Ping Phil: dental cleaning after Metacam injection?

Hi Phil,

I have been reading more about Metacam and the more I read, the more
scared I get. Kotyo was given an injection of it yesterday (Monday), and
the vet and I talked about scheduling a dental cleaning for Thursday or
Friday. But now I don't know... The anesthesia for the dental will put a
strain on his kidneys, and he had the Metacam injection already... From
what I read, it is supposed to be a single-use injection only, and also
it should not be given together with other NSAIDs. And Kotyo will need
some kind of anti-inflamatory/pain relief after the cleaning. Should I
ask the vet to prescribe Tolfedine instead? He was on it 1.5 years ago
when he had a particularly bad cystitis flare-up, and it didn't seem to
do him any harm. But Tolfedine is also an NSAID, so I don't know if it
will be ok for him to have it 3-4 days after the Metacam?

With all these doubts, I have pretty much decided that I will postpone
the dental for now. Kotyo has lots of tartar on his teeth, and also
gingivitis, plus those 2 sores/lesions at the back of his mouth, but
surely that's something that he can live with for a few more weeks or
months, until the Metacam is completely out of his system and it is safe
to give him Tolfedine after the dental?

I know this is stuff I should be discussing with the vet. But how am I
supposed to trust her when she gave me the oral Metacam to give to
Kotyo? It's the dog version, which I read has 3 times more Metacam in it
than the cat version (1.5 mg/ml as opposed to 0.5 mg/ml). I've started
looking for a new vet, but of course there's no way of knowing if the
new vet will be any better until there's a problem with one of my cats.
Still, I'll be going to a few vets in the area, tell them the whole
sorry tale about the Metacam, etc, and ask their opinion. And I'll
choose one depending on what they tell me, and also on the type of
anesthesia they use for dentals (the current vet told me the name of the
product they used, but I couldn't find it at all when googling - it is
most definitely not isofluorane, which is what my Kotyo had at his last
dental in Canada).

Nadia and Kotyo


--
Little Monster pictures: http://picasaweb.google.com/nnakova/Kotyo
Sweety pictures: http://picasaweb.google.com/nnakova/Sweety
Kotyo and Sweety together:
http://picasaweb.google.com/nnakova/KotyoAndSweety

Nadia N. wrote:
Hi Phil,
snip

With all these doubts, I have pretty much decided that I will postpone
the dental for now.
snip


Well the dental cleaning question is now moot. The vet called a little
while ago with the results of Kotyo's blood test. His BUN is within
normal range, but creatinine is 2.1 (she said the normal is 1.5). Also
his cholesterol is a bit high, but she didn't say how high. I'm going
there tomorrow to pick up a printout of the full test results.

So the vet said she doesn't want to risk a dental at the moment. She
wants to put Kotyo on Fortekor and Ipakitine, as well as switching him
to Hill's k/d (currently he eats mainly Hill's Chicken and Liver with a
snack of pure chicken white meat in broth - it's a German canned food
called Porta21 Feline).

I am going to ask about doing a urinalysis as well when I pick up the
blood test results tomorrow. I know we should check the USG (urine
specific gravity).

I do have another question though. Could drinking a lot of water make
creatinine levels higher, even though there's no problem with the
kidneys? I have been adding a lot of water to Kotyo's wet food at every
meal (3 times per day), to get him to urinate more often. If I don't do
that, he will hold it for 24 hours or more, and that leads to cystitis
flare-ups. We're not talking a couple of tablespoons of water per meal
here. I'm not sure how much it is exactly, but I put about 1/2 a 5 oz
can of wet food in his dish and then add enough water to fill the dish.
Because of the added water, the last time we did a urinalysis for Kotyo
his ph was a bit lower than normal, but not too much so. But all this
water must make his urine very dilute - that is one of its purposes, so
it doesn't irritate his bladder and cause the cistitys to flare up). So
I wonder if the higher creatinine is due to that... I'll be asking the
vet as well, tomorrow.

Kotyo is also a big, well-muscled cat - he weighs 6.1 kg and it's all
muscle. I read on http://www.felinecrf.org/diagnosis.htm#which_tests
that "Because creatinine is a by-product of muscle, large, muscular male
cats may naturally have high normal levels of creatinine." Spanish cats
are pretty scrawny and small, and I wonder if the labs here have a lower
"normal" range of values for creatinine. I guess I am sorta grasping at
straws, hoping to find an explanation for the blood tests which is not
kidney problems...

