Post Dental Surgery

[GraciesParent]

Thanks for the 411, daftcat75 and mrsgreenjeens .

I actually found, and wound up buying, these instead -- they were $10 cheaper and also have very few additional ingredients.

My vet wasn't in today, and the vet tech I spoke to at the clinic had never even heard of S. boulardii (*sigh*). I wanted to check whether it's OK to give it alongside FortiFlora (which Gracie's already getting) or if it should be an either/or situation. The tech was going to check with another of the clinic vets and then get back to me, but guessed that it would be better to stay on FF for a few days to see if it starts working and then, if it doesn't, switch to SB. That makes sense to me, since it's easier to tell that way which one of the two is actually the one working. Haven't heard anything further yet.

The gastro food I picked up from the vet is Royal Canin Gastrointestinal. I took two cans for now -- Gracie is a super-picky eater, so we'll see if she likes it. If not, I'll see if they have the A/D and will try that.

Oh, and the vet tech recommended unscented baby wipes to help soothe Gracie's bum, so I picked up a small packet of those on my way home, as well. I'm doubtful she'll let me wipe back there, but we'll see.

 

[GraciesParent]

As expected, Gracie's reaction to me trying to get near her bum with a baby wipe was: NNNNOOOOOOOOOOO.

 

[daftcat75]

Your first choice was actually better. There’s FOS (okay) and guar gum in the second one. Probably wouldn’t hurt, though.

FortiFlora is weak sauce. It’s basically a flavoring. It’s got too little of the bacteria to move the needle. You can give them both at the same time. In fact, you can use FortiFlora to make SB more appealing if she’s not crazy about the taste. But I wouldn’t wait for the FF to work. SB is much better and more effective. Start that yesterday if possible. SB is good stuff and very safe and can be a regular part of her diet if she likes it. But if you go that route, I’d recommend ordering the Jarrow for extended use. The MOS in Jarrow is better than FOS in the other stuff.

 

[daftcat75]

FOS is like lunch boxes for beneficial bacteria in the gut. That’s all good if she has those strains in her gut. But if her gut is imbalanced or if it’s running too quickly, those lunch boxes are just being flushed out with the poop.

MOS is like scrubbing bubbles for the gut. Its structure is very similar to the gut wall itself. It attracts those bad guys (like E. coli and clostridium) that feed on dead gut lining cells. It binds them to its decoy gut and flushes them out in the poop. MOS also has some gut soothing properties making it a better choice even if her bad guys are under control.

 

[GraciesParent]

Thanks -- the Jarrow brand is not readily available here, so I got what I could find the fastest/easiest for now. The first brand (NFH) I linked to wasn't available in a 30-capsule size today, and the next size up was considerably more expensive. I may try another retailer tomorrow to see if they have the NFH brand in a smaller/less expensive size.

 

[daftcat75]

Thanks -- the Jarrow brand is not readily available here, so I got what I could find the fastest/easiest for now. The first brand (NFH) I linked to wasn't available in a 30-capsule size today, and the next size up was considerably more expensive. I may try another retailer tomorrow to see if they have the NFH brand in a smaller/less expensive size.

Try what you have. It's really the SB that you're after. The other stuff is just working with the margins. FOS vs MOS is probably not going to make a huge difference here. Prioritize this over FortiFlora. But you can give them together. I just don't want you to wait for a FortiFlora miracle that's probably not going to happen.

 

[GraciesParent]

Success! Found the NFH brand, and cheaper than the previous price! I was able to return the NOW brand, as well.

When I got home from the short outing to make the above swap, I found a litter box splattered with poo, and poopy pawprints leading out of the bathroom and through the living room. So, her first dose of SB is now in her dinner, waiting to be eaten.

How quickly should I notice an improvement?

 

[daftcat75]

It takes three days to build a steady state in her gut. But you can speed that up with more frequent administration. If she likes the taste, make yeast balls out of a favorite food and let her eat those between meals. If she doesn't like the taste, see if you can mix it with something she does like--like the FortiFlora or Hills A/D.

 

[GraciesParent]

Noted. I'll try mixing small amounts into other stuff, as well.

