Vet Dr. Hive help - stomatitis

[Terabith]

I need help thinking things through.  

Three years or so ago, our vet suggested our cat (then age 11) have a dental cleaning and remove a few teeth.  We agreed, and immediately afterwards, she started having massive mouth pain and inflammation and was diagnosed with stomatitis.  The vet said that dental cleanings and extractions can sometimes stir up the bacteria in the mouth and trigger it.  So, I'm already kinda irked.  It's probably irrational, but I sort of feel like if we had not done this thousand dollar plus surgery when there were no problems that she would still be healthy.  

Vet offered at the time full mouth extraction as a possible treatment, but he recommended against it because he said it often didn't work and sometimes made things worse.  He suggested several rounds of oral antibiotics and steroids, which we did, but it triggered massive emotional trauma in our cat (Scout).  It involved chasing her down twice a day, prying open her very painful mouth, and forcing extremely foul tasting medication into her mouth.  We tried both pills and drops, but the whole process was incredibly awful for everyone, and she began to be afraid of us, never coming for pets and running and hiding from us all the time.  We finally decided enough was enough and that we'd see what the baseline was.  

Things got better for awhile, but never really got great.  She stopped being afraid of us.  I took her in in November because she needed shots and was very constipated.  Vet was kind of horrified by the state of her mouth.  I said, "I am not giving her daily meds anymore.  It absolutely decreased her quality of life.  If her quality of life is not good without daily meds, then it's time to put her down, but we are absolutely not doing the daily meds thing."  Vet did an enema to resolve constipation, suggested mixing in a half a teaspoon of miralax into the "extra gravy" part of the extra gravy pate twice a day, and gave her a shot of antibiotics and a shot of steroids.  She improved immensely.  

We did a couple rounds where every six weeks or so we'd take her in for another shot, and it seemed to help for about four weeks.  They said we could only do the shots every six weeks because of side effects, but this still seemed like an improvement, and my husband and I decided that it was absolutely worth $100 a month or so for her quality of life and for all the bad things to happen at the vet.  It means that she's not associating us with trauma.  

But, the last time we did a shot, she never got even temporary relief.  The different vet at the practice who saw her said we need to consider full mouth extraction.  And.....I don't know what to do.  

She's now 14.  My primary concern is her quality of life, and I feel like we're getting to a point where I'm having trouble evaluating it.  She is eating very little, and she is crying out in pain even when she's not trying to eat.  Pus literally drips out of her mouth fairly frequently.  She really only eats once every few days, and it's a huge production that involves putting out food at the appointed times, letting Obama eat (I think she makes sure Obama eats first out of either a dominance thing or to make sure the food is safe), then send him outside, and then SOMETIMES, if all the stars align, she will eat.  I can usually get her to eat the push up treats, which made me think the very expensive tikki mousse food would work, so I bought some, and it worked for like two days and then she wouldn't touch it. 

I kinda think probably it is worth trying the extraction, but my husband is like, "Are we seriously going to do a $1500 surgery on a very slim chance that it will help?"  But at the same time, she moves around easily.  She comes to us for pets.  She purrs.  She even plays on occasion.  She has places that she likes to sleep.  The pain does not SEEM constant....it's more like she gets jabbed with something and then yelps?  Except around food.  I don't have peace that it's time to put her down, but I also don't want her in agony if she's hiding constant pain.  When we put our 19 year old cat to sleep, the timing seemed clear and she wasn't doing anything (playing, walking around, coming for affection).

So...all that to say, does anyone know the odds on full mouth extraction resolving stomatitis?  She only has a very, very few teeth left.  The first vet made it seem like it was unlikely to help, and even the second vet, with whom communication is challenging because of covid protocols and coming through the vet tech who brings her out to the car, makes it sound like it's not necessarily all that likely to help but that there's nothing else to try.  

And, how do you evaluate the quality of life of a cat?  

[Selkie]

It sounds like her quality of life is awful. I'm sure she is in serious pain, poor kitty. I would absolutely do the teeth extraction. We had that done for one of our cats and she was instantly so much happier and more comfortable. From what I've read, only about a third of cats do not respond well to extraction, so those are pretty good odds.

