Dear Dr. Barchas,
My Abyssinian cat has had all but his canine teeth removed due to stomatitis. He requires shots of prednisolone along with clindamycin added to his food for a period of time every month due to flareups in the back of his throat that are very painful.
It is getting so he needs the prednisolone more frequently than ever (from 3 months to 1 month), and I am wondering if it would not be better for him to put him down rather then subject him to the recurring pain.
It is impossible to administer anything orally, and the rescue group from whom I adopted him provides me with the injectible pred.
Stomatitis is a feline syndrome in which the body’s immune system attacks the gums and soft tissues in the mouth. This results in chronic inflammation (irritation) of the affected tissues. The inflammation is painful, and it can predispose afflicted cats to recurrent infections that require antibiotics such as clindamycin. The infections often can be recognized by the severe halitosis (bad breath) that accompanies them. Since cats use their mouths to groom their fur, the halitosis that accompanies oral infections can translate into a foul-smelling coat.
Two main treatment tactics exist. First, medicines such as prednisolone can be administered to attenuate the activity of the immune system, while painkillers and antibiotics are used to treat pain and infection that may accompany the condition.
The second option involves removing the impetus for the immune system’s overactivity by removing the cat’s teeth in the affected area. This treatment, which is often termed full-mouth extraction, involves significant initial pain for the cat. It also is expensive (anesthesia, IV fluids, IV antibiotics, and powerful painkillers are necessary). However, it leads to significant improvement in many cats. In my experience, about 85 percent of cats that undergo full-mouth extraction require no further treatment once they have recovered from the procedure.
Sadly, that leaves about 15 percent of cats for whom the treatment is not curative. Laura, I am sorry to hear that your cat is among them. I realize that this situation is frustrating (and painful for your cat), but I would not recommend euthanasia at this point. There are a few options to be explored.
First, what technique was used for the full-mouth extraction procedure? Were oral X-rays taken to confirm that all of the tooth roots were fully extracted? If not, a second procedure may reveal (and allow removal of) fragments that could be contributing to ongoing inflammation.
You also have more medical options. Cyclosporine can be used in conjunction with or in lieu of prednisolone to attenuate your cat’s immune system. Many cats respond well to it, and it does not have as many long-term side effects as pred.
Since you say your cat won’t tolerate pills or oral suspensions, be aware that compounding pharmacies can make tuna- (or other-) flavored prednisolone and cyclosporine to add to your cat’s food. Prednisolone also can be compounded into a transdermal gel and applied to the ear, although its absorption can be inconsistent with this method.
As a last resort, consider long-lasting (also known as depo) injections of medications with activities that resemble prednisolone. Depomedrol is similar to prednisolone, but it lasts two to four weeks. It can cause serious side effects, especially when used long-term, but it also leads to significant quality of life improvement for many cats.