My cat refuse to eat after tramadol and still in pain after tooth extraction

[neely]

I think I will bring the report to find another vet to have a second opinion tomorrow if other vet is available.

I think this is an excellent idea. However, please be sure to see a vet at another animal hospital not the same one your present vet is at or you may not get an objective, unbiased opinion. If you have a specialty hospital within driving distance it might be even more advantageous to see an Internal Medical Specialist. Best of luck, please keep us updated.

 

[silent meowlook]

Hi. Try to get a copy of the biopsy to take to the new vet with you.

This is an article from 2015. Unfortunately there isn’t much out there about this. Here it states it is not bacterial in nature.
Inflammatory Oral Diseases in Cats - WSAVA 2015 Congress - VIN

 

[daftcat75]

Can you ask the vet for a tube of Mirataz? It is a transdermal appetite stimulant that you put a little bit in his ear and it goes a long way. My Betty had dental extractions over a month ago now and her eating still hasn't recovered. In her case, we're thinking there may still be some tooth resorption causing pain but not looking bad enough to be extracted yet. She gets twice daily gabapentin. And twice weekly, I give her a Mirataz wet willy to get her appetite back up. She will very likely see a veterinary dentist next year about whether the dentist can get proactive about these teeth the general vet don't want to pull yet. And she may also go back on prednisilone to help with her appetite and give her a measure of anti-inflammatory medicine.

The other thought I'm having is that A/D is a rich food. I call it Betty's "cake frosting." I used to reserve it only for coating her meds. But since her eating dipped before the dental and hasn't recovered after it, she gets a measure of A/D mixed in with her regular food, Hills I/D stew. Sadly, Betty never cared for the I/D pate. So I also spend a few seconds each meal prep "pre-chewing" her stew with a fork before mixing it in with the A/D. I find that if I offer her A/D alone, even though it is easier on her mouth, she doesn't eat enough of it. Presumably it's too rich for her. But between the twice weekly appetite stimulant and the 2:1 mix of chopped I/D to A/D (about 24 grams I/D to 10-11 grams A/D) fed four times a day, her eating and her weight loss seems to have stabilized. She also likes Royal Canin GI Kitten food and Royal Canin PR--not enough to put out on their own. But sometimes I'll put an extra mound on the plate because these are softer foods and whatever she eats of those, is that much less of her I/D-A/D mess that she has to eat. And finally, as much as I don't like feeding her dry food, I use an herb grinder to grind up two or three kibbles (I/D kibble) at a time and use that powder as a meal topper. I've had much more enthusiastic first passes on her meals since I've been topping them with kibble powder. It usually takes her two to three passes over several hours to finish one of those 34(ish) gram servings. Betty is pretty lazy. But I still don't see how she keeps her weight up on what seems, by all calculations, like half of what she should be eating.

 

[iPappy]

I would be concerned about using the tramadol if your cat has autoimmune hepatitis:
Tramadol | VCA Animal Hospital | VCA Animal Hospitals
(From the article: "Tramadol should not be used it pets that are hypersensitive to opioids. It should be used with caution in patients with seizure disorders, liver or kidney disease, or in geriatric, debilitated, pregnant, or lactating pets. Do not use tramadol in conjunction with medications that decrease brain or lung function. ")

Please, please get a second opinion if your vet is not taking your cats problems seriously. I agree that what you're seeing is NOT normal at all and needs further review. Just because most cats handle it find doesn't mean all do.
to you both.

 

[Kelvin]

Update: 26 November 2023

Appetite seem return to 80% of normal, finish 90G AD wet food and 40G normal wet food that i will offer him before. The pain level seem remain the same that he will still grinding his teeth and even walk away when eating the normal wet food. Appointment to second opinion will be wednesday, hope I will get some pain relief for him.

The first dose of new antibiotic Doxycycline 50mg was given to him, wish no side effect for my cat.

 

[Kelvin]

I would be concerned about using the tramadol if your cat has autoimmune hepatitis:
Tramadol | VCA Animal Hospital | VCA Animal Hospitals
(From the article: "Tramadol should not be used it pets that are hypersensitive to opioids. It should be used with caution in patients with seizure disorders, liver or kidney disease, or in geriatric, debilitated, pregnant, or lactating pets. Do not use tramadol in conjunction with medications that decrease brain or lung function. ")

Please, please get a second opinion if your vet is not taking your cats problems seriously. I agree that what you're seeing is NOT normal at all and needs further review. Just because most cats handle it find doesn't mean all do.
to you both.