[Terabith]

Just now, Selkie said:

It sounds like her quality of life is awful. I'm sure she is in serious pain, poor kitty. I would absolutely do the teeth extraction. We had that done for one of our cats and she was instantly so much happier and more comfortable. From what I've read, only about a third of cats do not respond well to extraction, so those are pretty good odds.

That does sound worth trying.  She just....acts fine other than around eating?  And that's very new.  She hasn't been going without eating for years.  She was eating steadily up until this past month.  Before, she might go a day or so without eating, but also sometimes Obama will be like, "Nah, I am not liking this can of food," either, so it's been hard to say if it was mouth oriented or not.  But the last month, and especially the last few days, have made me very worried.  

[Selkie]

2 minutes ago, Terabith said:

That does sound worth trying.  She just....acts fine other than around eating?  And that's very new.  She hasn't been going without eating for years.  She was eating steadily up until this past month.  Before, she might go a day or so without eating, but also sometimes Obama will be like, "Nah, I am not liking this can of food," either, so it's been hard to say if it was mouth oriented or not.  But the last month, and especially the last few days, have made me very worried.  

I would get her seen ASAP because cats can suffer organ damage very quickly if they're not able to eat.

Here's a study about about the success rate of tooth extraction in cats with stomatitis:

https://pubmed.ncbi.nlm.nih.gov/25719848/

Conclusions and clinical relevance: Extraction of teeth in areas of oral inflammation provided substantial improvement or complete resolution of stomatitis in more than two-thirds of affected cats. 

[Terabith]

That sounds like significantly better odds than I had been led to believe.  I'm calling the vet right now!  Thank you!

[TexasProud]

I guess I just do not see spending 1500 dollars on a 14yo cat. 

[itsheresomewhere]

Before the extractions, the vet should run bloodwork to check the kidneys along with other stuff.  I would plan for the extractions but if her blood work comes back not ok, I would then discuss her quality of life.  

[Terabith]

1 minute ago, itsheresomewhere said:

Before the extractions, the vet should run bloodwork to check the kidneys along with other stuff.  I would plan for the extractions but if her blood work comes back not ok, I would then discuss her quality of life.  

We did blood work three months ago, and it showed some kidney issues, but they were pretty mild and said she was basically in pretty good health.  

[itsheresomewhere]

1 minute ago, Terabith said:

We did blood work three months ago, and it showed some kidney issues, but they were pretty mild and said she was basically in pretty good health.  

She should have it again before the extractions.  It can change quickly. 

[Jean in Newcastle]

If you don’t do the extractions now, that cat needs to be put down. It’s the humane thing to do. 

[Pawz4me]

I'm sorry, Terabith. Deciding issues like this with elderly pets is very difficult. I do agree that it sounds like her quality of life right now isn't good. So I'd either have the extractions done or have her euthanized. I don't think either decision is wrong. I do think @itsheresomewherehas a good point in that doing the pre-anesthesia blood work might help with your decision.

Hugs.

[Terabith]

5 minutes ago, Pawz4me said:

I'm sorry, Terabith. Deciding issues like this with elderly pets is very difficult. I do agree that it sounds like her quality of life right now isn't good. So I'd either have the extractions done or have her euthanized. I don't think either decision is wrong. I do think @itsheresomewherehas a good point in that doing the pre-anesthesia blood work might help with your decision.

Hugs.

I'm waiting for a call back from the vet.  Hoping we can get in today.  If vet approves, we will proceed with extractions.  She ate today, and today's been a good day for her, but the last couple days before had been bad.  It's been peculiar.  She was doing well and eating well with the previous steroid shots, but the last couple weeks have definitely gone downhill a lot.  

[ktgrok]

Stomatitis is hell. I hate it. And at 14 there is no way in Hades I'd chance the full mouth extraction on a 14 yr old cat....on a young cat with a long life left, yes. But in this severe a case, where the vet is not hopeful, and given her age, personally I wouldn't. 

If it was my cat I'd put her down. I'm so, so so sorry, but yes, it is horrifically painful, and if she doesn't eat she's going to get fatty liver disease and go into liver failure more than likely, etc etc. So status quo is not sustainable. 

If you choose extractions there is nothing wrong with that. But there is nothing wrong with euthanasia at this point either...and I'm so sorry you are having to decide this. 

Edited February 16, 2022 by ktgrok

[Spy Car]

No advice, just sending positive thoughts your way.

Sounds stressful.

