Need help for a tongue ulcer

Cheeto is a super sweet 7 year old rescue that I have had since she was 5 months old. She developed stomatitis a few years ago, nothing new for me, it seems like 1 out of every 5 or 6 cats I rescue developes this mouth problem. I currently have 2 cats with stomatitis and I keep it under control with Methylprednisolone injections. About 7 months ago I had all of Cheeto's teeth extracted to try to help with the stomatitis. I don't know what happened, but after her dental procedure she developed a very painful tongue ulcer. I took her immediately back to the vet and he gave me a round of antibiotics to give to her. It didn't work. Another round of a different antibiotic. Still didn't work. I have taken her to the vet 5 times, she has been tested for FELV, FIV and FIP and all are negative. The vets have no idea why she has this tongue ulcer or what to do for it except give her horrible tasting medicine (Tramadol) which she absolutely hates. She is so skinny and she drools and chatters because her mouth is so painful. I syringe her Nutrical to keep her weight up the best I can, and I prepare special meals for her and I do everything I can, but it breaks my heart to see this poor sweet cat in pain. Her blood work shows she is an otherwise healthy 7 year old, but she is so miserable I would do anything to help her if I only knew what that was. Can anyone help?

Hi

Poor Cheeto, i feel so badly for her.  Tramadol is a pain killer.  Since she hates it so much I would ask your vet to consider giving you buprenorphine to administer sub Q (a needle under the skin).  Your vet can teach you how to do this, its painless, and "Bupe" is an excellent pain reliever.  You can also squirt it under the tongue, its a very tiny amount of liquid but Cheeto won't like this as much as sub Q, because it doesn't taste good either.  It's a controlled substance so I don't know what the laws are with respect to taking it home.

I'm assuming Cheeto didn't have any URI symptoms (sneezing, coughing, mucous discharge) when the ulcer appeared?  I only ask because there is a type of URI called Calici which includes sores in the mouth.

This is a good article on oral ulcers in cats.  Did any of your vets discuss the possibility of a tumor, and the need for a biopsy?

http://www.icatcare.org/advice/cat-health/oral-disease-cats

Stephen

Go see another vet. I have a strong suspicion you cat has a yeast infection in her mouth. The steroids she was on lower the immune system then add in antibiotics and it makes for a nice yeast infection that only an anti fugal can get rid of. Also steroids can cause diabetis and weight gain. The good almost negates the bad. But I think a new vet is in order.

Could it be cancerous? Cancer usually is known for causing wounds that don't heal properly.

Do you have any vet specialists in your area?  Can your vet consult with a Veterinary School?  Those would be my suggestions.  Has your vet had the area biopsied and sent away for analysis?

Your poor cat, it must be really hard seeing her like this and having so much difficulty eating still despite her surgery.

Mouse had stomatitis and had a number of lesions in his mouth until he was about 18 months old including severe tonsilitis and a large lesion on his tongue which healed but left scarring, plus a successive lesion which healed.  He was totally off his food when his mouth was at its worst and my heart goes out to you and your cat that this has gone on for so long without healing.  I feel very lucky that Mouse's condition settled.  About 6 months after his oral problems settled he started to present with runny eyes and after the 3rd or 4th episode the vets diagnosed feline herpes virus and said that they strongly suspected that that had been the cause of his mouth lesions.

I agree with others that I would be looking for further vet investigation including wider consideration of viral infections, fungal infections, and discussion of biopsy.  If your existing vet isn't keen to take things further and seek advice I would start asking around to find one who is a cat specialist or has a good reputation for feline care.

