? My first post about Marley, and I need advice about dosing when he won't eat

[Daddy Jack's Mommy (GA)]

Marley, age 14, was dx with diabetes on 5/30 (only eight days after Jack officially came out of remission). He is in the midst of an absolutely horrible, painful flair up from stomatitis. He's had this heartless disorder since he was 4 years old, and has had all of his teeth removed except for 4 incisors on the top. Some were removed when he was 6, and the rest were removed when he was 10. He has always had occasional flair ups but they pass without any real drama. Not this time. He has open ulcers in the back of his mouth, and has been to the ER and to my regular vet four times since May 22nd. He also underwent a small procedure where he was put under and x rayed to be certain that no roots or bone fragments were remaining in is gums. There are none. It was during this time that he was dx with diabetes and it's been a tough road. He is wonderful for testing and shooting. (But HORRIBLE for giving meds, even liquid). I don't test him frequently because he often is in too much pain to mess with if it's not necessary. His numbers are high and I feel like I may be fighting a losing battle. Eating is a struggle, as sometimes food instantly causes what I have come to refer to as an "episode." During these episodes, he widely opens his mouth and loudly growls, turning his head from side to side and pawing at his mouth with both feet. He also will run around growling. He literally freaks out. I know he's hungry (because of his elevated BG) and sometimes will eat an enormous amount of food. When he can't eat, I never try and force it because it would throw him into a painful episode. For the most part, he usually eats at least one good meal a day, sometimes two. On rare days, he doesn't eat at all, although those days may finally be behind us. I test him for ketones (yesterday was the last time), and he has no trace.

Here is my question - Should I give Marley a token dose or a small amount of insulin when he doesn't eat at all? I reduce his dose when he only eats a portion, but so far, I don't dose him at all if he doesn't eat. I'm not sure if this is the right thing to do. What would you do?

Marley is so sweet, affectionate, personable, and funny. Yes, he's funny. It's so sad to see him in so much pain. I have an appointment to bring him to a new vet this Saturday. They have specialists at this animal hospital and will refer me to the appropriate one, if needed. Otherwise, they are more experienced with stomatitis and I'm hoping and praying for some relief for my sweet little guy.

 

[Bron and Sheba (GA)]

Poor Marley. That must be horrible for him. And he’s still a sweet affectionate boy!
I’m very glad you are testing most days for ketones. I’d keep that up daily at the moment.
Is he getting anything routinely for pain? That may help with flare ups and with the ability to eat.
Is soupy food any better or worse for him?
Have you joined a fb page for stomatitis? They may have suggestions..
In regards to the insulin, it would be better if you could give some insulin when he doesn’t eat.
I’ll tag @Wendy&Neko as she may have a suggestions about this. As he is getting Prozinc. Will also tag @Panic and @JanetNJ

 

[Daddy Jack's Mommy (GA)]

Is he getting anything routinely for pain? That may help with flare ups and with the ability to eat.

He was on buprenophine, but I think it makes him nauseated. He won't eat if he's had it. I was then giving him gabapentin, but he started hiding because he despises anything given orally. I went two days without giving him meds and tonight, I finally tried putting it in tuna water. It worked! He licked that plate clean.

Is soupy food any better or worse for him?

This is hit or miss. Currently, he's eating his raw, a little soupy. Other times, he prefers drier canned food, with no water.

Have you joined a fb page for stomatitis?

Yes, I have. It's a wonderful group!

Thanks for your help, Bron. I'm beside myself right now.

 

[Bron and Sheba (GA)]

I can imagine how worried you are.
I’m glad he had the tuna juice. I’m sure if you can reduce the pain, he might feel more like eating.
It is very hard to eat with a painful mouth.

Is there a pain medication patch you could use for when he gets flare ups?
He looks such a sweet boy

 

[Wendy&Neko]

Sorry, I have no experience with stomatitis. I'll send a note to someone who has and see if she can stop by. Normally cats that cannot eat due to anaesthesia are good to get a half dose, so you might try that.