Bill

[I talk to the trees]

If Scout is otherwise in good health (labwork all good, acting normal except for the mouth) I would probably go ahead and try the surgery. Keep in mind though, that I am one of those people who sees pets - dogs in my case, cats in yours- as family, and I set aside a monthly budget for their health care just as I do for ours. I know it’s not exactly the same, but I spent uh, well, more that your quote on a dental for one of my pups when she was 13, almost 14, and she lived another 3 happy years.(I posted here about adopting her at age 11 with all sorts of health issues. We never thought she would make it to 12, forget 17!) All that to say that some animals do respond well to treatment! 
 

If the price tag is the real issue, have you shopped around? I don’t know where you take your cats, but some of the local vets have gone out of all reason! Angels of Assisi  may be able to offer the procedure for less. Hugs to you! I know this isn’t an easy decision!

 

[Terabith]

1 hour ago, I talk to the trees said:

If Scout is otherwise in good health (labwork all good, acting normal except for the mouth) I would probably go ahead and try the surgery. Keep in mind though, that I am one of those people who sees pets - dogs in my case, cats in yours- as family, and I set aside a monthly budget for their health care just as I do for ours. I know it’s not exactly the same, but I spent uh, well, more that your quote on a dental for one of my pups when she was 13, almost 14, and she lived another 3 happy years.(I posted here about adopting her at age 11 with all sorts of health issues. We never thought she would make it to 12, forget 17!) All that to say that some animals do respond well to treatment! 
 

If the price tag is the real issue, have you shopped around? I don’t know where you take your cats, but some of the local vets have gone out of all reason! Angels of Assisi  may be able to offer the procedure for less. Hugs to you! I know this isn’t an easy decision!

 

I like our vet.  They have never guilted me about doing extreme things (cough cough Veterinarians for Cats).  I think I need to talk to them.  They didn't call me back today, but she definitely ate this morning, so today has been a better day than yesterday, when she seemed miserable and I was alarmed, though she did eat some of the push up treats.  I think we can probably wait until tomorrow safely.  I think I really need to TALK to the vet.  It's been a problem because of covid protocols.  I've been taking her in every month to six weeks for shots, which genuinely seemed effective for several months, but now, do not.  I've been relying on very minimal communication from frenzied vet techs who bring her out to the car.  But I think this really requires a conversation.  I am willing to do the whole mouth extraction.  But, I'm not sure if it's the right thing to do.  If it was Obama, who is six, it would feel like the clearly correct thing to do.  Scout, at 14, I'm not quite so sure.  

 

1 hour ago, I talk to the trees said:

If Scout is otherwise in good health (labwork all good, acting normal except for the mouth) I would probably go ahead and try the surgery. Keep in mind though, that I am one of those people who sees pets - dogs in my case, cats in yours- as family, and I set aside a monthly budget for their health care just as I do for ours. I know it’s not exactly the same, but I spent uh, well, more that your quote on a dental for one of my pups when she was 13, almost 14, and she lived another 3 happy years.(I posted here about adopting her at age 11 with all sorts of health issues. We never thought she would make it to 12, forget 17!) All that to say that some animals do respond well to treatment! 

I definitely feel that pets are family, but honestly, I've also had family members who the clearly correct thing would have been to euthanize them.  We have the money to do the surgery.  It's obviously hard for me to evaluate her health.  I need to talk to the vet about labwork again, but three months ago, it was okay, although they were suggesting we give her subcutaneous fluids at home, but my husband and I came down solidly on "we are not performing medical procedures that are uncomfortable on this cat at home because it is seriously traumatic to her.  Any bad things that happen should happen at the vet's."  She acts fine but kinda old.  She moves around easily.  

I need to have a conversation with the vet.  I appreciate this thread making me realize that we really do need to do SOMETHING right away, and not just wait out the time until the next steroid shot is possible.  