Yes, I think Tramadol is not the right pain relief for my cat that the side effect is too unacceptable. I make the appointment to new vet and ask for the second opinion about my cat issues. I want to have a good pain control to my cat that I do not want to see my cat eating painfully.

 

[Kelvin]

Can you ask the vet for a tube of Mirataz? It is a transdermal appetite stimulant that you put a little bit in his ear and it goes a long way. My Betty had dental extractions over a month ago now and her eating still hasn't recovered. In her case, we're thinking there may still be some tooth resorption causing pain but not looking bad enough to be extracted yet. She gets twice daily gabapentin. And twice weekly, I give her a Mirataz wet willy to get her appetite back up. She will very likely see a veterinary dentist next year about whether the dentist can get proactive about these teeth the general vet don't want to pull yet. And she may also go back on prednisilone to help with her appetite and give her a measure of anti-inflammatory medicine.

The other thought I'm having is that A/D is a rich food. I call it Betty's "cake frosting." I used to reserve it only for coating her meds. But since her eating dipped before the dental and hasn't recovered after it, she gets a measure of A/D mixed in with her regular food, Hills I/D stew. Sadly, Betty never cared for the I/D pate. So I also spend a few seconds each meal prep "pre-chewing" her stew with a fork before mixing it in with the A/D. I find that if I offer her A/D alone, even though it is easier on her mouth, she doesn't eat enough of it. Presumably it's too rich for her. But between the twice weekly appetite stimulant and the 2:1 mix of chopped I/D to A/D (about 24 grams I/D to 10-11 grams A/D) fed four times a day, her eating and her weight loss seems to have stabilized. She also likes Royal Canin GI Kitten food and Royal Canin PR--not enough to put out on their own. But sometimes I'll put an extra mound on the plate because these are softer foods and whatever she eats of those, is that much less of her I/D-A/D mess that she has to eat. And finally, as much as I don't like feeding her dry food, I use an herb grinder to grind up two or three kibbles (I/D kibble) at a time and use that powder as a meal topper. I've had much more enthusiastic first passes on her meals since I've been topping them with kibble powder. It usually takes her two to three passes over several hours to finish one of those 34(ish) gram servings. Betty is pretty lazy. But I still don't see how she keeps her weight up on what seems, by all calculations, like half of what she should be eating.

I think my cat condition is similar to your cat. He still in pain when eating but without any pain relief. He is willing to eat AD wet food with pain but not the other wet food. My cat is very lazy too, about 20 hours on the bed and sleep like a pig. By all calculations, he is appetite can eat half of what he should be eating. I think I need to have a further check to his oral and dental condition from the dental specialists.

 

[iPappy]

Kelvin I think having another vet do an exam is an excellent idea. Please let us know what they say!!

 

[Kelvin]

Kelvin I think having another vet do an exam is an excellent idea. Please let us know what they say!!

On Wednesday, I will ask the second opinion on the biopsy result and the treatment plan only. The another dental check may be on next year that he is weak after the second anesthesia last Saturday. I think he need some time to recover...

 

[Kelvin]

Update: 27 November 2023

Appetite remain the same, but he seem more painful when eating. He will eat a little and walk away with pain if i feed him normal can food that i feed him before. One more strange behaviour, he will use his back leg to pawing his left face(the first excraction site)after he finish his meal.

 

[Kelvin]

Update: 28 November 2023

Appetite not as good as yesterday, it seem affect by the new antibiotic now, he eat the food more slowly than yesterday, but still can finish by himself. The pain level remain no change, he still grinding his teech when eating and eat in slow speed.

Tomorrow I will consult a new vet, if I ask for pain relief for him, buprenorphine or gabapentin is better? which one have less side effect? Thank you.

 

[daftcat75]

Update: 28 November 2023

Appetite not as good as yesterday, it seem affect by the new antibiotic now, he eat the food more slowly than yesterday, but still can finish by himself. The pain level remain no change, he still grinding his teech when eating and eat in slow speed.

Tomorrow I will consult a new vet, if I ask for pain relief for him, buprenorphine or gabapentin is better? which one have less side effect? Thank you.