Thanks SO MUCH for all the suggestions, advice, and sympathy.  I didn't even suspect a yeast or fungal infection but i can definitely question the vet about that. If this poor cat is suffering like this because of something as simple as Calici virus or something that has a treatment I will feel terrible and also very angry. The vet I go to works with rescue groups and gives us a very generous discount, also gives many services free which allows me to help a large quantity of cats and get them all the medical help they need, and in the past this vet has always been right on target with diagnosis and treatment. He has been a vet for about 40 years and is the owner of a very well regarded hospital. But my next step is going to be a specialist, I'm willing to do whatever it takes to help Cheeto. I have one last appointment with the current vet on Saturday for a Buprenorphine injection. I talked to him today because she has developed an URI and I needed antibiotics and I again pleaded for anything that would help her tongue lesion. He replied "these things just have to heal on their own" and he too is wondering why her's is not healing. On Saturday I will ask him to run every test known, ask him about the possibility of a yeast or fungal infection, and pray that I get an answer.

I took Cheeto back to the vet today, got loads of medicine. She got an injection of Buprenex for her mouth pain and although she is completely stoned right now, I don't think it helped her pain because she is still chattering. I probed the vet more about what caused this tongue lesion, and now he thinks it is Calici virus. He said there is no medicine for it, because it is a virus, all I can do is supportive care. I got 2 antibiotics (Zythromycin and Amoxi), appetite stimulant pills, eye drops, more fluids, and I am continuing on the Nutrical and hand feeding.  I am just happy that she is a little loopy right now and is purring, she deserves a break from this miserable condition. Hopefully all of the meds and my love and care will get her better.

Calici does cause mouth sores but you would usually see other URI symptoms likes mucous, coughing, sneezing, and possibly a fever.

Oh no, your poor kitty.  Glad you were able to get some help for her.  I have seen Calici where the only symptom is a mouth ulcer.  You might want to try adding Lysine to your regimen, it works great on viruses.  I would give 500mg twice a day while your kitty is sick then on a daily basis.

stephenq said:

 
Calici does cause mouth sores but you would usually see other URI symptoms likes mucous, coughing, sneezing, and possibly a fever.

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Not necessarily. My Boo has confirmed calicivirus (via the specific blood test). There was one time he was drooling profusely, wouldn't eat or drink, and wouldn't open his mouth or meow. I took him to the vet the next day, and he had a large ulcer on his tongue from the calicivirus. He had no other symptoms. He was given a Fentanyl pain patch (which lasts for three days) and anti-inflammatory. I doubled his l-lysine dosage. The ulcers are very painful.

If Cheeto's ulcer is not going away or is getting larger, I would definitely look into other possibilities, such as an infection or mass.

Is it an ulcer or is it a mass/lump?

My cat had a huge lump on her tongue. Vet #1 said thought it was cancer and said to take her to the vet school. I called the vet school and they would have run up a $800 just for testing, biopsy, bloodwork, etc. Not including any treatment.

I took her to my local vet who is better than vet #1 but more expensive. (I use vet #1 for routine stuff- vaccines, bloodwork, basic wellness, anything difficult I use vet #2).

Since she has a history of esinophillic granuloma, the vet opted to treat her as if this was a granuloma to see if it would shrink with steroid shots and it did.

Cancer would not be treatable anyway, as oral cancer is very malignant.  The vet is confident it is a granuloma as the lump is shrinking, if it was cancer it would be growing.

She has an ulcer on the roof of her mouth as well, one small one on her lip as well.

Sarah Ann, good point!

I really feel for you having seen how severely Mouse was affected for that year his oral lesions were presistent.  He had suddenly turned in to a quiet loner who didn't want to play or snuggle in, and looked so depressed when I looked at him.  I was so worried after his period of illness and pain that his personality would be forever affected:  I want to reassure you that, as I noted in my earlier post his lesions and secondary infections healed, and once they did he quickly returned to the incredibly loving, sociable, bouncy pest that he was before he became ill.  I will continue to send you massive bunches of good vibes for Cheeto until we hear she is improving and out of pain.  