 

[JanetNJ]

I was then giving him gabapentin, but he started hiding because he despises anything given orally. I went two days without giving him meds and tonight, I finally tried putting it in tuna water. It worked! He licked that plate clean.

Gabapentin and bupe can also be made into a trandermal gel that can be applied to the ear!!! It would eliminate the nausea because it won't go into the mouth or stomach. https://www.wedgewoodpharmacy.com/items/gabapentin-twist-a-dose-transdermal-gel.html

https://www.wedgewoodpharmacy.com/items/buprenorphine-transdermal-gel.html

 

[JanetNJ]

With these high numbers I would give at least 1 unit even if he doesn't eat much. Try it and see how low he goes. I wouldn't skip entirely. The last throng he needs is to develope ketones. I might even do 1.25 when he's over 350.

 

[Amy&TrixieCat]

Hi Carolyn - I'm the member Wendy mentioned. My Holly had stomatitis, but she was lucky enough to resolve after having all of her teeth extracted. It sounds like poor Marley is a refractory case. You have done a wonderful job with trying to find solutions for him!! Unfortunately I'm not experienced with refractory stomatitis, but I have heard that some people have had luck with atopica, food changes, and even Zyrtec. I've also heard that stomatitis kitties are extra sensitive to things like flea bites, too, so those could all be things to investigate when you see the new vet this weekend. Removing those last four incisors might do the trick, too...sometimes ANY tooth material will cause problems. And I'm guessing you probably already belong to the FaceBook stomatitis group, but in case you don't, the link is below.

Also, I know this goes against everything for diabetes (and in a way feline health in general), but believe it or not, many stomatitis cats actually do better on dry (kibble) food than wet. I know, it makes me cringe, too. But, with dry food, they can swallow it whole with very little manipulation; with wet or raw, they have to manipulate the food around in their mouth a lot more, increasing pain - plus wet food can really get stuck in the ulcerations, thus increasing the pain level, too. There are some low carb dry foods out there that can be "OK" - not ideal, but getting them to eat is, of course, most important.

https://www.facebook.com/groups/856632484350109

 

[Daddy Jack's Mommy (GA)]

@Bron and Sheba (GA), @Wendy&Neko, @JanetNJ, @Amy&TrixieCat
Well, Marley didn't eat again this morning. No food since yesterday's breakfast. I decided to dose him (first time without his eating anything) at .06U, because I was so afraid of him going hypo with an empty tummy. I'm soooo glad that I didn't give him more. When I gave him his shot, his BG was 342, 218 @+1.25, 107 @+2, 86 @+2.25. He was not looking good - slightly lethargic although he was purring his little heart out. At 107 I tried getting him to eat some regular canned food. I was putting it into his mouth with my fingers. No interest in food. When it went to 86 (15 minutes later), I put some honey in his mouth and opened a can of FF Grilled Beef Feast in Gravy. I fed him by hand and after quite a few bites, he was interested. He ate the entire can and was clearly very hungry. After he was finished eating (this all took a while), his BG was 129. That was 25 minutes ago. I'll take it again soon and keep taking it until +7 or +8. This is my first hypo scare--although he was never really hypo-- with either of my sugar babies. It was scary!

Added: He's up to 205 @+3.5.

 

[Daddy Jack's Mommy (GA)]

Is there a pain medication patch you could use for when he gets flare ups?
He looks such a sweet boy

Hi Bron. I'll check into a patch or transdermal gel when I see the new vet on Saturday. I think the medication (both) takes his appetite away. (Probably nausea?). He is an unbelievably sweet little creature. I'm so looking forward to having another vet see him. He deserves some relief.

 

[Daddy Jack's Mommy (GA)]

Sorry, I have no experience with stomatitis. I'll send a note to someone who has and see if she can stop by. Normally cats that cannot eat due to anaesthesia are good to get a half dose, so you might try that.

