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Bilateral sores in my cat's mouth--my vet and dental surgeon are stumped!
I have an 18 year old female tabby who had a full mouth extraction exactly one month ago. She began exhibiting signs of FOPS (feline orofacial pain syndrome), the most severe of which was her clawing at her mouth--which was triggered by any mouth movement (grooming, yawning, eating). She was started on gabapentin and I was told to give it time. We returned to our regular vet (after just dealing with the surgeon) and I implored the vet to get a good look inside her mouth (as the surgeon really only looked when the cat was hissing). We found bilateral sores/ulcer looking things at the back of her mouth (where the top meets the bottom), they are brighter red, there is even a clear blister looking thing in one of them. (I have pictures which I would love to upload). She received a shot of covenia (just in case of infection)...and as an experiment my vet put a topical analgesic on each sore to see what happened when we got home--could she eat better, more solid food, etc. She did! Yay! So it might not be FOPS after all. Perhaps it is these sores that are bothering her, but.....WHAT are they?? I have been assured that post-op x-rays have been looked at again and that there is nothing left over (the surgeon is also the best around), maddie is negative for all the FIV, FeLV, etc. stuff. The biggest clue (and biggest head scratcher) is the bilateral-ness. Anyone feel like taking on a challenge? Best educated guess? Again, I have pictures....Any help, words of encouragement, etc. are greatly appreciated. xoxo Heather and Maddie
no sorry our expert area no longer has a Vet...looking for one if you know any?
you got some interesting suggestions there, good for you for keeping up the intensive research!!
that makes sense the upper gums may have created a friction on unhealed gums...and produced an ulcer, I didnt think it took 2-4 months for sutures to dissolve when Sami had his extractions and had an examination a week later they had already dissolved, just one partial one was remaining.
you mentioned ASSIST FEEDING...are you doing this...(sorry again if I missed something)
It is very important that she keep up a good calorie count, she has lost alot of weight already, sure don't want her to get hepatic lipidosis...caused by too drastic a drop in calories..I will send you a link to that too..it can be fatal, so important to give her high quality protien and liquify.
http://healthypets.mercola.com/sites/healthypets/archive/2011/12/13/feline-hepatic-lipidosis.aspx
yes we are aware of tanya's site, I've sent many CRF kitty parents over there...its a great site, didn't realize Maddie was crf too...poor girls sure has her problems.
I do think once you get the pain under better control she will slowly start to want to eat...just be very sure its always soft canned food. :)
hopefully those ulcers will slowly heal and she'll recover nicely. ♥
you got some interesting suggestions there, good for you for keeping up the intensive research!!
that makes sense the upper gums may have created a friction on unhealed gums...and produced an ulcer, I didnt think it took 2-4 months for sutures to dissolve when Sami had his extractions and had an examination a week later they had already dissolved, just one partial one was remaining.
you mentioned ASSIST FEEDING...are you doing this...(sorry again if I missed something)
It is very important that she keep up a good calorie count, she has lost alot of weight already, sure don't want her to get hepatic lipidosis...caused by too drastic a drop in calories..I will send you a link to that too..it can be fatal, so important to give her high quality protien and liquify.
http://healthypets.mercola.com/sites/healthypets/archive/2011/12/13/feline-hepatic-lipidosis.aspx
yes we are aware of tanya's site, I've sent many CRF kitty parents over there...its a great site, didn't realize Maddie was crf too...poor girls sure has her problems.
I do think once you get the pain under better control she will slowly start to want to eat...just be very sure its always soft canned food. :)
hopefully those ulcers will slowly heal and she'll recover nicely. ♥
Hello ladies! Quick message as I am out the door....I ended up going to **********.**** in the middle of the night (the 'expert' area here doesn't seem to really be active?)...and found it very helpful (assuming he is right)--I sent the *********** vet the pic and some information...he thinks it was a bad reaction to the sutures (which was my real vets first thought) and that they will heal, but it is just going to be awhile.
