Discussion about stomatitis

I have a 14-year-old cat who has been diagnosed with stomatitis. She's currently on prednisolone for it, which seems to help. But I know that steroids aren't a good long-term option. She has had 2 Depo-Medrol shots, too, which I've heard are supposed to be more effective than oral prednisolone, but the first one lasted less than 3 weeks and the second one less than 2 weeks, so I'm back to giving her tablets, 5mg a day.

Having her teeth removed isn't an option because of the price, also her age and general condition (she also seems to have some IBD which the pred helps with too), and there are no dental specialist vets in the area. My vets says that his previous clinic cat got stomatitis, so he had his teeth removed by another vet, but they didn't get all the roots, so he had to have it re-done, and it still didn't cure it. . .anyway, my vet feels a little negative about the removal option, is what I'm saying.

Also---this is a big one---she is very aggressive, nearly unhandleable. She's always been like this. I have to put on leather gloves to pill her, and when we gave her the Depo-Medrol shots she screamed and peed on herself and tried to kill everyone, even wrapped in a towel. She had to be sedated for the initial diagnosis. So, with any treatment options, stress for her and danger to me and vets needs to be considered! I would rather not look for a second/third opinion, just because they probably will not be able to examine her, and my current vet is willing to give me meds without seeing her.

After reading up on it, I'd like to ask my vet for some buprenorphine. Does anyone use it for stomatitis? I understand it's pretty expensive; any tips for getting it cheaper? I think she might be nicer with some opiates in her system too .

And, any ideas on why the Depo-Medrol isn't working for very long? Is that a dosage issue? It would be nice to not have to pill her every day but she doesn't fight the pills too much so either one is fine. The pills are probably better just to spare the vet from having to deal with her anyway.

Any ideas, tips, tricks, etc.? She cannot be force-fed so keeping her eating is important. She's picky and won't eat baby food or pureed meat. She's currently eating Fancy Feast chicken flavors, classic and chunky, with the occasional can of turkey Gravy Lovers. I haven't noticed any link between what she eats and her condition.

Willowy said:

I have a 14-year-old cat who has been diagnosed with stomatitis. She's currently on prednisolone for it, which seems to help. But I know that steroids aren't a good long-term option. She has had 2 Depo-Medrol shots, too, which I've heard are supposed to be more effective than oral prednisolone, but the first one lasted less than 3 weeks and the second one less than 2 weeks, so I'm back to giving her tablets, 5mg a day.

Having her teeth removed isn't an option because of the price, also her age and general condition (she also seems to have some IBD which the pred helps with too), and there are no dental specialist vets in the area. My vets says that his previous clinic cat got stomatitis, so he had his teeth removed by another vet, but they didn't get all the roots, so he had to have it re-done, and it still didn't cure it. . .anyway, my vet feels a little negative about the removal option, is what I'm saying.

Also---this is a big one---she is very aggressive, nearly unhandleable. She's always been like this. I have to put on leather gloves to pill her, and when we gave her the Depo-Medrol shots she screamed and peed on herself and tried to kill everyone, even wrapped in a towel. She had to be sedated for the initial diagnosis. So, with any treatment options, stress for her and danger to me and vets needs to be considered! I would rather not look for a second/third opinion, just because they probably will not be able to examine her, and my current vet is willing to give me meds without seeing her.

After reading up on it, I'd like to ask my vet for some buprenorphine. Does anyone use it for stomatitis? I understand it's pretty expensive; any tips for getting it cheaper? I think she might be nicer with some opiates in her system too

.

And, any ideas on why the Depo-Medrol isn't working for very long? Is that a dosage issue? It would be nice to not have to pill her every day but she doesn't fight the pills too much so either one is fine. The pills are probably better just to spare the vet from having to deal with her anyway.

Any ideas, tips, tricks, etc.? She cannot be force-fed so keeping her eating is important. She's picky and won't eat baby food or pureed meat. She's currently eating Fancy Feast chicken flavors, classic and chunky, with the occasional can of turkey Gravy Lovers. I haven't noticed any link between what she eats and her condition.

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As you say steroids are not a good long term therapy.  Stomatitis is EXTREMELY painful.  Teeth removal usually provides 100% relief. One of may cats had all her teeth removed and she is fully cured and happy.  Stomatitis can be so painful that euthanasia should be  considered for some cats who can't have their teeth removed.  Steroids are a temporary solution. Basically your cat hates its teeth, and will hurt her terribly,  Steroids can reduce the inflammation but it isn't a dosage issue, its an effectiveness issue.  Personally I would try to figure out how to fund her teeth removal (gofundme, friends fundraiser, etc) or consider euthanasia at some point.

Buprenorphine is not a good long term solution.  Short term its a good pain killer.  But it will make her loopy, possibly agitated, you will either have to pill her twice daily or inject her.