Edited February 17, 2022 by Terabith

[ktgrok]

2 minutes ago, Terabith said:

I like our vet.  They have never guilted me about doing extreme things (cough cough Veterinarians for Cats).  I think I need to talk to them.  They didn't call me back today, but she definitely ate this morning, so today has been a better day than yesterday, when she seemed miserable and I was alarmed, though she did eat some of the push up treats.  I think we can probably wait until tomorrow safely.  I think I really need to TALK to the vet.  It's been a problem because of covid protocols.  I've been taking her in every month to six weeks for shots, which genuinely seemed effective for several months, but now, do not.  I've been relying on very minimal communication from frenzied vet techs who bring her out to the car.  But I think this really requires a conversation.  I am willing to do the whole mouth extraction.  But, I'm not sure if it's the right thing to do.  If it was Obama, who is six, it would feel like the clearly correct thing to do.  Scout, at 14, I'm not quite so sure.  

 

I definitely feel that pets are family, but honestly, I've also had family members who the clearly correct thing would have been to euthanize them.  We have the money to do the surgery.  It's obviously hard for me to evaluate her health.  I need to talk to the vet about labwork again, but three months ago, it was okay, although they were suggesting we give her subcutaneous fluids at home, but my husband and I came down solidly on "we are not performing medical procedures that are uncomfortable on this cat at home because it is seriously traumatic to her.  Any bad things that happen should happen at the vet's."  She acts fine but kinda old.  She moves around easily.  

I need to have a conversation with the vet.  I appreciate this thread making me realize that we really do need to do SOMETHING right away, and not just wait out the time until the next steroid shot is possible.  

If they suggested sub cutaneous fluids that suggests to me the kidnesy are definitely compromised. 

[Terabith]

Okay, and now just to make a liar out of me and to make this decision harder, in addition to eating half a can of friskies extra gravy chicken pate this morning, she's eaten over half a can of friskies salmon pate tonight and is working on a pouch of tikki mousse now.  

Edited February 17, 2022 by Terabith

[YaelAldrich]

Hugs @Terabith!

[Terabith]

I just got back from the vet.  We're going to do the extraction.  The vet thinks there's a good chance that it will resolve the problem, and she's very active and alert, so he thinks she has a lot of life left if we can just get the pain/ infection under control.  He said her kidney stuff indicated mild dehydration more than damage, and likely the pain reduces her desire to drink.  He suggested we spike water bowls with chicken broth. 

I think it's worth a shot, and it costs a lot less than I was envisioning, closer to $500 than $1500, which is a plus.   

[TexasProud]

4 minutes ago, Terabith said:

I just got back from the vet.  We're going to do the extraction.  The vet thinks there's a good chance that it will resolve the problem, and she's very active and alert, so he thinks she has a lot of life left if we can just get the pain/ infection under control.  He said her kidney stuff indicated mild dehydration more than damage, and likely the pain reduces her desire to drink.  He suggested we spike water bowls with chicken broth. 

I think it's worth a shot, and it costs a lot less than I was envisioning, closer to $500 than $1500, which is a plus.   

Sounds reasonable. 

[Spy Car]

38 minutes ago, Terabith said:

I just got back from the vet.  We're going to do the extraction.  The vet thinks there's a good chance that it will resolve the problem, and she's very active and alert, so he thinks she has a lot of life left if we can just get the pain/ infection under control.  He said her kidney stuff indicated mild dehydration more than damage, and likely the pain reduces her desire to drink.  He suggested we spike water bowls with chicken broth. 

I think it's worth a shot, and it costs a lot less than I was envisioning, closer to $500 than $1500, which is a plus.   

Good news.

Since I feed Desmond a lot of fresh minced dark meat chicken, I will save up the bones (freezing) and then make up a batches of broth. He seems to like it. But he likes anything. Like having another dog.

Bill

 

 

[Kanin]

Oh, that sounds just awful. I'm so sorry. I hope the vet can fix things ASAP!!!!! I couldn't live with that.

[ktgrok]

2 hours ago, Terabith said:

I just got back from the vet.  We're going to do the extraction.  The vet thinks there's a good chance that it will resolve the problem, and she's very active and alert, so he thinks she has a lot of life left if we can just get the pain/ infection under control.  He said her kidney stuff indicated mild dehydration more than damage, and likely the pain reduces her desire to drink.  He suggested we spike water bowls with chicken broth. 

I think it's worth a shot, and it costs a lot less than I was envisioning, closer to $500 than $1500, which is a plus.   

Oh, that is more reasonable, and I'm glad the kidneys were not as bad as I feared. And yes, being able to eat and drink more will help with hydration. Fingers crossed - you are a great cat mom!

