My kitty cat had abdominal surgery. How long until he doesn't need pain meds?

[StephCat]

My sweet boy is almost 7 years old, and we found a mass in his intestines during an ultrasound. It was in his cecum. The ultrasound-guided fine needle aspiration failed to yield results, so we needed to do something else. Unfortunately, the surgeon did not want to do just a surgical biopsy sample because she didn't think it would heal well. We agreed to do the full surgical resection (anastomosis) to remove the mass entirely. She removed his entire cecum due to the location and also had to remove the ileocolic junction. She also removed the two prominent lymph nodes that were nearby and potentially cancerous, as well. She also found a second mass in his stomach, which two ultrasounds done by two different people missed, and she took a biopsy sample of it.

This type of surgery involves a long incision from below the sternum to above the pubis. In my cat, the incision is somewhere around 5 inches long. The surgery was done 8 days ago, and I was given buprenorphine to give him for 3 days after he came home from being hospitalized for 1 day. I was told that should be enough buprenorphine. After he ran out of buprenorphine, he stopped eating and acted like he was in pain. I couldn't tell if he was also nauseated. I gave him some gabapentin and Cerenia, and he started eagerly eating again. I also called and got a refill on the buprenorphine. I was told yesterday that since it had been a week, he should no longer need the buprenorphine. She said if I thought he was in any pain to just give gabapentin now, but only give it every 12 hours instead of 8 hours. However, she didn't specify for how long to give the gabapentin.

I've tried to stop his pain medicines a couple times, and he stops eating. I'm not sure if this is due to pain or nausea or both. I'm really trying not to give him much for pain anymore, but he just stopped eating again today, so I gave him gabapentin and ondansetron a couple hours ago and then he happily ate. I'm not sure if I should continue the gabapentin or maybe just something for nausea.

He doesn't like taking medicines and sometimes shivers in fear when I have to pill him. I also don't want to risk harming his organs or causing other side effects if he doesn't need certain medications. I also do not want him to have to deal with pain. His incision is healing okay, but it's definitely still there. I feel like he has to still have some pain because he's walking slowly with small steps and stopping his stretches short, but I just don't know, especially since the two people I spoke to about his pain were acting like he really shouldn't have any pain anymore.

I'm not sure if it matters, but he is also FIV+ from his mother.

Does anyone have any experience with this type of surgery? How long did your cat need pain meds?

Thanks in advance.

 

[stephanietx]

I am sorry you and your baby are going through this. I've never had to deal with something like this, but I'm sure someone more knowledgeable will be along soon. One thing I can think of is that he may be nauseous and that may be contributing to his inappetence. Have you tried something to help with that?

 

[silent meowlook]

Hi. Yes, that is a big surgery and a painful one. When is he due for a recheck?

 

[StephCat]

I am sorry you and your baby are going through this. I've never had to deal with something like this, but I'm sure someone more knowledgeable will be along soon. One thing I can think of is that he may be nauseous and that may be contributing to his inappetence. Have you tried something to help with that?

Yes, the Cerenia and ondansetron are for nausea. I feel like he probably does have some nausea, but then I also feel like he probably still has pain. I can't tell if it's one or the other or both. Thank you so much.

 

[StephCat]

Hi. Yes, that is a big surgery and a painful one. When is he due for a recheck?

The only recheck they want is a photo of his incision 14 days after the surgery. They have been keeping in touch via email and phone, but they haven't been all that helpful in figuring out with me if he's still in pain, nauseated, or both. I feel like maybe it's both, but I'm not sure.

 

[silent meowlook]

Hi.
At the cat hospital I worked at, that type of surgery would be followed up with at least 3 days of hospitalization with a fentanyl CRI continuing until discharge, then weaned off the fentanyl before starting Buprenorphine that would be given at home for usually about a week. The cat would then, provided all going ok, would be rechecked in a few days after discharge.



Not all veterinarians follow the same protocols and each cat is an individual. There are also veterinarians that do not recognize pain in cats.

Cats and people feel pain the same, although it is expressed very differently. So, if something would hurt a person, it hurts the cat,

There are risks with every surgery, but the risks with what your cat had would be leaking or suture failure of the incisions in the intestines, causing leaking into the abdomen. The way to check for that is with an ultrasound. The symptoms would be lethargy, refusal to eat, maybe a fever. This is not a common occurrence, but can happen. So if your cat is improving but then declines, it is something to discuss with your vet.

Signs of pain in cats can be seen as reluctance to interact with their environment, reluctance to move, laying in a meatloaf position with head down, hiding, growling, hissing, excessive purring, not using the litterbox. They can also show very guarded behavior.

