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Feline facial features when in pain

VeroniqueM

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Hello Dr Jeff!

I would be very interested to get your opinion on Darwin's facial features during his intermittent abdominal pain episodes. I did the suggested test to give him a drop of buprenorphine during an episode in order to truly find out if it was pain related and he responded favorably within 15-20 min.
So he was responding well to Nux vomica 30c 10 succussions lately before April 2nd, but still getting intermittent episodes although not as often and sometimes not even every day.
His facial features considerably change during those episodes (see first 2 photos below from March 12th). His ears come down and I even think I see a sardonic grin (risus sardonicus) on his photos, am I over imagining this? With his high specFPL, it's reasonable to think that those episodes might be related to pain from chronic pancreatitis.
Darwin acute episode March 12,21.jpgDarwin acute episode March 12.jpg
And this is how he looks like following his episode (his more normal self):
Darwin normal March 12, 2021.jpg
Now those 3 photos below are from April 5th so yesterday: his right ear is down more than the left and that happens with most of his episodes. I was wondering: could there be a correlation between which ear is down the most and the side where the pain is most prevalent? With Darwin, I noticed that during the episodes if I pet him a little more deeply on the right side of his abdomen he reacts more strongly (bringing his right ear down much lower, shifting his weight from side to side) than if I do the same on the left side (he mostly lowers both his ears a little lower, the right lower than the left, but doesn't shift his weight from side to side). I didn't do a full abdominal palpation because he seems quite painful already, but he definitely seems more painful on the right side of the abdomen. I just thought it was interesting because the choice of remedies from the Materia Medica might be different depending on which side of the abdomen is most painful?
Darwin episode April 5, 2021.jpgDarwin episode April5, 2021.jpgDarwin episode April 5,2021.jpg
And this brings me to my last question about his recent remedy dose change which was increased to 15 succussions and to give him one dose every evening even if no episode for 5 consecutive days: he seems worse since on Nux vomica 30c 15 succussions (instead of 10 succussions).
I started it April 2nd in evening and he has been having more frequent episodes since then especially on April 4th and 5th (2-3 episodes per day treated each time with an additional dose of Nux vomica at 15 succussions), but on the 5th his BEAM was particularly down and his appetite and mood were considerably down. Not sure if I'm wrong, but this change seemed so sudden that I thought it might be an aggravation in his response to the remedy as opposed to the disease progression. I remember learning in my homeopathy course that sometimes an aggravation can be treated by giving a lower potency dose of the same remedy to decrease its energetic value within the body.

So mid pm on April 5th I gave him Nux vomica 30c but down to 10 succussions like before (instead of 15 succussions): the change was night and day within 10-15 min. He started eating better, was more playful, more talkative, I was so surprised! So on April 5th late evening, I gave him his dose even without the presence of a painful episode, but with 10 succusssions: no aggravation and he's back to playing with his toys today and is walking faster again as opposed to walking more slowly.

Tonight is his fifth and last dose of the consecutive 5 doses you recommended me to give: should I try 15 succussions again or stay at 10 succussions?

Thank you so much for your advice!

Véronique
 
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Great pics Dr. Veronique. Thanks for sharing them.

1. No, for the most part, I don't think you're over imagining.

2. Possibly (side of ears correlating with side of pain) but I would use this in his repertorization unless there are other right-sided symptoms.

3. Neither. When you see a clear response (either good or bad) it's good to wait and watch (and not dose).

You're very welcome! ?
 
Great, thank you!

He has not had any painful episode since Monday afternoon, but if he gets another episode before we speak again on Friday, should I treat or not? And if so, how many succussions would you recommend?

With gratitude,

Véronique
 
Great that Darwin has not had any other episodes! Is he improving in any other way?

15 succussions. Just once (since it may have been the repetition that triggered the pain episodes).
 
Hello! And thank you for asking about him :)

Actually, after seeing your message, I noticed a few other changes in Darwin:
- after an energetic playful episode this pm that lasted 20-30 secs, he was resting comfortably in sternal position and I could visually see a jugular pulse in both his jugular veins which got me quite concerned (never noticed that on him before)
- he also vomited twice today: once early this am (a hairball with very little fluid) and this pm he vomited a few smaller hairballs with his meat and a fairly large amount of light brown fluid
- his stools have changed (didn't see him do it but I'm 99% sure it's him since I noticed it after he came back from the basement where the litter is): one BM almost black and firm but more pasty/sticky towards the end, then he went back for another BM containing 2 small almost black pasty/sticky droppings.

His heart rate varies between 142 and 150, I did hear a gallop rhythm once when I was listening long enough and I'm hearing a mild grade 1 heart murmur which I have never noticed before. Maybe I should decrease the amount of subcutaneous fluids I'm giving him (he currently gets 150cc SID). I called the local vet to try and get him in for blood work fast, was hoping to have his pro-BNP checked as well as his other regular BW and probably some x-rays too, but apparently they can't see him before April 19th unless it becomes more urgent...

Still no painful episode, I have not used Nux vomica since April 5th late evening. His appetite and mood are certainly better than between April 2nd and April 5th, his energy is I think slowly improving, BEAM of 6.5-7 I would say (was more quiet this morning).

Thanks again for your time,

Véronique
 
Oh! I forgot to mention that I still notice his pupils dilating at times, especially in early morning, but sometimes later on throughout the day as well. But it doesn't seem to be associated with abdominal pain anymore since the last abdominal pain episode that was on April 5th in pm.
 
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