Post Dental Surgery

[Lhaff]

Hello- my 15 y/o cat had dental surgery 4-5 days ago (4 teeth removed) and was put on bupanorphine for pain. It did not seem to be giving her much relief so vet prescribed her small dose of gabapentin (25mg) in addition to the bupanorohine. She has been having severe diarrhea since about day 2 after surgery but I am told by the vet that neither of those medications should be causing the diarrhea. I have been feeding her pro plan wet food shreds in sauce which she seems to be eating ok, as long as she is on both meds. Does anyone have experience with diarrhea after dental surgery, or from either of the two meds? Vet prescribed her metronidazole to help with the diarrhea but when I gave her a dose with the gabapentin it seems to make her symptoms of wobbly/out of it much worse, where she is almost non-responsive. I stopped the metronidazole because I read some bad reviews and I was nervous with her reaction to it. Her diarrhea has still not gotten any better and I’m worried if I stop the pain meds she won’t eat. How long are pain meds usually given with that level of dental extraction. Thank you all in advance for any advice

 

[Antonio65]

My experience with brupenorphine is terrible.
My cat was kind of stoned for nearly two days after just one injection of it, so the vet said no to repeat it the next two days. She was in pain due to a pancreatitis.
Other users in this forum had similar experiences with the same drug.

As for the dental extraction, I have an outdoor cat who had a full extraction a year ago, but as long as I remember she wasn't put on pain killer, but I could be wrong. She was on antinflammatory (prednicortone), though.

 

[neely]

Our cat was on Buprenex post-dental surgery and fortunately did not show any signs of diarrhea but definitely some lethargy. Both Buprenex and Gabapentin have side effects, one of them being diarrhea, so perhaps the combination of both those meds or the dosage is the culprit. You could try adding a little pure pumpkin to her food since the fiber in it can help with diarrhea. However, I would recommend contacting your vet and discussing your cat's side effects with them. Best of luck!

 

[mrsgreenjeens]

I have found that drug induced diarrhea is often helped by using FortiFlora. Not always, but often. If not that, you might try Proviable for cats. These are both Probiotics, so IF you are also giving antibiotics (which can also cause diarrhea), be sure to give the probiotics at least two hours before or after the antibiotics

 

[daftcat75]

It's possible the vet gave your cat a long-lasting antibiotic shot if you weren't sent home with one to give her. Ask the vet about this. If you have an itemized bill, it may show up as "Convenia".

Gabapentin and buprenorphine often cause constipation. The anesthesia can sometimes cause some poop disturbances. But those resolve quickly as the anesthesia clears her body. With Krista, her first poop after anesthesia was usually "interesting" in one way or another--sometimes looser, sometimes harder depending on other meds she might have been given. If nothing else was bothering her gut at the time, this usually resolved by the next poop.

Sachharomyces boulardii is a much better probiotic for drug-induced diarrhea. Because it is yeast-based, it is not affected by antibiotics (which target bacteria.) Therefore the recommendation to separate probiotics and antibiotics by a couple of hours does not apply to s. boulardii. You can give her as much as a half capsule every few hours until the diarrhea resolves. Then half a capsule once or twice a day if she needs a maintenance dose. Many cats like the taste making it easy to mix into food.
My Cat Has Diarrhea - What Do I Do?

 

[Lhaff]

Thank you all! A few things I should have included: she was taking bupanorphine prior to surgery for about 2 weeks for pain until we could get some test results back and get the surgery done. It had no negative effects so I don’t think that is the culprit. She was given both convenia and meloxicam during surgery. Both of which I’ve heard mixed reviews…Thinking one of them may be the cause of her stomach issues?

As an update, her vet suggested taking her off the gabapentin and re-starting the metronidazole, both of which I did yesterday. She seems to be much more alert/herself but is still having diarrhea, although not as often. I was instructed to give it to her until Saturday night (3 full days) and see if it clears up. The vet also said I should not need a probiotic unless this all continues after Saturday. Luckily she is drinking and eating some, although not as much as normal which I think is to be expected. Hoping her diarrhea clears up with the metronidazole in the next few days, as I’m a bit concerned about dehydration since it has been going on for about 5 days.

