Continuned facial discomfort almost 2 months after dental

[Jenna AK]

Hello friends,
I'm dealing with continuing discomfort in my 12 year old girl, Jenna. On December 1 last year she had a dental with four extractions: two lower jaw molars and a canine tooth, with it's neighbor, on her upper left jaw. She'd been pawing at her face and rubbing it on the bedding, plus scratching at her face and ears and having difficulty controlling her tongue. She's already lost most of her teeth, it would probably be easier to tell you which ones she has left but I don't have a current chart.


At first she seemed to do a bit better but the surgery itself was crammed into an already busy schedule which caused me concern as to how thorough they were being; she bled quite a bit more than she has in previous extractions which really scared me and I didn't realize they gave her a nerve block which we've tried to avoid in the past because of how small her face is and history of it causing more post operative difficulties. While she's been seen several times since the surgery and the vet has claimed her surgical sites healed properly and he sees no obvious ear issues, (which doesn't mean she may not have something going on in her inner ear) she did have a fistula at the canine extraction site and it seems to me she's still having discomfort at this spot. I cannot brush (what's left of) her teeth anymore because it sends her off into spasms where she'll scratch and paw at her face furiously, worse than it was before the operation. We've got her on once daily metacam and now have added gabapentin just this last week at 0.2 mls once in the evenings. Honestly she hates the taste which makes her flail at her mouth even more and mealtimes and walks outside in the cold and the wind result in at least an hour of agitation where she's grinding her teeth and rubbing her face or scratching and pawing her mouth and chin.


I'm beginning to despair that we can get her feeling better and the vet we see has no answers for me as to what it can be. Does anyone have any suggestions as to what could be going on and what we can try to help her now? I'm worried the gabapentin is only making her too sedated to care if she's in pain, not necessarily relieving her pain, or that she may have a root fragment in her jaw that's causing issues or maybe the fistula hasn't healed? She also tends to move her lower jaw from side to side in a horizontal motion which she's never done before, usually while falling asleep. It's heartbreaking to see her trying to find relief from whatever is causing her mouth issues and I can't buy the explanation that it's just from her having lost so many teeth that she can't figure out where to put her tongue and so is biting it. The vet can't find any damage to the tongue either. I'm at the end of my rope and sadly feel the next thing they're going to suggest is pts.

Sleep has been sent to the devil for us both for months now and I worry she's just going to give up at some point. I think there may be nerve damage from the block or the extractions and worry there's no way to resolve it. I've also read that gabapentin can prevent some nerves from healing themselves. I want her to have pain relief but not at that cost.


Many thanks in advance for any and all replies.

[Bluebells]

It sounds like you and your little girl have gone through a lot, and I wish I had some relevant experience or advice to offer.

My only thought is to try to find a veterinary dental specialist for a second opinion. I’m not saying anything against your vet, but perhaps he/she doesn’t have the expertise to address your pup’s issues. I would personally hate to consider euthanasia while only guessing at the cause of her pain.

I’m sorry. I hope you are able to figure this out. It’s terrible to watch someone suffer and not be able to understand or help.

[Lovetodream88]

I'm so sorry. I would agree maybe a dental specialist is your best bet or a second opinion by a different vet. They may need to do xrays to see if something was left in the gums or if there is another issue in the gums.

[matese]

I have to agree, I would definitely take her to a dental specialist for a second opinion.

If she keeps pawing at and rubbing her face seems something is there.

For my own piece of mind, I would take my pup to a dental specialist for a second opinion.

[Jenna AK]

After googling, nearest veterinary dentist is 5 hours away from me. I live near Brookings on the southwest coast of Oregon, does anyone happen to know of someone closer? I am an older lady who can't drive terribly far and on a limited income as a deli clerk in a grocery chain. I'd need to find financial assistance (other than Care Credit, whom I used to have but who caused me more trouble financially than they were worth.) I have no family to ask for help.


Feeling particularly desperate as this morning I can tell she's losing weight because she's not eating as often. The surgeon who did her procedure did an anal gland removal on my daughter's dog some years ago and wound up having to repeat it as he didn't get all the tissue the first time, but he only charged for anesthesia the second time. I would think if he messed up he would offer to do the same again, but I fear he doesn't think he messed up.


Could any remaining fragments be seen on xray? I know he took one film of her face after the surgery. Maybe he missed seeing something? Could any of this behavior have to do with her ears?
She's also licking her private areas a lot more than she used to. Could this be related some way?



This afternoon when she yawned I noticed the underside of her tongue seems a little fleshy white near the base where it attaches to the bottom of her mouth...like it's been rubbed repeatedly on something. For the most part she keeps it in her mouth but it's protruding out her left side a bit whenever she's sleeping or is uncomfortable. Despite being in some kind of discomfort, she insists on washing my arm after meals or when she's settling down for the night. Can't get her to stop, she gets upset, but it can't be good if something's hurting in there.


