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Need help on deciding on kitty jawbone operation, please
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Need help on deciding on kitty jawbone operation, please

One of our kitties has about half her lower jaw bone that has died.  Our vet gave us a CD copy of her film (not sure if x-rays or another type of scan) and part of the lower jaw bone is just 'gone' and one largish piece has broken away and moved towards the middle of her mouth.  This area of bone death has increased noticeably per our vet since we took her to him a couple of months back because we'd noticed her drooling (he pulled another tooth at that time and we've been giving her prescribed liquid meds since).  We were waiting to see if what we thought was a gum and just bone underneath a bad tooth problem was healed by pulling that tooth and the meds, but noticed the drooling had started again so took her back this week. Our vet thinks probably cancer but can't tell of course without operating.  

Moxie will be 11 in April.  The vet pulled several of her teeth a number of years ago because they were starting to move out of the sockets and diseased (found because we'd noticed she developed bad breath), so possible the problem was already affecting her jaw bone then though if our vet made film of her jaw bone then he didn't mention any problem with it back then.  She has not seemed to be in pain, though of course hard to tell with some animals.  She did hate getting the liquid meds (accepts them and the liquid pain med now better from me than from my husband, however).

We have a surgery date of next Tuesday for her to have the bad half of her lower jaw bone removed.  My questions are:  

Are there other diseases than cancer that could cause this jaw bone breaking or dissolving problem and if so, what?  

How much pain will we be causing her (during the operation and after) and live a halfway decent life after surgery as far as eating, lack of pain, (assuming if cancer all of it is removed).  She has eaten dry food since we've had her - since the pet deaths in the early-2000s from off-the-shelf pet foods, a combo of Wellness Core and Halo Spot's Stew Dry - which we feed both our dogs and cats.  Before that we fed Royal Canin dry food (found on a diabetic cat forum - and yes, we had a diabetic kitty we home tested daily, adjusted her insulin shots, and kept alive and healthy 5-6 years till she got inoperable cancer), but the Wellness and Halo foods are rated better.

What could we expect for Moxie's length of quality life-time wise at almost 11 (our kitties normally live to 15-16 with a few having lived to 20+)?  

If cancer, does this type of cancer recur often and spread, i.e., like to her brain, or her whole mouth where she'd be unable to eat?  

We love her dearly, but I don't want to put her through lots of pain and a lingering or painful death if the surgery isn't likely to really help her - we'll do what's necessary as long as she has quality of life, though.  Our vet has apparently done the surgery on several dogs and said they recovered well and could eat normally (don't know their quality of life in other ways or length of life afterwards).  He has 'not' mentioned having done the surgery on other cats.

Any help most appreciated.
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874521_tn?1375890587
Oh my gosh, your poor dear kitty. you have a very hard decision to make, I wish I could be of more help.....
On this site we are all just owners and not Vets. I don't know of anyone on here that would be able to give you the answers you need.
IMO it does sound like a cancer, I can't say I've ever heard of this happening before.
there is a disease called FORL's that is a re- absorption of the tooth and root, but I don't think it can also absorb bone? I will send you a link to see if that helps.

http://www.medicinenet.com/pets/cat-health/dental_problems_in_cats-page2.htm

http://www.dentalvet.com/vets/cats/feline_dental_pathology_and_care.htm

You can try and ask this question on our Expert forum. we do have a Vet there, but I'm afraid she doesn't reply on a regular basis and maynot before the impending surgery date.

http://www.medhelp.org/forums/Animal-Health---General/show/112?controller=forums&action=show&id=112&camp=msc

I wish I could be of more help. I know how hard a decision this must be, we don't want to give up on someone we love so much, yet we don't want to see their quality of life reduced either. Is your Vet a skilled surgeon with a good reputation?
Is there some way you could get the names of the people whose pets have undergone this and talk to them directly?
It would be a similar surgery no matter cat or dog.
But the pain meds would certainly be much different and be sure your Vet is up on that...kitty will have alot of pain for a good while after. your right, cats sometimes hide pain very well.