 

[daftcat75]

Ah. The Convenia is most likely the suspect. Unfortunately, that's a long lasting antibiotic that can last 6 to 10 weeks. I had "No Convenia" put into Krista's file. Although it's convenient to not have to give antibiotics by mouth, especially after oral surgery, the only course for its side effects is to either play whack-a-mole with other meds (and their side effects) or ride it out. As you know, diarrhea is dehydrating, and shouldn't just be ridden out. But I don't know that metro is the answer either. Finish up the metro as prescribed because you don't want to breed antibiotic-resistant super bugs with a "too short" course. But I also encourage you to pick up the s. boulardii and give that anywhere from a half capsule every few hours to twice a day depending on how frequent and urgent the diarrhea is. There's nothing contraindicated (no interactions to worry about) that would prevent you from giving s. boulardii along with the metro.

This is the recommended brand of s. boulardii. You should be able to find it anywhere human probiotics are sold. Even though it doesn't require refrigeration, you may still find it in the refrigerated section with the other probiotics that do require it.
https://www.amazon.com/dp/B0013OVW0E/?tag=thecatsite

Here it is at Vitamin Shoppe. You may have one near you if you can't wait for Amazon's shipping.
Vitamin Shoppe

 

[Lhaff]

That is really helpful, thank you! I’ve heard lots of good things about s. boulardii but wasn’t sure which brand to get. I will try that!

 

[MamaMačka]

Give some good cat probiotics to cat. My cat had diarrhea 2 days after dental surgery but I think it was due to antibiotics.

 

[Catlover1955]

Ah. The Convenia is most likely the suspect. Unfortunately, that's a long lasting antibiotic that can last 6 to 10 weeks. I had "No Convenia" put into Krista's file. Although it's convenient to not have to give antibiotics by mouth, especially after oral surgery, the only course for its side effects is to either play whack-a-mole with other meds (and their side effects) or ride it out. As you know, diarrhea is dehydrating, and shouldn't just be ridden out. But I don't know that metro is the answer either. Finish up the metro as prescribed because you don't want to breed antibiotic-resistant super bugs with a "too short" course. But I also encourage you to pick up the s. boulardii and give that anywhere from a half capsule every few hours to twice a day depending on how frequent and urgent the diarrhea is. There's nothing contraindicated (no interactions to worry about) that would prevent you from giving s. boulardii along with the metro.

This is the recommended brand of s. boulardii. You should be able to find it anywhere human probiotics are sold. Even though it doesn't require refrigeration, you may still find it in the refrigerated section with the other probiotics that do require it.
https://www.amazon.com/dp/B0013OVW0E/?tag=thecatsite

Here it is at Vitamin Shoppe. You may have one near you if you can't wait for Amazon's shipping.
Vitamin Shoppe
[/QUO

Ah. The Convenia is most likely the suspect. Unfortunately, that's a long lasting antibiotic that can last 6 to 10 weeks. I had "No Convenia" put into Krista's file. Although it's convenient to not have to give antibiotics by mouth, especially after oral surgery, the only course for its side effects is to either play whack-a-mole with other meds (and their side effects) or ride it out. As you know, diarrhea is dehydrating, and shouldn't just be ridden out. But I don't know that metro is the answer either. Finish up the metro as prescribed because you don't want to breed antibiotic-resistant super bugs with a "too short" course. But I also encourage you to pick up the s. boulardii and give that anywhere from a half capsule every few hours to twice a day depending on how frequent and urgent the diarrhea is. There's nothing contraindicated (no interactions to worry about) that would prevent you from giving s. boulardii along with the metro.

This is the recommended brand of s. boulardii. You should be able to find it anywhere human probiotics are sold. Even though it doesn't require refrigeration, you may still find it in the refrigerated section with the other probiotics that do require it.
https://www.amazon.com/dp/B0013OVW0E/?tag=thecatsite

Here it is at Vitamin Shoppe. You may have one near you if you can't wait for Amazon's shipping.
Vitamin Shoppe