I feel very let down by her vet but there aren't any better vets nearby. Only one of his partners has suggested something like TMJ nerve pain/damage but of course the surgeon doesn't agree. I'm afraid he'd resort to taking what's left of her teeth and that's just going to cause more stress to her jaw. It's all very frustrating and I'm really angry about the whole thing.

[ladyjane]

Not much I can add...I would definitely get a second opinion somewhere if I were not satisfied. I will say that I had a foster pup once who had a heck of a time because of his tongue after extractions... there was nothing wrong. He just had a difficult adjustment.

The one thing that I can suggest is that, if you end up using Gabapentin long term, you can get it in tablet form. The liquid is nasty and I gave up trying to give it because it caused my Pippi so much distress. She was taking it for IVDD and would shake her head, scaring me that she was irritating her neck more. I got the tiny tabs from Wedgewood Pharmacy. Problem solved!

https://www.wedgewoodpharmacy.com/

[Jenna AK]

Hi folks, sorry to be so long responding. I appreciate all the advice given here. Glad to know it's not all just in my head!


ladyjane, thank you for the suggestion on the gaba tablets. I did look them up and it appears the smallest dose is 25 mg? Can you tell me how that would translate as opposed to 0.20 ml of liquid? I can't tell if it's too much or just a bit over what she takes now.
Agreed that it must taste awful as Jenna does the same thing. I think after almost a week and a half she may be getting used to it, but it's not appreciated. I also worry she's shaking her head so violently that she's not doing her arthritis any good. I've wondered about IVDD with her, would like to get another xray of her spine and neck to be sure she's not deteriorating more rapidly there, that might cause us to rethink her therapy.


She's still mortal painful in the face apparently if her pawing at it after meals or when she wakes from sleeping is any indication. Most of the day she's asleep, as I would expect her to be at her age, especially with how cold it is here. Neither of us likes to be outdoors in the Oregon weather. I notice too her face is very drawn around the cheekbones and that makes me think this is also an old age thing or maybe something else? It really started losing definition when she was taken off steroids last year. I've thought she might be dealing with some kind of muscle wasting disease but she'd need more testing, some of which might be of a biopsy nature, to be sure. I doubt I could get my vet to look into it without a lot of begging on my part.


She's had this hanging tongue for awhile now it just hasn't been as pronounced, so I think she's fairly used to it, but I'm not going to just let the vet explain it away due to that. She's uncomfy. It could be her teeth, her jaw or her eyes...no matter which it is I think she's better served to determine the cause instead of just treat the symptoms and "hope" it goes away.


She's also got "wheezy" nasal breathing but I'm not sure if it's from how tightly she keeps her paws around her face while sleeping.



I might add her left eye has a corneal ulcer that today looks a little deeper than in the last few days. There's no pus or exudate of any kind, the eye has been weeping more clear fluid (I'm assuming it's aqueous humour) but not excessively. I know that must sting, every time we use her drops she either doesn't want to open the eye or will react when I use her medicine on it. The whites are also quite bloodshot, but often the antibiotic ointment given to treat the ulcer will cause that. It clears up and then about the time she's due for more meds it flares up again.


If anyone has any other ideas, or questions I can ask on her behalf, I'm all ears. Thanks again for all your help.

[ladyjane]

That eye needs to be checked out!! That may be the reason she is in pain. Eye ulcers are terribly painful.

Gabapentin has a wide range on dosage....just ask your vet about it.

[Jenna AK]

Hello again friends,


It's now been over 3 months since Jenna's December 1, 2020 dental. As of this writing I can say she is doing better, has begun eating more and gained back some of her weight. We're still using gabapentin, 0.2 mls once in the evenings. I did ask my vet about getting the pills but was quoted $110 for a two month supply and since Jenna was only supposed to be on this medication temporarily we elected not to go to that expense. When I questioned the vet if there were someone besides Wedgewood we could acquire it from, he angrily dismissed me out of hand, saying there were only two compounding pharmacies and both were the same price, so if I wanted the drug I'd have to suck it up and pay the fee as it costs a lot to compound veterinary medications. Okay, granted, but there's no call for attitude. He's become a very surly character as opposed to how gregarious he was in past dealings with him and while I guess some of it is due to Covid restrictions that we're all tired of, it's a bitter pill to swallow when a big sign on his door claims they have a ZERO ABUSE POLICY that allows them to send you packing if you contradict or otherwise argue with them.

