Update on Razzeratz and the kittens

[Auntie Debbie]

I will bring all paperwork and xrays with me and I will spell out what took place and what I see now as far as how he eats.
I went out this morning and bought a people digital scale. Last weighed at the vet he was 7.08# (6/29). Today on this scale he weighed 7.50. I couldn't weight him by himself since he didn't want to stand there, so I weighed me, then me & him, then just me again. I did this three times and I kept coming up with 7.50#. I don't know if this scale is calibrated to the same degree as the vet scale, so I will start with 7.50# as his new base and see how well he is gaining from here.
About an hour ago he did just eat a fair amount of deli turkey and didn't seem to have a real struggle with it, though he didn't look like he was chowing down without any difficulty. He still did a little of that dog eating taffy thing, and there was no crunch noise this time.
Still, I'm not saying that it is his teeth or mouth area cause, just that with the way he is having difficutly chewing, this really needs to be ruled out with a real certainty. Some vet and his sidekick tech just cleaning his teeth and reporting they didn't see anything togo nuts over doesn't cut it.

I did speak with one of the woman in my rescue group and she swears by them. When I told her that they didn't take x-rays of his mouth, she told me they do take x-rays and that some woman she knows has an elderly cat that they did them with. She was certain of it!
Do I have a sign on my head that says "F" me?????

[Traci]

Well, you can't depend on a second-hand person relating the story of a third-hand person, so I'd not take what she said at face value, unless you call the vet and ask for an explaination, in which you're not going to get an acceptable answer anyway. In any event, the fact remains that they told you not once, but at least twice, they didn't or couldn't take dental xrays. Which is freaking PATHETIC.

We might be different, but had that been me, and was told no xray was done BEFORE the dental was done, I would have raised holy h-e-double-toothpicks, you could be sure of that. Not to even OFFER you the option or as they gave you an initial QUOTE on a dental is just freaking negligent.

Believe me, I'm just as irate as you are.

[Auntie Debbie]

This is the invoice...the only difference between this and the estimate I WAS given is the invoice is minus the estimated possible extraction ($70 a piece).
Teeth Cleaning (Feline Package)......$145.00
Fluids IV Package....................$105.00
Naxcel Injection.....................$ 42.00
Pain Management......................$ 52.00
Medical Waste Disposal Fee...........$ 6.00
Clavamox Drops.......................$ 14.00
Cyproheptadine 4mg...................$ 7.10
Tax..................................$ 1.48

Total................................$372.58

The Teeth Cleaning Feline Package is where I stupidly assumed whatever was necessary was included, such as the x-rays. I can't imagine how much it would have cost then if the x-rays were included.
I now know, wherever I go with my cats to actually make sure this is done first or that they actually do this sort of thing.
Even so, after the fact I requested them and was told numerous times by the mouthy tech, and both vets that it just isn't done and I'd be referred to Red Bank if I really wanted them.

[Traci]

I can't speak for what alot of vets do with their quotes and invoices, but xrays are considered to be a seperate service and would be itemized on the initial quote. The quote itself should have included xrays. That is, had they been capable of taking xrays in the first place!

Medical Waste Disposal Fee: $6

That's a ripoff if I ever saw one.

[Auntie Debbie]

I'm surprised they didn't charge me for litter. They did keep him extra time and didn't charge me hospitalization. I'm looking forward to getting on with it at Red Bank on Monday.
Thanks for your help and support.

