Unrelenting feline stomatogingivitis

RE: Unrelenting feline stomatogingivitis

Anthony Todd — Tue, 28 Aug 2018 16:38:38 GMT

[quote user="Julian Earl"]The megoestrol?[/quote]

It had and probably still has a comparable anti-inflammatory action to Dmed but seemed to work when Dmed didn't.

If given at 5mg weekly, and not more, or more often, sometimes at longer intervals, or lower, but effective doses and dose rates, and only until resolution and/or reducing response or recurrence never seemed to give permanent or serious side-effects.

All the horror stories, when examined, turn out to be gross overdoses or one sort or another which will happen with most drugs.

The 'roids are never forgiven whatever the excess causation.

RE: Unrelenting feline stomatogingivitis

Julian Earl — Tue, 28 Aug 2018 11:12:32 GMT

The megoestrol? Does it cause visible improvement in the inflammation? Or does it make the cat so darned-hungry that it ignores the discomfort? I was always a little sceptical of Ovarid compared to just corticosteroids.

RE: Unrelenting feline stomatogingivitis

Martin Atkinson — Sun, 26 Aug 2018 18:23:25 GMT

[quote user="Evelyn Barbour-Hill"]Let us be clear about this. Burmese Orofacial Pain Syndrome has absolutely nothing whatever to do with Feline Chronic Gingivostomatitis and probably has nothing to do with periodontal disease at all.[/quote]I don't think we suggested that it was connected to FGGS and from my experience the affected cats didn't have periodontal disease either. But they did have mild gingivitis and they did respond to dental prophylaxis which suggests there is a connection somewhere along the way.

RE: Unrelenting feline stomatogingivitis

Evelyn Barbour-Hill — Fri, 24 Aug 2018 20:34:22 GMT

[quote user="Martin Atkinson"]

[quote user="Richard Carter"]

the first time I saw a kitten with oro-facial pain syndrome (Burmese) I couldn't believe how much pain and self mutilation was going on with rips to his gums, cheeks etc. Something similar?

[/quote]Burmese seem to be a rule unto themselves with this they seem to suffer from neurological oro-facial pain out of all proportion to the extent of the lesions.

[/quote]

Let us be clear about this. Burmese Orofacial Pain Syndrome has absolutely nothing whatever to do with Feline Chronic Gingivostomatitis and probably has nothing to do with periodontal disease at all.

RE: Unrelenting feline stomatogingivitis

Anthony Todd — Fri, 24 Aug 2018 16:03:49 GMT

I wonder if the fact [?] that dinovets didn't see much diabetes, and certainly not in today's numbers, nor probably after Csteroids, has anything to do with the fundamental change in the source of energy in cats' food from fat and protein to totally carbohydrate, which they weren't/aren't designed for??

RE: Unrelenting feline stomatogingivitis

Rob Davis — Fri, 24 Aug 2018 11:09:53 GMT

[quote user="Anthony Todd"]I wish someone would do some research on this horrible condition which wasn't too rare, and is still around and difficult!?[/quote]

This is from Norman Johnston's website and is a good review of the current thoughts on this condition.

RE: Unrelenting feline stomatogingivitis

Rob Davis — Fri, 24 Aug 2018 10:31:49 GMT

[quote user="Michael Woodhouse"]Did you see a couple of posts above yours that the cat was PTS?[/quote]

I was referring to the cat in the picture I posted, not to the other one.

RE: Unrelenting feline stomatogingivitis

Anthony Todd — Fri, 24 Aug 2018 09:40:36 GMT

[quote user="Martin Atkinson"]As it is I have not yet failed to control one, some as bad or worse than the examples shown, with a combination of radical dentistry, intra-lesional/oral interferon (Virbagen Omega), antibiotics and NSAIDs. I've not yet had to play that last resort[/quote]

There you go, managed to extract [no pun intended] something that's worth a try and almost certainly an advance on my historical suggestion.

I remain to be convinced though that sensible intermittent use of any Csteroid will ever cause the side-effects always quoted.

Always the examples quoted involve gross overdose, usually continuous and over a long time, but this is never accepted or acknowledged on vetsurgeon.org.

I never ever had any of these complications, but then I dosed sensibly and intermittently.

RE: Unrelenting feline stomatogingivitis

Martin Atkinson — Fri, 24 Aug 2018 09:20:19 GMT

[quote user="Richard Carter"]

the first time I saw a kitten with oro-facial pain syndrome (Burmese) I couldn't believe how much pain and self mutilation was going on with rips to his gums, cheeks etc. Something similar?

[/quote]Burmese seem to be a rule unto themselves with this they seem to suffer from neurological oro-facial pain out of all proportion to the extent of the lesions. Even minor gingivitis can cause self-mutilation. We had one owner with two Burmese which had this problem and they hadn't even reached the point at which I would advise a routine scale/polish, let alone suspicion of CFGS, yet after one their symptoms resolved, but we had to perform prophylactic treatment every 6 months to keep them happy.

