Tips for getting nutrition into cat with mouth pain?

[david68]

My 15 year-old Liza has both hyperthyroidism and chronic feline gingivostomatitis. As I posted last week, after two years, we've been having trouble keeping her thyroid levels properly controlled with methimazole, so I was going to do radioiodine 131 treatment, but to do that, we had to take her off methimazole to get a T4 baseline. I consulted carefully with my vet before doing this, and she said she thought it would be fine. After 10 days, we abandoned this because her overall condition was declining so quickly. The spike in T4 levels seems to have triggered the worst flare in her gingivostomatitis she's ever had. She's lost a lot of weight. She's able to eat a little bit, but it's obviously hard for her. I'm able to feed her some shredded and dampened pieces of chicken, which I've been doing regularly. She will also lick Nutrical off my finger, but not a huge amount. I've also been giving her gabapentin to control the discomfort, which does seem to help. I restarted methimazole on Thursday evening, and she's improved significantly since then. I just need to get as much nutrition in her now as possible in the hope that we can restabilize her overall condition.

Any tips on helping get calories into a cat with oral pain are greatly appreciated.

I'm not happy with my vet right now because I had misgivings about taking her off methimazole, but the doctor said it would be fine. It wasn't. The vet did give her fluids on Thursday, and I'm wondering if I should get them to give me a home subcutaneous fluids setup to support her. I've done it before for a year with a cat that had chronic kidney disease.

 

[iPappy]

Hi,
I am so sorry you and Liza are going through this. If it were me in that situation I would definitely tell the vet you are interested in giving fluids at home until she is eating well again.
If she is only eating very little, do you think she would like something like wet kitten food (it's more calorically dense)? You could try mixing a bit of warm water in it to make it more soupy. It would offer extra hydration.
Make sure anything you offer her is room temperature. Easier on sensitive teeth, if you have ever had a toothache or tooth sensitivity you'll know what I mean!
Another option would be a prescription product like Hill's A/D. It is very high in calories and seems to be very palatable.
I hope this helps, and Liza gets to feeling better.

 

[silent meowlook]

Hi. I would get another vet asap. If you can find any feline only hospitals, they are usually good, as they only handle cats.

When was the last time a full blood panel was done?

Has anyone ever discussed full mouth extractions with you? Not now, but when she is feeling better?

A different vet may be able to prescribe medication such as a steroid to help with the inflammation of the mouth. I would also think the addition of buprenorphine might help address the oral pain for now.

SQ fluids are a good idea.

There are prescription liquid diets you could give her. Whatever you do, don’t syringe feed her. The syringe bumping against the gums would be excruciating.

I am sorry your cat is going through this.

 

[david68]

A full blood panel was done on Thursday. She only has three front teeth left. Vet does not believe that removing them would help. She received a steroid injection in June.

 

[CoffeyCats]

So sorry about Liza! I have abandoned Cole's I131 as well. Same reasons declined and by the time his treatment time rolled around it would have been 43 days off meds and right at 30 post blood work.

Sounds like you're intuition about vets is correct. Same with the sub q fluids. When mine have not eaten I've resorted briefly to baby food...meat varieties only and check the ingredients that it is only meat. Either that or something very smelly. Perhaps she will lick it and be encouraged to take in more. There is a transdermal appetite stimulant but I seem to remember something about not being able to give it with methimazole.

 

[FeebysOwner]

I agree the Hill's A/D food might be something to try - that and the baby food meat. If she won't eat the A/D but will do so with the baby food meat, you can use this for her primary food source for as long as necessary - if you have a supplement to it to make it nutritionally compete. I use EZ Complete (EZComplete Premix Information (foodfurlife.com), 1/2 tsp per 2.5oz jar. It can be used with any of the meat flavors besides chicken, due to the calcium level in both the chicken and the EZ Complete. The EZ Complete also helps to break down the baby food meat so that it becomes a little bit soupy, which should also help her to eat it more easily. A few days of baby food meat without the supplement is fine while you would wait to receive your order.

I'd ask about the sub-Q fluids and whether or not it would be helpful to her. I realize that is a bit harder to do since you don't trust this vet much, but the question of its benefit needs to be addressed by a vet and none of us here are vets.

As far as finding a new vet, I have found the Next Door Neighbor web site to be very helpful. You can ask for recommendations through your surrounding neighborhoods who have pets, helping to reduce your research time in finding a replacement.

The thing is, any cat who is being considered for the radioiodine treatment must be off of the thyroid meds for a period of time, in order to properly assess their candidacy for the treatment. So, I am pretty sure you would hear the same thing from other vets as well. What you might consider doing is consulting with a vet that specializes in endocrinology to see if they could shed any light on why your cat's body seems to be resistant to the thyroid meds.

 

[catsknowme]

I am so sorry that you're dealing with the dreaded stomatitis. My vet will give a steroid/pain combo injection as needed, even a couple of weeks apart. My cats usually can eat a thinned Gerber Stage 2 baby food and when out of flare-up, I make a gruel of canned food plus broth or water in the blender using the smoothie function. Two of my cats (actually my sister's cats) will eat gruel with some Slippery Elm bark decoction added (I make sure to separate from meds by 2-4 hours) but my worst-off cat Janie refuses any food with herbs or meds. For extra pain management , the vet has me give a drop of Metacam in a small amount of food and that helps with pain.

 

[david68]

As an update, Liza continues to improve back on methimazole, and she is eating some. Having tried a bunch of foods, I found a Hill's kitten food she seems to like, so I'll buy more of that. I've been feeding her wet food mixed with water as a kind of porridge for a while.

As to the vet, I do trust my local vet. They are highly-regarded and frequently recommended on NextDoor. In fact, I think their current problem is that they are suffering from being over-popular. The city where I live is growing rapidly, and you can tell there is a lot of pressure on doctors of all kinds, human and veterinary. (Trying to get through to talk to someone at my mother's dermatology practice can take two or three days!) My vet told me that most cats are OK going off methimazole, and I don't think she could have known in advance that Liza would be one of the ones who wouldn't. She seemed fine for the first week.

They did set me up with sub-q fluids.

The vet practice that irked me was the one that does radioiodine, which is a different place. They promised me twice last week that they would tell me if they could work with a T4 level of 10 days off methimazole instead of 14 days, but never did. They were supposed to call me this week with an answer, but they haven't.