Nugget/xray of teeth, plus his skin is worse

[squirrelfairy]

My poor baby boy.
Dr. said she did not see any abnormal looking growths in his xray....
I looked at his fur under microscope, no mites, he has had revolution recently, gave him a hemp bath, his skin is worse, will look at under woods lamp in a little while.
I do not want to give him oral antibiotics, I had to give to him last summer and he had diarrhea for almost 2 months.
His eye is runny, milky sometimes, and the vet thought it looked slightly bulged.
I know he's an older boy. I want to make him comfortable and happy again, too many things for him to deal with .
thanks for looking!
Carrie

didn't mean to post the diarrhea pic, that is from last year

[squirrelfairy]

Sorry trouble uploading, here is the xray and skin again

[Charley Chuckles]

🙏

[squirrelfairy]

No mange mites, no fungal or ringworm, will try injectable Baytril and see how that works.
What could be causing this? Does anyone know?

[SamtheSquirrel2018]

No mange mites, no fungal or ringworm, will try injectable Baytril and see how that works.
What could be causing this? Does anyone know?

Hi SquirrelFairy:
If I might make a few comments---I know that you have utilized microscopy (which is great!) with the goal making a definitive diagnosis of the Nugget's skin issue and that no definitive "culprit" was identified! I would like to suggest that you consider giving a dose of Revolution anyway! Sometimes mites, ova and fungal elements are just not seen but may still be present.

I know that you were informed that the x-ray study was negative. Was this Dr. E who read the film or did someone else read this film? The reason I am asking (and I am NOT a Veterinarian, nor am I a radiologist) but if you look at the the bases of both upper incisors (the end of the tooth farthest back from the exposed tip of the teeth), there is a small light density around the root of one of the upper incisors. I can't tell whether this is the left or right upper incisor because these are just overlapping shadows. If you look at the root areas of both upper incisors, only one has the small white density at the root area. I suspect that this may represent a small odontoma. Do you have any other x-ray images such as Ventro-dorsal (bottom to top) or a dorso-ventral (top to bottom) views, This would help determine which tooth was associated with the small white density or if it may not even be associated with a tooth at all! Which eye seems to have the problems you noted?

Regards,
SamtheSquirrel

[squirrelfairy]

Hi SquirrelFairy:
If I might make a few comments---I know that you have utilized microscopy (which is great!) with the goal making a definitive diagnosis of the Nugget's skin issue and that no definitive "culprit" was identified! I would like to suggest that you consider giving a dose of Revolution anyway! Sometimes mites, ova and fungal elements are just not seen but may still be present.

I know that you were informed that the x-ray study was negative. Was this Dr. E who read the film or did someone else read this film? The reason I am asking (and I am NOT a Veterinarian, nor am I a radiologist) but if you look at the the bases of both upper incisors (the end of the tooth farthest back from the exposed tip of the teeth), there is a small light density around the root of one of the upper incisors. I can't tell whether this is the left or right upper incisor because these are just overlapping shadows. If you look at the root areas of both upper incisors, only one has the small white density at the root area. I suspect that this may represent a small odontoma. Do you have any other x-ray images such as Ventro-dorsal (bottom to top) or a dorso-ventral (top to bottom) views, This would help determine which tooth was associated with the small white density or if it may not even be associated with a tooth at all! Which eye seems to have the problems you noted?

Regards,
SamtheSquirrel


Thank you for replying!
Yes, he had revolution a week and a half ago. I am trying Baytril for 7 days to see if it helps, for staph.
No Dr. E has not seen, still working on getting in touch with her.
I did notice the white calcified looking areas on the xray, I indeed would be interested to know if that is a concern, as he does have the milky eye, on his right eye.
Poor boy seems in pain today, and rather miserable, and needs his teeth cut again....I don't know how long he will be able to do this.

[SamtheSquirrel2018]

Thank you for replying!
Yes, he had revolution a week and a half ago. I am trying Baytril for 7 days to see if it helps, for staph.
No Dr. E has not seen, still working on getting in touch with her.
I did notice the white calcified looking areas on the xray, I indeed would be interested to know if that is a concern, as he does have the milky eye, on his right eye.
Poor boy seems in pain today, and rather miserable, and needs his teeth cut again....I don't know how long he will be able to do this.