Well here's some information about the Covenia Shot. I read a quote from a veterinarian online that said Covina does nothing for the bacteria that is found in the oral cavity. It's specifically for wounds like your cat gets in a fight with another cat and gets bit or maybe one of their claws gets torn what have you. It is not to be used on an animal whether it be a cat or a dog if they have a compromised immune system. Or they have any kind of like kidney or liver failure it causes anemia it causes asphyxiation I've read so many horror stories on it and as a matter of fact my cat had a abscess in her mouth I didn't know that the vet gave her that poison she died four days later from anemia I'm sure because kidney failure also causes anemia and he told me he thought her kidneys were failing but I couldn't afford to have the blood work done. Cuz I hadn't worked since June 26th so I had to set up a GoFundMe account to even get the money together to go see the vet and then he killed my cat. He didn't tell me what he was giving her all he said it was a 14-day antibiotic. Had I known the adverse side effects, I would have never allowed him to give it to her. I blame him. Why would a veterinarian give a cat that he thought was going into kidney failure and antibiotic that causes anemia it was a double whammy. More people really have to look into this and refuse this poison because that's exactly what it is.

 

[GraciesParent]

Relieved to find this thread and hoping for some advice while I wait to hear back from the vet.

Gracie had a dental cleaning + one extraction yesterday morning. She seemed to be bouncing back by last night -- not as spaced out, no longer wobbly on her feet, peed + pooped normally -- but has had repeated diarrhea today: 5 times since about 8am, almost always shortly after eating (i.e., triggered by eating).

Of those 5 instances, two were large amounts (the very liquidy equivalent of a normal solid poop) and the other three were rather small (maybe a tablespoon each). The consistency is that of Nestle Quik chocolate syrup... or thinner. Her energy level is very low, and her appetite went from ravenous last night to so-so today.

She is not on any antibiotics, only 5mg of transdermal codeine twice a day for pain. She's had two doses of the codeine (which normally causes constipation, not diarrhea!) so far -- one last night and one this morning.

I contacted the vet this morning, and then picked up some FortiFlora earlier -- she ate a full dose (she loves it) with about 1.5 tbsp of wet food + water. I know it takes a couple of days for the FortiFlora to kick in, but the frequency of the diarrhea is concerning. I've contacted the vet again this evening to provide an update on the ongoing diarrhea and to see what advice she has.

In the meantime, and as a way of trying to calm my anxiety, I thought I'd post here to see if anyone else has had experience with post-dental diarrhea and what could be causing it. The anesthesia? The stress of the procedure/vet's office? Both?

Thanks in advance for any insight!

 

[mrsgreenjeens]

I would take a look at the sheet she came home with to see what all medications were used during the dental. I'm guessing something she was given is causing this. I am totally shocked she wasn't given any antibiotic with an extraction. One of mine had a dental with extraction last week and we had a long discussion about giving him an antibiotic because he has adverse side effects with most of them. His Vet decided against giving him any because of that and because she didn't find any infection in the area of the extraction, but we thoroughly discussed it prior to his coming home and I was given instructions on what to look for. Plus he was given penicillin DURING the dental.

As to your girls low energy and low appetite, these can be from the codeine. My guy was given a transdermal one time drug called Zorbium which lasts for 3 - 4 days. He was high as a kite for 3 days. Not sure I would use it again, but it saved me needing to do anything. His appetite was great though throughout that entire time.

Oh, also, I'm guessing your girl's appetite was great last night because she hadn't eaten in awhile due to the dental. My boy acted like he hadn't eaten in weeks his first meal afterwards. It was wonderful since he's such a picky eater.

I'm hoping the diarrhea clears up sooner than later. The Fortiflora may help, but she may need something stronger. You could try S. Boulardi (1/2 capsule twice daily) if the Vet doesn't prescribe something.

 

[GraciesParent]

Thanks mrsgreenjeens . :-)

Didn't hear back from the vet so I called to follow up, and was told by a staffer that they can prescribe something (which I can pick up in the morning). I'm going to see how Gracie does overnight and in the morning, just in case it improves. Then I might ask to speak to the vet directly (she'd already left for the day today) before picking up another prescription.

As for the list of meds during her dental, she got hydromorphine, midazolam and metacam. The anesthesia was isoflurane. She took 50mg gabapentin at home, pre-dental, just so I could get her into the carrier, which the vet knew/approved and which I reminded the staff of (verbally and in writing) when I dropped her off.

I suspect all the meds combined, along with the stress of the day and procedure, have just done a number on her system, so I'm hoping things start to resolve soon. She did eat her dinner (with extra water added) tonight and just had her evening dose of codeine, so she's now curled up, asleep, on the bed.

