Recurring mouth ulcers--need advice

Hi everyone.  My cat Presley began having trouble eating this past Februrary--mid-bite, she would cry out and appear to have trouble swallowing.  The vet said she had an ulcer in her mouth, and recommended a dental cleaning.  We tried a round of antibiotics first, but the symptoms returned and she had a dental cleaning in Feb or March.  She improved after the cleaning, was eating normally, playing, and acting like herself.

A couple of months ago, the symptoms started again.  The vet had said initially that if this happened, she may need all of her teeth removed (something about developing an allergy to the tartar).  However, they chose not to go that route, and instead recommended another cleaning and Depo shots every 60 days.  The vet also told us to feed her only dry food, give her dental treats, and use a mouthwash and/or toothbrush if possible.  This cleaning, along with the first shot of Depo and another round of antibiotics, were administered on 9/10/12.  Since then, I have followed the dry food recommendation and given her Greenies treats on a regular basis.  We haven't had much luck with the mouthwash and tooth brushing, though.

At about the 1.5 month mark I began to see the signs that she was having trouble again--each time, she has become less active and more reclusive along with eating less, and I noticed her acting that way beginning a week or so ago.  She started having the 'crying out' response when eating, then started refusing food and sleeping all day.  She is due for her next Depo shot on 11/10, and we were planning to take her next week to get it.

I guess I am just startled by how soon the symptoms returned, and I'm kind of questioning this course of treatment.  It was bad enough when the symptoms returned 6 months after the first cleaning, but a month and a half seems really soon.  The shot left a lump between her shoulder blades, which worries me (the vet said it would take a couple of months to go down, which it has, but still), and I'm not too happy that it didn't even keep her symptoms at bay for the full 60 days until the next shot.  I think the lump itself lasted longer than the relief from it!  Not only has all of this cost us a fortune, but poor Presley has had to deal with episode after episode of feeling lousy.  I so want her to feel like herself for longer than a few weeks!

Has anyone successfully treated something like this, or could offer any advice?  Should we continue to try the Depo shots--and is using them repeatedly safe?  Would surgery to remove the teeth be a better option, or is that too risky/invasive/etc to attempt at this point?  Is there anything else we could do that would offer longer-term relief?  I just want my girl to feel well again.

Oh, I probably should have noted, Presley is about 10 years old, spayed, and blood tests run in February showed she is in great health otherwise.

Yes, this condition is called Stomatitis - the reason why she is acting this way is because it is an extremely painful condition.
The usual routes are either 100% extraction or Depo-medrol and antibiotics treatments for life.

My cat Bugsy has this, I was lucky to have an amazing clinic close to me that offered a third choice,. so I did not need either of those routes. He did AMAZING for a long time. He still needed daily medication and annual dentals, but that was ok - the medication didn't have steroids or side-effects.

I am speaking in the past sentence because since I changed him to a raw diet his stomatitis symptoms started to disappear. He is now medication free. I can't say it will be forever, like IBD (he also has IBD), there is no cure for stomatitis - you just control it, so I can't say how long it will last..... But so far so good! It's been 7 months since we stopped the meds and he had his last dental, and his vet said his teeth look like he had a dental just last week :bigthumb:

Depo shots long term would be my last option, honestly due to short and long term side effects........

You definitely have some choices to make.... one thing I would advise you is to look for a dentist who is experienced with stomatitis. Even if you chose the full extraction route, you want to make sure that dentist has done for stomatitis - it has to be very well done to ensure that the condition will not recur in the future. Keep in mind full extractions are not 100% guaranteed to work - in a lot of cats it doesn't and they still need treatment afterwards.
It does work for most, it seems.

Thank you for the info, Carolina.  I didn't even know what it was called!  That will help with researching.

What was the third option your vet gave you?  I wouldn't mind giving a medication long term as long as it didn't have negative side effects, and one dental a year would be a huge improvement from one every few months!

I don't know much about raw diets--I'm guessing that is a huge transition from dry cat food.  Presley is pretty picky so I don't know if she'd go for it.  It does make sense though, that a more natural diet would be better for the teeth than a bunch of additives and ingredients cats wouldn't eat in the wild.