He wrote:
"The tooth sockets are typically sutured shut after extractions. These sutures break down over 2-4 months. It may be that they are irritating the gums as they dissolve and fall out. That could lead to these ulcers and sores in the mouth. Those sockets look like they just didn't heal in well. They'll eventually granulate in and heal over with normal gingiva, but it's going to take some time. I didn't see any sutures in there either in the picture. There should be sutures somewhere. I wonder whether they already dissolved. The location of the ulcers is probably from the upper jaw coming down and making contact. Eventually when they granulate in, the mucosal lining should be more fibrous like a callous formation to deal with the pressure in the area. I wish I could tell you how long that will take, but it could be anywhere from weeks to months to be honest."
Whether or not that is what we are dealing with, I like the answer (it isn't cancer or pieces of root left over...)
Yes, it was a complete extraction with pre and post x-rays ($2200 full works) and all that stuff....the place she went was state of the art with best surgeon around--that being said, I am having the x-rays and all info sent to regular vet for second opinion...
The homeopathic stuff was Hyland's Baby Teething Gel. It was just a bit on a q-tip and I don't even think I got it on her sores, but it did get in her mouth--this was our first attempt at anything of the sort....which is a good segue to the assist feeding....
I really don't see that happening. And that is where the wit's end comes in. I am keeping track of how much she eats by counting the 'laps' of food (blended/liquified) that she takes. She was averaging about 300-400 laps, but the past couple of days have been worse. She is having bowel movements, but they are tiny of course. She has lost 1.5 pounds in a month so I am concerned. I am hoping with the transdermal gabapentin which is coming today, we can begin to get this pain under control (she has wised up to the fact that it was in her tuna juice + the pain from eating added up to her not getting consistent therapy--however at the beginning of the gabapentin she did seem better, but developed some ataxia, so we reduced the dose and she hasn't been back to seeming better....so am trying to get back to better with consistent transdermal)....I will also keep the buprenex in mind, might even try to get some today from vet...
Also, I plan on going in again on Tuesday for Sub-Q and B-12 shot and have the vet put a topical on the sores--which leads to increased eating even if for a short period. Maybe I will do that twice a week (want to also weigh the stress put on her of going to vet). So, right now this is where we are:
-Sub-Q/B-12/topical at least once a week
-starting today we will have consistent gabapentin therapy
-starting today we will have consistent hyper-t therapy (that has been lacking too as I also use tuna juice/eating for that)
-continue to offer blended/liquid diet with pedialyte
-Transdermal buprenorphine is on hand (too bad she doesn't have three ears! one for each medicine!)
-Continue to stay by her side with Zoom Groom therapy ;) (I work mostly from home so am able to be here with her which I think helps)
Our gabapentin just arrived! I have to say she has been soooo good, even putting something on her ears before wasn't easy, but she knows I am trying to help and she lets me mess with her ears for the most part. Not sure she knew that when I was attempting to put a q-tip in her mouth last night though...
Thanks again for checking in and brainstorming, sending links and stuff...I think you two should compile all your advice/knowledge and end up getting a book published like tanya's crf/ckd website evolved into...I just saw that last night and was happy for her, kitties, and crazy cat ladies everywhere!
http://www.amazon.com/Tanyas-Comprehensive-Feline-Chronic-Disease/dp/1469968649/ref=sr_1_1?ie=UTF8&qid=1363383699&sr=8-1&keywords=tanya%27s+comprehensive+guide+to+feline+chronic+kidney+disease
putting on a netflix movie for her now (i am that crazy that i put a kid's movie on for her when i leave...;))
xoxoxoxoxo
He wrote:
"The tooth sockets are typically sutured shut after extractions. These sutures break down over 2-4 months. It may be that they are irritating the gums as they dissolve and fall out. That could lead to these ulcers and sores in the mouth. Those sockets look like they just didn't heal in well. They'll eventually granulate in and heal over with normal gingiva, but it's going to take some time. I didn't see any sutures in there either in the picture. There should be sutures somewhere. I wonder whether they already dissolved. The location of the ulcers is probably from the upper jaw coming down and making contact. Eventually when they granulate in, the mucosal lining should be more fibrous like a callous formation to deal with the pressure in the area. I wish I could tell you how long that will take, but it could be anywhere from weeks to months to be honest."
