Lip Entrapment and Loss of Appetite

[kaTYAruh]

Hello. I need help. Our 10+ year old male cat Winston had his upper canine teeth removed three years ago. No problems until about three weeks ago. Winston suddenly lost the movement of his left ear and couldn't blink his left eye. He was placed on antibiotics. A week later a few of his rear teeth were removed. Now, he can blink and he can move his ear once again. Unfortunately, he won't eat. We've tried every type of food you can image. We have even tried an appetite stimulant prescribed by the vet. He licks his food but hardly eats anything. He's starting to look bad. I'm thinking he can't move his lips and mouth as well as he once could and now his lower teeth are biting his upper lip and making eating a bad experience. Any suggestions?

 

[daftcat75]

My Krista went through lip entrapment after several rounds of tooth resorption extractions left her teeth and bite hopelessly mismatched. You will most likely need a veterinary dental specialist. In Krista's case, history told us that she would keep needing extractions until the tooth resorption had run its course (not an option) or we finally found someone with the courage and expertise to proactively remove her remaining teeth. We went with option B. I met with the dentist and told him, "make this the last dental procedure she'll ever need." After reviewing records and films with me, he agreed that would be the best course of action for her. The "remaining mouth extraction" (it was far from full by the time he got to her) proceeded smoothly without incident. The recovery was about two weeks. She ate like she hadn't eaten in weeks that first night before all the surgery drugs wore off. Over the next couple of weeks, I mixed her regular food with Tiki Cat ahi tuna food (something highly appealing to her that she only got in emergency times to keep that appeal high.) She ate more and more each day until she was finally eating normal amounts again. I also weaned her off the tuna flavor and back to her regular food.

If you're in North America, you can find an AVDC accredited dental specialist here:
Find A Veterinary Specialist | AVDC.org

Otherwise, I would ask your vet for a referral for a dental specialist.

It's also possible that the dentist could reduce and rebuild the lower teeth so that they don't extend as far and bite into his lip. But this requires even more skill and expertise than a full (or remaining) mouth extraction. It might also be more expensive depending on how long the dentist needs to spend on this and the cost of the materials to rebuild the shortened tooth/teeth. In either case, you'll mostly likely need a dentist or dental specialists. General vets are reluctant to pull otherwise healthy teeth--especially if they are structural like the canines.

Dentists/specialists are few and far between and usually come with long wait times for initial consultations. The procedure appointments are usually much easier to get if they agree to take his case. I had five different dentists in my area (SF Bay Area in California.) Four of them were telling me two to six months wait time. We lucked out and found one who had an active wildfire (as lucky as wildfires can be, I suppose) that was likely burning through his schedule or at least evacuating much of his service area. We were able to get a consultation appointment in two weeks and the procedure that same day as the consultation due to an afternoon cancellation. This is not the norm. When calling around, take the appointment they can give you. Ask to be put on a waiting list for any cancellations. If they get a cancellation, they can call you up to see if Winston is ready to go in their place. Go to the next dentist on your list. Make appointments with all of them and get on all their cancellation waiting lists. You can cancel the appointments you don't need once Winston has finally been seen. When making appointments, I would ask them if they work out of a full service animal hospital or a private practice. The private practice dentists won't have the same level of support if anything should go wrong. For that reason, they also prefer to only work with otherwise healthy cats.

In the short term, you may have to experiment with pureeing his food and offering him food that is literally more appealing than the discomfort or pain he gets from eating now. Fish flavors, gravy flavors, mousse texture foods, "junk" grocery store brands, even homemade if you have a supplement mix you can add to it. A second option, especially if he has a long wait until he can see a specialist, is to get a feeding tube put into him. This is not as extreme as it sounds and you will mind the tube far more than he does. It will take the pressure off both of you while you are waiting for a dentist or seeking other help. And often, an otherwise healthy cat can be encouraged to eat on his own once he's gotten a little food in his belly through the tube. There's nothing saying he has to be exclusively tube fed or exclusively eating by mouth. If he wants to eat by mouth, encourage that and make up the difference by tube if he pulls up short of what he needs to sustain himself. When making appointments with the dentists, you should ask if they will work with him if he has a feeding tube. A dentist who works out of a hospital is much less likely to be fussed with this than a private practice dentist.