Mouse's lesions were probably due to FHV 1 although it was not identified until later as he did not present with any of the other usual symptoms, and he does seem to present with fewer issues when he takes L Lysine as a preventative measure, however I have not found any research that supports L Lysine use for Feline Calcivirus.  Others on this site may know otherwise, but in the absence of other information I would proceed cautiously and discuss with your vet given L Lysine's effect inhibitting a cat's body absorbing Argenine which is an essential protein.  I would be particularly cautious given Cheeto's poor apetite and low body weight just now.  It may be more beneficial to concentrate on trying to build up her general immune system with pro-biotics and optimum nutritional content of the food she does take in.

The other piece of information that I looked through which might be useful to chat with your vet about was on prescription of Recombinant feline Interferon Omega, and attach a link for the article.  What I do not know is the cost of such treatment, but suspect it might be high and prohibitive unless you have pet insurance cover.

http://www.dr-addie.com/Respiratory.html

Recombinant feline Interferon Omega

 

Mouse is so fortunate that his lesion healed up. I had one other cat, who passed away about 5 months ago, that had a tongue ulcer very similar to Cheeto's and she too healed up. I really didn't do anything aggressive for her, I guess her immune system was just stronger than Cheeto's, or her ulcer was from a different reason. Cheeto has stomatitis also, she has had it for years, so she began with a compromised immune system. Her tongue ulcer is definitely only a lesion, not a mass (thankfully). I check it everyday and sometimes it looks smaller and less red, but Cheeto still paws at her mouth when she tries to eat. On occasion it has been very red, but she acts the same no matter how red it is-like she is in a lot of pain.

As far as this new comment from the vet about Calici, I don't know if it is accurate, she doesn't sneeze or have a fever, but she chronically has thick, yellowish mucous oozing out of the sides of her mouth. My poor cat! She is such a mess. She is the sweetest little calico and she doesn't have a mean bone in her body. None of the pain meds are working, I am on the second day of the Zithromycin and so I will see how that works.

I am offering her favorite foods-ice cream, butter, yogurt- not the best diet but I know at this point any nutrition and caloric intake is a good thing.

I will research the medicine on the link, but no, I don't have pet insurance, all of the medical costs for my rescues are out of my pocket, but if something will help I won't spare any expense. As far as Lysine, I would be willing to give that a try also, but I want to make sure that I don't give her too much, she only weights 3.5lbs. Is 500mg twice a day too much for her little body?

Hi Cat Stress 15, I really wouldn't want to advise on dosages for anything as it depends on your cat's weight and general health.  I have found my vets very open to use of L Lysine though and they will usually discuss things about the L Lysine with me over the phone if i want advise.  I have also found quite a clear article on the use of Inteferons in stomatitis:

http://www.vetstream.com/felis/content/generic/gen60017

I had another vet journal artice that was very interesting if a challenging read which talked about this but seem to have deleted it from my favourites which is a real pain.

All the best with further discussions with your vet and finding something that works.  I'm with you on giving favourite foods at this point, if she can eat them then go for it.

Good news...Cheeto is eating!!! I don't know if it was the Zithromycin, the Buprenex injection, or even the butter, but she has a voracious appetite and seems to be eating with no more pain, no chattering, head twisting or drooling. I am so thankful!!

    Excellent!      Long may this continue.  Hopefully this will be the start of  her tongue heeling and being able to get some good nutrition to build up her immune system.  Fingers crossed and sending good vibes that this is the start of an upwards journey and a pain free Cheeto.    

Would love to know how she's doing: if she continues to eat well and how her mouth is looking in a few days.

Yeah for Cheeto!  So glad the little one is eating and has gotten some relief from the discomfort. Is there any change in the ulcer (hopefully for the better)?

Thanks!! So far so good, she is still eating I didn't look in her mouth to see if her tongue looks any better,  I am just going to let her do her thing and eat away. I'm going to keep her on the Zithromycin until it's gone (she is on the once every three day regimen now) and I hope this ulcer will GO AWAY for good!