[Auntie Debbie]

Razzeratz went to the big clinic on Monday.
The first vet, Dr. S. said that Razzeratz did indeed have a tooth that looked like it needed to come out, said also that he is missing a tooth, which the old vet(s) didn’t mention to me at all. I asked if this could be what is causing him to have a hard time chewing and he said it’s possible, and he may find more stuff once they start working.
However, looking at his bloodwork and x-rays from the previous vet he wanted to do his own bloodwork because of the poor blood values.
Once he looked at the new bloodwork they took he suggested an ultrasound to see what is going on with his insides. The wall of his small intestines is showing a little thickening, kidneys show that he has chronic kidney disease, slightly inflamed pancreas.
Dr. B that did the ultrasound said that the lymph nodes are inflamed, which could possibly indicate cancer. I could have one aspirated for $200 or do a full blown endoscopy for $1400. There is just no way I could afford the endoscopy, as much as I would love to have it done for him. Besides what I’ve spend at the other vets, I am now up to $800 at the specialist for the ultrasound, bloodwork and consult with two vets. This does not include further testing or treatments. So he said they could do an aspirate of a node for $200 and there will be a 50-50 chance of finding something. I had that one done.
Dr. B is suspecting at the very least IBD, chronic kidney disease and possible some pancreatic activity going on with Razzeratz. Maybe cancer.
The aspiration came back negative on cancer but does support the lymph node being inflamed.
For the next two weeks he will be on medication and sub-qs. In the event the tap is causing the kidneys to be flaring up, he ill now have one full dose of tap in the morning, but cut back on just ½ tap at night, and see if that helps. The vet that he was going to can handle that. Since I am working with the big clinic, the old vet is merely handling the supplies and will do the recheck on the blood in two weeks, which will be faxed to RedBank. It will cost less and we won’t have that long drive. (Future health problems will be taken someplace else, but for now, this place can handle bloodwork and supplies.)
So, I still have no dental x-rays (they want to make sure first that he can withstand being put under for the surgery.) He seems to have more issues going on besides the dental that would require attention first.
Please wish him well and that we can straighten out whatever is ailing him!

Red Bank

(7/6/09)
7/6/09=
ULTRASONOGRAPHIC FINDING:
Liver: The liver appeared diffusely normal; the liver margins were smooth.
Gallbladder: The gallbladder contained a moderate amount of echogenic material-the visible biliary tree is not dilated.
Spleen: The spleen appeared normal.
Right Kidney: The right kidney had very decreased corticomedullary distinction; irregular capsule; there were no nephroliths and the renal pelvis was mineralized. The right kidney measured 3.32 cm.
Left Kidney: The left kidney had very decreased corticomedullary distinction, irregular capsule; there were at least two hyperechoic nephroliths, measuring 0.28 cm and 0.30 cm respectively, and the renal pelvis was not dilated. The left kidney measured 3.40 cm.
Urinary Bladder: The urinary bladder appeared normal; no urolith or masses seen.
Right Adrenal: The right adrenal was not visualized.
Left Adrenal: The left adrenal was not visualized.
Stomach: The stomach appeared normal.
Small Intestines: The small intestine had mildly disrupted wall layering measuring 0.20 cm.
Colon: The colon appeared normal.
Pancreas: The pancreatic region appeared hypoechoic surrounded by hyperechoic mesentery.
Lymph Nodes: There was mild to moderate mesenteric lymphadenomegaly, and marked colonic lymphadenomegaly, measuring 2.78 cm by 0.66 cm.
Prostate: Appeared small and symmetrical for a neutered male.
Uterus: N/A
Testicles: Not visualized-neutered
Ovaries: N/A

Additional Comments: A scant amount of peritoneal effusion was noted.

Bloodwork (7/6/09) * reference range *

ALB= ( 2.6 g/dl ) * 2.3-3.9 *
ALKP= ( 52 U/L ) * 14-111 *
ALT= ( 23 U/L ) * 12-130 *
BUN/UREA= ( 29 mg/dl ) * 16-36 *
Ca= ( 10.0 mg/dl ) * 7.8-11.3 *
CHOL= ( 100 mg/dl ) * 65-225 *
CREA= ( 2.8 MG/DL ) * 0.8-2.4 *
GLU= ( 133MG/DL ) * 71-159 *
LIPA= ( 902 u/l ) * 100-1400 *
PHOS= ( 4.5 MG/DL ) * 3.1-7.5 *
TBIL= ( <0.1 mg/dl ) * 0-0.9 *