I've got to agree with stephenq about tooth extractions, even in an elderly cat, as stomatitis is something I saw so often at the shelter, and full-mouth extractions were the only thing that provided long-term relief. We saw so many positive personality changes, too, that it was clear how much pain the cats had been in, even with painkillers. A lot of them were surrendered due to behavioral problems and/or the cost of treating stomatitis. Many of the cats were seniors, and several were ferals that couldn't be given meds on a regular basis, making surgery the only real option

Mogli had all but his front teeth removed (due to FORL) back in October with no adverse effects, but he's much younger at 4 1/2. One consideration when opting for removal of most of his teeth all at once was that painkillers could have aggravated his IBD in the long run.

I am also in agreement with @StephenQ  and @jcat  on full mouth extractions as well as the meds you asked about. This stomatitis can easliy get well out of control, where nothing else works anyway.

I have had and dealt with this quite a few times in rescue, in fact currently I have a resident feral who lives at my house outside and basement, as I didn't feel comfortable putting her back out at her colony without teeth.

Luckily one of the vets I work with who is semi-retired and I keep telling him I won't allow full retirement ever due to the incredible savings he gives me, full mouth is done for $100.00. Yep.

Limb or eye removal, same.

He knows the importance of removing every bit of root for the body to stop reacting as there are invaders there, and one piece of remaining root will do just that.

I can only imagine the cost at a regular dental vet....

I actually sent someone who contacted me for help with her cat to him as one of my rescues, for the cost. Otherwise this poor cat would have been a goner and it just doesn't seem fair to cut short a life if there are any other options, and I happen to have the means to prevent that so I was happy to help her and her kitty.

I've never once from any cat sent to him seen stomatitis continue once this was done.

I've heard it from others, but can't help but think there may have been root left. 

The healing process is surprisingly fast and they eat dry and canned just fine. If you think about cat vomit, the food is mostly whole bits anyway so I guess they don't chew so much as it sounds

Great weight gain and much happier.

Lucy, the former feral tortie here I only gave her pain meds for 2 days afterwards too, she did fine.

Aside from all of this, you might want to consider using acepromazine for vet visits. I had to laugh a little when you said your current vet is glad to give you meds without seeing her, lol I bet! Yes as a matter of fact I would like to keep my arm........cats can be intimidating for sure!

I thought about euthanasia, praticularly considering her temperament. But she doesn't want to die and I hate to put down a cat who hasn't given up. I've had other cats who obviously were ready to go but she's made it pretty clear she doesn't want to yet. So we'll see how that goes in the future.

I'll have to do more research into what vets in the area are able to do this, and what they might charge.

I have an 18-year-old formerly feral who had bouts of stomatitis throughout her life.  Hers has always responded well to depo-medrol.  In the past I had two brothers with stomatitis and both had the full tooth removal.  For one it was a cure, but for the other the stomatitis was back within a short time and we put him back on depo-medrol.  It usually lasted about a month and it bought him another year or so of life, but eventually it stopped working and he was put to sleep.  His brother lived to be 18 with no further problems.  At the time the research I read showed 50% cure with the full tooth removal, and that's exactly what I got.

When this little black one came into my life and started with the stomatitis, she was treated with the depo for immediate relief and it worked so well that she just stayed with that.  Sometimes it would last two months, sometimes one month, occasionally three months.  I didn't consider the full teeth removal for her for two reasons -- one because I could not afford it (the vet dentist I had gone to with the others charged $800) and also because my previous experience was only 50% cure, so I considered it to be an $800 gamble with a 50% chance of losing, so as long as the depo worked, I would stick with that.  All her labs were normal a year ago also. Well, here it is about 14 years later and the depo still works for the mouth flares, but when it wears off, the pain of her arthritis seems worse than the pain of her mouth so YES, I do use small doses of buprenorphine when the weather changes and she's in pain.  (I suffer the same arthritic aches when the weather changes too.  We are both old ladies.) There are some things you can NOT use with depo, but the buprenorphine is fine to use and my vet provided some.  It is expensive but the best thing to use when needed.  I give her very tiny doses, and use the liquid solution (0.3 mg./ml, recommended dosage is 0.02 to 0.04 mg./kg), so it doesn't take much at all for a 7-8 lb. cat.  We know she isn't going to be around much longer because she recently developed a mammary tumor (slow growing but growing) and I won't put her through surgery at this point.  She's not active much anymore and lives on my heated waterbed (with added cat steps to it of course).  She still eats and will get off the bed to use the litter box.   She still purrs and likes ear rubs and cuddles, and the sun shines in on the bed during the day and she likes it.  She was a kitten in 1999, so she has had a long life but I know it's winding down.  I'm glad I have medication that keeps her comfortable when she needs it.  It's worth every penny.

Willowy said:

I thought about euthanasia, praticularly considering her temperament. But she doesn't want to die and I hate to put down a cat who hasn't given up. I've had other cats who obviously were ready to go but she's made it pretty clear she doesn't want to yet. So we'll see how that goes in the future.

I'll have to do more research into what vets in the area are able to do this, and what they might charge.