 

[daftcat75]

All good advice above.

Get some saccharomyces boulardii from a vitamin store. The less additional stuff in it the better. If it has something else, it may be FOS or MOS. FOS is okay. MOS is better. If you can find the Jarrow brand, that’s the best. Give 1/4 capsule on its own or in food every few hours to stop the diarrhea faster and then a 1/2 capsule twice a day to keep the poops solid. You can either give it until a day or two after the diarrhea stops, or you can give it indefinitely if she likes the taste. If she doesn’t like the taste, it wouldn’t harm her to mix it with FortiFlora.

Whatever you do, don’t let them give her metronidazole. That’s only going to make this worse.

 

[GraciesParent]

Thanks daftcat75 — noted on all counts.

In terms of the probiotic, when you refer to the capsule, what’s the dosage? Or do all capsules contain the same amount/potency, so 1/4 or 1/2 a capsule would be the same regardless of brand? (Sorry if that’s a dumb question!)

 

[daftcat75]

Thanks daftcat75 — noted on all counts.

In terms of the probiotic, when you refer to the capsule, what’s the dosage? Or do all capsules contain the same amount/potency, so 1/4 or 1/2 a capsule would be the same regardless of brand? (Sorry if that’s a dumb question!)

This is the Jarrow brand. If you have a Whole Foods or a Vitamin Shoppe, you can probably find this brand easily enough.
https://www.amazon.com/dp/B00O4PUCZU/?tag=thecatsite

Jarrow is dosed out to 5 billion CFU (colony forming units) in one capsule. So I'm assuming 1/4 capsule would be 1.25 billion CFU if you are using a brand that isn't 5 billion CFU. It's odd that it's measured in CFU because S. boulardii does not colonize the gut like other probiotics. That's why you have to give it frequently to start, and consistently as long as it's needed. If the diarrhea is still present after day three, you may need to take her back to the vet for diagnostics (ultrasound and possibly a diarrhea PCR.) Unless the diarrhea PCR comes back saying that she's overrun with a bug that metronidazole is actually effective against, don't let them just give her metro and hope for the best. Metro may firm up her poops for a day or two and then it will all go to mush again as it kills off beneficial gut bacteria while allowing some nasty ones (clostridium and E. coli) to escape unharmed. This is why I recommend refusing metro. If she does go on metro--if the vet convinces you that it really is the best treatment for what she has--give SB along with the metro, and for at least a couple months after to help clean up any bad guys allowed to flourish in the void that metro leaves.

You can't really give too much of this stuff so just eye-balling 1/4 capsule is okay.

More info on SB:
My Cat Has Diarrhea - What Do I Do?

SB is magic stuff. I've been giving my Betty an FMT pill (fecal microbiome transplant from healthy donor cats) to fix up her gut biome. She has IBD. Her first gut biome test showed severe imbalance consistent with a cat who ate a lot of carbs (probably a kibble kitty before she came to me.) She had a course of antibiotics (Veraflox) in the summer to fix up a "fever of unknown origin." Her fever went away and she started eating again the very next day. But the five day course really did a number on her gut. Clostridium and e. coli both elevated. Fortunately, she never showed signs of either. But it wasn't until I started giving her SB (1/4 capsule) twice daily that her gut biome tests finally look more like a healthier cat. It's not all balanced out yet. But whole phyla that were missing before have started to return. The e. coli is gone. The clostridium is almost down to healthy levels.

Betty doesn't like the taste of SB. But she will take anything I can put in a cat-sized capsule for her, dip it in Hills A/D, and drop it on the carpet for her. She takes four capsules worth of meds and supplements in the AM and three in the PM--willingly, eagerly, and purring all the while. She doesn't always eat much of the meal that's served with her meds (after she's taken her meds and before they kick in), but she always shows up for meds. She's a real blessing that way. We basically do meds like in this video.

Jarrow comes in huge capsules. I bought a size four capsule filling machine off Etsy (seller name MYHERBAR) to turn a dozen human-sized capsules into 50 cat-sized capsules. I do this about once a month and it takes about 20 minutes. I also spend about 30 minutes each Sunday cutting up her meds for the week, and packing them into capsules for her. But seeing her eagerly taking meds twice a day and purring the whole time, totally worth the effort!