The following link may help you.

Pain assessment in cats | Feline Grimace Scale

The Feline Grimace Scale is a tool for assessment of acute pain in cats based on changes in facial expression. It can be used by veterinarians in hospitals, clinics, shelters and research laboratories. Useful for pet owners and anyone interested in feline health and animal welfare.

www.felinegrimacescale.com

Another important thing is to trust your gut instincts. Make sure you voice concerns to the vet and advocate for your cat.

I hope this helps

 

[Meowmee]

Hi,

So sorry your cat had to have this surgery and you are going through this. I don’t have any experience of that with my cats. In fact, I don’t remember any of them having any surgery except for spay and neuter except for one cat.

I looked it up, and this is obviously a major surgery which the cat is usually going to be hospitalized for a few days according to what I read. I don’t know what country you’re in, or maybe just a Dvm using a different protocol but this is going to be a painful surgery. Any type of abdominal surgery is painful.

Is there a way you can ask them if she can be seen in person again to be assessed for pain and make sure nothing is going on? At the least I think she should be seen again after such a major surgery and not just showing them a photograph.

I presume since two masses were removed they have done biopsies, and they’re going to contact you when the results come back?

Sorry I can’t be of more help. Here is the link I found, which had some information. Gabapentin is used for pain, but I think so soon after such a surgery, they’re probably going to need something stronger than gabapentin.

One of my cats about 3-4 years ago had an enucleation.
She was released the same day and then given gabapentin after that. But it turned out that she had cancer in her face which was not discovered until two weeks later on an x-ray. Long story.

Anyway, fortunately, she did not seem to be in pain and the gabapentin seemed to help her. I hope that was really the case. She went back two weeks later to get the stitches removed, and that was when the cancer was discovered.

Colonic Resection and Anastomosis in Cats - Conditions Treated, Procedure, Efficacy, Recovery, Cost, Considerations, Prevention

Colonic resection is a surgical procedure performed by your veterinarian to remove a section of your cat’s large intestine. Attaching the remaining ends of the bowel together is an anastomosis procedure.

wagwalking.com

 

[fionasmom]

My surgical vet would have followed a protocol similar to what S silent meowlook mentioned which is not to say that is the only possibility.

If nothing else, I am sure that this was a hugely expensive surgery and the vet needs to express a little more interest in discussing this with you, even if just to reassure you.

Personally, it sounds to me as if your cat is still in pain and I would discuss continuing the gabapentin.

 

[stephanietx]

My girl had a dental with one extraction of her fang and got Bupenorphrine for 4 days. I think you need more pain meds.

 

[StephCat]

Hi.
At the cat hospital I worked at, that type of surgery would be followed up with at least 3 days of hospitalization with a fentanyl CRI continuing until discharge, then weaned off the fentanyl before starting Buprenorphine that would be given at home for usually about a week. The cat would then, provided all going ok, would be rechecked in a few days after discharge.



Not all veterinarians follow the same protocols and each cat is an individual. There are also veterinarians that do not recognize pain in cats.

Cats and people feel pain the same, although it is expressed very differently. So, if something would hurt a person, it hurts the cat,

There are risks with every surgery, but the risks with what your cat had would be leaking or suture failure of the incisions in the intestines, causing leaking into the abdomen. The way to check for that is with an ultrasound. The symptoms would be lethargy, refusal to eat, maybe a fever. This is not a common occurrence, but can happen. So if your cat is improving but then declines, it is something to discuss with your vet.

Signs of pain in cats can be seen as reluctance to interact with their environment, reluctance to move, laying in a meatloaf position with head down, hiding, growling, hissing, excessive purring, not using the litterbox. They can also show very guarded behavior.

The following link may help you.

http://[URL]https://www.felinegrimacescale.com/

[/URL]

Another important thing is to trust your gut instincts. Make sure you voice concerns to the vet and advocate for your cat.

I hope this helps

Thank you so, so much. I went ahead and gave him another two doses of gabapentin, and it seemed to help. I think that he started doing much better today which is right around that time frame you mentioned: 3-ish days plus 7 on pain meds. We are now on day 10 post surgery, and I think we can discontinue any pain meds. He's walking around more normally, stretching somewhat, sharpening his claws a little bit, and generally acting a little more energetic. I haven't given him any gabapentin today. He does still squint his eyes sometimes, which makes me think he has pain, but I think that's nausea from the mass in his stomach. He threw up last night, unfortunately. I gave him some transdermal Cerenia I got from Wedgewood Pharmacy. I don't think it was working that well, though, because he was still licking his lips sometimes, refusing food sometimes, and just generally looking nauseated. I gave him some ondansetron, and then he started eating more eagerly. Although, he is not eating very much and hasn't been for a few weeks. He has lost 1lb in the last few weeks even though I offer food every 2 hours. It's been difficult, but I'm unemployed at the moment, so I have the time to continually offer food, even in the middle of the night.