TP= ( 8.8 g/dl ) * 5.7-8.9 *
GLOB= ( 6.1 g/dl ) * 2.8-5.1 *
Clinic Comments=PCV=20% TS=7.8 G/DL

Chloride= ( 121 mmol/L ) * 112-129 *
Potassium= ( 4.9 mmol/L ) * 3.5-5.8 *
Sodium= ( 153 mmol/L ) * 150-165 *



HCT= ( 10.0% ) * 30-45 *
HGB= ( 6.0 g/dl ) * 9-15.1 *
MCHC = ( ? ) * 29-37.5 *
WBC= ( 22.33 K/ul ) * 5.5-19.5 *
NEUT= ( 17.70 K/ul ) * 2.5-12.5 *
%NEUT= ( 79.3% ) * blank *
EOS= ( 1.31 K/ul ) * 0.1-0.79 *
%EOS= ( 5.9% ) * blank *
PLT= ( 335 K/ul ) * 175-600 *
Retics= ( 24.7 K/ul ) * bank *
% Retics= ( 1.0% ) * blank *
RBC= ( 2.39 M/ul ) * 5-10 *
MCV= ( 41.9 fl ) * 41-58 *
MCH= ( 24.86 pg ) * 12-20 *
RDW= ( 22.6% ) * 17.3-22 *
MPV= ( 12.13 fl ) * blank *
PDW= ( 22.0% ) * blank *
PCT= ( 0.4% ) * blank *
LYMPHS= ( 1.19 K/ul )* 0.4-6.8 *
% LYMPHS= ( 5.3% ) * blank *
MONOS= ( 9.0 % ) * 0.15-1.7 *
% MONOS= ( 9.0% ) * blank *
BASO= ( 0.13 K/ul ) * 0-0.1 *
% BASO= ( 0.6% ) * blank *

Lab Comments= MCHC out of reportable range
PLT aggregates detected

[Traci]

It looks like there is still some sort of infection, inflammation going on somewhere, the ultrasound was pretty revealing for inflammation (although oral could still account for infection and inflammation).

What's the "medication" he's on now? Are you giving sub-q fluids at home?

Keep us updated, it really doesn't sound like IBD at this point but the pancreas was always a potential, sometimes the two go hand in hand, especially in older cats, and sometimes, it just all ocurrs at once when you least expect it to. We thought the same thing for Cerenade, but there's no IBD, not that it can't develop later, but it's mainly pancreatic issues, so far, she's had a good long stretch between episodes.

I'm not sure I would have opted for an endoscopy, except for the fact they might have been able to take a sample and test for lymphoma. I'm holding good thoughts that lymphoma is totally ruled out. I'd think there would be a host of sudden symptoms by now. For now, I think the approach is a good one, keep an eye on kidney and pancreatic issues.

Did the vet feel there was another reason for the teeth grinding? Did he mention GI upset as a possible cause? Did he suggest pepcid or sucralfate on a temporary basis?

[Auntie Debbie]

I will be doing the sub-qs at home. The meds the doctor at RedBank are Metronidazole suspension.
I'm still partially shooting for an oral issue. Doc S did say taht there was one tooth in particular that looked like it needed to go bye-bye. Whether or not that or another tooth would be causing him to have a hard time chewing is up for grabs. Before going nuts on doing a dental he wanted to make sure he could be put under again and to find out what other issues he is having.
I can't help but wonder if the tap is causing the kidneys to go bad since he didn't appear to have a problem there before the tap.
There still is the inflammation with the pancreas, lymphs and the wall thickening in the small intestine that needs to be explained. Would an oral infection cause all that as well?
Would the clynda-guard he was on for almost 3 weeks treat some stuff well but not tackle certain other infections?
Both vets think the teeth grinding could be from internal issues, which I understand is a possibility, but what is causing the internal disruptions?
Vet B did suggest a special diet, but since all 7 cats are free fed, I don't see feeding and then lifting the food as a real viable option. To put them all on the same special diet would not only be all too expensive but on needed for their own dietary needs. The best I could do is to put them all on Friskies "Special Diet", but that only targets kidney diets and I think the doctor was shooting for an IBD/pancreatic type diet. We agreed to get back to that after the blood recheck.