please keep us updated on your decision and kitties condition. we are here to be as supportive as possible and will help answer as best we can.  sending you both my deepest wishes and prayers♥
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Avatar_f_tn
oh my goodness!!! You are a strong owner as I would be devastated if this was one of my "babies."
When the teeth were pulled years ago, did your vet mention anything about peridontal disease? The reason I ask is your description sounds like it could have been and also extreme disease can result in destruction of entire jaw structures. Good news is, if this is what it is then removal of the infected area and strong antibiotics should do the trick. However, I definately would see if you can talk to the people you mentioned that had pets that had a surgery like this and see how their pets adjust and their experiences since it will be a drastic change to your kitty.
As for cancer....if thats the case we're talking about bone cancer. Bone cancer has a pretty gloom outlook unless it is caught really early. (which does not sound like it in your description if it is cancer). If cancer has infiltrated the lymph nodes (which there are several in the neck region) re-occurance in considered nearly inevitable even if the initial cancer site is completely removed. The only question left with that is when and where the re-occurance would happen. However, I have never heard of bone cancer reabsorbing bone. This doesn't mean it can't or doesn't, I've just never seen it personally so I can't say with any certainty.
Has your vet done any chest xrays to check the lungs?? This can tell you a lot if it is cancer and if removing the affected area will be worth it. When bone cancer infiltrates the lungs it is often considered end stage with nothing else that can be done. Knowing if this is present or not can help to decide between surgery or just making her comfortable for as long as possible.
Definately make sure you discuss all your concerns with your vet. Also don't be afraid to ask more than one vet to see different opinions. Your regular vet should not mind since you are being a diligent owner to make sure you are doing everything possible to give the quality of life your kitty deserves.
Good luck and I deeply hope things work out for the best for your sweetie.
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1969304_tn?1325897351
I've sent my husband to the vet's today with a written list of questions I expect our vet to answer for me before deciding on surgery or not.  He's a good vet who loves animals, but like most non-specialist vets, I think is influenced by past experiences and drug and equipment manufacturers instead of constantly keeping up with the latest science.  I've caught him several times prescribing drugs that, after I researched, I refused to give our animals, and also have refused foods he has prescribed (Science Diet, for one, since it has had so many recalls because of the junk in it). Had we taken his advise on the diabetic kitty we had, she wouldn't have lived so many healthy years; instead I found out how we could check her blood sugars ourselves daily, adjust her insulin shots and which type most closely matched feline insulin, what the best foods were to feed her, how to overcome a hypo, etc..  I saved another of our kitties (very shy - whose blood sugars had spiked because he was so afraid of being at the vet's) who the vet said was diabetic who wasn't at all - in fact I had to rub Karo on his gums after giving him one Gypzide (sp?) pill because it threw him into a hypo.  We monitored his blood sugars daily for about 6 weeks and that kitty (Sulu) is absolutely not diabetic.  So our vet knows I expect answers I can check out online and won't hesitate to tell him if I think he's not being careful enough or has given us a wrong diagnosis or prescription.  

I do this with the 2 doctors for my husband and I, too - I expect they think I'm a royal pain just like our vet does, but tough.  They're not gods; just trained people who sometimes don't take enough care, don't pay enough attention, or are corrupted by pay-offs from drug or pet food companies.  If I can prevent it, none of my family - furry or not - will be victims of carelessness from the medical professionals.

Back to Moxie and the vet: I also asked whether or not he has done a biopsy, if it is possible he accidentally broke the bones in her jaw himself pulling some of her teeth 2-3 years ago (she does have bad teeth and gum disease; has had it since we adopted her as an adult) because of possibly her jaw bones being weaker because of the peridontal (sp?) disease.

I found a site at:http://www.mypetsdentist.com/site/view/113064_JawFractures.pml - a pet dental practice - that says often jaw bones are fractured in cats and dogs by vets pulling teeth (our poor critters!!).  Also asked whether he has done a physical exam looking for cancer, done x-rays of skull, throat and lungs looking for cancer, if he has done a biopsy and if not, why not.  

And asked if he has done the procedure on cats as well as dogs, and why the bone removal was done, and about quality of life and length of life afterwards.  Also whether or not he has experience in setting bones after fractures where they've successfully healed - or if that is even possible when that one bone has moved towards the center of her mouth.  Or if not cancer but instead just tooth/gum disease, he'd prefer that we take her records and take her to a pet dental expert.

Also asked if there is a fluid we could use to clean her mouth daily to keep down gum disease in future (at her age and with her gum disease, us brushing her remaining teeth daily isn't an option though flushing out her mouth would be).  And stressed that I wanted to know if old or new fractures.  If old, she has successfully adjusted and can eat fine, etc.  And if there are supplements like calcium or strontium that cats can successfully be given to help stop bone loss and maybe even help bone regrowth.

If the fractures are new, I asked why did they happen (she hasn't been in an accident or fight with our other pets - is in-house only and has lived in my office for the last 2-3 years as she should have been an 'only cat' - she doesn't enjoy being with the other pets though she gets along fine with the one dog who also likes to hang out in my office).