He does seem to have improved, but then he also has nausea and vomited. Do you think we are in the clear from any risks of leakage now that we are 10 days post op? You mentioned the "symptoms would be lethargy, refusal to eat, maybe a fever." I think he may have had a fever for the first 2-3 days after coming home. He did have a fever in the hospital, they said, but then they said it came down, and they wanted to discharge him after just one day of hospitalization. I think their philosophy is to get the cat home sooner so they will start eating and have less stress/fear. He wouldn't eat in the hospital at all, so I'm glad he could come home sooner and start eating and feeling more relaxed. Anyway, he shivered his hind legs and lower abdomen for a minute while laying next to me a couple days after surgery, and he also had hot ears. I called, and the surgeon said it was probably fear or anxiety or literally being cold from having a shaved belly. I didn't think that sounded right, because his ears were hot, our home is warm, and he was laying next to me (shouldn't be cold or scared). Does this sound like a fever to you? His ears seemed cooler around 4 days after surgery, and they have stayed a normal (warm, but not hot) temperature since then.

Aside from the possible fever, he definitely was lethargic at times and has refused food many times. I thought lethargy would be expected after surgery, and he does seem less lethargic now. He was also refusing food before surgery, so I'm not sure if refusing food now would indicate anything bad or just be the expected nausea. Do you have any more insight on this? Really hoping we're in the clear from the possibility of intestinal leaking. But also, is it possible he could have had leakage before and it could still be in there and maybe not causing many obvious symptoms right now?

Also, the surgeon used a surgical stapler with staples, as opposed to sutures, to do the intestinal re-sectioning (anastomosis).

Thank you so much for your help.

 

[StephCat]

Hi,

So sorry your cat had to have this surgery and you are going through this. I don’t have any experience of that with my cats. In fact, I don’t remember any of them having any surgery except for spay and neuter except for one cat.

I looked it up, and this is obviously a major surgery which the cat is usually going to be hospitalized for a few days according to what I read. I don’t know what country you’re in, or maybe just a Dvm using a different protocol but this is going to be a painful surgery. Any type of abdominal surgery is painful.

Is there a way you can ask them if she can be seen in person again to be assessed for pain and make sure nothing is going on? At the least I think she should be seen again after such a major surgery and not just showing them a photograph.

I presume since two masses were removed they have done biopsies, and they’re going to contact you when the results come back?

Sorry I can’t be of more help. Here is the link I found, which had some information. Gabapentin is used for pain, but I think so soon after such a surgery, they’re probably going to need something stronger than gabapentin.

One of my cats about 3-4 years ago had an enucleation.
She was released the same day and then given gabapentin after that. But it turned out that she had cancer in her face which was not discovered until two weeks later on an x-ray. Long story.

Anyway, fortunately, she did not seem to be in pain and the gabapentin seemed to help her. I hope that was really the case. She went back two weeks later to get the stitches removed, and that was when the cancer was discovered.

http://[URL]https://wagwalking.com/cat/treatment/colonic-resection-and-anastomosis#

[/URL]

Thank you for your insight even without having this experience. I'm in the U.S. (Texas specifically). I was actually surprised we would only do one day of hospitalization, as well, because we went to a different hospital originally and they estimated 2-3 days of hospitalization. I think this place may want to try to get them back home and more comfortable as soon as possible to reduce stress. They also said it's very common for cats to not eat while in the hospital, and he did not eat while there. He did eat at home, almost immediately. That could be a reason why they try to keep them there for only one day. They did say he may need to stay longer if he wasn't doing well.

They gave him pain meds intravenously in the hospital, and then they were just sending me home with gabapentin. I don't like using gabapentin since he's hard to pill, so I asked for the buprenorphine instead. They agreed, but only gave me 3 days worth and said that should be enough. I definitely don't think that was true. Maybe it's just that the tech who gave it to me was uninformed? But they have been acting like he should be pain-free now, and he definitely wasn't when they recommended stopping pain meds at the one week mark.