Buprenorphine works better in my experience. But you may find he doesn’t eat on it. He won’t feel pain. But it may kill his appetite and also make him restless and unable to sleep. The nice thing about bupe is that it is easy to give. I would try to combine bupe and Mirataz (transdermal appetite stimulant) together first. Gabapentin seems like the safer one for the long run. The big side effect for gabapentin is sedation. But if you can get him to take it, with your vet’s blessing, you can play with the dose to find what keeps him eating comfortably without turning him into a bag of jello. Betty takes approximately 37.5 mg twice a day. Cats can build up a tolerance to gabapentin over time. I try to keep Betty on the lowest dose that still keeps her eating. She might need the higher dose from here. But I’m still evaluating our new normal this week to see if she’s eating enough without Mirataz. I still plan on getting her back to the IM. I think a low dose of pred every other day might help with any inflammation in her mouth and in her joints. And it should shore up her appetite. She was on steroids last year and did quite well on them. Except she gained too much weight for her arthritis. I weaned her off so that we could see if she truly had IBD (her gut is still doing great!) and so she could lose weight again. But it seems like she could benefit from a low dose maybe every other day to keep long term side effects at bay.

So yeah. I would try the bupe in the short term since he’s still having acute pain. You may need to give him the Mirataz with the bupe to get him eating. If he doesn’t eat (and doesn’t sleep) on bupe or if you need to give it more than a short time, gabapentin is the better option.

 

[neely]

Buprenorphine works better in my experience.

I completely agree! Every cat we've ever had with FORL was given Buprenex after a tooth extraction(s). Buprenorphine is used as a short-term analgesic (pain killer) for mild to moderate pain. It is an injectable liquid squirted into the mouth on the side of the cheek to control pain after surgeries. It really did help and fortunately no long-lasting side effects for our cats either.

 

[Kelvin]

Update: 29 November 2023

Appetite remain the same, he can finish his food slowly. The pain level seem have a little improve, but he sill grinding his teeth when eating.

After consult the new vet, he said the biopsy report is not very accurate, there have many "presumptive" and "could be" in the report, but the report said the tissue cannot find any bad cell that can assume there is not a cancer. And i show a photo about my cat's mouth, the vet said the wound seem heal normally, but there should be a suture are not dissolve yet but he should not be very painful. He offer gabapentin for my cat and said do not give this pain relief if not necessary.

 

[iPappy]

Update: 29 November 2023

Appetite remain the same, he can finish his food slowly. The pain level seem have a little improve, but he sill grinding his teeth when eating.

After consult the new vet, he said the biopsy report is not very accurate, there have many "presumptive" and "could be" in the report, but the report said the tissue cannot find any bad cell that can assume there is not a cancer. And i show a photo about my cat's mouth, the vet said the wound seem heal normally, but there should be a suture are not dissolve yet but he should not be very painful. He offer gabapentin for my cat and said do not give this pain relief if not necessary.

Has your cat tried the gabapentin since you posted? I hope it helps. Please keep us updated.

 

[Kelvin]

Update: 06 December 2023

Last day of antibiotic on 05 December 2023. He have less appetite compare with last week, hope it will recover after he stop taking the antibiotic. The pain level remain the same, he still grinding his teeth when eating and go away and refuse to eat. I consider to take him to the new vet to have a complete oral check or just give him gabapentin to make sure he is in pain. Which way is better in this situation...and why he is still in pain 18days after the tooth extraction, I struggled...

 

[Kelvin]

Has your cat tried the gabapentin since you posted? I hope it helps. Please keep us updated.

He haven't take the gabapentin yet, but I think it should be the time to give him gabapentin if he is still in pain on 08 December 2023. I will call the new vet to discuss about his condition.

 

[fionasmom]

Is this the same new vet as of # 34 or a different one? You were never offered buprenorphine or Mirataz/mirtazapine? I am sorry if I missed something.

I am concerned that something is still going on in his mouth which is causing the pain and refusal of food, mostly because of the length of time. He definitely might need another painkiller and an appetite stimulant, but the length of time concerns me.

 

[iPappy]

Never feel strange about calling and talking to different veterinarians until one of them is able to find out what is wrong. I hope your cat is feeling good today.
I can't remember if this was discussed, but, are you making sure his food is room temperature/slightly warmed? If there is mouth pain, anything cold would probably make it worse.

 

[Kelvin]

Is this the same new vet as of # 34 or a different one? You were never offered buprenorphine or Mirataz/mirtazapine? I am sorry if I missed something.

I am concerned that something is still going on in his mouth which is causing the pain and refusal of food, mostly because of the length of time. He definitely might need another painkiller and an appetite stimulant, but the length of time concerns me.

My new vet offer him gabapentin if he cannot eat a whole can of A/D wet food each day. Although he is grinding his teeth when eating and lack of appetite, he still can finish a whole can when I put his dish near his mouth and he will eat slowly or turn away but he will come back to finish his meal an hour later. I do not offer him gabapentin because he meet the requirement that the vet request.