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My Harry died post-surgery last summer after all his teeth were extracted. He was only 10 months old. He would have gotten stomatitis if he'd kept his teeth. If he hadn't died, vet would have charged $2K.

Primula said:

My Harry died post-surgery last summer after all his teeth were extracted. He was only 10 months old. He would have gotten stomatitis if he'd kept his teeth. If he hadn't died, vet would have charged $2K.

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If she were 10 months old and friendly I might be OK with paying $2000. I hate to sound calloused but for a mean old cat I'd really rather not pay that much . She has bitten me so many times. . .I think most people would have PTS for that alone.

I've had luck with onsior and covenia combination for flare ups. The onsior is safe. I had a cat with it all her life and I couldn't afford an entire mouth extraction. We had to opt for extraction of the bad teeth as we go along. Though stomatitis sounds like a horror story kittys can lead quality lives with management of the flare-ups. And it is a cyclical disease. Euthanasia shouldn't be considered it can be managed.

I haven't read this entire thread, but I've recently had success with cold laser therapy treatment for my cat's severe stomatitis and wanted to share his story. Donovan is a senior cat, over 10 but not sure exactly since we adopted him a few years ago from the humane society. I think he had been in pain for some time - had terrible breath and eventually had trouble eating. We used Antirobe antibiotics a week a month for a while and that helped until it didn't. Then we tried steroids and those only worked for about a week. Finally I decided to get his teeth taken out (all but the very front ones). He had a terrible time recovering from surgery - I thought I was going to lose him. He was in severe pain for months afterwards and I had to give him gapapentin or buprenorphin just to manage the pain. As a somewhat last resort, I decided to try a new therapy that my vet started offering - cold laser. It's completely non-invasive, it's just a wand-type thing they wave in front of his closed mouth for about 30 seconds. Here's the protocol they used:

Week 1: 3 treatments

Week 2: 2 treatments

Week 3: 1 treatment

At this point his mouth was looking a lot better and he was having a much easier time eating, and his severe pain episodes (he would yelp in pain, run around, and then shiver until I gave him his medications) disappeared after the second treatment. We decided to continue with it once a week for a few weeks, and now we are trying 2 weeks. At this point, he is doing great - back to his old self, eating dry food, gained a lot of weight back, and is very active. For the first several weeks of the treatment, he was still quite lethargic. The cost is about $200 for 6 treatments. 

I had nearly given up hope on him and am thrilled with the results. I would encourage anyone to try this - before you resort to surgery, or afterwards if that doesn't seem to work. It is the same type of therapy they use for dogs for arthritis. Let me know if you have any questions. 

I should also have mentioned that after the surgery, the stomatitis had returned, along with new severe (I think nerve) pain. 

Thank you for sharing that, @LarisaInMaine.  I don't currently have any cats with stomatitis, but I have had them in the past.  I did have two brothers who had the total tooth removal surgery done years ago.  For one, it worked.  For the other, it only worked briefly and then his returned.  Depo-medrol shots were able to control the inflammation for awhile, but when that stopped working, I had to put him to sleep because there was nothing at the time that would kill the pain.  The literature I read said that 50% is the best one can really expect for the tooth removal to be a complete cure and that's what I got.  For the next one, I chose not to have the teeth removed and went with the depo-medrol and that controlled it all of her life (17 years) with no negative side effects.  My vet said that cats tolerate steroids much better than dogs and people and in this case it was absolutely true.  There are more options now, and it's always good to know about them.  I'm so glad the cold laser has been working for your cat.

Well, the cat I started the thread about has passed on. We think she had some kind of intestinal cancer, and that's probably what set off the mouth inflammation, but with her personality and age we decided not to put her through a bunch of interventions. She ended up with an intestinal blockage (probably a tumor) and had to be PTS .

But. Right after that another one of my cats was diagnosed with stomatitis :/. For pete's sake cats. He's young (4-ish) and otherwise healthy so my vet referred us to a vet in Sioux Falls who is known for specializing in dental issues (I don't think she's A Specialist, but apparently she has a good reputation). We just saw her today, they pulled pre-op bloodwork and gave him another round of Depomedrol and Convenia injections, and his surgery is scheduled for next Thursday. It will cost around $700. Which I think seems pretty reasonable, considering some of the other prices I've seen people talk about here.

She says that she really scrapes down to the bone, and does x-rays afterward, to make sure she gets all the roots. She says she has a 90% success rate, and the remaining 10% can usually be fixed with some kind of laser protocol. So wish poor Rocco success! The first time!

Hehe, she said it was nice to have a client who had done a little research because she normally has to spend 45 minutes trying to explain it to people.

Aww, how sad for her to have gone through that ending  

I'm sure you did all you could for her.

So the vet you described is exactly the kind of vet you want doing this procedure, she sounds very competent and aware of the root issue is huge.

Good luck!

What a shame the poor girl has passed. My condolences.

for Rocco!