I decided to mostly ignore that recommendation based on the comments here, but I did stop the meds today. We're on day 10 post op, and he's acting much less painful. I think we are good now, thank goodness. I'm still worried about an infection popping up, though, or him even having an underlying one that isn't really obvious, but he's done well today without any pain meds.

They did send off the samples for biopsy to Cornell University in New York. We should be getting the results back any day now.

 

[StephCat]

My surgical vet would have followed a protocol similar to what S silent meowlook mentioned which is not to say that is the only possibility.

If nothing else, I am sure that this was a hugely expensive surgery and the vet needs to express a little more interest in discussing this with you, even if just to reassure you.

Personally, it sounds to me as if your cat is still in pain and I would discuss continuing the gabapentin.

Thank you so much. It was definitely expensive. It was around $6500 for the surgery and one day of hospitalization. Every time I call or email, it takes them about 24 hours to get back to me, but they do get back to me. However, I just don't think they have really understood his level of pain and nausea to really give good advice? It's like they didn't think he really should have any more pain. They always tell me his incision looks great every time I send a photo, and I've sent many. Maybe they just think I'm overreacting.

I mostly ignored their advice from Monday to stop pain meds after hearing from this chat. I do think he was still in pain, too, but also nauseated, as well. I stopped giving him the occasional ondansetron, like they suggested, and then he threw up. I did not stop the pain meds until this morning, though, and he has done really well today without anything for pain. I'm glad I continued, because I can see a stark difference in his pain level now. It's much more obvious to me now that he did, indeed, have pain that needed some help. Thank you for helping to reassure and validate me in that.

Thank you again, so much.

 

[StephCat]

My girl had a dental with one extraction of her fang and got Bupenorphrine for 4 days. I think you need more pain meds.

That is a very good point that I did not consider. Thank you.

 

[Meowmee]

Thank you for your insight even without having this experience. I'm in the U.S. (Texas specifically). I was actually surprised we would only do one day of hospitalization, as well, because we went to a different hospital originally and they estimated 2-3 days of hospitalization. I think this place may want to try to get them back home and more comfortable as soon as possible to reduce stress. They also said it's very common for cats to not eat while in the hospital, and he did not eat while there. He did eat at home, almost immediately. That could be a reason why they try to keep them there for only one day. They did say he may need to stay longer if he wasn't doing well.

They gave him pain meds intravenously in the hospital, and then they were just sending me home with gabapentin. I don't like using gabapentin since he's hard to pill, so I asked for the buprenorphine instead. They agreed, but only gave me 3 days worth and said that should be enough. I definitely don't think that was true. Maybe it's just that the tech who gave it to me was uninformed? But they have been acting like he should be pain-free now, and he definitely wasn't when they recommended stopping pain meds at the one week mark.

I decided to mostly ignore that recommendation based on the comments here, but I did stop the meds today. We're on day 10 post op, and he's acting much less painful. I think we are good now, thank goodness. I'm still worried about an infection popping up, though, or him even having an underlying one that isn't really obvious, but he's done well today without any pain meds.

They did send off the samples for biopsy to Cornell University in New York. We should be getting the results back any day now.

That is good he is feeling better. I think pain is not being addressed the way it should be for both cats, dogs and people, etc. here now. Controlling the pain helps them to heal after they have a surgery or something like that too. You’re not going to heal as well if you’re stressed out for being in pain, etc. people can say they are in pain most of the time, but unfortunately it’s often hard to tell with our cats for sure, and they tend to hide it too.

I know when my Wizard had lymphoma I was so worried about pain, but the doctor did not want to have him on too many medication’s and he was on a lot of medication for the cancer and for his kidneys, etc. Now, when I think back on it, I think it really should’ve been addressed better.
Let us know what happens with the biopsies. I hope they will let you do an in person follow up too and there are no complications.

 

[silent meowlook]

Hi. You should taper the Gabapentin off, as opposed to stopping it abruptly. If you can without fighting with him. You don’t want to fight with him about anything right now.

If he were my cat, I would give him the odansetron or Cerenia daily for a few days and not wait until he shows signs of nausea.

They couldn’t have used staples internally, I don’t think. The sutures inside have to be water tight so to speak.

 

[silent meowlook]

Did you get the results from the lab yet on the biopsies?

 

[fionasmom]

I think that the pendulum has swung the other way with pain meds and dependency is such an issue that they are under prescribed for everyone.

Glad that there is improvement!

 

[StephCat]

That is good he is feeling better. I think pain is not being addressed the way it should be for both cats, dogs and people, etc. here now. Controlling the pain helps them to heal after they have a surgery or something like that too. You’re not going to heal as well if you’re stressed out for being in pain, etc. people can say they are in pain most of the time, but unfortunately it’s often hard to tell with our cats for sure, and they tend to hide it too.