Thanks for your reply, SquirrelFairy!
The density mentioned appears to me to resemble an odontoma! Do you have any other x-ray films that would show the density from a different direction (preferably in a Ventro-Dorsal or Dorso-Ventral view) as this would show which upper incisor is associated with the density (in the lateral view which you posted, it is impossible to determine that with any certainty as the incisors are overlapping in the lateral view) or if (I doubt this but it's possible) the density is off to one side or toward the middle and not associated with a tooth at all and in that case would likely represent something other than an odontoma! Upper odontomas are usually the most concerning concerning! If there is an infection secondary to an odontoma or let's day secondary to a dental issue (as I suspect with the involved eye), I would like to suggest considering the use of Amoxicillin plus Clavulanate rather than Baytril. It will work fine against Staph but also has broad coverage including coverage for anaerobes and would ordinarily be an optimal choice for oral or dental infections! I believe that
Dr. E usually prescribes Amoxicillin plus Clavulanate for her odontoma patients presumably for these very reasons!

I know that you know this but be very careful with the tooth trimming with the possibility of an infection/odontoma! Although there is no pain at the site of the trimming; it is common for some movement or forces to be inadvertently transmitted through the tooth to the root and jaw and this can definitely result in pain. It may be worth considering a dose of Meloxicam or Ibuprofen prior to the tooth trim!
Regards,
SamtheSquirrel

[squirrelfairy]

Thanks for your reply, SquirrelFairy!
The density mentioned appears to me to resemble an odontoma! Do you have any other x-ray films that would show the density from a different direction (preferably in a Ventro-Dorsal or Dorso-Ventral view) as this would show which upper incisor is associated with the density (in the lateral view which you posted, it is impossible to determine that with any certainty as the incisors are overlapping in the lateral view) or if (I doubt this but it's possible) the density is off to one side or toward the middle and not associated with a tooth at all and in that case would likely represent something other than an odontoma! Upper odontomas are usually the most concerning concerning! If there is an infection secondary to an odontoma or let's day secondary to a dental issue (as I suspect with the involved eye), I would like to suggest considering the use of Amoxicillin plus Clavulanate rather than Baytril. It will work fine against Staph but also has broad coverage including coverage for anaerobes and would ordinarily be an optimal choice for oral or dental infections! I believe that
Dr. E usually prescribes Amoxicillin plus Clavulanate for her odontoma patients presumably for these very reasons!

I know that you know this but be very careful with the tooth trimming with the possibility of an infection/odontoma! Although there is no pain at the site of the trimming; it is common for some movement or forces to be inadvertently transmitted through the tooth to the root and jaw and this can definitely result in pain. It may be worth considering a dose of Meloxicam or Ibuprofen prior to the tooth trim!
Regards,
SamtheSquirrel

Thank you so much for your reply.
I appreciate you looking at the xray and yes I think that you may be right. The xrays I took that day were so traumatizing to him, he struggled so hard at being held still, he injured his back, and now is in so much pain as he has some spondylosis and he is painful to the touch, I cannot put him through trying to get any more xrays.
I only opted for the Baytril because last year he was on oral antibiotics for an aspiration and he got horrendous diarrhea for almost 2 months, I cannot risk that again for him, so I will try doing injectable for now, but yes, he hates it and its painful too.
He still needs a tooth trim, and yes that hurts him too, and even trying to give him his formula with his calcium is traumatizing for him now, he squeals and pushes it away. This is not going well as you can tell. I have very good pet hemp oil I am giving him for pain and inflammation.
He can eat some on his own, he is very off balance, normal for him, but even more so. I will try to feed him his formula with as much nutrition as possible, but he resists everything I do, and everything is painful for him, everything.
So it seems I am going to try to make him comfortable and not cause him pain as best as I can, and I am considering and making a plan for euthanasia when he has really had enough and has no quality of life at all.
Carrie

[Charley Chuckles]

Can you give metacam, it helps with swelling and pain

[CritterMom]

As does the infant ibuprofen. All of the issues you are seeing right now seem pain related - take that mostly or all away and tooth trimming and getting him to eat likely all get better.