Whether or not that is what we are dealing with, I like the answer (it isn't cancer or pieces of root left over...)
Yes, it was a complete extraction with pre and post x-rays ($2200 full works) and all that stuff....the place she went was state of the art with best surgeon around--that being said, I am having the x-rays and all info sent to regular vet for second opinion...
The homeopathic stuff was Hyland's Baby Teething Gel. It was just a bit on a q-tip and I don't even think I got it on her sores, but it did get in her mouth--this was our first attempt at anything of the sort....which is a good segue to the assist feeding....
I really don't see that happening. And that is where the wit's end comes in. I am keeping track of how much she eats by counting the 'laps' of food (blended/liquified) that she takes. She was averaging about 300-400 laps, but the past couple of days have been worse. She is having bowel movements, but they are tiny of course. She has lost 1.5 pounds in a month so I am concerned. I am hoping with the transdermal gabapentin which is coming today, we can begin to get this pain under control (she has wised up to the fact that it was in her tuna juice + the pain from eating added up to her not getting consistent therapy--however at the beginning of the gabapentin she did seem better, but developed some ataxia, so we reduced the dose and she hasn't been back to seeming better....so am trying to get back to better with consistent transdermal)....I will also keep the buprenex in mind, might even try to get some today from vet...
Also, I plan on going in again on Tuesday for Sub-Q and B-12 shot and have the vet put a topical on the sores--which leads to increased eating even if for a short period. Maybe I will do that twice a week (want to also weigh the stress put on her of going to vet). So, right now this is where we are:
-Sub-Q/B-12/topical at least once a week
-starting today we will have consistent gabapentin therapy
-starting today we will have consistent hyper-t therapy (that has been lacking too as I also use tuna juice/eating for that)
-continue to offer blended/liquid diet with pedialyte
-Transdermal buprenorphine is on hand (too bad she doesn't have three ears! one for each medicine!)
-Continue to stay by her side with Zoom Groom therapy ;) (I work mostly from home so am able to be here with her which I think helps)
Our gabapentin just arrived! I have to say she has been soooo good, even putting something on her ears before wasn't easy, but she knows I am trying to help and she lets me mess with her ears for the most part. Not sure she knew that when I was attempting to put a q-tip in her mouth last night though...
Thanks again for checking in and brainstorming, sending links and stuff...I think you two should compile all your advice/knowledge and end up getting a book published like tanya's crf/ckd website evolved into...I just saw that last night and was happy for her, kitties, and crazy cat ladies everywhere!
http://www.amazon.com/Tanyas-Comprehensive-Feline-Chronic-Disease/dp/1469968649/ref=sr_1_1?ie=UTF8&qid=1363383699&sr=8-1&keywords=tanya%27s+comprehensive+guide+to+feline+chronic+kidney+disease
putting on a netflix movie for her now (i am that crazy that i put a kid's movie on for her when i leave...;))
xoxoxoxoxo
Heather, just re-read your first post...you didn't actually state that Maddie had a complete root removal at the same time and not just a crown amputation? I guess I just assumed it was the complete removal and post surgery radiographs were done to be sure no segment of the root remained? I will just include a link for reference on how important this is.
http://www.ncbi.nlm.nih.gov/pubmed/9693619
also a link to some possible complications...
http://veterinarycalendar.dvm360.com/avhc/article/articleDetail.jsp?id=766788&sk=&date=&pageID=3
((>^.^<))
http://www.ncbi.nlm.nih.gov/pubmed/9693619
also a link to some possible complications...
http://veterinarycalendar.dvm360.com/avhc/article/articleDetail.jsp?id=766788&sk=&date=&pageID=3
((>^.^<))
I looked at the photo too....no it doesn't look like stomatitis. I am stumped too....it is heartbreaking to see your kitty in so much pain and not know how to help.
