Post Op - Teeth Removed - Not Sleeping

[G-Factor]

Hello everyone, first post. I thought I would share my experience for others and to post a question. Please skip below for the question.

My cat Oreo, a rescue, has been with me for about 4-5 years and being approximately 10-11 years old. He has had various health issues, some breathing issues which seems to reside neck up (chest is fine via checkups) and in the past year a battle with stomatitis. We were trying to maintain his health and appetite with Prednisolone, which was working but unfortunately not well enough. 3 days ago I had him in to remove all remaining teeth.

This was an extensive surgery. Oreo has now been home for 72 hours, here is the progress.
- Day 1. Day or surgery. Hiding and pain control. Vet has administered some pain control when leaving the office. Oreo pretty much kept himself to one or two comfort spots once home. He didn't eat or drink anything. Eyes are dilated, he didn't sleep from what I can tell.
- Day 2. More of the same. I administered doses of buprenorphine for pain control. Oreo still hasn't eaten or drank any liquids. Eyes are still dilated and still hasn't slept (I keep watch on him with a webcam). By end of day 2, I get worried because I believe he may be getting dehydrated. I visit a 24/7 vet for check, they administer some liquids under the skin. I stop the Buprenorphine because this can cause appetite and insomnia issues in the some cats. I cannot confirm if he slept at all during the night.
- Day 3. Today. I visit my regular vet for follow-up. Some minor issues with gums, but mostly good checkup. Expresses concerns with Oreo not eating or drinking liquids. Our vet gave Oreo B vitamin shot and something in the ear (liquid) which is supposed to kickstart his appetite. I also prepared by getting some syringes in case I need to force feed water and food. Once Oreo was home after the shots, he was immediately different, he ate for the first time and I spoiled him with as much liquid(y) soft cat food he can eat. He still hasn't drank anything, but I feel better knowing his has soft cat food in him. Oreo still is hiding at times (probably from me as I think he is expecting another visit to the vet), but for the most part he is doing fine. He is loving all the attention and extra pets. His tail is still down for the most part which signals he is still in pain, but perks up when I talk or pet him. He still hasn't slept from what I can tell.

Q: My question to the group, has anyone experienced a cat post-op who hasn't slept in 3 days? It's been 72 hours after surgery and Oreo still hasn't slept (from the best of me watching him). He seems comfortable, curls up in his bed(s), but doesn't close his eyes.

 

[white shadow]

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Hi G-Factor and welcome to the forum !

You said:

Vet has administered some pain control when leaving the office.​

Can you find out exactly what that drug was ?
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[G-Factor]

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Can you find out exactly what that drug was ?
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From the invoice, it was a Buprenorphine injection.

 

[white shadow]

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Now, I did say "exactly".....so, what exactly does the invoice state?

Perhaps it is as you just wrote...but, that is also a generalized description of what and how the drug was supplied.

Here's what I'm getting at: there is a long-acting ("sustained release") version of buprenorphine - some people refer to it as "Bup SR") which also has a proper tradename (which I can't remember atm)....and which has had several reported very similar adverse reactions in some cats here on this forum. Those cats have similarly not slept, some have demonstrated even more agitated behaviours etc. These were very disturbing accounts.

I don't have time atm to search for you now, but can later.

If that's what's behind what you're seeing, then understand that those cats' symptoms did resolve, but it did take a total of several days.

Check the invoice again....perhaps call, speak to the Vet and determine exactly whether/not this "extended version" was what he received.
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[G-Factor]

Hello white shadow, thank-you for your responses.

The invoice just states 'Buprenorphine 10mg/ml inj'. In response to what you have stated, I believe it would be the non SR version. The vet sent me home with 6 doses of Buprenorphine oral medication 0.1ml which was to be administered the following day, then every 8 hours afterwards. This states to me that the original injection was non SR.

I did administer an oral dose of Buprenorphine on Tuesday morning at 8:00am, then a second dose at 4:00pm. During the evening, I found some articles on effects of Buprenorphine and cases of insomnia in cats, I discontinued any further doses. It has been 48 hours since the last administered oral dosage. I would suspect this has cleared his system by now.

At the vet today, Oreo received a Mirtazapine transdermal gel on his ear to stimulate eating. Since we are not administering Buprenorphine anymore for pain, he is now getting Codeine transdermal every 6 hours for the next 5 days.

Hope this answers your questions clearer now that I understand your intent.
Cheers

 

[pipperoo]

My cat Pip had a full mouth extraction 7 days ago. She was on bupenorphine every 8 hours for the first three days, then every 12 hours for two days.
For the first 36 hours or so, she did not sleep and retreated under the bed. She wouldn't eat what I put down for her even though I opened a few different cans to try to tempt her with different flavors. What finally worked was I fed her directly out of my cupped hand. I would put a spoonful in and hold it up for her and she took it!
After a few days, I was getting very tired of hand feeding so I switched to spoon feeding (also successful). I think the poor kid was just confused and a bit uncomfortable with her new mouth so she didn't really know how to eat. Finally today, I put down a plate of her usual pre-surgery food (commercial raw) and she ran over and gobbled it up on her own.
Good luck with Orea--sounds like he had the long acting bupenorphine, which I remember my previous cat having and she was definitely NOT HERSELF for 3+ days.