 

[GraciesParent]

Thanks daftcat75 -- it seemed to get better overnight (she only went once over 15 hours, which was a big improvement over going every two hours!), and I thought, "Yay! It's improving!"... but then the issue seems to have returned this morning: 5 trips to the litter box over about 90 minutes, with only small to very-small amounts each time. Consistency went from chocolate syrup yesterday, to pudding overnight and the first few today, to watery for the last one this morning.

You were correct: the vet did want to put her on metronidazole, but I declined. She said she feels it's stress colitis, brought on by the hospitalization/procedure, so I said I'd prefer not to give Gracie an antibiotic unless absolutely necessary. She also suggested feeding Gracie some prescription gastro food, so I'm going to go pick up a couple of cans from the office... along with some S. boulardii from the nearby health-food store on the way home.

As an aside (or an "ass-side," as it were), Gracie's anal area looks SUPER-irritated from all the post-poop cleaning -- is there anything I can apply to help soothe the area? I feel like that irritation/rawness is contributing to her urge to go, given how little came out the last few times. She's also now scooting her (poopy) bum across every carpet I own in search of relief, so I'd really love to help her find some so I can stop having to clean up skidmarks everywhere.

 

[GraciesParent]

p.s. Further to the above, I should add that Gracie will not let me get near her bum to clean it (she RUNS and then hides), and she won't let herself be picked up, so me washing/drying her rear end is not an option. I *might* be able to gently rub on some ointment or something during cuddles, but that's about it.

p.p.s. I'm in Canada, and the only S. boulardii available nearby is this one, which seems to have very few ingredients (yay!).

 

[daftcat75]

p.s. Further to the above, I should add that Gracie will not let me get near her bum to clean it (she RUNS and then hides), and she won't let herself be picked up, so me washing/drying her rear end is not an option. I *might* be able to gently rub on some ointment or something during cuddles, but that's about it.

p.p.s. I'm in Canada, and the only S. boulardii available nearby is this one, which seems to have very few ingredients (yay!).

Can’t really help you on the irritated bum front (or back as it were.) Perhaps getting this under control will help that resolve.

That s boulardii is perfect. Those non-medicine ingredients are to be expected. That’s just the capsule itself. So that’s 10 billion CFU. That’s twice a Jarrow capsule. You really can’t overdo this. 1/4 capsule of that size is twice the Jarrow dose but it’s fine. Give it every two or three hours. While you are at the vet, pick up a couple cans of Hills A/D. This is kitty crack food meant to get sick cats eating again. This is what I dip Betty’s capsules in and she loves the stuff. She’s not always hungry at meds time (or maybe it’s tooth pain or nausea as those are two of her meds) but she will alway takes the meds. Lately I’ve been taking a small smear of the A/D after the meds and giving her a starting point on her food. A couple grams of A/D smeared into a corner of her food is usually enough to get 10 grams of food in her. That’s good enough for me for first pass. I just want some food in her stomach when she takes meds. I know when the meds kick in, she’ll almost finish the remainder. Then she comes back a couple hours later for those last few bits she left on second pass.

If Gracie likes the A/D and most cats do, I would take just a small pinch and roll it in the s boulardii powder to make little yeast balls for her to eat. This is how you could get her to eat some SB every two or three hours that first day or two to get to a steady state faster and help stop her pudding poops sooner.

As for gastro food, to my surprise Betty loves Hills I/D in the stew cans. (Not so much the pate.) What’s not to love? It’s chunks of chicken in gravy. With rice and carrots. Okay. I could do without those. But this is what Betty likes. And I’ve been forbidden to make any diet changes until she got to and through her dental procedure. We’ve been trying for a year to get her one and she finally got one and a couple extractions last week. Next week is her checkup. Then we can talk about next steps (and new foods?) for her. Maybe it’s because she is already eating I/D and taking SB that she didn’t have these poop issues after. She didn’t go for a couple of days. But when she did, it was just like before. She’s also a mellow cat. She seems to be more upset with the car rides than the vet itself.

 

[mrsgreenjeens]

You can use coconut oil, or vasoline, or even neosporin (WITHOUT pain killer - just the plain version) for her irritated backside.