 

[kaTYAruh]

Hello daftcat75 thanks for your reply. Winston also has the tooth resorption problem you described. We have tried every type of food we can image. At this point, we have to use a syringe squirt food in his mouth to get him to eat. It's not much but I'm hoping it will keep him going until we can figure this out. Tomorrow, we're taking him back to the vet who most recently removed the teeth in the back of his mouth. I will find out more about the feeding tube situation and the feline dental specialist. At this point, I'd be OK with them removing his mandibular canine teeth if that's what it would take to get him eating once again.

 

[aleeming]

FYI look up fatty liver and cats. Not eating is an emergency in cats. I would agree with getting a vet dentist (I am I Houston and the one I use is about the same price as my regular vet). If he won't eat a feeding tube is actually less stress for everyone and if it were my cat I'd be considering that now, not later, depending on if you can get to a dentist ASAP.
Many vets don't think about fatty liver but it will cause a cat to starve. They don't eat well for some reason and the liver gets sick. When your liver is sick you don't want to eat, so then it gets sicker, and so on. The cat may be perfectly healthy otherwise by that point but starves themselves to death. It's difficult to syringe feed enough but if he's still interested in food I would do that every chance I could. Gerber baby food chicken with only cornstarch is VERY tasty and easy to syringe. You don't want any baby food with onion etc but can use other brands. Gerber is what we call kitten crack though because it's so tasty.

 

[daftcat75]

I agree that a feeding tube will be less stressful and more effective for all involved especially Winston. My Krista needed a feeding tube on a different occasion. The only time she minded the tube was when I fed too cold or too fast. She gave me instant feedback and I learned. But otherwise, as long as I was prepared, she was patient and calm until we were done. I wasn’t going to get that kind of cooperation out of syringe feeding by mouth. And as a bonus, any medicine she was taking, if it could be liquid or crushed, it could go down the tube without the usual wrestling match.

 

[kaTYAruh]

Thanks A aleeming and daftcat75 . We took Winston to the vet this morning. The vet is pretty sure his mouth is not the problem. We are scheduled for an abdominal ultrasound. In the meantime, we are going to be more aggressive about feeding him. In fact, we just had an extended session of syringe feeding - it was messy and I have a few scratches but we managed to get him to swallow quite a bit of the chicken broth & wet food mixture that my wife mixed up. I'm also going to start using ReadyCal paste on his paws and face to trick him into licking up more calories. I hope something good comes of this. Beyond the abdominal ultrasound, the next step is an MRI. I'm not sure how I feel about subjecting our 10+ year old cat to a possible brain surgery.

 

[daftcat75]

I don’t know that they do any brain surgery on cats. But there are other things that an MRI can rule in or rule out. Krista had one of those too. She stumbled off the bed early early one morning, threw up, and staggered around on her hocks (forearms) like she was either too weak or too dizzy to stand up. So off to the ER we went at 3am. Obvious stuff was ruled out of bloodwork and so she stayed overnight for an MRI in the morning. Turns out she had a really bad middle ear infection. She needed a surgery to basically drain her middle ear from beneath her jaw. It was that or poke out her eardrum. She came through it with flying colors. And if that was all she had, she’d probably be back to racing around again and poking me at 4am for first breakfast no matter how many times I tried to teach her 6am. But the rest of her story doesn’t bear any relevance here. She had GI lymphoma underneath it all. It was only a matter of time that something (bladder infection) caught up to her.

Anyway…

The ultrasound and MRI are both useful diagnostics. The nutritional gel doesn’t have as much nutrition as you’d like. Fingers crossed that they find something easy to treat with their tests. But don’t put off a feeding tube for too long if the syringe by mouth feeding isn’t working. Whatever he might have going on can only be improved with proper nutrition and only complicated further by a lack thereof.

Here’s a little more information on feeding tubes.
Feeding Tubes For Cats

 

[kaTYAruh]

A aleeming that Gerber chicken baby food was a really good tip. That is the first food in about three weeks that Winston has been interested in. He ate nearly two jars of that stuff this evening! He doesn't have his usual voracious appetite where he "attacks" his meal, but he ate it on his own with minimal coaxing.

 

[daftcat75]

That’s good news! It’s not enough. Baby food isn’t cat food. But it’s a start. He can eat this for a few days at least before he needs to be eating cat food again. I recommend experimenting with mixing some baby food with the tiniest amount of cat food and see if you can sneak even a tiny bit of cat food in him on his own. Hopefully you can slowly increase that ratio until he’s eating all or mostly cat food again. I also recommend feeding him small meals often. Krista had pancreatitis (what didn’t she have? ) and I would bribe and beg her to eat her calories a half ounce (14 g) at a time as many as ten times a day until she was feeling well enough to eat larger portions again. Has Winston been tested for pancreatitis? It’s not a standard test. You may have to ask for it rather than assuming it was already in his recent blood work.

