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I have a few questions to get a better idea as to what is going on. Is 1.9 her current creatinine value or her pre-anesthetic one. If that was the value before anesthesia, has it been rechecked?
Was she sent home on any pain medications? Or given anything there before she left?
Why were the teeth extracted? (if you know) Has your vet looked at the extraction sites since the procedure?
Was she doing the drooling before the procedure or did that just start after?
Thanks and I will respond further after you reply.
Ok, that is helpful and much as I suspected. It sounds like your vet is doing a good job. It doesn't sound like it has to do with any loss of kidney function as can happen sometimes after an anesthesia if there was not good fluid support. There are a few thoughts I have as far as why Kes may not be wanting to eat or drink well and I will list below.
1) Mouth pain - this doesn't sound likely as she was on the pain meds and it sounds like the extraction sites have healed up. Also if the roots were already gone, there would not have been a lot of oral surgery to remove them.
2) Adverse reaction to the antibiotics - making her nauseous. The Clavamox may have set it off but if you are still seeing soft stool, her GI tract may still be affected. Perhaps a round of probiotics may help to replace the good bacteria.
3) Adverse reaction to the metacam. This is a non-steroidal anti-inflammatory (NSAID), which is commonly used for pain, but can have GI side effects. In some cats, after prolonged use, GI irritation or even ulceration can occur. Even though her regime was only for 5 days, she may have been sensitive. Antacid meds like Pepcid AC (famotidine) - 1/2 of a 10 mg tab once daily may help. Your vet would be able to prescribe even stronger GI meds if needed.
4) This final one is the most worrisome, but I have seen it on more than one occasion. It is possible that there was underlying GI disease before the dental and the two teeth that were extracted were incidental and had no bearing on her decrease in appetite prior to the procedure. If this is the case, a further GI workup would be needed to rule out things like pancreatitis, inflammatory bowel disease (IBD) or even GI lymphoma. These are not uncommon disorders in cats and often when they first present, they signs are subtle and often can be thought to be due to something less serious, like dental disease. Unfortunately, IBD or lymphoma can be present and there can be no other abnormalities noted on bloodwork, xray or even ultrasound. The only way to confirm the diagnosis is with a biopsy of the intestine. This can be done via endoscope, but is better performed with an exploratory surgery. The problem with this is that many cat owners are not willing to pursue the diagnosis by these means. It is for that reason that many cats are "suspected" to have IBD or GI cancer as the cause of their weight loss and anorexia once all of the other easy to find things have been ruled out.
I hope her reluctance to eat is one of the more easily treated possibilities and not the last one, but just to be aware, I wanted to describe it to you. I would continue with supportive care as mentioned and perhaps add an appetite stimulant like mirtazipine. Give her a little more time and see if she starts to come around and if not, you can discuss a further workup with your vet.
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That sounds good and it sounds like your vet is on the right track. Good luck to her and I hope all goes well.
Thanks for the update and sorry for the delay. I was working in the clinic today. I can understand why you are stressed. This is all very concerning. Barium is not a bad idea, but even if abnormalities noted, will likely not give you the diagnosis. I would be tempted to be a little more aggressive in the hopes of getting a definitive diagnosis. A feeding tube is a necessity at this point as I think as she needs more aggressive nutritional support now. I would opt for a gastric feeding tube versus an esophageal tube since it seems there may possibly be something going on in her throat. I know a feeding tube sounds extreme, but they are a great way to support a poorly eating cat for whatever reason. If it is a problem that can be resolved, the tube can be a temporary measure, but if needed long term, they can be used for a long time. The cats tolerate them well. My own personal cat who had GI lymphoma had a gastric feeding tube for over 3 years and loved when we would feed him (he would just purr away).
As far as what diagnostics, I think an ultrasound would be a good place to start if one has not been done yet. It may help to decide what to do next if any abnormal organs are noted. Ultimately I think the decision needs to be endoscopy or exploratory to visualize and get biopsy samples. There are pros and cons to both.
1)Obviously, scoping her is less invasive and would allow visualization of the upper GI tract to rule out problems with the esophagus as well as stomach and in most cases with cats, proximal small intestine too. Biopsies of GI lining can be taken with a scope to look for inflammation or cancer, but there are limitations. Full thickness biopsies of the intestine cannot be done so there is a possibility that even if there is cellular infiltrate of the intestine it could be missed if in the deeper layers (this is a small risk). Also, endoscopy will not allow visualization of organs not within the GI tract, like pancreas or liver/spleen. This is where an ultrasound may help first to see if these organs look normal or not. A feeding tube can be placed with an endoscope.
2) An exploratory allows visualization of all organs and biopsy (including full thickness of GI) of the organs of concern as well as placement of a feeding tube. Of course, it is a much more invasive procedure with a little more involved recovery, but you are not likely to miss the diagnosis with this route. Even if everything looks grossly normal, biopsies of potentially involved organs should be taken. In the hands of an experienced surgeon, this procedure would not take too long.
I am starting to feel more and more that the teeth or the dental procedure was not the problem and they just brought the problem to light. I hope I am wrong, but with cats, I think you need to move fairly quick on this and not wait too much longer to get a definitive diagnosis.
There is not a right or wrong way to proceed her, so I would discuss with your vet and see what sounds best for her. I am sending good thoughts her way and hope you have an answer soon and can move towards resolving this for her. Good luck and please keep me updated as to how things progress.
Well that is encouraging news. Yes that sounds like a good plan for now. I'll keep my fingers crossed that she continues to eat. I have not seen an increase in drinking due to either of these meds so it may just be coincidental. As far as probiotics, the one that I use most frequently is Purina Fortiflora link here Unfortunately, it is a powder, but the cats seem to accept it pretty readily.
If she stops eating again, you really will need to have her seen by someone. Even if they do not know her, another set of eyes may see something new and if you already know and trust this vet, even better. Good luck with her this week.