I'm not sure how this is going to affect my search for a new vet. I
don't think that I'll be changing Kotyo's diet or giving him the
medicine this vet wants to prescribe before I've talked to a few more
vets about the test results. I just don't trust her enough. Now that we
know that there's a possibility that he has kidney problems, if I had
given Kotyo the Metacam she gave me, at best it would have made the
problems worse, and at worst... To be fair, when she called with the
blood test results she did tell me to not give him the Metacam, but that
was 24 hours after our vet visit - by the prescription she gave me, I
should have already given him the first dose.

Sorry for the long-winded post. I guess I talk too much when I'm scared,
and I am pretty scared right now. Kotyo is not quite 9 yet (2 more
months till his 9th birthday), and he should not be having kidney
troubles at this age...

Nadia and Kotyo


--
Little Monster pictures: http://picasaweb.google.com/nnakova/Kotyo
Sweety pictures: http://picasaweb.google.com/nnakova/Sweety
Kotyo and Sweety together:
http://picasaweb.google.com/nnakova/KotyoAndSweety

El Kot wrote:

Котьо is such a nice чудовище so sorry to hear about his
problems. Unfortunately I don't know much about creatinine levels and
their relation to muscle size in cats, so can't help. You're saying
"Spanish cats" - are you in Spain proper, or just another
Spanish-speaking country?


Hehe, thanks. Somehow "little monster" sounds nicer than "chodovishte".
I do call him "dzver" from time to time, when he's trying to shred my
hands :-)

And yes, I am in Spain. The cats I've seen here - at shelters, feral
colonies in the park, and pet cats met at the vet's, are so much tinier
than Kotyo. And the vet and her receptionist are always commenting on
how huge he is and asking if he's part Maine Coon.

And I see that you have your own pretty black and white kitty, Unche.
She does look like a little princess. Pretty as a picture.


--
Little Monster pictures: http://picasaweb.google.com/nnakova/Kotyo
Sweety pictures: http://picasaweb.google.com/nnakova/Sweety
Kotyo and Sweety together:
http://picasaweb.google.com/nnakova/KotyoAndSweety

Suddenly, without warning, Nadia N. exclaimed (3/9/2010 12:07 PM):
Hi Phil,

I have been reading more about Metacam and the more I read, the more
scared I get. Kotyo was given an injection of it yesterday (Monday), and
the vet and I talked about scheduling a dental cleaning for Thursday or
Friday. But now I don't know... The anesthesia for the dental will put a
strain on his kidneys, and he had the Metacam injection already... From
what I read, it is supposed to be a single-use injection only, and also
it should not be given together with other NSAIDs. And Kotyo will need
some kind of anti-inflamatory/pain relief after the cleaning. Should I
ask the vet to prescribe Tolfedine instead? He was on it 1.5 years ago
when he had a particularly bad cystitis flare-up, and it didn't seem to
do him any harm. But Tolfedine is also an NSAID, so I don't know if it
will be ok for him to have it 3-4 days after the Metacam?

With all these doubts, I have pretty much decided that I will postpone
the dental for now. Kotyo has lots of tartar on his teeth, and also
gingivitis, plus those 2 sores/lesions at the back of his mouth, but
surely that's something that he can live with for a few more weeks or
months, until the Metacam is completely out of his system and it is safe
to give him Tolfedine after the dental?

I know this is stuff I should be discussing with the vet. But how am I
supposed to trust her when she gave me the oral Metacam to give to
Kotyo? It's the dog version, which I read has 3 times more Metacam in it
than the cat version (1.5 mg/ml as opposed to 0.5 mg/ml). I've started
looking for a new vet, but of course there's no way of knowing if the
new vet will be any better until there's a problem with one of my cats.
Still, I'll be going to a few vets in the area, tell them the whole
sorry tale about the Metacam, etc, and ask their opinion. And I'll
choose one depending on what they tell me, and also on the type of
anesthesia they use for dentals (the current vet told me the name of the
product they used, but I couldn't find it at all when googling - it is
most definitely not isofluorane, which is what my Kotyo had at his last
dental in Canada).

Nadia and Kotyo



FWIW, Meep has been on Metacam for some months now, we check her kidneys
and liver values regularly, and she's doing fine. She only gets two
drops every three days, and it really seems to help with the arthritis pain.

