests were and if they included BUN, creatinine, PCV, ALT and protein. If so, these may be enough to determine anesthesia candidacy. HOWEVER, the tooth is the least of the concerns here, you said the vet diagnosed an obstruction, so that is the urgency here, where is the obstruction, what is the obstruction and does it require surgical removal. IF it requires surgical removal, then a full pre-surgical blood screen and ECG to monitor heart function should be done prior to anesthesia, given the age of this kitty.

7) Yes, the attending ER vet can request the kitty's health records and proceed from there. You will probably need to give the first vet your permission prior. Since today is Sunday, I would be for calling immediately, and if the vet is using a pager, etc, I would stress the urgency and request for record faxing, etc.

I can't stress this enough, if there is an obstruction and the vet didn't outline an approach, your friend needs to get kitty to the nearest ER vet facility immediately. In an older kitty with these problems, you can't risk another day of vomiting, not being able to hold down food and water, not knowing the source or cause of the problem. Poor nutritional and hydration support can fast lead to serious organ failure.

[Candee]

The cat has not vomited since the visit to the vet. As far as the tooth being caused by a stuggle comming of the anesthesia, the answer would be no she pretty much just sleep and laid in her bed. It must have already been broke or loose. The root looks to be still in tact. Right now the cat is acting totally normal except that she is having pain while trying to get her tounge out to eat or lap up water. She is eating a little can food when the food is put on her tounge. I stressed to my friend to take PeeWee to the Emergency Vet but they insists on waiting till the morning since she is acting normal and no vomiting or signs of dehydration. They are administering the IV fluids and holding off on the Reglan til they get 2nd opinion.

Thanks for all your input and opinions. I will forward your reponce to Peewee's owner. I will update as soon as I hear anything! Thanks again!

[Auntie Debbie]

I responded on another board

http://members5.boardhost.com/AcmeHouse ... 60628.html

In adddition to Traci's post, both Baytril and Reglan have been known to cause seizures in cats that may be predisposed to them (according to the the links in my post), which may explain the broken tooth not noticed by the vet.
I hope another vet will be more helpful.

[Candee]

My friend had went to the new vet on Monday after getting all the records and x-rays from the old vet. The new vet looked at the x-rays and determined that there was a little gas bubble not an obstuction. He also tugged on the tooth and it came right out. No anesthesia. Gave PeeWee an antibiotic shot and a vitamin B shot and sent her home. After getting PeeWee ate and drank normal and is doing wonderful today. So it was the tooth the whole time. Thanks again to everyone's replys. Take Care!