Does that mean three more days of diarrhea without change, and then it starts to improve on day three? Or will the stool start to get a bit firmer with each passing day? At this point, I'd take ANY improvement!

 

[daftcat75]

Noted. I'll try mixing small amounts into other stuff, as well.

Does that mean three more days of diarrhea without change, and then it starts to improve on day three? Or will the stool start to get a bit firmer with each passing day? At this point, I'd take ANY improvement!

With the more frequent dosing, it should firm up faster. I’m thinking you should see improvement tomorrow if she can get a few doses today.

 

[GraciesParent]

She’s had half a 10B capsule tonight, so I think that'll be it for today, and the smaller, more frequent doses can start in the morning.

 

[GraciesParent]

She had another 1/4 capsule before bed last night, and again earlier this morning... but her appetite has since waned (likely due to her morning codeine dose). She doesn't really want ANY food at present, let alone anything with probiotics in it. Heading to the vet's to get her some Hills a/d. Thanks for all the info and suggestions!

 

[GraciesParent]

No improvement yet. Gracie’s had the equivalent of roughly 12B S. boulardii split into 5 doses over about the past 24 hours. I actually wonder if all the new foods and completely screwed-up routine (i.e., feeding her small amounts of food throughout the day vs. her usual schedule, no kibbles or treats, etc.) are contributing to her digestive upset. Like many cats, she doesn’t manage change well at ALL, no matter how minor. And there has been HUGE change for her over the past four days.

She’s been having clusters of diarrhea episodes, separated by about seven or eight hours, for about the past day.

i.e., she’ll go to the litter box a few times over the course of an hour or so, then nothing at all for seven or eight hours, then another few visits within an hour, and so on. Each cluster episode starts with one sizeable runny poop (maybe one or two tbsps.), followed by one or two very small residual poops (one to two tsps., sometimes even less).

I think the codeine is also doing a number on her. She sat, motionless and glazed, for a good half-hour this morning. She’s a small, sensitive cat, and I’m wondering if it’s just too much/too strong… as well as how long it’s actually needed. The vet said to give it to her for five days (2x per day), but I almost want to NOT give it to her tonight (which would be dose #7 of 10) to see if that actually helps her feel better.

But I don’t want to do so if she’s still in pain and needs it — is there some way to know, or some signs she’d be exhibiting if her current state was due to pain?

She just finished another cluster episode, and is now hiding under my bed with poopy haunches. This is how each episode concludes… and sometimes how they start. If she’s under the bed, I know she doesn’t feel well. If she’s in my lap or walking around the house, I know she’s feeling better.

By 6 or 7 each night, she’s usually back to herself, personality- and activity-wise, just with an iffy appetite… and she stays that way until about 8 or 9 in the morning. Then, she becomes very subdued, a bit withdrawn, dazed, etc., and her appetite wanes further.

Sorry for the long, rambling, disjointed post, I just feel so bad for her and want to help her feel better. The vet’s office hasn’t been overly helpful — my vet only works in the clinic three days a week, so when she's not on duty, it’s hard to get advice/answers or consistency of care from the other staff.

And I haven’t slept more than a few hours a night for the past four nights, so my brain’s a bit fried!

 

[daftcat75]

Even though it’s runny and seems urgent, do you think there might be some constipation at play? Perhaps the runny spoonfuls are just the liquid part that’s able to get past? When Krista had clostridium, it was no small affair. She had blowouts. I had to tape pee pads halfway up the walls and had four boxes for one cat.. Now when she had lymphoma, that was another business. That was two or three rounds of increasingly smaller pudding drops. Each round increases the chances that she was going to put one on the carpet. And after round 3, if it went out that far, she’d usually throw up as well.

(Actual CENSORED footage. )

I’m not suggesting that Gracie has lymphoma. But it is possible that the codeine is constipating and maybe you’re seeing the dam leaking until it breaks.

I would not take away the codeine. It’s easier to stay ahead of pain than it is to catch up to it. Use it up like the doctor prescribed. I don’t know how it is in Canada. But in US, buprenorphine is prescribed instead and it’s a controlled substance. Even for veterinary use. They don’t prescribe it liberally. In other words, the vet probably considered how long it should be given in the amount that was prescribed to her.