At this time in her life, after so many years of gum disease, Moxie will never have a normal mouth but so far she hasn't exhibited signs of decline - no loss of weight, no depression, she grooms herself, and has been able to eat dry food only successfully.  She's grooming right now as I'm typing, in fact.  And she gets in my lap and rubs her head against my hands so her mouth evidently isn't extremely painful.

Told him I couldn't make a decision on surgery without getting a lot more data from him.  We're not willing to put her through radiation and chemo if oral cancer because I expect she'd slowly starve but surgery yes, if he knows it hasn't spread and that he could get it all and that surgery would give her at least 50% chance of recovery and good quality life.  And that the sooner he talks to me, the better for Moxie.

So, on hold for right now till I get some answers from him.

I sincerely appreciate the 2 of you answering me - it prodded me into different directions of online research last night that helped me find that pet dental clinic's site and find out that pet tooth-pulling could be the cause of the fractures.  Will report back when I know more.  Please keep your fingers crossed for Moxi - she's such a sweetheart of a kitty!  

By the way, we have 7 cats (down from 11 in the last 5 years as they're all older now; oldest still living is 15-16, tiny at 6 lbs. but is queen and rules the others) and 2 chows (one old for his breed at 11 and with dysplacia but still doing well, considering, and the other going on 5 and a lovely, healthy girl).  We get our dogs when they're babies and they grow up with the kitties and everyone gets along wonderfully.  In fact, a few of the kitties prefer the dogs' company to that of the other cats.  :>)

Thanks again - so much - for your data and your words of kindness.  Our pets are our very beloved family, and we so much want to do what's both best for them and keep them with us as long as their quality of life is good enough for them to enjoy it.  
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1969304_tn?1325897351
Just talked to our vet.  He actually has done the operation on more cats than dogs, so yes, experienced on this surgery.  He says more cats than dogs get injuries that pretty much shatter their jaws - cars, other accidents, being attacked by larger animals, etc.

Also found out what husband and I thought was a bit of bone left on that side of Moxie's lower jaw and some that we thought had moved to the middle of her mouth is actually scar tissue (didn't know it showed up in x-rays).  So if there is any bone really still left there, it is just fragments.

Our vet thinks it may be cancer and said he would love to do a biopsy but that there are risks.  He'd have to do a punch biopsy instead of scraping to have any chance of finding cancer cells, and the act of punching a hole in the scar tissue could destroy the integrity of it holding that part of her jaw together, could cause a fracture of adjoining jawbone, as well as still miss any cancer cells (he said about a 50% chance of punching in the right area).

There's an antibacterial mouthwash for kitties he'll get for us so we can try to keep her mouth cleaner to protect her gums from further damage (called CET something or other).  And he's going to check with our state university vet school to see if any supplements or meds have been developed to help kitties stop bone resorption or help them regrow any bone - though he'd not heard of any himself.

He also told me the rear part by the joint of any surviving lower jawbone is left in place in this surgery so in Moxie's case, he'd only be taking out fragments left from there up to the middle of her mouth - this to help make sure her jaw was still properly aligned for eating/drinking.  His experience has been that kitties learn to chew on the other side of their mouth, instead of on the actual scar tissue.  He also says x-rays normally aren't sensitive enough to detect cancer in lungs or lymph nodes so pretty useless - you'd need an MRI to be able to detect cancer before end stage disease.

Bottomline, I've decided to wait a month and then take Moxie back for another x-ray of her mouth - and he thinks if there has been progression in bone resorption he'll be able to tell the difference by comparing our now baseline film with the new one, as well as noting difference in appearance of her gums.

Of course I'll change my mind if I see any difference at all in her behaviors or if she appears to be in pain, and take her back immediately.  

I guess I'm playing god with her health but my gut tells me she feels good right now so I'm opting for non-invasiveness and wait and see.

Keep your fingers crossed for Moxie, and send positive thoughts her way, please.

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874521_tn?1375890587
congrats on being so proactive. it sounds like you have a very caring and experienced Vet. I don't blame you for wanting to wait the month, thats kinda what i'm doing too...my Sami has FORL's. and getting regular xrays to see how quickly the progression...when the time comes he'll need to see a dental specialist and possibly have all his molars removed as well as the roots.

I have heard of CET paste to help clean the teeth and prevent tartar yes. I haven't used it myself yet, but will look into in more as well.

I certainly hope for Moxie that she will get the very best of care and that this isn't cancer...IMO you are right not to go ahead with the punch biopsy.

Its a hard call isn't it....but you are doing the best you can and all you can to help your little fur baby.
I wish you both the very best of luck and prayers on your journey.
thankyou so much for the update and please continue to do so....we all learn from the experience of others on this forum..

God bless ♥
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