Update on Razzeratz and the kittens

[Auntie Debbie]

Razzeratz isn't doing as well as I was hoping he'd be doing by now. Even with the appetite stimulant he still seems to be having trouble with the front of his mouth. He takes in food from the dish with the side of his mouth, can't take pill pockets or treats unless I center it directly in his mouth...just lets it fall out if he tries to take it from the front himself.
He is on tap, appetite stimulant and an antibiotic. The dental was Tuesday, today is Friday...wouldn't he be eating better by now, even if it was just tartar and inflamed gums?
How long should I let this go on before I can declare I've wasted a bunch of money on this dental?

The basement kittens fecal came back neg, So yesterday they started a regiment of flagyl, albon and yogurt. This morning I'm already seeing a huge improvement! Most of the poops are like chocolate toothpaste instead of of the authority color puddles I've been seeing. I now have them in a huge crate and this morning even that looked so much neater.

Yesterday I was told Nanceen was doing well after her spay. Let's hope they got that one right. I will be picking her up later this morning.

[Traci]

Did the vet explain why the use of BOTH albon and flagyl? I think only the flagyl would be appropriate here. Please monitor the kittens carefully for any unusual side effects.

As for Razz, call the vet and ask again about the dental. Explain that he is having trouble eating, particularly from the front of the mouth. Ask if there was anything unusual noted during the dental as it would apply to the front teeth or mouth.

Also ask about the tapazole, ask about it being compounded into a liquid form, where you could use a dropper to place in the corner of the mouth instead of pilling and causing pain or discomfort. The vet also needs to determine if the tapazole dose is causing anorexia. Express your concern that you need to find out what exactly is causing the mouth pain, is it from inflammed gums, the dental, or tapazole leading to anorexia or other side effects. Also ask if there were any ulcerations present during the dental. (including the tongue)

Are you feeding canned food, in a soft texture? If you're feeding dry, try canned for a couple days to see if it's more comfortable for him, use a saucer or flat plate so he doesn't have to burrow his face into a deep dish. A wetted down version of canned food allows him to lap rather than chew if his mouth is painful.

If you don't get satisfactory answers from the vet, I'd consider seeing another vet for a recheck; explain that Razz had a dental, but no extractions, has gingivitis and is having trouble eating, tell them what meds he's on and that you're concerned with the anorexia and potential pain aspect, and you can't afford him to lose weight.

[Auntie Debbie]

I'm waiting for the vet to call. While picking up Nanceen I spoke again the with tech. She said there was nothing unusual, just some tartar and that his teeth really weren't bad at all. (Again, not to harp, why did Vet#1 say back when that his teeth were really, really bad???)
At least twice a day I put down two cans of wet, at least one is mush and the other is somethings chopped bits. They also get dry. When Razzeratz gets his pill pocket, they all get temptations. He used to scarf the pill pocket then have some temptations.
Both Sals and Razzeratz love deli turkey breast. Before I left to get Nanceen, I shredded some for him, but left it in a counter so when I got home it would be room temp. He ate just a few bites...and you could hear that crunchy noise he has been making...sounds like someone munching on potato chips...straining to chew....then tried some of the mush..don't know how much he was able to get in him...then walked away. Even <b>if</b> he did have inflammation and is not on pain pills, how long should the pain, soreness or whatever impede his ability to eat? He clearly has the desire.

As for the kittens, I'm not sure why the albon with the flagyl.

[Auntie Debbie]

Here is his last bloodwork, compared to two others

His hypterT is actually low

=XX from 3/18, (XX)from 4/4 (xx) from 6/06/09)@xx-xx@ is their reference range

(xx)=high (xx)=low

T4-result=6.8 (0.5) (0.4) @0.5-5.8 (now as of 6/6/09 4.7) ug/dl@

$$6/6/09=
RETICULOCYTE COUNT= 0.6 @0-1%@
ABSOLUTE RETICULOCYTE=23760 @0-50000/MM3
An absolute reticulocyte count of greater than 50,000/mm3 of blood is considered evidence of regenerative anemia.
Degree of regeneration: /mm3 (Aggregate reticuculocytes)
None= <15,000
Slight=50,000
Moderate=100,000

