Tooth resorption pain, elderly cat

[Catstmq]

Hi,
My 17 and a half year old cat, Zara has bad dental pain, thought to be due to tooth resorption (although she’s not had an x-ray).

Her appetite had been slightly reduced and she’d dropped a bit of weight, down to 3.6 kg (from 3.9, she is a small cat). I took her to the vet who ran blood tests and they were pretty good, her urea was slightly elevated and creatinine within normal range. The vets do think this could mean the very early stages of CKD. She has an overactive thyroid which is controlled by hills y/d diet and her thyroid results were well within normal range.

Since this vet visit 8 days ago her appetite has reduced much further, she’s eating barely a quarter of what she should be eating and only with coaxing and hand-feeding. It’s become obvious that this is due to dental pain. I took her back to the vet two days ago and explained that I can see her mouth is hurting and it’s causing her to stop eating. He looked and saw a fractured tooth which he thinks is due to tooth resorption. I’ve been given a low dose of painkillers. The vet is hoping that the tooth will be resorbed in a couple of weeks.

I don’t know if this is likely – I’m not seeing much on the internet about tooth resorptions resolving themselves and I’m seeing a lot of advice saying extraction is the only solution.

I did mention dental surgery to the vet but he said he would only want to anaesthetise a cat of her age if it was ‘a disaster’ – but I’m worried that as time goes on and she doesn’t eat this is just going to become a bigger disaster and a big anaesthetic risk.

I was wondering if anyone had any advice or experiences they could share? Has anyone ever had a painful tooth resorption resolve – and if so how long did it take? Any thoughts on anaesthetics for older cats? She’s been living a happily sedate, comfortable life up until now but now she is withdrawn, in pain and barely eating. 

[meriad]

I'd find another vet and ask for a second opinion. If she's in pain and not eating then the eventual weight loss (and stress from pain) - and potential toxins caused by the tooth would do more damage in the long run I'd have thought? Yes, the anaesthetic will have it's risks - they all do, even for for a younger cat. Your vet should give your girl fluids before the op (and if need be during or after) to give her the best chance and keep her in for close monitoring a good few hours afterwards

Raised urea and creatinine levels in older cats is actually quite normal - their kidneys do slow down as they get older; it's just one of those things with all of us as we age.

Personally (I know it's harsh) I'd rather run the risk of losing my pet under anaesthetic than have it in constant pain and not right - it's not fair on the pet

[booktigger]

I agree with Ria, I would speak to a second vet - raised Creatnine can be a sign of infection, so the levels could be high just because she has dental issues. I've had much older and poorlier cats go through dentals, as long as they do fluids, it does reduce the risk. I can't see how the tooth can resorbed.

[Catstmq]

Thanks a lot for responding guys. What you're saying matches what I'm thinking. I'm terrified of putting her under anaesthetic but I think it's probably what needs to happen.
I will speak to the current vet first and tell him I'm worried about this approach and see what he says. Then I'll seek a second opinion if he doesn't agree. I actually drive past another vet clinic to get to this one as I generally like and trust them and both of my cats have been operated on there before.
Thanks so much.

[MarkB]

My only experience was about 6 years ago, so my memory of it is a bit sketchy.

Our cat, Clpton had needed several dentals over they years since my OH adopted him from a rescue with mouth problems. He had teeth removed by at least 3 Dentists. He was already quite ill with stage 4 kidney disease, but my vet at the time said he needed to do x-rays. He found fragments of tooth in Clapton's gums from previous extractions. My vet said they had been bodge jobs and that any remaining tooth fragments after a dental should be atomized (I think that was the word vet used) to make them small enough for the body to reabsorb, otherwise, as in Clapton case, thy can cause problems down the line. He aid that Clapton's gums were infected and the only option was to operate to remove them, otherwise it would spread and cause his jawbone to turn necrotic - not to mention the fact that he was in great pain. It was quite serious surgery, which involved cutting his top and bottom gums open, but the vet said that despite his age and existing state of health, it needed to be done, otherwise it would be kinder to let him go. We went ahead with it. He obviously needed Metacam, as well as Vetergesic after the op. Several days later, we had to call the vet back for a home visit to give him more Vetergesic. He seemed to be getting better, but went downhill with his kidneys shortly after that.

Hopefully your situation isn't as severe, but just to point out what I was told about reabsorption.

[Catstmq]

Thanks @markb. I'm sorry about Clapton. Minuscule fragments of tooth I can imagine being resorped like your vet said but this is a whole tooth.

We've been to the vet and had an antibiotic injection and an appetite stimulant. She's still on a low dose of metacalm too. The appetite stimulant is very effective so far although I just hope she's not hurting too badly. We're back on Friday morning and it's likely she'll have surgery then. Hopefully she's strong enough to get through it.

[Crewella]

Poor girl, surgery does sound like her best option at this stage. I've had several oldies who've sailed through dentals in their mid to late teens, so everything crossed that she does too.