He actually wants to take her off gabapentin now and told me to just drop her doses completely instead of weaning her off. I've read it's dangerous to do that when they've been on it for more than a few weeks, so if we do remove it we're going to do so by degrees. I'm not convinced it helps her pain much, but my more pressing concern is that it's buggered up her digestive system: she has terrible gas now that she didn't before, both constipation in the mornings and loose stools in the evenings and a very loud, gurgling stomach which rumbles almost constantly. You can tell it's uncomfortable for her when it gets going.


Additionally it's become impossible for me to brush her teeth (what she has left) as it only aggravates her condition. Her breath is already putrid and I'm at a loss as to how to help her keep her remaining teeth and mouth healthy, overall. She still flaps her tongue about sometimes, but it's not every day anymore but mostly after she's eaten or awakened from sleep...and while she clearly still has some issue going on in her face it's not as pronounced as it was. Her eye pressures are even a bit below normal; 16 and 11 I think the vet said this last week, and her ulcer has not reacted to the flourescein stain so he feels it has healed, even though the corneal surface looks rough. She still gets lots of fur and hair in her eyes that collects under her eyelids, so this may be part of her issues there, but the whites of her eyes are quite bloodshot, probably due to severe dry eye caused by all the medications she is on for glaucoma. I do my best to keep them hydrated with Systane Ultra as needed throughout the day, as prescribed by her ophthalmologist.


The vet has supposedly examined her thoroughly and declares she is not in pain, but I'm skeptical of his findings. He suggested cytopoint for inflammation but I won't use that on my dogs. I feel it's another of those 'hype' meds that vets seem to push when they have some kind of agenda or a drug company on their backs. (Apoquel was one we tried for my daughter's dog's itchy skin, it only caused her other problems that we decided weren't worth the cost to her physically, and it stopped working as well, plus her reaction to Nexgard was similar...so these incidents set the precedent that we don't want to give the animals anything that represents a 'pushed product.' The next item to go will be the 'veterinary grade' dog foods.)


My vet's office has been sold to a corporation as the owners are looking to retire. My next course of action will be to secure Jenna's records (and those of our other pets) and find a different, and hopefully better, vet. It's obvious to me this doctor did something to her, unintentionally or otherwise, to cause her some kind of (semi) permanent damage and so I feel she is not safe in his care. Other than keeping an eye on her tonometry I won't be using him for anything else from here on in. I'm not even sure how I will handle her eventual end of life care at this point.


For now, she is happier than she was at the time of the surgery and in the immediate days and months afterwards. She is beginning to remind me of my old Jenna again and for as long as she is comfortable I'll keep doing my best to keep her happy. She deserves much more, but there are no professional resources available in my area to accomplish that for her.


In the meantime and to that end, I'll be looking into changing her diet, which is the last possible vector for her behaviour. If she's become allergic to something in her food, it might explain why she still has the mouth pawing and tongue flapping episodes and scratches at her face and ears to this day. (Ironically in the latter case...so does the other dog, despite the fact they are on different veterinary diets.) If anyone has any suggestions for how to either home cook or find a good quality prepared food for her, I'm all ears!


Thanks for reading, hope you all are well and surviving our crazy as ever world!

[Lovetodream88]

I am sorry you are having issues with your vet. Cytopoint is not just a hyped up medication and it is not like apoquel it is an extremely safe medication that is not not filtered through the liver nor does it really have any side effects like apoquel. It is actually an amazing medication. I'm not sure I have every heard of it given for anything other then allergies but maybe her face is itching from allergies. We have to be very careful judging all medications because a dog we know of having had an issue on it doesn't mean its bad and sometimes that happens even with the safest of medications but doesn't mean the medications are bad and many have saved lives probably far more then have had bad reactions. Veterinary foods can be very beneficial and life saving just like medications. Food allergies are rare and for a dog with a true food allergy they have to either eat a veterinary diet or a homemade diet because any over the counter food your buy at a store will have trace amounts of all ingredients used in that plant which is enough to set off a true food allergy. Again I am sorry for issues with your vet but I think you have the wrong mind set of medications and such.

[ladyjane]

A. If you feel the vet hurt her, find another vet.
B. Gabapentin can be purchased at many places. It probably is what he quoted. You could look online for vet pharmacies and call for pricing. Some of them actually post it online.
C. Cytopoint is fine. I have used it for a very long time without any ill effects on the pups I used it on.
D. If you wish to home cook (allergies to food are only about 10% of all allergies), then you really need to get it from a vet nutritionist. There is a free one at: www.balanceit.com but you have to purchase the supplements. You do need supplements if you home cook.
E. Try to find the positive and focus on that. Enjoy the time you have with her. Sadly, we never have enough time with our pups.