CHEM 21 with Comprehensive CBC/CHEM 21

ALK PHOSPHATE=25 (12 ) (30 ) @0-62U/L@
ALT (SGPT)=50 (52 ) (18 ) @28-100 U/L@
AST (SGOT)=25 (37 ) (35 ) @5-55U/L@
ALBUMIN=3.3 (3.0 ) (2.6 ) @2.3-3.9 g/dl@
TOTAL PROTEIN=7.7 (7.3 ) (9.6 ) @5.9-8.5 g/dl@
GLOBULIN=4.4 (4.3 ) (7.0 ) @3.0-5.6 g/dl@
TOTAL BILIRUBIN=0.1 (0.0 ) (0.1 ) @0.0-0.4 mg/dl@
DIRECT BILIRUBIN-0.0 (0.0 ) (0.1 ) @0.0--.2 mg/dl@
BUN=43 (42 ) (24 ) @15-34 mg/dl@
CREATINE=1.9 (2.8 ) (1.9 ) @0.8-2.3 mg/dl@
CHOLESTEROL=190 (152 ) (121 ) @82-218 mg/dl@
GLUCOSE=103 (109 ) (116 ) @70-150 mg/dl@
CALCIUM=10.0 (9.6 ) (9.1 ) @8.2-11.8 mg/dl@
PHOSPHORUS=4.5 (4.3 ) (3.7 ) @3.0-7.0 mg/dl@
CHLORIDE=117 (121 ) (118 ) @111-125 mEq/L@
POTASSIUM=4.3 (4.4 ) (4.8 ) @3.9-5.3 mEq/L@
SODIUM=157 (154 ) (149 ) @147-156 mEq/L@
A/G RATIO=0.8 (0.7 ) (0.4 ) 0.4-0.8@
B/C RATIO=22.6 (15.0 ) (12.6 ) @blank@
INDIRECT BILOIRUBIN=0.1 (0.0 ) (0.0 ) @0-0.3 mg/dl@
NA/K RATIO=37 (35 ) (31 ) @blank@
HEMOLYSIS INDEX=N (N) (n) @blank@
LIPEMIA INDEX ++ (+) (+) @blank@

CHEM 21 WITH COMPREHENSIVE CBC/CBC COMPREHENSIVE

WBC=5.7 (6.5 ) (19.8 ) @4.2-15.6 THOUS./ul@
RBC=7.37 (7.03 ) (3.96 ) @6.0-10.0 MILLION/ul@
HGB=11.6 (10.9 ) (6.8 ) @9.5-15 g/dl@
HCT=33.2 (34.2 ) (22.4 ) @29-45%@
MCV=45 (49 ) (57 ) @41-58 fl@
MCH=15.7 (15.5 ) (17.2 ) @11.0-17.5 pg@
MCHC=34.9 (31.9 ) (30.4 ) @29-36 g/dl@
NRBC=XX.X (xx.x ) (1 ) @0-2/100 WBC
NEUTROPHIL SEG=40 (79 ) (81 ) @35-75%@
LYMPHOCYTES=52 (12 ) (6 ) @20-55%@
MONOCYTES=2 (3 ) (8 ) @1-4%@
EOSINOPHIL=6 (6 ) (5 ) @2-12%@
BASOPHIL=0 (0 ) (0 ) @0-1%@
AUTO PLATELET=370 (435 ) (59* ) @170-600 THOUS./ul@
*Scanning of the blood smear revealed adequate platelet numbers. Due to clumping and/or large platelets the automated platelet number cannot be accurately determined.
POLYCHROMASIA=SLIGHT @blank@
ANISOCYTOSIS=MODERATE @blank@
REMARKS=SLIDE REVIEWED MICROSCOPICALLY
ABSOLUTE NEUTROPHIL SEG=2280 (5135 ) (16038 ) @2500-12500 /ul@
ABSOLUTE LYMPHOCYTE=2964 (780 ) (1188 ) @1500-7000 /ul@
ABSOLUTE MONOCYTE=114 (195 ) (1584 ) @0-850 /ul@
ABSOLUTE EOSINOPHIL=342 (390 ) (990 ) @0-1500 /ul@
ABSOLUTE BASOPHIL=0 (0 ) (0 ) @0-100 /ul@

[Auntie Debbie]

