Update on Razzeratz and the kittens

[Auntie Debbie]

The only x-rays that were taken were one of his chest and one of his abdomen to see if there was something going on with his innies. The only thing noticeable was a very slightly ennlarged kidney, something not to worry about, just keep an eye on, so I was told. I have the blood results and the notes they all took on him as this progressed.
I did ask the new place if he could get in any sooner and I was told that was the best they could do.
Eating wise, he doesn't really appear to be doing anything different today without the pain meds and appetite stimulant than he did yesterday with them. I will give him the rest of those meds (one more dose of the pain meds and a few more days I think of the other) and of course the antibiotics and the tap. I think he will do okay between now and next week. I do wish it could be sooner, I really do, but this place is hard to get in. Unless it's a total emergency, their services are strictly by referral. They have a very good rep. Most vet clinics and rescue groups in this area alone highly recommend them.
There is that other place I thought of, but they have a very bad rep and charge alot too. I'm not interested. There are other vets in the area, some may even do xrays, but I want the RedBank place at this point. Razzeratz seems to be hanging in there, and with alot of TLC by me should be able to wait it out. If not, he goes in as an emergency, I guess. We'll see.
And yes, they will charge high...Like I said $138 just for coming in and saying hi.

[Traci]

Debbie,

I ran all this by Dr. S today, whom I trust explicitly, the first thing he asked me was what did the xrays look like. I told him none were taken and he was as appalled as I was. He was concerned because had an xray been taken and if that xray had looked good, then the next step would have been to look elsewhere, not necessarily teeth/mouth, but abdominal, and his first thought was pancreatitis. The only thing is, is that pancreatitis can manifest differently in each cat. If there is a pain problem going on somewhere, that could affect the abdomen, and subsequently cause the teeth grinding and anorexia. Unfortunately, xrays and ultrasound aren't always useful, it is generally the fPLI you want to utilize. I noticed in your bloodwork that amylase and lipase were absent enzymes, and either or both might have been slightly off. Even IF the two enzymes were included in the chemical profile, one cannot and should not use them exclusively to diagnose, since they can fluctuate and they aren't truly diagnostic, they are only a step to investigate further.

GI tract upset (gastric) would be among the major signs of pancreatitis, but there are various other symptoms. Painful abdomen, anorexia, lethargy, fever, reluctance to move, withdrawal, vomiting, diarrhea. I realize Razz has none of these symptoms other than the anorexia, but pancreatitis can be slow developing in some cats, fast developing in others. He very well could be nauseated, have a gastric problem, and painful in the abdomen and maybe you're not noticing. Pancreatitis is one of the most painful conditions concerning the abdomen.

I don't want to worry you or tell you to focus strictly on pancreatitis, but it's a rule-out that might be worth investigating. The fPLI is a quick blood draw, and the soonest it's sent out, the better because it can take 5-7 business days to get results from the lab. (the vet can ask for expediting the results though). It's alittle pricey though, here we charge $86 (sent to Texas A&M), but it is a specific test, and it will tell you if pancreatitis is suspected.

The globulin in Razz' test results might still indicate inflammation in the mouth, but it could also indicate inflammation elsewhere in the body (which is another reason to rule out pancreatitis).

I think it would be worth it to test, at least you'd know, and IF it's pancreatitis, you'd want to get started on treatment IMMEDIATELY. The soonest it's treated, the less severe the condition during treatment, and you can prevent worsening symptoms with quick treatment. Remember, the soonest you discover pancreatitis, you might be able to treat at home if symptoms are mild and the pancreas isn't inflammed to the point of needing agressive hospitalization.

Again, you still want to rule out mouth/dental problems with dental xrays, but I'd think the buprenorphine and clindamycin would be helping by now. You can still call the vet and ask for a couple more doses of buprenorphine, as it would be worth having on hand and using a couple more days. But, it makes me wonder, it's been a week, and neither antibiotic has resolved this, and if you don't think the buprenorphine is helping, then there's something else going on, not necessarily the mouth.

[Auntie Debbie]

He's not anorexic, he has an appetite and does eat however much it may be. When he eats often he will chew like a dog chewing taffy. Sometimes he'll make the noise, others he won't. He may start out okay, noise starts and then stops during the same round of eating. The fact that he has gained 4 oz would be an indicator that he is indeed eating?
I will mention this to the vet when we go.
Thanks for the suggesion on this. I do appreciate your help.

[Traci]

I just went through your earlier posts as well and for some reason, it slipped my mind that the grinding started in middle March. Seems like it's progressing now?

If it's not teeth or oral, it's elsewhere, like gastric, kidney, pancreas. I'd think less-like pancreas since he's still eating, but you want to keep an eagle eye out for symptoms of pancreatitis.

Acid in the stomach might be problematic, ask your vet for sucralfate or pepcid, or both. You could give it a try and see if it makes him feel better, if he feels better on these, you'd have an idea if he has acid stomach. Remember, the grinding might not have anything to do with oral problems. Nausea and acid can cause a host of strange behaviors, including grinding teeth or even scratching at the face.