If you do suspect there may be a constipation element to this, you can reduce (but don’t eliminate) the SB.

The SB can take a few days to work. In cases of severe gut imbalance or a bug like c perf (a particularly nasty strain of clostridium), it can take weeks or months to balance things out again. When Krista had c perf, it took a couple months to resolve. Betty doesn’t have diarrhea. So I haven’t done a diarrhea PCR for her. But that would be useful for Gracie to determine if there is a gut bug like c perf behind this.

I would keep giving the SB, maybe in 1/8 capsule amounts which is awfully ridiculous to try to measure out. But if you can do a 1/4. You can split that once more. With SB, it doesn’t have to be precise. But it can constipate at higher doses—and your pills are twice the strength of the recommended brand and its dosing protocols.

So use up the codeine. That’s three more days. That’s also the time it takes to build a steady state of SB. Perhaps give it another three days after the codeine for her to get that all out of her system. If she’s still puffing poopy (or worse), grab a sample as best as you can and take that in for a diarrhea PCR. That would rule in or rule out a gut bug like c perf. The most effective treatment for c perf is SB. So it’s not a terrible thing to wait on the PCR until she’s done with the codeine.

Of course if the vet wants to and can see her earlier, a physical exam to feel for backed up poop or imaging to search out things like inflammation may also be next steps to consider.

 

[GraciesParent]

Yikes. All of that sounds super-scary. And now I'm worried I've given her too much SB. I had no idea that too much of it = possible constipation.

Also, of course, I read your post above about 10 minutes after deciding to give Gracie her antihistamine (2.5mg cetirizine hydrochloride) -- which I'd stopped giving her the day before her surgery -- instead of her codeine tonight.

When she stops her daily antihistamine (at any other time during the year), she gets very subdued, loses her appetite and basically behaves like the saddest clown in the world. By the morning after I restart the antihistamine, she's perked up, eats REALLY well, etc. So, I started to wonder if Gracie not having had her antihistamine for the past five days might be contributing to her current state. I checked with the vet clinic today to see whether it's safe to have her take BOTH the antihistamine and the codeine, and the vet tech said the vet on duty said yes. But my vet wasn't working today, and I'm not 100% confident in the tech's reply. I really don't want to risk Gracie being dangerously over-sedated (the antihistamine already makes her a bit drowsy) or worse.

I can always switch back to the codeine tomorrow morning, if needed.

Interesting point about Gracie possibly being constipated, although I doubt it. She had a big normal poo right before I took her in for her dental, then a smaller normal poo once she came home that night, so she was pretty cleared out by the time the diarrhea began less than 24 hours later, especially after having fasted.

Also, yesterday, the same vet tech said unscented baby wipes might help soothe Gracie's bum, so I picked some up and used them (as best I could) last night, just holding them against her bum for a few seconds at a time and trying to wipe away some of the poo, but just now -- in a bid to figure out why Gracie's so listless today after being perkier last night/this morning, and thinking "maybe it's something in the wipes?" -- read that you should absolutely NOT use baby wipes on a cat. At all. <sigh>

So, now I'm worried I unknowingly covered her behind in toxic chemicals, or have inadvertently caused (instead of cured) digestive issues with too much SB, and THAT'S why she's behaving oddly today.

Of course, it could also be very simple: she had dental surgery a few days ago and has diarrhea, and she just isn't herself because both of those things were/are unpleasant and unsettling for her.

 

[daftcat75]

In case you missed it, because I know how much I spew out sometimes, and because I know all too well how exhausting cat health issues can be...