[booktigger]

Good luck for Fri

[meriad]

best of luck for Friday from me as well

Just do speak to the vet before again and make sure they'll be on top of the fluids

fusses to your girl x

[Catstmq]

Thanks so much everyone for the good wishes and advice. @meriad, I will do as you suggest and check about fluids.

I was surprised at how effective the appetite stimulant was. It's obviously in no way a long term solution or helping with her pain but it was lovely to have her eating well and being active and sociable last night. Hopefully it'll let her get her strength up a little for surgery.

[meriad]

Crossing fingers for Zara for today - hope all goes well.

What time can you call to see how she's doing?

[Catstmq]

Hi, I've just had a call from the vet. They did some blood and urine tests and the urine tests show she has a 'raging' urinary tract infection. She'll not have surgery today, they're treating the infection with antibiotics and fluids, probably keeping her overnight. The vet thinks this could be a big factor in her lack of appetite. I guess we'll see when she's clear of the infection.

Thanks so much again, I don't tend to use online forums (well I read them but don't post on them) but it's been so nice. I'll update on how she recovers from her UTI.

[meriad]

Please do let us know how she gets on... the infection definitely could be the cause of the loss of appetite. Fingers crossed she feels loads better in the morning.

[Crewella]

Poor girl, that definitely could be the cause. I wish her better soon, and please do keep us posted.

[booktigger]

Aww, poor thing. Fingers crossed for her

[Catstmq]

Hello, just to update, Zara is home, she's eating and looking a bit better although she has just been sick. It does seem that the urinary tract infection is at least her biggest problem and the biggest factor in her lack of appetite so hopefully after more days of antibiotics she'll be a lot better xx

[Crewella]

I'm glad she's home, and hopefully on the mend.

[Mayday21]

She'll feel better now she's home. Hope huge improvement is seen. Fusses to the fur babe. Vivian

[Catstmq]

Hi, just thought I'd give an update although I'm not too sure what the situation is! Zara's doing better than she was but still not eating enough to put on the weight she's lost. She was a lot better and eating really well for a couple of days when she came home from the overnight fluids and antibiotics but then that sort of tailed off and she was eating less again.
I took her back to the vet last night. They tested blood creatinine and urea again because it had gone up with the uti and it was normal. They've extended the course of antibiotics and asked that I get a urine sample at the end of it. They gave her some sub-Q fluids. She also got an appetite stimulant at my suggestion because it worked well before, she seemed quite cheery on it too and I hate seeing her dropping weight. I know that doesn't address the root of the problem though.
Additionally, she's had watery eyes and sneezed a few times so it looks like there's maybe an upper respiratory tract virus going on too. Probably the stress of all the vet visits!
So, yeah, bit of a long story . She is doing ok but not really any better than ok. I'm hoping she's maybe just got a bit out of the habit of eating with everything going on and that the appetite stimulant might kick start her appetite.
Hopefully have a better update next time! X

[Crewella]

I hope so too!

It's quite possible that she still has the tooth problems going on in the background, I guess. There have just been other issues over and above that that have needed immediate treatment. See how she goes, and keep us posted. xx

[Catstmq]

Hi, so the vet has never seemed convinced that dental issues were the main cause of Zara's loss of appetite, although blood and x-Ray results had been alright. Today she had an ultrasound scan and it turns out she has a mass on her kidney and enlargement on adjacent lymph node.
The vet has suggested that I take the weekend to consider whether I want to go with palliative care only or be referred to the university to have a biopsy then determine whether chemo is an option and whether it's one we want to try.
It's not a good turn of events and although at nearly 18 I couldn't realistically expect very many more years with her she's always been pretty good for her age and I had hoped for a good few years. I'm completely on the fence, I think I need more information on how invasive the biopsy is, how traumatic the chemo will be and how long it might give us.
Right at this moment she is fine, she had fluids at the vet and she's eaten well and is purring, sociable, mobile although I don't expect to see her on top of the wardrobe anytime soon!
I said I would update, sorry it's taken a while and then not been good. It's been all limbo, tests and then this. Hope everyone and their furry ones are well xx

[booktigger]

I'm so sorry to hear this. One of Busters kidneys died a few years ago, my vet said that if it was cancer the only option was palliative due to the fact that kidney cancer is normally a secondary cancer and aggressive due to the kidneys function. Good luck

[Crewella]

I'm sorry to hear this too, it's a difficult decision and you're right to try to gather as much information as you can before making it. I'm glad to hear she seems comfortable, though - long may that continue. (((hugs)))

[Catstmq]

Hello, I just wanted to say thanks again for everyone's kind wishes and let you know that Zara sadly passed away on Friday. She did OK although her appetite and weight never recovered she was well, mobile and happy enough for those weeks until she took a dip and was struggling to walk and making sad mews .
I took her to the vet saying 'maybe fluids, maybe painkillers' but I think I knew really, also her weight had dropped further so the heartbreaking decision was made.
Sorry, reading about other people's losses always makes me think of my own and cry! Thanks again for advice and good wishes xx

[booktigger]

I'm sorry to hear this, but glad you got a good couple of weeks with her. RIP little one