I have a kind of vague understanding that Depo shots have negative side effects long term, but I can't remember where I heard it or what the side effects were.  It does seem like if the shot doesn't keep the symptoms away for even the full 2 months, any side effects wouldn't be worth it :/

Are there any big reasons not to do the extraction?  I work with a rescue and we've had several cats with no teeth, and they seem to do fine, but it seems like taking them all out at once would be very painful and difficult to adjust to.  How much higher is the risk (of the surgery) compared to a dental with one or two extractions? 

It looks like the nearest veterinary dentist is about 4 hours away from me...not really possible for us right now.  We live paycheck to paycheck as it is, and our current vet lets us make monthly payments, which is very helpful--otherwise we wouldn't have been able to do half of what we've done so far.  I will try to find out how experienced they are with stomatitis, but I do have a lot of confidence in them as far as surgeries go--my 20 year old cat had to have surgery on an abcess and came through fine.

Hi.  We recently adopted a 6 yr old cat with severe stomatitis.  We found the best vet we could (no dental specialists here) who had had some success treating it without steroids.  This meant leaving our regular vet to get a second opinion.  (Our vet said there was only a 1% chance she could live a life without steroids.)

Lucy ended up having all her teeth removed behind the canines.  We also are trying to give her superior nutrition (raw food) and some supplements (omega 3's, probiotics and lysine for a kitty cold problem.)  At the very least a stomatitis kitty should probably be eating grain free canned.  The grains in food can sometimes contribute to the problem.

Lucy is about 7 weeks past her surgery and her mouth is greatly improved but it is too soon to say for sure if she will need ongoing meds or treatment.  The stitches have to dissolve totally for us to know for sure. 

Here's an article that discusses treatment options.  If you look at the section that discusses extractions you will see why it is important to have a really thorough vet do the surgery....I'd ask if they take x-rays to make sure they got all the root out.  There is no room for sloppy technique with a stomatitis kitty. 

http://www.allfelinehospital.com/site/view/206537_Stomatitis.pml

Carolina used a vet in Dallas that has a proprietary blend of meds to treat stomatitis without steroids.  They will work with your vet long distance and ship the meds if needed.  I've contacted them and it would be about $45 per month with shipping for us to try the meds.  That's pretty steep for our budget.  If you would like the vet's name you could private message me or Carolina and we could give you the info.

In my mind there was no reason not to try the extractions.  We feed wet food anyways, so no worries about not being able to chew.  You just have to go into it knowing that extractions don't always solve the problem.  But done meticulously I was seeing success rates from 30-90% from different sources on the internet.

Good luck with your kitty. 

Thanks, txcatmom.  Sorry your kitty has to deal with this, but I'm glad you are having some success after the extractions.  I have a kitty named Lucy too

After reading some of the info on here and other sites about raw diets, it looks like that is the way to go for all-around health.  I'm not sure I could do it financially right now (I have seven cats, a dog, two fosters, and no job--yikes) but I will check into the grain-free canned food.  I definitely raised an eyebrow when our vet said to give Presley only dry food--not only are most brands full of junk, I have read so much negative info about them being linked to dehydration, urinary issues, etc.

Thanks also for the link.  It does look like extraction is the best way to go, even if it doesn't guarantee success.  I would love to try the alternate medication you and Carolina mentioned, but $45/month is out of my budget too!  Rather than wait until next week, we made Presley a vet appt for tomorrow morning since she is barely eating.  They said they'd have a look at her and go from there.  I really don't want to continue with the steroids, but I know the extraction will cost a fortune, and I am nervous that the vet won't want to add to our bill since we can't pay upfront.  If they are willing to do it, I will be sure to ask whether they ensure the roots are completely removed. 

I took a cat that was abandoned by some very bad people (they ran a meth lab). He is a black and white of indeterminate age but I am guessing he was about five or six when we got him. Needless to say, he had stomatitis or more correctly lymphocytic plasmacytic gingivitis stomatitis (LPGS) although I did not know it at the time.