Thank you for tagging Amy.

 

[Daddy Jack's Mommy (GA)]

Gabapentin and bupe can also be made into a trandermal gel that can be applied to the ear!!! It would eliminate the nausea because it won't go into the mouth or stomach. https://www.wedgewoodpharmacy.com/items/gabapentin-twist-a-dose-transdermal-gel.html

https://www.wedgewoodpharmacy.com/items/buprenorphine-transdermal-gel.html

Hi Janet. Thank you for those links. I actually spoke to my vet, yesterday, about transdermal gabapentin and he said he doesn't know if it comes that way. He said he'll check with the compounding pharmacy and get back to me, which he never did. I'm changing vets and Marley is seeing her this Saturday. I can't wait!

 

[Daddy Jack's Mommy (GA)]

Hi Carolyn - I'm the member Wendy mentioned. My Holly had stomatitis, but she was lucky enough to resolve after having all of her teeth extracted. It sounds like poor Marley is a refractory case. You have done a wonderful job with trying to find solutions for him!! Unfortunately I'm not experienced with refractory stomatitis, but I have heard that some people have had luck with atopica, food changes, and even Zyrtec. I've also heard that stomatitis kitties are extra sensitive to things like flea bites, too, so those could all be things to investigate when you see the new vet this weekend. Removing those last four incisors might do the trick, too...sometimes ANY tooth material will cause problems. And I'm guessing you probably already belong to the FaceBook stomatitis group, but in case you don't, the link is below.

Also, I know this goes against everything for diabetes (and in a way feline health in general), but believe it or not, many stomatitis cats actually do better on dry (kibble) food than wet. I know, it makes me cringe, too. But, with dry food, they can swallow it whole with very little manipulation; with wet or raw, they have to manipulate the food around in their mouth a lot more, increasing pain - plus wet food can really get stuck in the ulcerations, thus increasing the pain level, too. There are some low carb dry foods out there that can be "OK" - not ideal, but getting them to eat is, of course, most important.

https://www.facebook.com/groups/856632484350109

Hi Amy. I'm so glad that Trixie found relief with a FME. Marley has not been so fortunate, the poor baby. I'm currently crushing Zertec into his food and he doesn't seem to notice, although he doesn't always want his food. I'll mention Atopica when I see the new vet on Saturday. And I just received some lysine powder, which I'll also add to his food, in the hopes that it will build up his immunity to ward off future flair ups. I did join that FB group, and I've learned so much! As far as removing those incisors - my current vet said no, but I'll see what the new vet suggests. I'm for it, personally, even though it appears as though the incisors don't need to be removed. But it's interesting to note that some have only found relief once they had those out as well. I guess every cat is different. And... I think I may order some Elsey's no carb dry. I'm willing to try anything to get him to eat. Of course he wolfed down that high carb FF this morning!

Thanks for answering Wendy's tag. Now I have a couple more ideas (atopica and dry food) and I'm open to trying anything that may help him.

 

[JanetNJ]

How

@Bron and Sheba (GA), @Wendy&Neko, @JanetNJ, @Amy&TrixieCat
Well, Marley didn't eat again this morning. No food since yesterday's breakfast. I decided to dose him (first time without his eating anything) at .06U, because I was so afraid of him going hypo with an empty tummy. I'm soooo glad that I didn't give him more. When I gave him his shot, his BG was 342, 218 @+1.25, 107 @+2, 86 @+2.25. He was not looking good - slightly lethargic although he was purring his little heart out. At 107 I tried getting him to eat some regular canned food. I was putting it into his mouth with my fingers. No interest in food. When it went to 86 (15 minutes later), I put some honey in his mouth and opened a can of FF Grilled Beef Feast in Gravy. I fed him by hand and after quite a few bites, he was interested. He ate the entire can and was clearly very hungry. After he was finished eating (this all took a while), his BG was 129. That was 25 minutes ago. I'll take it again soon and keep taking it until +7 or +8. This is my first hypo scare--although he was never really hypo-- with either of my sugar babies. It was scary!

