Palatal ulceration

Re: Palatal ulceration

Evelyn Barbour-Hill — Thu, 26 Feb 2015 00:58:15 GMT

[quote user="Rob Davis"] ("I've been in twice and you've not fixed it yet....").[/quote]

If anyone said that to me I'd be politely (ever so politely) suggesting they might go elsewhere.

Re: Palatal ulceration

Kate Richardson — Wed, 25 Feb 2015 17:05:45 GMT

I might think about increasing the steroid dose and/or frequency. Is oral pred an option? I personally wouldn't swab for FCV as I don't find it changes how I treat them but I might for FHV (although prob not much in it costs wise to do both), but if FHV related, then famcyclovir might be an option. Costly though so might not beof use in this case. Bypassing the oral cavity is a good idea- NO good for short term but for longer term nutrition not ideal, O tube prob better and I am guessing hospitalisation to manage is prob out of the question to. An O tube can prob be managed at home better than an NO tube as well (depending on the owner)

Re: Palatal ulceration

Martin Atkinson — Wed, 25 Feb 2015 15:58:04 GMT

[quote user="Rob Davis"]"I've been in twice and you've not fixed it yet...."[/quote]Hmmm...I would be very wary of this type of client and not run up any big bills so wise to tread warily. They also sound like the sort who will go for a second opinion to the cheap bullshit practice down the road (with a bit of luck). A suggestion that if they're not happy with your treatment you can make a referral usually does the trick. I would be losing patience with them if they won't let you perform a set of diagnostic procedure that may be helpful so its their problem not yours don't lose any sleep over it.

Re: Palatal ulceration

Rob Davis — Wed, 25 Feb 2015 15:23:43 GMT

[quote user="Evelyn Barbour-Hill"]Yeah. I was thinking of oesophagostomy not as a means of emergency nutrition but as therapy – by sparing the lesions the abrasion of food passage and tongue movement..[/quote]

Absolutely a good reason, but the owner has been fairly resistant to coming in at all so far ("I've been in twice and you've not fixed it yet...."). If we do end up biopsying then I will suggest placing a tube at the same time.

Re: Palatal ulceration

Evelyn Barbour-Hill — Wed, 25 Feb 2015 15:04:04 GMT

[quote user="Rob Davis"]This has now been ongoing for around 5 weeks, so it is difficult to justify tube feeding at this stage when the cat is managing ok.[/quote]

Yeah. I was thinking of oesophagostomy not as a means of emergency nutrition but as therapy – by sparing the lesions the abrasion of food passage and tongue movement..

Re: Palatal ulceration

Rob Davis — Wed, 25 Feb 2015 14:44:26 GMT

[quote user="Martin Atkinson"]Vaccination status does not rule out FCV lymphocytic-plasmocytic stomatitis so I would want a viral PCR as well as a decent biopsy[/quote]

I appreciate that vaccination status doesn't rule out FCV, but there is no stomatitis, and this doesn't look anything like feline chronic gingivo-stomatitis. Given the financial contraints, I don't think that spending money on FCV PCR can be justified at the moment.

[quote user="Martin Atkinson"]It sounds as though the cat is eating well enough to survive but have you considered a naso-gastric feeding tube - cheap and easily placed in a conscious cat and usually well tolerated. It at least buys some time and gets nutrition in while you get a diagnosis..[/quote]

Any sort of feeding tube was my first suggestion. The owner declined this and took the cat home with oral metacam. We didn't hear from him again until 11 days later when he phoned to say the cat was still struggling. I was very concerned that she was going to be in a dreadful state, but was pleasantly surprised by her general condition and demeanor. This has now been ongoing for around 5 weeks, so it is difficult to justify tube feeding at this stage when the cat is managing ok. Unless things have significantly improved by the time she next comes in, then I am going to have to pursuade the owner to at least allow me to anaesthetise the cat to examine more thoroughly and take biopsies.

Re: Palatal ulceration

Evelyn Barbour-Hill — Wed, 25 Feb 2015 14:34:55 GMT

[quote user="Rob Davis"]I'm due to see the cat again next week, and if it's not changed signficantly then biopsy etc will be the next step. How would you go about this?[/quote]

Very carefully!

Well, seriously, it would have to be just a snippet or a pinch from somewhere near the margin of the lesion, but deep enough to be representative.

(Unless you fancy doing a whole-thickness soft palate biopsy ....)

Re: Palatal ulceration

Martin Atkinson — Wed, 25 Feb 2015 09:45:07 GMT

Vaccination status does not rule out FCV lymphocytic-plasmocytic stomatitis so I would want a viral PCR as well as a decent biopsy. If it is that then some will respond better with interferon treatment but it is expensive. But to be fair I would have expected gingivitis as well and the teeth I can see look OK.

It sounds as though the cat is eating well enough to survive but have you considered a naso-gastric feeding tube - cheap and easily placed in a conscious cat and usually well tolerated. It at least buys some time and gets nutrition in while you get a diagnosis..

Re: Palatal ulceration

Rob Davis — Wed, 25 Feb 2015 08:58:49 GMT

[quote user="Kate Richardson"] What dose of corticosteroids? Any history of upper respiratory disease to suggest FCV or FHV? Any skin lesions or signs of fleas?

[/quote]

Injected with 0.2ml dexafort (weight 3.15kg), repeated after one week. No history of URT or skin disease, been fully vaccinated since kitten.

[quote user="Kate Richardson"] Also could you do do a swab conscious? For cytology.

[/quote]

Cat is remarkably well-behaved, so have taken conscious swab for cytology: mainly squamous epithelial cells, few rbcs and neutrophils, only occasional eosinophils.

[quote user="Evelyn Barbour-Hill"]

Wow. I'm not surprised she's having difficulty eating.

I'd still suspect caustic substance originally, but anyway, wot Kate said.

And would biopsy really be that expensive, given that otherwise treatment might drag on and expensively on.

On the same principle, would the client accept oesophagostomy tube placement?

[/quote]

The cat was initially seen by a colleague, who then asked me for a second opinion as it wasn't getting better. I did suggest oesophagostomy tube placement, but owner declined. To be fair the cat is still catching mice and eating fairly well, although is obviously in discomfort. There was some weight loss initially, but this appears to have stabilised at present.

I'm due to see the cat again next week, and if it's not changed signficantly then biopsy etc will be the next step. How would you go about this?

Re: Palatal ulceration

Evelyn Barbour-Hill — Tue, 24 Feb 2015 21:14:04 GMT

Wow. I'm not surprised she's having difficulty eating.

I'd still suspect caustic substance originally, but anyway, wot Kate said.

And would biopsy really be that expensive, given that otherwise treatment might drag on and expensively on.

On the same principle, would the client accept oesophagostomy tube placement?

Re: Palatal ulceration

Lindsey Edwards — Tue, 24 Feb 2015 20:05:39 GMT

+1 for cytology for eosinophils

Re: Palatal ulceration

Kate Richardson — Tue, 24 Feb 2015 20:00:49 GMT

Also could you do do a swab conscious? For cytology.

Re: Palatal ulceration

Kate Richardson — Tue, 24 Feb 2015 19:58:55 GMT

What dose of corticosteroids? Any history of upper respiratory disease to suggest FCV or FHV? Any skin lesions or signs of fleas?