I have owned over twenty cats in my life and never had a cat with this type of problem. For the first year we would take him to the vet every three or four months for steroid shots but there is a danger of cats developing diabetes from prolonged steroid shots. Eventually it got so bad Dee Jay would scream when he tried to eat and was in constant agony and would crawl into hiding places and not come out.

Consequently my vet recommended an oral cat specialist. So I took him and the man was extremely knowledgeable as all he did was deal with cat oral problems like Dee Jay's. He explained all about LPGS to me and his recommendation was extraction as the only cure-all in Dee Jay's case. He took picture of Dee Jay's mouth and it was literally raw and bleeding. I cried. I also cried when I heard the fee: $4000.

Needless to say, (following the adage that no good deed goes unpunished. LOL!)  I went ahead and had it done as a committed (I probably should be committed for being crazy) pet owner (I have eight animal dog/cat rescues) who, thank heavens, can afford to do this albeit with some buckle tightening, lean meals and uh...no vacations, no cable, no movies, etc. (I am retired and have dedicated my golden years to animal rescues). Well, miracle of miracles, Dee Jay immediately showed signs of improvement and now almost two years later he is a happy, healthy kitty. In fact, he is so able to eat without pain now he gained two pounds! My biggest surprise was that he could still eat dry food without any teeth. I guess they "gum" it.

Here he is, the very happy Dee Jay now (He's trying to look serious for the camera though).

http://img.photobucket.com/albums/v155/btavis/deejay.jpg

Love those golden eyes!

I can only imagine for all the years before I owned him what agony he must have been going through (I can only hope his previous, despicable owners are in jail). Now, I am not saying that getting all of the cats teeth extracted is the best solution for all situations but it was the last resort for Dee Jay. The price I paid for complete extraction was very high for sure and I am sure there are probably places that will do it for less but the doctor I used is nationally known for his oral veterinary care. His name is Dr. Chris Carter of Main Street Veterinary in Lewisville, Texas. But I could not under any circumstances and good conscience let it go on without some kind of permanent solution as the cat would only keep needing those steroid shots and prolonged application of which has consequences and side effects as well.

I have four other cats and I adore all of them and they me. But Dee Jay has a special relationship with me. He never leaves my side, sleeps with me and is usually sprawled across my computer keyboard like right now (Consequently, I make lots of typos as a result:-)).

And, I think he now knows who the good guys are.

LPS Stomatitis is what Bugsy has too. Not fun.... Thank goodness he is doing well now, but yeah, he was really bad some years ago.

Before doing a full mouth extraction, I would try exhausting all other possible treatment options, like feline omega interferon, Atopica, Biotene Veterinary Maintenance Gel, and even gold salts. There's a good article on Stomatitis here: http://thrivingcats.com/html/stomatitis_in_cats.html  

Here is an excellent article on LPGS:

http://www.manhattancats.com/Articles/Severe Gingivitis-Stomatitis.html

Sugarcatmom said:

Before doing a full mouth extraction, I would try exhausting all other possible treatment options, like feline omega interferon, Atopica, Biotene Veterinary Maintenance Gel, and even gold salts. There's a good article on Stomatitis here: http://thrivingcats.com/html/stomatitis_in_cats.html  

Click to expand...

I agree.... By the way, in the article you quoted:

More recently, Dr. Robert (Bob) Wiggs, a Texas veterinarian considered an expert in the field of feline denistry, was working on developing a "stomatitis cocktail" before he unexpectedly passed away on 2009. The clinic where he worked, The Dallas Dental Service Animal Clinic, has since reopened and is continuing his work and offering the cocktail via a request from your veterinarian. It is an all natural, experimental treatment that is reported to have a very high success rate. This treatment is the most promising to date.

Click to expand...

That's the place Bugsy goes to. It worked amazingly well. Dr. Wiggs was Amazing - he was the pretty much the #1 specialist in stomatitis during his lifetime, actually, considered pretty much the #1 Animal Dentist in America by many.
Bugsy started years ago, and he is patient # six thousand something of this formula. He was able to keep all his teeth and thrive. I would chose this treatment over full mouth extraction any day.
Is is not an all natural treatment though. The cocktail is made of natural supplements and mostly subclinical FDA approved drugs, but no, it is not all natural.