 

[aleeming]

A aleeming that Gerber chicken baby food was a really good tip. That is the first food in about three weeks that Winston has been interested in. He ate nearly two jars of that stuff this evening! He doesn't have his usual voracious appetite where he "attacks" his meal, but he ate it on his own with minimal coaxing.

Good to know. The only problem in the long run is that it doesn't have taurine in it, although you can get that as a supplement. But it's definitely the best thing I've found to use. If a cat won't eat it generally they won't eat anything. It will give enough nutrition if you can get enough in them. Cats are obligated carnivores and it's nothing but meat. The turkey is good too, but chicken seems to be the most accepted. Most cat food, even pate, does not syringe that well and has to be blended a lot and even strained. That's not an issue with the baby food.

I am surprised the vet doesn't think it's the teeth issues though, since it seems he has an appetite and will eat soft food. I would assume that an MRI would show any tooth infection or other issues too, though.

 

[daftcat75]

The baby food isn’t balanced and complete nutrition for a cat. He can eat it alone for a few days. But then you must make an effort to transition him back to cat food. Even if it’s a slow transition hiding or pureeing small amounts of cat food into the baby food. Besides lacking sufficient taurine, meat alone without a calcium supplement will eventually become problematic for his teeth and bones. Right now, though, eating is more important than what he eats. It’s better to eat at McDonalds than starve at Whole Foods.

 

[kaTYAruh]

I'm happy to report that Winston is starting to show signs of returning back to his usual routine. After a few days of eating nothing but the baby food, he's finally started eating chunks of chicken. He's also starting to come out of his bedroom and spend time at his usual hang outs (couch, wife's pillow and lanai). Tucker (all grey) is there to encourage his buddy.

 

[daftcat75]

This is great news! Chunks of chicken are great. But he still needs to work his way back to actual cat food. Meat alone is not complete and balanced nutrition for cats. It won't cause problems right away. But since he hasn't been eating right for awhile, I would start sneaking real cat food into the baby food or chunks of chicken sooner than later with a goal to get him back on cat food by the end of the month.

Alternatively, you can get a vitamin premix powder like EZ Complete which will allow you to turn chunks of chicken into a balanced and complete food. I like EZ Complete the best because you can balance it down to a single meal and you don't have to add liver to the chicken. Simply weigh out the meat, measure out the powder, make a gravy with the powder and water, and mix with the meat. It does not get easier than that.

EZComplete Premix Information

 

[kaTYAruh]

We're working on it.

 

[kaTYAruh]

He is starting to respond to his automatic feeder!

 

[kaTYAruh]

daftcat75 and A aleeming hello. It's been a rough few weeks. We've had to force feed Winston and things were not getting any better. But, today we took him to the neurologist for an MRI. As it would turn out, he had inner ear infections in both ears with the left ear being particularly bad. The neurologist drained and flushed his left inner ear (because is was in really bad shape) but she left his right ear in tact as she believed antibiotics would clear that up. Much of the surrounding tissue was inflamed and agitated. After we got Winston home, he actually ate food. He was jumping up and clawing at the food as we presented it to him. When we put a plate on the floor, he attacked it like he used to do before he got sick. So, I feel like we've finally turned a corner on this problem. Unfortunately, Winston has a tumor growing in his brain. The neurologist said it is benign, non-invasive but guaranteed to keep growing until it gets to a size where it will disrupt his brain function. But, she said that she rarely gets a chance to catch these tumors before they cause problems so, in a way, there may have been some good in this ear infection situation. It looks like Winston will be going back for brain surgery soon.

 

[kaTYAruh]

I have sad news to report. After showing some initial improvements with the feeding tube, our little buddy Winston suffered a ruptured bladder on 8/25. His skin suddenly started to turn yellow, his abdomen was swollen and you could see that he felt miserable. Our vet suggested that it was time to end his suffering.

I'm not sure why this happened. Our vet said this was the first time in her career she has seen this (a ruptured bladder is usually the result of a traumatic injury). As I look back, I wish I would have placed the feeding tube after the first week of appetite loss. I'm hoping that this thread will be helpful to the next person who runs into these problems.

I'm posting a picture of Winston (grey and white) with his buddy Tucker (all grey) - this is the way I'd like to remember him. He was a wonderful companion and his memory brings us great joy.