Just got back from the vets. I first spoke with the vet (Vet#2) who actually did the dental. The tech was support, though whenever I talked to her, she sounded like she did it.
The vet said he agreed that he should be eating more by now but he really didn't see anything but some tartar and a little inflammation (the amount varies by the day).
He told me I cvould come right in for some pain meds...it would be waiting for me and an antiinflammatory. I should also schedule an appointment for Monday...can cancel if he realloyi perks up, and he'll take another look. I did.
I went to pick up the meds and after waiting 45 minutes for the meds to be "waiting" I only got the pain meds. I asked about the antiinflammatory and they said he already had an anntibiotic, clavamox, wasn't it. Was, changed to clindamycin...their called charts, please look at them. Where's the antiinflammatory...someone will be with you shortly. 20 minutes later, still no vet,k just a tech saying the pain meds should be all he needs. (Okay, then what pray tell happened to the antiinflammatory I was told about on the phone...screw it, at this point my brain needs it more than Razzeratz).
I'll play this out over the weekend, unless something major happens, keep the appt Monday in necessary just to see what they say and then Tuesday take him elsewhere (as well as in the future).

[Auntie Debbie]

Morning update

He is still just picking at his food, eating with some difficulty (with pain killers and the appetite stimulant). Just a little while ago, next me by the computer I gave him one of his pill pockets...nothing inside, just the soft pocket. He took only the one but chewed on it like he was eating saltwater taffy, making that crunching on potato chip sounds. The noise was clearly coming from his mouth. I don't know if it's the teeth making this noise or his jaw as he chews. It took him literally 3 minutes or so to finish the pocket off. Poor guy just looks so miserable all the time.

[Traci]

I'm just alittle confused on the bloodwork, did you post them in order of date, from first to last? If so, some of the results look like possibly infection and inflammatory response. Also, has he been dehydrated? Is he drinking sufficiently?

This is where they should have taken xrays before the dental, especially in an older cat. Xrays give you an indication of problems that can't be seen on visual exam, they also can show jaw problems (or bone absorption). You don't know these things by simply doing a dental, xrays are crucial to know what's going on under the gums, roots, bone, etc.

Are they open today, (like until noon)? Any chance you can call them and tell them you're expressly concerned he is not eating, despite all the meds and that it has been 4 days since the "simple" dental and that you need a resolution NOW. The concern here is that he is not eating sufficiently, and very well could be in pain or discomfort. Would you consider getting dental xrays done? One other problem that may need to be ruled out is tracheal tube irritation (from intubation), while rare, some cats are irritated from the tube and it can lead to soreness and even infection. Usually they refuse food, or present short coughs, appear to have a sore throat.

What is the pain med they gave you? Metacam, in three doses (one dose each day, for 3 days) would have been my personal choice, given orally. It is technically an NSAID, so it would help with any inflammation present.

Did you not pick up a few cans of A/D? I realize you said you have soft canned food, but maybe he's associating it with pain. My Colby just had a dental (with extractions), and he didn't eat much of A/D, but I found that he loved Iams kitten food canned, just added water and made it soupy for him. Of course, this is only intended for short-term feeding.

While I've never seen it in a cat before, you mentioned previously you heard other owners see some teeth grinding in hyperthyroid cats, discuss that with the vet and see if there's a connection. Can you remind me, how long before the dental was he grinding his teeth? Was there any drooling or blood-tinted drool?

At this point, it's important you get him eating. Try canned Iams if you have it or can get it. If he likes his treats or any dry food, soak it in water long enough for it to soften, then mash with a fork, add more water if he seems interested. Whatever he will eat at this point is better than not eating at all.

Watch also for stomach upset, nausea, vomiting etc, clindamycin is a rather strong antibiotic, I don't know why he prescribed this after the clavamox. Again, without those xrays, he doesn't even know if there might be an infection in the mouth somewhere (or ulcers on tongue/roof of mouth, back of throat) or resorption problems.

If you know of another vet in your area you trust, I'd suggest calling them today (before they close) and making a Monday appointment if you can get in, express the urgency. You can still keep the original appt with the other vet, but try to see a new vet, then cancel the other one.