I just posted about my foster who was diagnosed with "rodent ulcers". Could this be what your cat has been suffering from?

Google ..there are some photos out there too. Hope you find our answers!!
 

The vet suggested trying another round of Depo and Clindamycin, and seeing how Presley is in a week.  She is doing a bit better--much more active, and eating a little.  I don't really expect this to last, but hopefully it will make her feel better long enough for me to decide whether to try something else or go for the extraction.  The vet admitted that using steroids long term is a bad idea, but wanted to try it again and see if it worked--although I don't understand why she thought it would provide a more lasting effect this time than it did 2 months ago!  

BTavis, bless your heart for taking in this kitty and giving him the care he needed!  He is gorgeous!  Your experience with Dee Jay sounds a lot like mine with Presley--crying out when trying to eat and hiding.  It is heartbreaking seeing them go through cycles of this over and over--which is why, like you said, I am definitely aiming for a permanent solution.  We got Presley at about 4 years old (we think) and she'd had kind of a hard time of it before we took her in, having been tossed outdoors and vying with the resident ferals for food.  We just want her to be as healthy and happy as possible for as long as possible.  Thanks for the input on your experience and the link.

Sugarcatmom (and Carolina), thanks for the link and suggestions.  It looks like some of these have to be prescribed/obtained from a vet, so I will ask ours when we (inevitably) have to call about Presley.

Levi68, I'm not sure!  I did a quick google search and it looks like they are usually on the lip?  If so, I don't think that's it, since Presley hasn't had any ulcers on her lips that I know of.  Maybe I should ask our vet for a diagnosis to be sure (they've never told us the name of what she has...).  Thanks--I hope your foster kitty gets better!

Best of luck with Presley. I cannot stand to see one of my pets  in pain. Right now I have a three year old (Ringo) with an ear infection and he has been hanging around me all day crying.  Of course it always happens on a Sunday!! I will take him to the vet tomorrow but I gave him some special otic solution in the meantime and that seems to have helped. It is probably a yeast infection which cats are prone to getting. He had to go the vet on Wednesday anyway to get his annual shots but I think I need to take him sooner.

With 8 animals it is always something!
 

i find it odd the vet specifically said to feed only dry food, that runs counter to everything i have read. i have two cats who just had full mouth extractions (well one had FME, the other still has 3 canines), both have had a history of bad teeth and each had several extractions in the past. part of the reasoning for avoiding dry food is that it can cause inflammation in the mouth, which exacerbates the condition. secondly, dry food is not great for cats in general. 

other options for treatment include cyclosporine and prednisone. Both are better for long-term treatment than the Depo shots (the first is an immunosuppressant, the second is a steroid like Depo but at a lower dose). 

I would love to know more about Dr. Wiggs' treatment though, sounds promising!

Has your cat's kidney function ever been checked?............via bloodwork and urinalysis?  I ask because senior cats (which your kitty would be considered) are prone to kidney disease........and with kidney disease comes mouth ulcers (due to elevated uremic acid/reflux of stomach acid).  

Such frequent Depo shots put your cat at risk for developing steroid induced Diabetes, which may or MAY NOT resolve if the Depo is ever no longer given.   I personally would never ever let any of my cats be given a long-acting steroid like this, as often as your cat is receiving it.   Even in humans it's advised that they don't receive such a shot more than 2-3 times per year.    With all due respect I would question the thought processes of ANY Vet who felt it okay to give a long acting steroid injection like this, that often....seriously.   Every 60 days, that is ludicrous!   As someone else suggested, a daily course of shorter acting Prednisone would be a lot better (but not on a permanent basis).   Also, long term use of Depo can be hard on the kidney and liver.

Do you know if your cat's kidney function has been checked lately?  (bloodwork:  BUN, creatinine......urinalysis would indicate whether protein in urine, urine specific gravity)

BTavis, I hope your kitty is doing better.  You are so right--I have 7, most of them seniors, and it is always something!

jimmylegs, I totally agree about the dry food.  Dry food seems like it is almost always filled with more 'junk' than wet, and I've always heard that wet is better in terms of overall health.  The first time around I followed their instructions about this, but it didn't seem to make any difference in terms of extending her time without a flareup, so I have since disregarded that part and fed her mostly wet. 

the_food_lady, Presley had a blood panel run before the first dental, and everything looked great, including kidneys, liver, etc.  I'm not exactly sure what the panel is called or what specifically it checks, but it is the same panel that detected kidney problems in another of my cats.  We haven't had a urinalysis done on her, but in my experience Presley is much too fat to be a renal failure kitty.  She also isn't dehydrated at all.