Added: He's up to 205 @+3.5.

wonderful that he ate a whole can!!!!

 

[JanetNJ]

@Bron and Sheba (GA), @Wendy&Neko, @JanetNJ, @Amy&TrixieCat
Well, Marley didn't eat again this morning. No food since yesterday's breakfast. I decided to dose him (first time without his eating anything) at .06U, because I was so afraid of him going hypo with an empty tummy. I'm soooo glad that I didn't give him more. When I gave him his shot, his BG was 342, 218 @+1.25, 107 @+2, 86 @+2.25. He was not looking good - slightly lethargic although he was purring his little heart out. At 107 I tried getting him to eat some regular canned food. I was putting it into his mouth with my fingers. No interest in food. When it went to 86 (15 minutes later), I put some honey in his mouth and opened a can of FF Grilled Beef Feast in Gravy. I fed him by hand and after quite a few bites, he was interested. He ate the entire can and was clearly very hungry. After he was finished eating (this all took a while), his BG was 129. That was 25 minutes ago. I'll take it again soon and keep taking it until +7 or +8. This is my first hypo scare--although he was never really hypo-- with either of my sugar babies. It was scary!

Added: He's up to 205 @+3.5.

Good job keeping him safe. Can you enter the numbers in the ss?

 

[Bron and Sheba (GA)]

I’m so glad he ate a whole can. It sounds as if he enjoyed it in the end. If he’ll eat only some higher carb food, you might have to adjust the insulin until the flare subsides. Eating is the most important thing.

 

[Daddy Jack's Mommy (GA)]

I’m so glad he ate a whole can. It sounds as if he enjoyed it in the end. If he’ll eat only some higher carb food, you might have to adjust the insulin until the flare subsides. Eating is the most important thing.

When Marley does eat, usually once a day, he eats an enormous amount of food. But this morning, he turned each thing away until that high carb FF. I'll remember this for those days when he refuses anything else. I was just so happy to see him eat. And he clearly enjoyed it.

 

[Daddy Jack's Mommy (GA)]

Good job keeping him safe.

Thanks Janet.

 

[Ann & Sister]

For years I thought my cat Missy had stomatitis. It turned out to be resorptive lesions. She was never in pain, however. I feel it is important to get pain under control with your cat. Can you give Cerenia for the perceived nausea and then continue with the pain meds? One of my cats gets 1/4 a 24mg pill when needed, and I crush it into a half teaspoon of pate or gravy to get it in. I push it into the side of his mouth. Not much to swallow. Seems to disguise the taste. That same kitty gets transdermal gabapentin which gets applied to his inner ear flap as needed. I have it compounded at a pharmacy. It is a good drug for long term. But I do not think it works as well for pain as the one your kitty was on. The trans-gaba just seems to take the edge off which is what my kitty needs. I have run across a couple of stomie cats in rescue, and I always advised braising fresh chicken or beef so there was NO salt or seasonings whatsoever. I felt the salt or flavorings added would surely sting. I guess prednisolone is out because of the diabetes.

 

[Christie & Maverick]

Carolyn, have you seen this post about stimulating kittie's appetite

There may be some things to try and sometimes all it takes is getting them going, then they start eating.

 

[Daddy Jack's Mommy (GA)]

For years I thought my cat Missy had stomatitis. It turned out to be resorptive lesions. She was never in pain, however. I feel it is important to get pain under control with your cat. Can you give Cerenia for the perceived nausea and then continue with the pain meds? One of my cats gets 1/4 a 24mg pill when needed, and I crush it into a half teaspoon of pate or gravy to get it in. I push it into the side of his mouth. Not much to swallow. Seems to disguise the taste. That same kitty gets transdermal gabapentin which gets applied to his inner ear flap as needed. I have it compounded at a pharmacy. It is a good drug for long term. But I do not think it works as well for pain as the one your kitty was on. The trans-gaba just seems to take the edge off which is what my kitty needs. I have run across a couple of stomie cats in rescue, and I always advised braising fresh chicken or beef so there was NO salt or seasonings whatsoever. I felt the salt or flavorings added would surely sting. I guess prednisolone is out because of the diabetes.