I will say when you contact your Vet for some pain medication, the buprenex that I spoke of comes in a liquid that is absorbed in the mucosa, they will/can put it in syringes for you so all you need to do is get the tip to the side of her cheek...don't even need to force the mouth open.the usual dose is 0.1ml (up to 0.2ml max) 2x's per day.
careful with using any homeopathic stuff.....there are many that are safe for animals..but some are NOT. be careful of those containing alcohol. what did you use?????
I can give you a good suggestion in that regard too and how too prepare
it...
I will do a longer reply a bit later....
I will say when you contact your Vet for some pain medication, the buprenex that I spoke of comes in a liquid that is absorbed in the mucosa, they will/can put it in syringes for you so all you need to do is get the tip to the side of her cheek...don't even need to force the mouth open.the usual dose is 0.1ml (up to 0.2ml max) 2x's per day.
careful with using any homeopathic stuff.....there are many that are safe for animals..but some are NOT. be careful of those containing alcohol. what did you use?????
I can give you a good suggestion in that regard too and how too prepare
it...
I will do a longer reply a bit later....
COMMUNITY LEADER
Just looked at your pic, and see what you're saying. You know, an ulcer in the mouth is going to take time to heal simply due to it's location. Idk how the sores looked initially, but the left side in the photo (right side of mouth) looks better than the other, so either not as bad to begin with or it's healing??
Poor Maddie, this is heartbreaking. With her mouth hurting so badly, how much is she eating? If not enough, you may have to assist feed for a bit to bring up her strength. The hiding could be both due to pain and the fact, she is just plain hungry.
Yeah, good times alright :(((
Poor Maddie, this is heartbreaking. With her mouth hurting so badly, how much is she eating? If not enough, you may have to assist feed for a bit to bring up her strength. The hiding could be both due to pain and the fact, she is just plain hungry.
Yeah, good times alright :(((
oh, and i posted a pic of maddie's mouth on my profile page. let me know if you can't see it, i am new here and not the most computer savvy...
jade and opus,
ah, great cat minds think alike! first let me say i am typing with one hand/finger as maddie is laying on me, so this message might be disorganized, but i wanted to get a few words out tonight...
i did think it might have been an apparatus used during surgery, i will ask more about that, but also think if it was just that, they would have healed by now (?)...so...it is on my list of things to ask about/keep in mind...
i too thought of stomatitis, i even asked the surgeon about it when i first noticed 'red marks' at the back of her mouth, but was told it was not stomatitis, which does make sense, since as you said, it is something that is present before, not after....and the pics don't really seem stomatitis-y...?
maddie had a covenia shot after surgery (2/15) and she got another one yesterday. she has had a few before for urinary tract infections....i should mention here that she is a handful, one of those cats with a huge red warning on her chart at the vet (that's my girl! ;)) and not much easier at home...i have never pilled her, used a syringe for medicine, etc. so we always opt for injectibles and/or transdermals...she has never had a bad reaction (that i know of...eek...), so fingers crossed all is ok on that end...i'm too scared to read the article on covenia right now...yikes...
she is on transdermal buprenorphine right now, but honestly i don't feel like it is doing anything....i might get some oral tomorrow as i have realized i need to get over my fear of upsetting her/putting her through a few moments of torture (wrapping in a towel and forcing her mouth open) so that she can have hours pain free.....i did get some oral analgesic tonight and *attempted* to put it on the sores...so i went from never pilling or giving liquid medication to trying to accurately place a q-tip on each side of the back of her mouth...good times...
the oral analgesic the vet used was otc for kids with benzocaine in it, which is toxic to cats, so i went to whole foods and bought some homeopathic stuff so a.) not as 'strong' and b.) i don't even know if i got anywhere near the sores....first time! i told her we will try again tomorrow...it didn't seem to do anything...