I'd be happy to hear options for her though, since I know Metacam does
have a bad rep.

jmc

jmc wrote:


FWIW, Meep has been on Metacam for some months now, we check her kidneys
and liver values regularly, and she's doing fine. She only gets two
drops every three days, and it really seems to help with the arthritis
pain.

I'd be happy to hear options for her though, since I know Metacam does
have a bad rep.

jmc

From what I read in the last 3 days (lots and lots of googling), if the
Metacam dose is not right it shows pretty quickly. If she's been on it
for months it's probably ok.

I wish I knew of an alternative, but the only other pain/inflammation
medicine Kotyo has been given was Tolfedine, which is also an NSAID like
Metacam but supposed to be easier on the kidneys. He did fine on it - he
took it in pill form for 5 days in 2008. However that was for a cystitis
flare-up. I don't know if it's any good for arthritis pain relief.


--
Little Monster pictures: http://picasaweb.google.com/nnakova/Kotyo
Sweety pictures: http://picasaweb.google.com/nnakova/Sweety
Kotyo and Sweety together:
http://picasaweb.google.com/nnakova/KotyoAndSweety

"Nadia N." wrote in message
news
Hi Phil,

I have been reading more about Metacam and the more I read, the more
scared I get.

The problem I have with meloxicam is that its classified as a COX-2
selective NSAID-- and it is-- but not it cats. In all the studies I read on
meloxicam in cats there was not a *single* dose-strength where COX-1 wasn't
also inhibited at least 20% - and that dose was so low that it hardly had
any therapeutic effects. At the therapeutic dose of 80% inhibition of COX-2,
COX-1 was also inhibited by more than 40%. For a cat, that ain't COX-2
selective.

Just so you understand what I'm talking about: COX-2 inhibition is
responsible for the analgesic, anti-pyretic, and anti-inflammatory effects
of meloxicam, and COX-1 inhibition is responsible for renal and liver
toxicity and other nasty side effects such as perforating duodenal ulcers-
which are difficult to detect.


Kotyo was given an injection of it yesterday (Monday), and
the vet and I talked about scheduling a dental cleaning for Thursday or
Friday. But now I don't know... The anesthesia for the dental will put a
strain on his kidneys, and he had the Metacam injection already... From
what I read, it is supposed to be a single-use injection only, and also
it should not be given together with other NSAIDs. And Kotyo will need
some kind of anti-inflamatory/pain relief after the cleaning. Should I
ask the vet to prescribe Tolfedine instead? He was on it 1.5 years ago
when he had a particularly bad cystitis flare-up, and it didn't seem to
do him any harm. But Tolfedine is also an NSAID, so I don't know if it
will be ok for him to have it 3-4 days after the Metacam?

The half-life of meloxicam in cats is about 15 hours.



With all these doubts, I have pretty much decided that I will postpone
the dental for now. Kotyo has lots of tartar on his teeth, and also
gingivitis, plus those 2 sores/lesions at the back of his mouth, but
surely that's something that he can live with for a few more weeks or
months, until the Metacam is completely out of his system and it is safe
to give him Tolfedine after the dental?

I know this is stuff I should be discussing with the vet. But how am I
supposed to trust her when she gave me the oral Metacam to give to
Kotyo? It's the dog version, which I read has 3 times more Metacam in it
than the cat version (1.5 mg/ml as opposed to 0.5 mg/ml).


How much did she tell you to give him?


I've started
looking for a new vet, but of course there's no way of knowing if the
new vet will be any better until there's a problem with one of my cats.
Still, I'll be going to a few vets in the area, tell them the whole
sorry tale about the Metacam, etc, and ask their opinion. And I'll
choose one depending on what they tell me, and also on the type of
anesthesia they use for dentals (the current vet told me the name of the
product they used, but I couldn't find it at all when googling - it is
most definitely not isofluorane, which is what my Kotyo had at his last
dental in Canada).

Nadia and Kotyo


--
Little Monster pictures: http://picasaweb.google.com/nnakova/Kotyo
Sweety pictures: http://picasaweb.google.com/nnakova/Sweety
Kotyo and Sweety together:
http://picasaweb.google.com/nnakova/KotyoAndSweety


Great pictures.

Best of luck,

Phil

Phil P. wrote:
"Nadia N." wrote in message
news
Hi Phil,

I have been reading more about Metacam and the more I read, the more
scared I get.