Meanwhile, back at the ranch...when I went to pick upu the meds and subs, Mouth the tech was there and didn't hesitate to tell It wasn't his teeth after all. I was very quick to point out (with an attitude) that not all conversations was reported and that the dental vet did indeed find at least one tooth that he felt should have been removed. We're waiting to get his other issues under control before we continue to pursue the dental work. That conversation took place but was not recorded.
I can only hope she gets a killer yeast infection and her gyno only wants to treat herfor genital warts.

[Traci]

Oral bacteria can affect various organs if left undetected/untreated for long enough. But, this doesn't sound like infection from the oral cavity, exactly. Granted, there could be a pocket of infection behind a tooth yet, but you're an observant mom and you would have noticed additional problems had it been strictly oral bacteria.

It very well could be the tapazole masking renal disease, this is common, yet a decreased dose if possible, might bring the renal values back to normal, with no additional kidney insult. That's why you want to monitor renal values, yet still be able to keep the thyroid in check. As you know, with our older cats, renal disease may affect any number of them, we can't predict who or when, you just have to be prepared in advance for treatment if necessary. You also know that sometimes a primary disease can be accompanied by any secondary problem, and for some cats, these things happen suddenly, usually due to compromised health, stress, or slow/failed treatment of one or the other.

The clindamycin may or may not have targeted a few different types of bacteria. The problem is not knowing what to prescribe in absence of knowing the type of infection and where it is exactly. Knowing what you know now however, there may be an infection in the GI tract, which might explain the inflammation. It's a bit odd though, there was no soft stool or diarrhea or vomiting etc.

Without knowing which diet he recommended, I can tell you that with pancreatitis alone, for some cats, a prescription diet is not always necessary, unless the pancreas is reacting to something specific. It is not known with 100% certainty, but it's theorized that dogs suffer more acute and chronic pancreatic attacks due to the fat content in their food (like table scraps, consistently fed human foods, or questionable foods etc). Food is not suspected to be the main reason for pancreatitis in cats. It is not truly known what causes pancreatitis in cats, other than another primary disease or secondary factor. For the IBD, a hypoallergenic or novel-protein diet would be approached. For the kidneys, a renal diet. It's important that the kidneys are supported but without a clearer diagnosis at this point, recommending a specific diet would be difficult.

I can also tell you, or should I say warn, that if the pancreas is inflammed, this can be an excruciatingly painful condition. You can only visualize so much on ultrasound, but if you were able to see an actual inflammed pancreas, you'd know just how painful it can be. Even if it's only slightly inflammed, you and your vet must keep an eye our for symptoms and monitor/followup, but ideally, with an fPLI to confirm. You'd never want a case of acute pancreatitis to go undetected and untreated, the first hint of a symptom of pancreatitis demands and affords quicker treatment and quicker recovery.

Screw the tech, and as a matter of fact, if at all possible, I'd tell the vet there she is not to direct your cats' care ever, from this point forward. The VET needs to get off his high horse and do the job he's been payed to do.

Again, did he at least mention giving pepcid or sucralfate at least to help calm both GI and the pancreas? If you can humor me, at least call and ask about it.

[Auntie Debbie]

Dr. B and I did start to talk about a special diet for him and I told him that I free feed six others as well. He said he actually wasn't overly concerned about the diet at this point. He really wanted to cut the tap down, give him the medicine for two weeks and see what that gets us first.
I haven't noticed any flat out runs, though if the stool was mildly soft and buried or covered in litter I wouldn't notice. There has been no vomiting from him whatsoever. Except for the chewing problem he doesn't seem to be in any pain anywhere else. He can run and jump onto things, even with all the weight he's lost, he's still got some real kick left in him.

I think the sub-q he got yesterday helped him feel a bit better too. He'll be getting 100 ml daily.