yes, as mariemitzi said in the fops thread, i am at my wit's end, i have read through that thread many times just to know i wasn't alone--i feel that same thing she felt about having her teeth removed--yes, she needed them removed, she was in some pain (many forls), but she could eat fine and she ran from the litter box in joy after each bowel movement and she looked out the window, she had her little routines....and now she is miserable, in constant pain and sleeping 24 hours a day under the covers....i keep thinking about how food is one of life's pleasures, so much so that before we kill someone in prison (sorry to be so graphic), we let them pick out anything in the world they want to eat! and i took that from her...i still have some hope (but the day to day, hour to hour is h a r d)...i think i have mariemitzi's posts memorized by date--mitzi wasn't doing so well in november of 2011 and the next post was august of 2012 and she was great...so...hanging in there...THANKS FOR BEING OUT THERE...it helps to have people to commiserate with, brainstorm with, and just generally not feel so alone....oh, these animals!!!
=^..^=
ah, great cat minds think alike! first let me say i am typing with one hand/finger as maddie is laying on me, so this message might be disorganized, but i wanted to get a few words out tonight...
i did think it might have been an apparatus used during surgery, i will ask more about that, but also think if it was just that, they would have healed by now (?)...so...it is on my list of things to ask about/keep in mind...
i too thought of stomatitis, i even asked the surgeon about it when i first noticed 'red marks' at the back of her mouth, but was told it was not stomatitis, which does make sense, since as you said, it is something that is present before, not after....and the pics don't really seem stomatitis-y...?
maddie had a covenia shot after surgery (2/15) and she got another one yesterday. she has had a few before for urinary tract infections....i should mention here that she is a handful, one of those cats with a huge red warning on her chart at the vet (that's my girl! ;)) and not much easier at home...i have never pilled her, used a syringe for medicine, etc. so we always opt for injectibles and/or transdermals...she has never had a bad reaction (that i know of...eek...), so fingers crossed all is ok on that end...i'm too scared to read the article on covenia right now...yikes...
she is on transdermal buprenorphine right now, but honestly i don't feel like it is doing anything....i might get some oral tomorrow as i have realized i need to get over my fear of upsetting her/putting her through a few moments of torture (wrapping in a towel and forcing her mouth open) so that she can have hours pain free.....i did get some oral analgesic tonight and *attempted* to put it on the sores...so i went from never pilling or giving liquid medication to trying to accurately place a q-tip on each side of the back of her mouth...good times...
the oral analgesic the vet used was otc for kids with benzocaine in it, which is toxic to cats, so i went to whole foods and bought some homeopathic stuff so a.) not as 'strong' and b.) i don't even know if i got anywhere near the sores....first time! i told her we will try again tomorrow...it didn't seem to do anything...
yes, as mariemitzi said in the fops thread, i am at my wit's end, i have read through that thread many times just to know i wasn't alone--i feel that same thing she felt about having her teeth removed--yes, she needed them removed, she was in some pain (many forls), but she could eat fine and she ran from the litter box in joy after each bowel movement and she looked out the window, she had her little routines....and now she is miserable, in constant pain and sleeping 24 hours a day under the covers....i keep thinking about how food is one of life's pleasures, so much so that before we kill someone in prison (sorry to be so graphic), we let them pick out anything in the world they want to eat! and i took that from her...i still have some hope (but the day to day, hour to hour is h a r d)...i think i have mariemitzi's posts memorized by date--mitzi wasn't doing so well in november of 2011 and the next post was august of 2012 and she was great...so...hanging in there...THANKS FOR BEING OUT THERE...it helps to have people to commiserate with, brainstorm with, and just generally not feel so alone....oh, these animals!!!