I know when my Wizard had lymphoma I was so worried about pain, but the doctor did not want to have him on too many medication’s and he was on a lot of medication for the cancer and for his kidneys, etc. Now, when I think back on it, I think it really should’ve been addressed better.
Let us know what happens with the biopsies. I hope they will let you do an in person follow up too and there are no complications.

I'm so sorry for your Wizard. I will definitely keep his pain in mind going forward. Does lymphoma cause pain? We should get the results today (Monday), I'm told. I will definitely let you know. I'm really nervous about it, and I'm pretty sure it's lymphoma. Do you have any advice about that? I haven't spoken with an oncologist yet since we don't have results yet, but I've done a bit of research, and I'm struggling with if chemo is even the right thing to do.

I got a call a couple days ago, and the doctor said we should be out of the woods now for risk of any complications, such as with intestinal leakage. She said the 10-day mark is a pretty safe distance out that he should continue to heal and not have any complications. We're at 14 days post-op now, and he seems to be doing well. We're doing daily Cerenia for nausea/vomiting and giving Mirataz occasionally to help with his decreased appetite. The Mirataz irritates his ears, so I have to use it sparingly. I did get an oral mirtazapine yesterday that I can give if needed, but he is very hard to pill.

 

[StephCat]

Hi. You should taper the Gabapentin off, as opposed to stopping it abruptly. If you can without fighting with him. You don’t want to fight with him about anything right now.

If he were my cat, I would give him the odansetron or Cerenia daily for a few days and not wait until he shows signs of nausea.

They couldn’t have used staples internally, I don’t think. The sutures inside have to be water tight so to speak.

Thank you for letting me know! I dropped him down to 25 mg of gabapentin and then skipped a day, and then gave him 10 mg to taper him off as you suggested. Pilling him is difficult, but I was able to do that much. I'm glad you mentioned that, because I had read that somewhere, but the hospital didn't mention doing any tapering. I think it helped.

They actually called me back on Friday and suggested doing the same thing you suggested: giving daily Cerenia and ondansetron. I think maybe the tech who instructed me before to just give these as needed might have been misinformed or just giving alternate advice? I'm not sure. But he threw up a couple times, once on Thursday and once on Friday, just doing it that way (looking for symptoms and giving occasionally). The call I received was from the surgery supervisor, and she said it would be best to consistently keep him at a lower nausea level rather than waiting until he's showing signs of nausea. I'm glad you were both saying the same thing about this. I haven't been able to get any ondansetron in him even though I've tried 3 times. I think he's getting stronger! It seems like his jaw certainly is. But I've been giving him Cerenia daily, and he seems much better and hasn't vomited since.

The surgeon did actually use staples inside to staple his ileum to his colon for the resection. She explained she uses a circular stapler. I asked if that was safe, and she said it was actually safer than using sutures because the sutures have a greater chance of leakage. I've since looked online, and I can't find any studies to say that's actually true, but one definite benefit of using staples is that it's much faster and saves about 10 minutes under anesthesia. The staples will stay inside him, and she said they won't cause any harm. They will show up on radiographs, so I will just have to make sure I'm aware of that if he ever needs radiographs again. It freaked me out a little bit, and it still does, but that's how she wanted to do the surgery, so I didn't question her.

I'm actually kind of thinking maybe using staples was for the best, because she removed the ileocolic junction which contains a sphincter, and doing so often causes chronic diarrhea since the fecal material is not stopped by the sphincter before it gets to the colon. He did have diarrhea a couple times, but then after that his poops have been great. I don't know if this is owed to the staples or not, but I sort of think so. I really have no idea, but I picture the staples helping to keep that area tighter, and maybe if that's true, it could sort of function as a faux sphincter or at least slow the fecal material down a little bit. I'm probably making things up, but I'm glad he doesn't have diarrhea, and I wonder why not. This surgery often causes chronic diarrhea, but I think the studies on that are primarily based on using sutures.

Here's an example of a surgical circular stapler for anastomosis: https://www.jnjmedtech.com/en-US/product/ethicon-circular-stapler

 

[StephCat]

Did you get the results from the lab yet on the biopsies?

We are supposed to get them back today. I will let you know the results! I'm super nervous about it. I'm pretty sure it's large cell lymphoma, and I have no idea if chemo will even be the right thing to do for him since he is FIV+ and such an anxious cat. He doesn't do well in the car or at the vet.