[quote user="Anthony Todd"] I must have given Dmed to calici positive cats, yet never remember any adverse effects, only positive ones??[/quote]The FCV related CFGS is all to do with a complicated multi-factorial immune mediated response, including the virus, not directly to the infection itself so suppressing this will result in resolution of the symptoms. I think re-activation of patent virus would only be an issue in cats also immunocompromised by FIV/FeLV.

[quote user="Anthony Todd"]No experience with megestrol??[/quote]Only diabetes with depomed and that +/- mammary hyperplasia/tumours with Ovarid! Playing Devil's Advocate with you aside Tony (so please don't turn this into a Dinovet corticosteroid crusade), using these products in this situation is a last resort when the alternative is poor quality of life or euthanasia so there is nothing to lose but I would hope that even you would warn the owner of the likelihood of these complications in the long term.

As it is I have not yet failed to control one, some as bad or worse than the examples shown, with a combination of radical dentistry, intra-lesional/oral interferon (Virbagen Omega), antibiotics and NSAIDs. I've not yet had to play that last resort card.

RE: Unrelenting feline stomatogingivitis

Anthony Todd — Fri, 24 Aug 2018 03:27:24 GMT

[quote user="bevs2251"]Would you be prepared to use it long-term[/quote]

I reckon if I got an equivocal response to Dmed or Ovarid before all other options probably not and, without a response to some medication I'm not sure I'd go for the full mouth extraction etc. although I think they all did well, BITD.

I wish someone would do some research on this horrible condition which wasn't too rare, and is still around and difficult!?

RE: Unrelenting feline stomatogingivitis

bevs2251 — Fri, 24 Aug 2018 03:14:01 GMT

To clarify - my cat (female desexed) developed mammary hyperplasia after just one course of Ovarid. She was an overgroomer - likely needed Clomicalm or Prozac rather than Ovarid. Weren't using those type of drugs at the time (late 1980s/early 1990s).

Diabetes occurred with Ovarid in some cats on it long-term (months/years).

I haven't used Ovarid or MPA in years. Would you be prepared to use it long-term in these young cats (< 1 year) with severe gingivostomatitis where all other options have failed (including full mouth extractions) ?

RE: Unrelenting feline stomatogingivitis

Anthony Todd — Fri, 24 Aug 2018 03:00:02 GMT

[quote user="bevs2251"](my own cat after just one course !)[/quote]

That's not my experience?? From memory 5mg weekly for 4 weeks was my usual course and AFAIK no diabetics, not that I ever had to test for it.

I wonder, sometimes, if the "diabetes" is transitory and would resolve with time?

Ovarid certainly made them fat and eat more while on it.

Typically, blood glucose levels will return to normal after you finish taking the steroids but in some cases, particularly if you have pre-existing risk factors for type 2 diabetes, you may be diagnosed with this form of diabetes.

from

Diabetes.co.uk

Thinking, these days, of most cats on massive carbohydrate diets as their only energy source??

So cat's on tinned food and "cats meat" therefore less at risk as they were back in the day [BITD]?

RE: Unrelenting feline stomatogingivitis

bevs2251 — Fri, 24 Aug 2018 00:30:50 GMT

[quote user="Anthony Todd"]

[quote user="bevs2251"]

Other Rx - cyclospoine, thalidomide (!), delta-albaplex tablets (pred/tetracycline combo) daily worked well when it was available. Metronidazole/Stomorgyl long-term ?

[/quote] Been advised of these Rxs by specialists/in books but no personal experience (cyclo/thalidamide). Used Delta-Albaplex a lot last century, worked well. Have used metronidazole/Stomorgyl long-term in small dogs with immune-mediated stomatitis (biospy confirmed).

Yes, but how do they do and was it curative? eg pred/tetracycline and did you culture something sensitive to tetracycline (NO) or was it just the pred??

No experience with megestrol?? Heaps (last century).

We might have found an answer For Future's Sake.

[/quote] Plenty of experience with Ovarid/MPA but if you use those in Australia now and there is a problem/side-effect, expect a complaint to the board and specialists will not stand by you (same in USA). Used to see loads of diabetics post-Ovarid Rx and mammary hyperplasia (my own cat after just one course !). Works brilliantly, unfortunately vets too scared to use any more due to possible litigous action !

RE: Unrelenting feline stomatogingivitis

Anthony Todd — Thu, 23 Aug 2018 13:24:00 GMT

Sorry to go on but nobody seems to have tried megestrol which always was magic when given to chronic "rodent ulcers" so might be worth a try on these severe oral lesions.

RE: Unrelenting feline stomatogingivitis

Marie Kubiak — Thu, 23 Aug 2018 13:08:34 GMT

[quote user="Anthony Todd"]

Anyone got any history of the sequel following Depomed in calici positive cats? I must have given Dmed to calici positive cats, yet never remember any adverse effects, only positive ones??

[/quote]

I tried it on both of my own calici positive cats with chronic gingivitis - perhaps a little improvement in comfort on the first injection but not convincing and gums looked the same, no benefit on subsequent treatments and nasal/ocular discharge resulted. No response to interferon trickled over gums. Obvious improvement on metacam with no concurrent calici flare-ups, and resolution of lesions after extractions of teeth in affected areas (all bar canines in one, only 4 or 5 extractions in the other).