=^..^=
I was trying to find a photo of a surgery procedure to show the type of breathing tube they insert...(also used to administer inhaled anesthesia) I found this site with a good look, I really think this maybe the cause...irritation/rubbing of the tube...speak to your vet abt it.
http://www.catster.com/lifestyle/10-stages-cat-surgery-health
http://www.catster.com/lifestyle/10-stages-cat-surgery-health
COMMUNITY LEADER
I sifted through quite a few questions on the web, but wasn't able to find an owner with this complaint in regards to Convenia. Like I said, may not be that at all. I will leave you a link to read up on Convenia though. I wouldn't allow this antibiotic again because if there IS a reaction, this drug stays in kitty's system for up to 2mos.
Very sorry for Maddie and the pain she is going through, as well as your worry and stress over this. I am assuming you are continuing with the topical analgesic to control her pain? Pictures would be great!
I hope you're able to find some answers soon~
Very sorry for Maddie and the pain she is going through, as well as your worry and stress over this. I am assuming you are continuing with the topical analgesic to control her pain? Pictures would be great!
I hope you're able to find some answers soon~
hi Heather....your poor dear Maddie..sounds like she is in a ton of pain. Jade had a good suggestion, could it have been the tube they put in to administer the gas with???
I'm afraid I've got no real thoughts of my own..except one perhaps...stomatitis? but this is usually present before the surgery not afterwards..I will send you a site that has a photo so you can see if this looks familiar.
I see the convenia was given afterwards so that won't be the cause, but it can give other problems b/c some cats are allergic to it and when it stays in their systems for (they say up to 65days...) it takes way too long to clear. but its done so we will hope for the best that Maddie doesn't have a reaction that adds to her existing problems.
see what you think after looking at the photo. since the oral analgesic gave her some relief I would really suggest that no matter what the reason for these sores that she be put on a pain med. IMO one of the very best and safest for cats is buprenex(buprenorphine) which is also the main one used for dental pain..
the fentanyl mentioned in the article is also a safe choice. keep posting, we sure want to know how Maddie does...sending you both my prayers♥
http://www.marvistavet.com/html/body_plasma_cell_stomatitis.html
I'm afraid I've got no real thoughts of my own..except one perhaps...stomatitis? but this is usually present before the surgery not afterwards..I will send you a site that has a photo so you can see if this looks familiar.
I see the convenia was given afterwards so that won't be the cause, but it can give other problems b/c some cats are allergic to it and when it stays in their systems for (they say up to 65days...) it takes way too long to clear. but its done so we will hope for the best that Maddie doesn't have a reaction that adds to her existing problems.
see what you think after looking at the photo. since the oral analgesic gave her some relief I would really suggest that no matter what the reason for these sores that she be put on a pain med. IMO one of the very best and safest for cats is buprenex(buprenorphine) which is also the main one used for dental pain..
the fentanyl mentioned in the article is also a safe choice. keep posting, we sure want to know how Maddie does...sending you both my prayers♥
http://www.marvistavet.com/html/body_plasma_cell_stomatitis.html
COMMUNITY LEADER
Hello Heather, and welcome. Yes, Opus is very good; I'm sure she will check in at some point. My first thought being the sores are bilateral...an apparatus of some kind must of been used to keep Maddie's mouth open during the extractions; I wonder if it could have been pressing so hard in the back, it produced ulcers, see what I mean? So sorry, having trouble concentrating and typing my thoughts, I hope you understand what I am trying to say. Of course my idea could be completely off the mark, just my first thought.
Another thought is the Convenia. Very BAD drug for some kitties. Can produce neurological damage, but maybe something like this as well? I will do some research and see if anyone else's kitty reacted in this way...
Another thought is the Convenia. Very BAD drug for some kitties. Can produce neurological damage, but maybe something like this as well? I will do some research and see if anyone else's kitty reacted in this way...
Opus88, I followed you on MarieMitzi (sp) post as that is the only post with FOPS subject matter, was going to post there, but now that it might not be that, am posting here....anxious to hear your opinion! ;)
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