The problem I have with meloxicam is that its classified as a COX-2
selective NSAID-- and it is-- but not it cats. In all the studies I read on
meloxicam in cats there was not a *single* dose-strength where COX-1 wasn't
also inhibited at least 20% - and that dose was so low that it hardly had
any therapeutic effects. At the therapeutic dose of 80% inhibition of COX-2,
COX-1 was also inhibited by more than 40%. For a cat, that ain't COX-2
selective.

Just so you understand what I'm talking about: COX-2 inhibition is
responsible for the analgesic, anti-pyretic, and anti-inflammatory effects
of meloxicam, and COX-1 inhibition is responsible for renal and liver
toxicity and other nasty side effects such as perforating duodenal ulcers-
which are difficult to detect.

So basically it gives them pain relief and works on the inflammation at
the cost of damage to their kidneys and liver. Oh, and bleeding ulcers.
Great.



I know this is stuff I should be discussing with the vet. But how am I
supposed to trust her when she gave me the oral Metacam to give to
Kotyo? It's the dog version, which I read has 3 times more Metacam in it
than the cat version (1.5 mg/ml as opposed to 0.5 mg/ml).


How much did she tell you to give him?


She prescribed 12 drops per day for 5 days. I pointed out to her when I
returned the unopened Metacam that she had given me the dog version, and
she said that it was ok because she had based it on the instructions in
the package which said to give 2 drops per kg. He weighs 6 kg, so 12
drops. But from what I've read online, the cat version also says to give
2 drops per kg. 12 drops of Metacam with concentration 0.5 mg/ml is NOT
the same as 12 drops of Metacam at 1.5 mg/ml. I think Kotyo and I had a
very narrow escape there.


Great pictures.

Best of luck,

Phil


Thank you very much Phil. Since Kotyo's blood tests came back with
creatinine at 2.11, I'll probably be back with lots of questions for you
and others in the group once I have read through the entire
www.felinecrf.org site. My poor little monster is not quite 9 yet. Too
early for him to have kidney damage :-(

Nadia and Kotyo

--
Little Monster pictures: http://picasaweb.google.com/nnakova/Kotyo
Sweety pictures: http://picasaweb.google.com/nnakova/Sweety
Kotyo and Sweety together:
http://picasaweb.google.com/nnakova/KotyoAndSweety

El Kot wrote:

Unfortunatelly, you're in Valencia, from what I can see. If you were
around Alicante or Barcelona, I could ask my daughter's boyfriend (he's
Spanish, and a cat person) to recommend a vet.

Yeah, if I was in Barcelona I could find a cats-only vet. I'm lurking on
a Spanish cat forum and they know of a couple of cats-only vets there.
And some in Madrid, too. But Valencia doesn't seem to have any.

Unche is due to him, actually. She came to him first, and he named
her Uno Perciento (or however you spell 1% in Spanish). She's American,
but even so, considerably tinier than Kotyo, only about 3.5kg (even
though size is not linear with weight). She's incredibly fast, though.
The video is when she was still mostly a kitten. Now she catches the
laser pointer (would you believe it), and jumps about 2 meters up the
wall when chasing it.

Hehe. Unche looked very determined to catch the laser pointer in the
video. Does she get a crazed look in her eyes while she's chasing it? My
Sweety does that while chasing her own tail. She goes completely nuts,
running round and round. She's 2 and still doesn't seem to realize the
big brown fluffy thing she's chasing is part of her. Of course because
her tail is pretty big she actually catches it from time to time, and
sits down to lick it into submission. Silly girl :-)


--
Little Monster pictures: http://picasaweb.google.com/nnakova/Kotyo
Sweety pictures: http://picasaweb.google.com/nnakova/Sweety
Kotyo and Sweety together:
http://picasaweb.google.com/nnakova/KotyoAndSweety

"Nadia N." wrote in message
...
Phil P. wrote:
"Nadia N." wrote in message
news
Hi Phil,

I have been reading more about Metacam and the more I read, the more
scared I get.

The problem I have with meloxicam is that its classified as a COX-2
selective NSAID-- and it is-- but not it cats. In all the studies I read
on
meloxicam in cats there was not a *single* dose-strength where COX-1
wasn't
also inhibited at least 20% - and that dose was so low that it hardly
had
any therapeutic effects. At the therapeutic dose of 80% inhibition of
COX-2,
COX-1 was also inhibited by more than 40%. For a cat, that ain't COX-2
selective.