Lastly, yet concentrating on getting dental xrays done, ask if the tapazole might need to be either ceased temporarily, then restarted. When ceased, if symptoms improve, you'd have an idea if it's a side effect. You'd restart the tapazole in slow, low doses and increase gradually to maintain proper levels. I don't recommend this UNLESS there is suspicion of a tapazole side effect.

Can you gently feel any enlargements of the thyroid? Don't manipulate, just gently feel for a second or two. If enlarged, it might help explain pain or discomfort.

This is where the thyroid is located, on either side of the trachea/wind pipe.

[Auntie Debbie]

I'm not feeling any swolleness by the thyroid. I'm no expert on this, but I'm not feeling much there and he didn't seem to mind my doing it.
I brought him in originally because he looked like he was starting to lose some weight and because of that noise he was making.
He tested badly on the HyperT which could explain the initial weight loss I was seeing. Vet#1 also said he needed that dental real, real bad. I wasn’t so convinced that it was that bad, because he did appear to be eating…or was he? He was retested to see how the tap was working out in two weeks and the HypterT was a little lower and the kidney values started getting interesting. Also, he had been scratching at his face a lot in the beginning with the tap…which is one of its side effects….that all later subsided. So, vet#1 told me to wait a while before doing the dental to see how the kidney values are doing. Well when he started the grinding noise real bad and not taking the pill pockets, etc I decided it’s time for that dental after all. The new bloodwork came back basically good, HyperT on the low side, kidney values within normal range, just that nasty little wbc count and values that go along with it. He also lost a couple of pounds, so it’s looking more and more like he needs that dental. He put him on clyndamicin for a couple of weeks and told me to bring him back to be reweighed. In 1-1/2 weeks I took him back and he lost another 4 ounces. That’s when vet#1 said it could all be caused by something else….let’s do xrays of the chest and abdomen. They were good except the one kidney looked very slightly enlarged…let’s keep an eye on that.
So off to the dental we go. And the rest is history.
Yesterday I didn’t give him any pain meds or appetite stimulant and he showed no difference in the amount of times he ate or I guess how much he ate. In fact, at one point I said, “Ya wanna treat?” And he came charging! He nibbled at the turkey breast. Now mind you, I’ve got seven cats and being that they are free fed, none of them really eat so much that you’d really tell they’re eating a lot. Maybe that’s part of my problem with him and how much he may or may not be eating…after all he did gain back 4 oz rather than losing more. All I’ve really forced on him was a few syringes very pedialyted down baby food here and there a day for two days, hardly enough to make any kind of a caloric difference.
This morning we have a brighter looking cat. Maybe those pain meds and appetite stimulants were making him on the groggy side and making him just look even more miserable that he may be. I’ve seen him eat and drink a couple of times already, no noise, and he doesn’t even look like that dog chewing taffy. Later on I will see if he wants to try a pill pocket. Yesterday he ate some temptations okay but refused the pill pocket, maybe because of the previous trouble he had with it.
All in all, so far this morning (I know, it’s early yet) he looks like he just feels better. Maybe like I said the pain meds and appetite stimulant was slowing him down. Of course I will be watching him like a hawk and looking for further signs on trouble chewing. I could see how something gastric could cause the noise but I don’t see how it would cause the troubled chewing. It’s because of that I think it’s an oral issue..not necessarily teeth, maybe gum problems, cancer, jaw misalignment, even a sinus issue, although there’s no discharge or trouble with breathing.
Thanks for your help Traci…you know I will keep you posted.

[Traci]

I'm so glad to hear he's feeling better.

However, the buprenorphine wouldn't make him groggy or feeling worse. If anything, it takes the edge off of pain, and it is more effective than say, butorphenol. Colby was on buprenorphine for 3 days after his metacam (he had extractions), and he actually did better with the buprenorphine, it jump started his appetite.

Likewise, the appetite stimulant shouldn't have been causing any unusual side effects. Although, it is horrible-tasting for the cat. Whatever meds you're giving, make sure Razz has at least eaten something before his meds. A half hour to hour after eating is a good time to give meds.

The grinding could also be due to dehydration or even the bitterness of the tapazole tablet. Does he swallow it whole or?

[Auntie Debbie]

I really don't think the grinding is due to the tap because he was doing that before he was even diagnosed with HyperT. This is one of the reasons I brought him in.
He's off both the pain and stimulant all day yesterday and so far today. He has been drinking and at the food bowl numerous times that I've seen and actually eating, bits at a time, as he was with the meds as well as drinking.;
I put down some deli turkey and he paced while I was shredding it. He ate some. Missy and Sals ate some too. He was the only one that seemed to have trouble chewing it. He had some then went and had some of his room temperature canned mush. Earlier he had about 7 or 8 temptations.