[Terabith]

We can't get in until March 2, but she has not lost weight since December, when we started paying a lot of attention.  It's also possible she's eating more than we realize.  There's a weird dominance thing where she will not eat until Obama eats and leaves.  Like I can't lock them in separate rooms to eat....he has to eat first before she will touch it.  But I also leave the wet food out for a few hours, and it's possible she's eating more than I think, and there is always dry food out, and I guess it's possible she occasionally snags a few pieces of that, not that I want to encourage her to eat dry food. And her activity and demeanor is good, even if her mouth looks like it's painful, but it's hard to tell if it's constant pain or not.  

[Carol in Cal.]

When we couldn't get our cat to swallow antibiotics in any form (pills, ground up in her food, pills that we dropped into her mouth and then held her mouth closed and rubbed her throat gently to get her to swallow them) IIRC that was the point at which we asked the vet to equip us to give her shots ourselves.  Cats have an almost nerveless area on the backs of their necks, and you can inject into it and they don't feel it.  (That's why mother cats can carry their kittens around by the scruffs of their necks.)  So we did that, and it was so so so much easier.

A side note--our cat was VERY sick at the time, but when we did the two person attempt to get her to swallow a pill, she glared at us for the 20 minutes or so that we held her mouth closed and very gently rubbed her throat, and when we let her go, she jumped down, moved half a room away from us, and then turned around, fixed us each dead in the eyes to make sure that she had our full attention, spit the pill, which clearly had been in her mouth that whole time, up into the air at us, and turned around and stalked away with her tail up in the air, obviously patiently teaching us that she got to decide this, and that it was very insulting to her to think that we could make her ingest anything she darn well did not want to.  I love cats.  

Anyway, the vet was amazed at these stories and gave us the needle rigs.  Maybe yours would, too.  It was so much easier on all of us.

[Terabith]

2 minutes ago, Carol in Cal. said:

When we couldn't get our cat to swallow antibiotics in any form (pills, ground up in her food, pills that we dropped into her mouth and then held her mouth closed and rubbed her throat gently to get her to swallow them) IIRC that was the point at which we asked the vet to equip us to give her shots ourselves.  Cats have an almost nerveless area on the backs of their necks, and you can inject into it and they don't feel it.  (That's why mother cats can carry their kittens around by the scruffs of their necks.)  So we did that, and it was so so so much easier.

A side note--our cat was VERY sick at the time, but when we did the two person attempt to get her to swallow a pill, she glared at us for the 20 minutes or so that we held her mouth closed and very gently rubbed her throat, and when we let her go, she jumped down, moved half a room away from us, and then turned around, fixed us each dead in the eyes to make sure that she had our full attention, spit the pill, which clearly had been in her mouth that whole time, up into the air at us, and turned around and stalked away with her tail up in the air, obviously patiently teaching us that she got to decide this, and that it was very insulting to her to think that we could make her ingest anything she darn well did not want to.  I love cats.  

Anyway, the vet was amazed at these stories and gave us the needle rigs.  Maybe yours would, too.  It was so much easier on all of us.

Oh yeah, I gave our other cat subcutaneous fluids at home, and I'd feel fine about doing shots.  The tech said they could do antibiotic shots and get pain meds compounded to rub on the ears.  So there is a plan.  

I have pilled a lot of cats over the years, but I don't think we could pill Obama unless he was very lethargic either.  He is a fighter.  

[Carol in Cal.]

Just now, Terabith said:

Oh yeah, I gave our other cat subcutaneous fluids at home, and I'd feel fine about doing shots.  The tech said they could do antibiotic shots and get pain meds compounded to rub on the ears.  So there is a plan.  

I have pilled a lot of cats over the years, but I don't think we could pill Obama unless he was very lethargic either.  He is a fighter.  

Maybe start with the shots and meds to try to stabilize things until you do the surgery?

[Terabith]

Unfortunately, because she had a steroid shot in the last month, we can't do pain meds currently.  Which is not ideal, but vet said she didn't look too bad today.  

[ktgrok]

1 hour ago, Terabith said:

Unfortunately, because she had a steroid shot in the last month, we can't do pain meds currently.  Which is not ideal, but vet said she didn't look too bad today.  

Yeah, no NSAIDs if she had steroids. But if she gets worse, let the vet know. There are opiate options but they are oral, other than a fentanyl patch, as far as I know.