Marley is currently getting gabapentin 2x a day. I missed 2 days because he started hiding from me because of my giving him that liquid med. But then I discovered that he'll take it in tuna water, so I've been able to give it to him since last night. I prefer buprenophine, but my vet only gives that for a short amount of time. Marley is seeing a new vet on Saturday, and I'm looking forward to having a vet who will prioritize controlling the pain. That's one of a few reasons why I'm changing vets. As far as the cerenia, I'm not convinced that he feels nauseous, although sometimes it appears that way. More often, I think he's very hungry but his mouth pain keeps him from eating. But I will talk to the vet about that.

 

[Daddy Jack's Mommy (GA)]

Carolyn, have you seen this post about stimulating kittie's appetite

There may be some things to try and sometimes all it takes is getting them going, then they start eating.

I've seen that post before, but it was worth seeing it again. Thanks for sharing that link- plenty of great suggestions. For the most part, I think Marley has an appetite but his mouth pain stops him from eating. And when he eats, he eats a LOT. However, I will try some of these suggestions because I have seen him eat like crazy, once he finally took that first bite.

 

[Christie & Maverick]

I know, I can't imagine how painful it can be for him, poor guy, he has the face of an angel. Always good to have a few options, some maybe less painful than others. It's been a while, but one of my crf kitties who was a sweet black kitty like yours had mouth ulcers, and I tried making a syrup of slippery elm bark to help sooth them. http://felinecrf.org/holistic_treatments.htm#seb_syrup_recipe

 

[JanetNJ]

I'm curious why they left his canine teeth. Wouldn't they cause pain too?

 

[Ann & Sister]

As far as the cerenia, I'm not convinced that he feels nauseous, although sometimes it appears that way. More often, I think he's very hungry but his mouth pain keeps him from eating. But I will talk to the vet about that.

If only we knew for certain when they were nauseous. Many times, Monkeydo will be walking around looking for a piece of lint on the floor or seeking plastic to chew. That is a sign.
He can't tell me if it's his plastic obsession (pica) or he's feeling sick. When it continues, I give the Cerenia pill. It never hurts and often it resolves the situation and he starts eating food again.

 

[Daddy Jack's Mommy (GA)]

I know, I can't imagine how painful it can be for him, poor guy, he has the face of an angel. Always good to have a few options, some maybe less painful than others. It's been a while, but one of my crf kitties who was a sweet black kitty like yours had mouth ulcers, and I tried making a syrup of slippery elm bark to help sooth them. http://felinecrf.org/holistic_treatments.htm#seb_syrup_recipe

Thank you for that link! I'm all for using holistic treatments, and I think I have seen others, in the stomatotis FB group, who use slippery elm bark.
I have a 16 year old kitty in kidney failure, although she's doing wonderfully and her kidney values have improved since her dx 2 years ago. Tanya's website is amazing.
I love black cats! And Marley truly is a little sweetheart.

 

[Daddy Jack's Mommy (GA)]

I'm curious why they left his canine teeth. Wouldn't they cause pain too?

His canines were removed. Only his four, tiny front, top incisors (the tiny ones between the canines) remain. The professional consensus is that those front incisors don't cause issues with stomatotis because only the teeth that touch the cheeks are involved in causing inflammation. Additionally, those little incisors can help to scoop up food and possibly hold the tongue in place. However, in the stomatitis FB group, I've learned of others who didn't have success until those were removed also. My vet is set against it because those teeth, of Marley's, are securely in his gums with no plaque or inflammation, and his ulcers are in the extreme back. Marley is seeing a new vet on Saturday. If she supports having those removed, I'll do it.