So, I go to the vets to pick up his x-rays. Vet#1 that referred me to Red Bank was in the lobby. We spoke briefly. I told him Razzeratz was more alert today since I stopped the pain meds and stimulant and that I made the appt for next Monday. He asked me to let him know how it goes. And to show you how unprofessional they are, the tech that assisted the dental brought them out, and on her way out she said to someone, "What a waste of money, but if that's what she wants!" I guess she just felt compelled to say it loud enough for me to hear because I am not happy with how things currently stand with my cat. And for the record, the only thing they are offering me right now is an ultrasound.
I'm in no way disagreeing that the grinding may be from something internal, such as gastric whatever, but I do see him having trouble chewing. If his teeth are fine and there is no oral problems, x-rays will rule that out,. Vet#1 took only x-rays of his chest and abdomen. Maybe there’s something going on with his jaw. If he does have something going on inside, somewhere other that his mouth area, why would he be having such difficulty chewing? Even if he had cancer someplace other that his mouth area, would that give him difficulty chewing?

Now, I may not be a vet, or as wonderful and knowledgeable as that attending tech, but I know what I see. Remember all that crap and time lost I had with Sals and that ear infection? Didn’t know for sure the exact cause because at first she wasn’t showing any debris, but watching her dart from the pain, tilt her head and scratch her ears a lot told me she had something going on with her ears. That one vet in particular kept blowing me off and when finally the debris showed and was diagnosed, and ultimately turned vestibular that one vet had no clue as to what was going on with her and wanted me to send her to Red Bank.

And of course with vet#1 there was that out in the wild speech he made about the kitten I brought in. He got paid for that visit and all he did was talk down to me. He barely looked at the kitten and felt only one of Nanceen’s nipples to see if she was able to nurse enough.

Don’t know what Red Bank will get me, but unless this clinic can show me x-rays where his teeth are in tip-top shape, they can’t say his teeth are fine.

[Traci]

If the vet was standing there when the tech said that, he should have fired her on the spot. I don't know of any clinic that would put up with that. My guess is it might be family-owned or some nepotism going on.

Oral pain/discomfort, meds side effects, gastric upset, dehydration, illness or organ disfunction could cause any unusual symptom like teeth grinding. Just as with every other condition, symptoms can mimic something else which is why you persue testing.

I would fire this vet, his clinic, and never go back. Not doing dental xrays before a dental, in a 14 year old cat is just negligence. They don't deserve your business and Razz certainly deserves better. As a matter of fact, I'd contest any unpaid balance from this point on. Of course, if you have to rely on them for whatever the reason, you kind of have to bite your tongue, but it would serve you, Razz, your other cats and all your foster kittens/cats to find a new, more competent vet, preferrably one with emergency services.

[Auntie Debbie]

No one will offer emergency visits. You will be referred to an emergerncy clinic such as Red Bank or the one we took Wildfire to (although no one really refers them). There is at least one other one that I know of.
One of the places I considered does do Sundays but they are over priced and on the net they've gotten some overall bad reviews and some of the rescue people I work with and the other team at Petco all give mixed reviews on them as well. If needed on a Sunday maybe, but at night, all vet around here close and you're on your own.
The clinic is most certainly fired. Even if his teeth are fine and the next step would ultimately be an ultrsound, the general treatment we got there leaves just so much to be desired. Every day or every time I spoke with someone it was a different story.
They remind me of a really bad waitress we had once at some diner; she was so bad we kept laughing at her, the people behind us was too...only this involves my cats' health and costs alot more.
I can nonly hope that if these people have children and/or spouses the same crap happens with all of them in the medical field. Let's see if they like it. (Not that I really wish ill on the kids or spouses but you know what I mean).
Given how I see him trying to eat, even if I am wasting money, I would think dental and facial x-rays would and should be the next step with this. I'm sure they'll want to do their own round of bloodwork. If nothing is really found with these x-rays, then the ultrasound of his innies?
I just wish mmy poor old guy could talk and tell me where it hurts.

[Traci]

As long as the new vet has the xrays taken last week, along with all of Razz' health records, including his latest lab results, they may not need to do additional bloodwork, unless they would consider a CBC to help determine any changes in inflammation or infection potential. They MAY suggest re-testing the thyroid, but they can refer to Razz' health records beforehand.

Yes, dental xrays a must at this point. The simple fact that they did not do xrays before the dental is just appalling.

If the xrays done on the chest and abdomen last week are clear (and not hazy or bad film, etc, they may not need to do additional xrays on the chest and abdomen. Get their opinion on dental xrays first, take it from there. If the dental xrays don't show anything of concern, ask about the thyroid and the meds, making sure side effects are ruled out.

An ultrasound would be helpful in looking at the kidneys, because as you know, kidney disease and thyroid problems sometimes go hand in hand, you want to make sure that the hyperthyroidism is not masking developing kidney disease. Not saying Razz has kidney issues, but because the last xray indicated one kidney was slightly enlarged, you want to keep an eye on that. Get the new vet's opinion on whether or not an ultrasound is warranted at this point.