Marie

RE: Unrelenting feline stomatogingivitis

Anthony Todd — Thu, 23 Aug 2018 12:55:45 GMT

[quote user="bevs2251"]

Other Rx - cyclospoine, thalidomide (!), delta-albaplex tablets (pred/tetracycline combo) daily worked well when it was available. Metronidazole/Stomorgyl long-term ?

[/quote]

Yes, but how do they do and was it curative? eg pred/tetracycline and did you culture something sensitive to tetracycline or was it just the pred??

No experience with megestrol??

We might have found an answer For Future's Sake.

RE: Unrelenting feline stomatogingivitis

bevs2251 — Thu, 23 Aug 2018 03:31:37 GMT

Other Rx - cyclospoine, thalidomide (!), delta-albaplex tablets (pred/tetracycline combo) daily worked well when it was available. Metronidazole/Stomorgyl long-term ?

RE: Unrelenting feline stomatogingivitis

Anthony Todd — Wed, 22 Aug 2018 23:59:03 GMT

[quote user="Rob Davis"]I would also be slightly wary of using it in a calici positive cat (which is also showing respiratory signs).[/quote]

Anyone got any history of the sequel following Depomed in calici positive cats? I must have given Dmed to calici positive cats, yet never remember any adverse effects, only positive ones??

Would have been nice to see the histo.

PS What are the "more expensive treatments" and how do they do?

RE: Unrelenting feline stomatogingivitis

Michael Woodhouse — Wed, 22 Aug 2018 23:58:35 GMT

[quote user="Rob Davis"]

I have generally found that FCGS cases do often seem to respond well to depomedrone, but the efficacy and duration of effect tends to decrease with repeated usage. I agree that as a last resort if all else has failed, or in cases where financial constraints prevent more expensive treatments, then depomedrone is a reasonable drug to try. I would certainly suggest trying it before euthanasia.

We are not at that stage with this patient at present

[/quote]

Did you see a couple of posts above yours that the cat was PTS?

I'm sure your experience is much greater than mine, but teeth out and depo seems to be the cornerstone of treatment in these cases in my experience. I used to mess around using all sorts of other things and recklessly spending owner's money but I don't anymore.

RE: Unrelenting feline stomatogingivitis

Roland Bulkyn-Rackowe — Wed, 22 Aug 2018 23:42:00 GMT

I have had a case very similar to this, 6 month old FS DLH rescue cat. Tried s+p, oral care biscuits, chlorhexidine and systemic antibiotics (wouldn't eat the biscuits). Radiographs were then taken, if there was a furcation, it was exposed, also extensive FORLS (still under 9 months old!!!), So we extracted everything. She settled down pretty well, much to our surprise.

RE: Unrelenting feline stomatogingivitis

Rob Davis — Wed, 22 Aug 2018 19:58:56 GMT

[quote user="Anthony Todd"]

I'd like to see if there was a response to either Depomed or megestrol in a highish dose before I gave up.

[/quote]

We are not at that stage with this patient at present. I would also be slightly wary of using it in a calici positive cat (which is also showing respiratory signs).

RE: Unrelenting feline stomatogingivitis

Anthony Todd — Wed, 22 Aug 2018 19:44:45 GMT

I'd like to see if there was a response to either Depomed or megestrol in a highish dose before I gave up.

RE: Unrelenting feline stomatogingivitis

Rob Davis — Wed, 22 Aug 2018 19:22:26 GMT

[quote user="Liz Barton"]Worst case I've seen - a 7mo old kitten with severe oral pain[/quote]

Similar case: another kitten, 7 months old when these photos were taken. Positive for calici, had thorough scale and polish and gingivectomy (old fashioned scalpel, no access to fancy lasers!). Then started on interferon (virabagen omega): given 4MU sc every other day for 2 weeks then 0.1MU daily onto mucous membranes (alternating sides) on advice from Virbac.

After 6 weeks there is possibly some slight improvement, but not very convincing yet. I will try to remember to get some more photos and post reports in due course. Is also on oral metacam.

RE: Unrelenting feline stomatogingivitis

Richard Carter — Wed, 22 Aug 2018 18:45:23 GMT

the first time I saw a kitten with oro-facial pain syndrome (Burmese) I couldn't believe how much pain and self mutilation was going on with rips to his gums, cheeks etc. Something similar?

RE: Unrelenting feline stomatogingivitis

Liz Barton — Tue, 21 Aug 2018 23:46:21 GMT

Sadly folks, we PTS'd the cat; she was a rehoming shelter case and came in like this. Was on a hypoallergenic diet in the shelter cattery for about 5 weeks total while we tried to treat; steroids/ABs for 3 weeks, then the extractions on one arcade which didn't seem to make an iota of difference. Funds limited so no IFN, she was poorly socialised and obviously sore - no improvement in demeanour or behaviour despite the dedicated efforts of the cat team.

Thanks for your thoughts/input as ever.