Begin quote:

"
Give one-quarter of the 250mg / 5 billion CFU capsule every two hours or so. Many cats accept it when mixed into finely ground poached chicken breast / turkey breast / pork loin or meat-only baby food. (Beech Nut, Goya, and Gerber list “meat” and broth or gravy as ingredients. These are fine, they are referring to the water used to cook the meat, and they contain no spices). If your cat does not like the taste of the probiotic, you can syringe after mixing with water. If you are not experienced syringing liquids into your cat, you can use empty #3 gel capsules. Simply fill 10 to 20 of these by transferring the S boulardii from the larger capsules into the smaller ones. These are a size easy to pill your cat. Pill your cat with one #3 capsule filled with S boulardii every two hours or so. For pilling instructions, see How to Pill (Your Cat).

This frequent dosing method usually stops diarrhea within 24 – 48 hours, other than when diarrhea is caused by another disease that requires treatment (low B12, exocrine pancreatic insufficiency, hyperthyroidism, as examples). This “loading dose” can be continued for longer if necessary, up to three to four days – but if you do not see substantial improvement in the diarrhea on day 3, it is best to follow-up with your veterinarian. It is NOT necessary to use this approach, it can be given at “therapeutic” doses as discussed above twice a day (and doubled if you see improvement in stool but diarrhea or soft cow patty stools have not resolved).

When the diarrhea has substantially resolved with use of the emergency stop treatment protocol, begin use of S. boulardii at the therapeutic dose level (2.5 billion CFU twice daily) and continue for at least one week. If stools soften, resume use of S. boulardii at the therapeutic dose as needed. Given its role in improving performance of bacterial probiotics and its anti-inflammatory properties, the use of S boulardii at maintenance levels (anywhere from 500 million CFU to a total of 2.5 billion CFU daily) can be continued indefinitely along with a bacterial probiotic. It confers many health and GI protective benefits, and we use it along with bacterial strains in all of our cats, all the time. "

Source: My Cat Has Diarrhea - What Do I Do?

So give it a few days, at least until she's done with the codeine, and then follow up with your vet if it's still not resolving.

 

[GraciesParent]

Thanks very much for reposting that link — I know I saw it back when you posted it previously, but I hadn’t clicked on it until now. I feel MUCH better that I haven’t faffed up.

And I just wound up giving Gracie a half dose of the codeine because she was licking her bum raw, non-stop, tonight, and I figured it might help take the edge off for a while so the area gets a break. She is clearly stressed, distressed and uncomfortable from the diarrhea.

 

[GraciesParent]

Just got back from four hours at the emergency vet. After a miserable night, with Gracie running back and forth to the litter box, she started vomiting around 1am, so I wasn't taking any chances. A slew of tests and exams revealed an impacted left anal gland and mild dehydration. Blood work all fine, abdominal x-rays clear, extraction site fine. The vet figures a lot of Gracie’s current issues have been brought on by stress, compounded with more stress.

She’s now home, trying in vain to use the litter box. I asked them to cut her bum hair, which they did. She got an anti-nausea shot, a painkiller, sedative, antibiotic/steroid spray for her behind, and cone. She’s been so panicked and agitated since coming home that the vet said to take the cone off until she settles.

It’s all been horrible, frankly.

 

[mrsgreenjeens]

Oh gosh, I'm so sorry you and she are going through all this. Did they happen to mention whether or not she can come off the codeine at this point?

Using a spray on a cat is always tricky as they hate the sound of sprays or spritzers for some reason. If you have trouble getting it on her, you can always try putting it on a cloth first and then holding the cloth up to her hind end.

You can also try playing some cat music for her to help her de-stress. And remember, she easily picks up on YOUR emotions, so try to stay calm. This too, shall pass.

 

[GraciesParent]

Thanks mrsgreenjeens . It really has been a pretty horrible few days for Gracie and me.

Yup, the ER vet said I could switch her to gabapentin, which I already have on hand for her pre-vet anxiety.

And Gracie is scared of spritzers, so we’ll see how that goes.

Right now, my challenge is getting her to eat. Her last meal was 10pm yesterday, but she threw it up at 1am. I boiled some chicken, but she refuses it. And the ER vet said not to give her the A/D, as it’s too high in fat for her system right now. It’s also the food she ate and threw up at 1am, so I’m avoiding it.

I took the cone off, but it made no difference.

To help with her stress, I have Feliway Optimum plugged in, and Feliway Classic in another room. YouTube calming cat music will be next.