Just so you understand what I'm talking about: COX-2 inhibition is
responsible for the analgesic, anti-pyretic, and anti-inflammatory
effects
of meloxicam, and COX-1 inhibition is responsible for renal and liver
toxicity and other nasty side effects such as perforating duodenal
ulcers-
which are difficult to detect.

So basically it gives them pain relief and works on the inflammation at
the cost of damage to their kidneys and liver. Oh, and bleeding ulcers.
Great.



I know this is stuff I should be discussing with the vet. But how am I
supposed to trust her when she gave me the oral Metacam to give to
Kotyo? It's the dog version, which I read has 3 times more Metacam in
it
than the cat version (1.5 mg/ml as opposed to 0.5 mg/ml).


How much did she tell you to give him?


She prescribed 12 drops per day for 5 days. I pointed out to her when I
returned the unopened Metacam that she had given me the dog version, and
she said that it was ok because she had based it on the instructions in
the package which said to give 2 drops per kg. He weighs 6 kg, so 12
drops. But from what I've read online, the cat version also says to give
2 drops per kg. 12 drops of Metacam with concentration 0.5 mg/ml is NOT
the same as 12 drops of Metacam at 1.5 mg/ml. I think Kotyo and I had a
very narrow escape there.


Wow! You sure are lucky! The safety margin of meloxicam in cats is very,
very low. 12 drops of 1.5 mg/ml would have probably killed him. I'm so
glad you questioned it!




Great pictures.

Best of luck,

Phil


Thank you very much Phil. Since Kotyo's blood tests came back with
creatinine at 2.11, I'll probably be back with lots of questions for you
and others in the group once I have read through the entire
www.felinecrf.org site. My poor little monster is not quite 9 yet. Too
early for him to have kidney damage :-(


He looks like a big fella- part Norwegian Forrest Cat. I have a gray &
white version with almost identical markings:
http://maxshouse.com/Mine/Sly_Almum_3/index.htm


If he's a well muscled as my cat is, the slightly increased creatiinine
might be normal for him- especially if he struggled a little while you were
getting him the carrier. My Sly's creatinine is also a little above the
normal range and he's only 2 1/2.

Best of luck,

Phil



Nadia and Kotyo

--
Little Monster pictures: http://picasaweb.google.com/nnakova/Kotyo
Sweety pictures: http://picasaweb.google.com/nnakova/Sweety
Kotyo and Sweety together:
http://picasaweb.google.com/nnakova/KotyoAndSweety

Phil P. wrote:
"Nadia N." wrote in message
...


Wow! You sure are lucky! The safety margin of meloxicam in cats is very,
very low. 12 drops of 1.5 mg/ml would have probably killed him. I'm so
glad you questioned it!

If you hadn't mentioned that it's not a good idea to give oral Metacam
to cats, I might not have questioned it. I would like to think that I
would have - I usually do read through anything written on the box and
on the insert inside for any medicine my cats are prescribed, but still
- what if this time I hadn't? The thought of that just makes me sick to
my stomach :-( You probably saved Kotyo's life with just that one
comment on Metacam.


He looks like a big fella- part Norwegian Forrest Cat. I have a gray &
white version with almost identical markings:
http://maxshouse.com/Mine/Sly_Almum_3/index.htm

He probably has some Maine Coone in him. I got him from a shelter in
Whistler. The whole litter were pretty large kittens - twice as big as
another litter of kittens that they were sharing their room with.

Your Sly is gorgeous. And he does look very similar to my little
monster. I love those pink-nosed tuxedo kitties :-)


If he's a well muscled as my cat is, the slightly increased creatiinine
might be normal for him- especially if he struggled a little while you were
getting him the carrier. My Sly's creatinine is also a little above the
normal range and he's only 2 1/2.


He is pretty much all muscle - there's no fat on him at all. He didn't
struggle getting into the carrier - he's a good boy at home. However, he
fought ferociously when they tried to draw blood. He shredded my hands,
and the vet tech's hands too. So that might have caused his creatinine
to be higher as well...

I need to find out if the higher creatinine really means he has CRF or
if it's something that's normal for him. I've been reading up on CRF for
a week and half now, and I wrote another post with questions about what
tests I can have done to confirm or disprove that he has CRF. If you
have time, I'd really appreciate if you could take a look at it.

Nadia and Kotyo


--
Little Monster pictures: http://picasaweb.google.com/nnakova/Kotyo
Sweety pictures: http://picasaweb.google.com/nnakova/Sweety
Kotyo and Sweety together:
http://picasaweb.google.com/nnakova/KotyoAndSweety