 

[G-Factor]

My cat Pip had a full mouth extraction 7 days ago. She was on bupenorphine every 8 hours for the first three days, then every 12 hours for two days.
For the first 36 hours or so, she did not sleep and retreated under the bed. She wouldn't eat what I put down for her even though I opened a few different cans to try to tempt her with different flavors. What finally worked was I fed her directly out of my cupped hand. I would put a spoonful in and hold it up for her and she took it!
After a few days, I was getting very tired of hand feeding so I switched to spoon feeding (also successful). I think the poor kid was just confused and a bit uncomfortable with her new mouth so she didn't really know how to eat. Finally today, I put down a plate of her usual pre-surgery food (commercial raw) and she ran over and gobbled it up on her own.
Good luck with Orea--sounds like he had the long acting bupenorphine, which I remember my previous cat having and she was definitely NOT HERSELF for 3+ days.

Thank-you pipperoo for sharing your information. It's good to compare notes on recoveries. Oreo ate again for the second times today, he ate twice what he usually does, without much coaxing. Go Oreo! I was watching him eat and yes, just as you said he is learning to adjust to not having teeth. Must be very confusing for him! I have another cat who doesn't have any teeth except for his large K9's and he gobbles up food as fast as any other cat I've seen. I know in the end this doesn't slow them down. I hope your little one is adjusting well and continues to thrive. Cheers.

 

[LTS3]

Are you giving the buprenex correctly? It's not given like liquid medicines. You just squirt the buprenex in between the gums and cheek where it will be absorbed. If the cat swallows the buprenex, the medicine will have no effect on pain.

 

[G-Factor]

Are you giving the buprenex correctly? It's not given like liquid medicines. You just squirt the buprenex in between the gums and cheek where it will be absorbed. If the cat swallows the buprenex, the medicine will have no effect on pain.

Hello LTS3. No, I've discontinued the Buprenorphine a couple days ago in case this was affecting his sleep. Thanks for checking in and yes it must be applied correctly to be absorbed. Cheers.

 

[white shadow]

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Back again.

OK - so now it's codeine......I'll be interested to hear whether/not - or, better, what, if any odd/unusual reactions you may see with this. I wonder if he'll be able to catch some zzzzz's!

It is somewhat comforting to hear of other similar accounts, especially when recovery was achieved - as in pipperoo 's case.

Yes, there are authentic reports of the reaction Oreo experienced, though the more common reactions are of sedation.

I have an older copy of Plumb's Veterinary Drug Handbook and interestingly, while it only mentions sedative effects for buprenorphine, it includes this for codeine:

"In cats, opiates may cause CNS stimulation with hyperexcitability, tremors, and seizures are possible."​

In my cats (after dental surgeries), I saw a very 'pleasant high' with kneading and lots of purring and rubbing against me....as well as sedation.

Great to hear that the appetite is back - it sounds like he's out of the woods.

FWIW for future reference purposes, good practice these days - especially for severe pain - is to use more than one agent for pain management. "Multimodal Pain Management" involves using two or three drugs, each targeting different pain pathways. This also allows for a reduced quantity of all drugs. Typically, an opiod, a Non-Steroidal Anti-Inflammatory (NSAID) and an "adjunct" drug are used: Focus On Pharmacology | Management of Chronic Pain in Cats.

One of mine was in palliative/hospice mode for many months and experienced excellent quality of life (with Bupe, meloxicam and gabapentin) right up until his lungs became involved.

So, keep us posted............and, btw, we never...ever...refuse pictures of the patients discussed in this forum
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[G-Factor]

Thank-you again for the excellent post white shadow. This is the reason why I joined up the forum and posted here.

I'm a bit more content knowing that Oreo's non-sleeping isn't an abnormality, though it still is concerning that he hasn't' slept yet. I would suppose that at some point, he will get tired and snooze.

I have noticed a difference in Oreo's personality in the last couple days. He has been more energetic, affectionate, and generally looks happier. I don't remember his purr engine being this loud before. This may be partially attributed any problem teeth that have been extracted, relieved of the pain. I'll keep checking back in and update this thread.

And here is a couple pictures of the guy everyone is helping.

 

[white shadow]

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WOW - that last one, his profile, struck a chord here. Stryker, the one of mine I 'nursed out', was so similar




Yes, I'd say it's a relief for Oreo to be pain-free for sure. As well, that euphoria you're describing sounds to me like the 'high' I mentioned having seen in my guys. So, maybe it's a combination of these.

Thanks for the pics!
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[G-Factor]

An update to the thread for future reference.

Oreo is returning to normal.

He was wide awake for nearly 4 days before I started to see him start to put his head down and eyes start to close. By the fifth day he was sleeping normally. I'm not if this was his natural response to the teeth removal and visits to the vet, or perhaps medication has some part in this.

Oreo ate his first full meal today, which is 5 days after taking him home. There were times he was interested in food and would hover over the dish, smell the food but never eat. There were times he was just pull away when food was introduced. I had to force feed Oreo over the past couple days with a syringe and wet cat food with additional water added resembling a thick soup. He lost some weight through this, but I expect the weight to return with problem teeth removed and hopefully being pain free.

That's all. Thanks to everyone who contributed.

P.S. Love the picture of Stryker, I understand your statement on striking a cord. What a handsome guy, I'm sure he is missed.