I must say that you have both voiced concerns that I too have felt regarding our vet's course of action.  They have never mentioned any of the other possible treatments to us, and as the_food_lady pointed out, continual use of the steroid injection seems like a terrible idea.  We had been looking for a good vet for a long time before finding this one, and I admit that this experience has raised doubts.  It is so hard to find a truly competent vet, especially in rural areas like where I live.  I would love to find a vet that I felt I could fully trust with my animals' health; so far, I have always felt it necessary to research conditions, treatments, diets, etc to make sure I am doing all I can for my cats and dog.  I would probably do this anyway, and of course it never hurts to be as informed as possible, but it'd be nice to feel secure in my vet's knowledge and that my animals are getting the best care possible. 

As for an update on Presley, only a month later, the injection has once again wore off, and Presley is already exhibiting all of the signs of mouth trouble.  At this point, we feel it is best to go ahead with the extractions.  Among the various other treatments, we might have found something that worked, but poor Presley has went through too many cycles of brief healing followed by painful flareups and I just want to see her well again.  The procedure is scheduled for tomorrow; I hope and pray that this makes a difference for her.
 

I have several cats who have issues with severe allergies/possible immune issues who have had to receive multiple steroid shots, they get rodent ulcers among other symptoms and they would recur as soon as the steroid shots wear off. My vet had me put them on Atopica (cyclosporine) to see if we can get them off the steroid shots, since it's not good for them to keep getting those all the time... The Atopica/cyclosporine is the only thing that has worked to alleviate Mr Grey's skin reactions and rodent ulcers besides the steroids.

This might be something to talk to your vet about and see if it may be something that could work for your cat.

I had to go through a couple of vets until I found one that not only seemed to 'hear' my concerns, but also offered helpful suggestions. I love my old vet but he is stuck in the past, he said we have to do the steroid shots even if it causes diabetes. I refused to accept that, so I went to a dental specialist (plus started using another regular vet) and found much better advice. One of my cats has been doing great for a month since surgery and the other (whose stomatitis was much more severe), is doing well right now though I'm prepared for it to go south again soon. 

There's a great page on feline stomatitis on Squidoo: http://www.squidoo.com/stomatitis-in-cats

Lily the cat is profiled here for her many ailments, and there has been excellent discussion of treatments. One treatment I've never heard of is a steroid cream which you apply directly to the cat's gums. This might minimize the dangers of the medication while targeting the problem area. I'm probably going to try cyclosporine next if it comes back.

Thanks, jimmylegs and Nekochan.  She had the full mouth extraction on Thursday, but the vet cautioned us that it might still recur, so if it does, I will ask about the cyclosporine.  The steroid cream sounds like a good option--if your cat will let you rub it in their mouth, LOL! 

I do have a new question about Presley, for anyone with experience or knowledge regarding full extractions--how soon after the surgery should the cat be able and want to eat?  Presley's surgery was on Thursday, and she ate a little the first night, but very little since.  I've been trying all sorts of different (soft, of course) foods but she will barely touch them, if at all.  

She was given a pain injection after the surgery, and the vet sent me home with four 0.1ml doses of Metacam.  The fact that she was interested in the food the first night, but not since, makes me wonder if her mouth has been hurting after the injection wore off, making her hesitant to eat.  Last night she came running when I was getting the food ready, but seemed like it bothered her mouth when she tried to eat.  Just wondering if this is typical, if we should try syringe feeding her, or what.
 

I would check with the vet, my cats ate the next day, they one with the more severe issue was definitely hesitant but she did eat and within a few days was eating nearly normally. These operations use stitches so it's possible they are annoying her. Try something really pungent like sardines, that often brings them around!