[Auntie Debbie]

Bloodwork was posted from first to last. The last was pretty good overall except the wbc values.
Here is an excellent link to what I'm going through

http://www.justanswer.com/questions/18j ... -crunching

I gotta go the the bank and store, but I shall return

[Auntie Debbie]

He is currently on tapazole for the hyperT, Buprenorphine for the pain, clindadrops for the antibiotic, and Cyproheptadine as an appetite stimulant.

The stimulant alone claims lethargy as a side effect. I think that was listed as a side effect in one of the others as well...could that be a contributing factor to his current condition? Still, he does have much trouble eating, maybe drinking as well.

As i posted earlier, after waiting over an hour for the meds I was told I wasn't getting an anti-inflammatory, just the pain meds. No f'n reason by the tech bringing the meds out. I waited even longer and she came back out, sticking to the story...never got to talk tothe vet...he's the one that said on the phone I'd be getting some!

There really aren't any vets in this area that is reasonable with the $$ that I know. Even the place I used to work turns out wasn't all that great and they were money mongers.

I'm going to google the ones in my driveable area and see if any are actually rated. meantime, Razzeratz will be getting alot of tlc by me...he doesn't much care for the a/d, none of them do...and his wanting to eat isn't the problem...he does, he goes over to the food eats a scant, I guess feels pain and leaves, comes back later and does the same. I don't think he's suffering from NOT wanting to eat, he just has too much trouble doing so., And that noise just goers right through ya!

And I did ask about why they didn't take x-rays for the dental and I was told that if I wanted x-rays they'd refer me to a specialist? How hard is it to stick a cat's head under a camera?'

[Traci]

Maybe you missed it, but again,

How long before the dental was he grinding his teeth? Was there any drooling or blood-tinted drool?

Is there a certain texture of food he seems to prefer over another?

Can you determine if he's drinking water at all? Is he dehydrated? (check by using the pinch test and lightly touching his gums if you can, if you're scared of causing him pain by touching the gums, you can usually visualize dry, tacky gums, which would indicate dehydration.

Have you tried tuna water juice or canned white chicken juice? If he can drink, lap at, rather than chew, this might give you some indication how the pain is manifesting, i..e, he can't tolerate chewing motion either due to oral tooth problem, throat problem, jaw problem.

Dehydration alone wouldn't prohibit him from eating, unless he was seriously ill.

I doubt the cyproheptadine is causing any adverse effects. You can try omitting his dose tomorrow, it won't make much difference for one day, but I doubt it is causing anything troubling.

Actually, the buprenorphine should be helping if there is any pain involved. Unless it's an abcess or ulceration undetected in the mouth or throat, in which the buprenorphine will only mildly take the edge off.

I'm really appalled they didn't consider xrays first, and they shouldn't be doing dentals if they aren't doing xrays. That's just negligence. As well as unethical. You can't just do a visual exam and tell the client a dental will help when you've done nothing to rule out underlying problems that may go much deeper than what you see in visual exam. I don't know why they said refer you to a specialist for xrays, that's crazy, unless they truly don't have the equipment or expertise in dental surgeries. In which case, again, they shouldn't be doing dentals at all. Who told you exactly, about referring you to a specialist? If it was the tech, you need to tell the vet or the owner of the clinic that this tech is giving you questionable advice and information. I've said it before, she has no business directing Razz' care without the vet's explicit instructions. I abhorr vets who don't bother to talk to the client especially when there are problems ensuing.

Here's a site that explains why teeth-grinding might occur:

http://www.mypetsdentist.com/site/view/ ... 8qwopqucdz

You might also be dealing with Lymphocytic-Plasmacytic Gingivitis Stomatitis (LPGS) , although I'd think this would have been detected earlier. Still, infection in tissues could be a problem, and missed by the vet.

Please don't rely on JustAnswer for valid answers. That site is littered with non-experts.

Again, you have to get him eating something. Water it down, heavily, at first, see if he can at least lap something up with his tongue. Maybe try something bland, something that won't make him nauseated.

I don't know what to say about another vet, just try to find another one, AAHA-accredited, consider one with emergency services, with more than a few vets there. I always recommend those vet hospitals because they have combined experience and are usually established, and just as experienced for general care during normal business hours. And most importantly, get those xrays done, and an evaluation on the mouth and throat.