Polyps/Feline Orofacial Pain Syndrome

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Rysiek

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Oh I completely understand! It's heartbreaking... 😔
I was asking because I had a similar experience with one of my cats following a major surgery. He was clearly hungry and wanted to eat but when I would give him a small piece of food (he wouldn't eat from a bowl), he would kind of toss it around in his mouth and spit it out, then he'd look baffled and walk away 😢
In his case it turned out to be severe nausea caused by Metacam (same as Loxicom) + being under general anesthetic 3 times in 10 days + probably the stress of being at the vet's. But it looked really similar to what you're describing, like he had a problem with his mouth.
I am definitely not saying that this is what's happening with your cat, I just thought it's worth mentioning. He's been on quite a cocktail of medications in the last month and most of them can cause nausea. But if he's eating the soft foods happily and with good appetite, and not vomiting at all then that's not very likely.
It's really positive that you have found soft foods that work for him! Well done for that, you have saved him from weight loss and additional health complications. Just make sure that most of what you're giving him are complete foods (I'm sure you've already checked :)).
I wonder what the dental check will show, please keep us updated. Although I always worry what another trip to the vet's will do to them, stress-wise :sigh: They're not going to put him under anesthesia for this again, are they?
Nutraflora looks good, I think it's a good idea for him, especially after the antibiotic. Is this the only medication/supplement that he will be on after you end the steroid?
I still need to get a referral for the dental check, and I would prefer to do this in the university hospital. Somehow I do not trust completely my local vet at the moment, also I need some second opinion...
The hospital is around 40 min drive...I expect he will be at least sedated...

They also suggested neurological cause, but I would prefer to check the dental hypothesis first...

I think with my cat is more related to his teeth than nausea, as he even was unable to catch the spider 😿 It is a mistery...
Strangely he still attends to his box biting and spitting habit...

I added probiotic, so to address some digestive discomfort...he has a normal appetite and eats quite a lot...I give him complete food + additional treats...at the moment, as he suffers I spoil him a bit...

Hope you cat is ok now...
 

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You are such a good cat parent Rysiek Rysiek !! ❤ He is lucky to have you. It is great to hear that he is eating well - that's the main thing. Of course you should spoil him!! :)

I know how you feel regarding your vet. I initially trusted my local vets completely, thinking "surely they are the experts, they have the education, tons of knowledge..." A number of experiences over the years made me seriously question that thinking. Medical ethics and protecting the patient seem to have been replaced with money grabbing. I am sure that there are great vets out there, I just wish I could find one in my area.

I agree that it would be sensible to check his teeth and gums first. How odd that he's still chewing on cardboard but won't eat hard food?

I am curious about one thing you said: Did your cat use to catch spiders in his mouth before this? Mine chase spiders and pounce on them but NEVER pick them up with their mouths even though it looks like they want to :lol: Flies and moths - now that's a different story, straight in their mouth they go! :happycat:

Yes, my cat is OK now, thank you :hearthrob:. That was after a leg amputation 4 years ago. It took me a long time to find foods that he would eat reliably after that, and he is still very picky.
 
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Rysiek

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I received an answer from the vet:
"Dental problems, including FORLs, has been ruled out by the CT scan which does not identify any such changes within the crowns or roots of any teeth. Referral to a dental specialist is always an option however I can’t see any indication for this at present given there is no clear oral pathology or inflammation noted.(...)
I am sorry to hear and see that he is still very much struggling to bite/chew and given this I wonder if trialling gabapentin solution would be sensible to see if this can improve it and if so then may give further indication as to a neurological factor underlying things.(...)
I have forwarded the videos along with my findings to the neurology department also for them to review and see if they feel this could be something neurological that they might be able to assist with so will also await their response."

Unsure about gabapentin but perhaps I need to try...will contact my local vet, as this is them who have to prescribe it...
 
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Rysiek

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I am curious about one thing you said: Did your cat use to catch spiders in his mouth before this? Mine chase spiders and pounce on them but NEVER pick them up with their mouths even though it looks like they want to :lol: Flies and moths - now that's a different story, straight in their mouth they go! :happycat:
[/QUOTE]

Yes, he used to chaise spiders and then ate them!
 

FurryMonsters

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I received an answer from the vet:
"Dental problems, including FORLs, has been ruled out by the CT scan which does not identify any such changes within the crowns or roots of any teeth. Referral to a dental specialist is always an option however I can’t see any indication for this at present given there is no clear oral pathology or inflammation noted.(...)
I am sorry to hear and see that he is still very much struggling to bite/chew and given this I wonder if trialling gabapentin solution would be sensible to see if this can improve it and if so then may give further indication as to a neurological factor underlying things.(...)
I have forwarded the videos along with my findings to the neurology department also for them to review and see if they feel this could be something neurological that they might be able to assist with so will also await their response."

Unsure about gabapentin but perhaps I need to try...will contact my local vet, as this is them who have to prescribe it...
Thank you for the update.
Of course the gabapentin is completely up to you. Just please bear in mind that you have found food that works for him, he's eating well, not losing weight. Is it worth risking medication side effects? Weigh the risk vs what benefit you're trying to achieve for him. You're a loving cat parent and you know him best, so I'm sure you'll make the right decision for him ❤
 

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The use of gabapentin is up to you and your vet; I have used it many times with pets, including long term use with a dog. What you are trying to determine though is whether or not he will feel much better on it and be able to eat his usual treats and hard food. You don't want him sedated to where he sleeps all the time which shows you nothing except that the gabapentin knocked him out.

I see your vet's point in saying that they are not sure that seeing a dentist will help and that it might be neurological. However, the other side becomes that maybe a real veterinary dentist would know more or be more familiar with some very subtle cause of the pain.
 
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Rysiek

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The use of gabapentin is up to you and your vet; I have used it many times with pets, including long term use with a dog. What you are trying to determine though is whether or not he will feel much better on it and be able to eat his usual treats and hard food. You don't want him sedated to where he sleeps all the time which shows you nothing except that the gabapentin knocked him out.

I see your vet's point in saying that they are not sure that seeing a dentist will help and that it might be neurological. However, the other side becomes that maybe a real veterinary dentist would know more or be more familiar with some very subtle cause of the pain.
Thank you, we have a referral for dental appointment as well. It will take some time, as there is a waiting list...I will go ahead with this...

In terms of gabapentin I am in two minds, as I don't want him to be constantly medicated and as we are going down with steroids (hopefully without relapse), I would like to have a meds free period...
It is intriguing that he bites and spits the cardboard-box, but somehow cannot process dry food...if he was in such pain I think his cardboard box habit would be impossible...or perhaps chewing cardboard box works as a way of dealing with some mouth irritation, but he has been doing this since I know him!
 
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Rysiek

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Thank you for the update.
Of course the gabapentin is completely up to you. Just please bear in mind that you have found food that works for him, he's eating well, not losing weight. Is it worth risking medication side effects? Weigh the risk vs what benefit you're trying to achieve for him. You're a loving cat parent and you know him best, so I'm sure you'll make the right decision for him ❤
Yesterday we had some fresh tuna, I cut it using scissors to really tiny pieces , size of a little pea...and I fed him by hand, he ate quite a few! 😸...
I think I will make some medication free period for him, hopefully he will not relapse after stopping steroids...
 
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Rysiek

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Thank you for all your support, it has been so important in this difficult time...

I want him to have medication and procedures free period, so I will not medicate him with gabapentin...
So far so good with decreasing steroid, hope it stays with no major set backs...on a day without steroid she is much happier and more active...

I have also observed him more re: process of eating. I noticed that when I give him grass (I always bring him some from the garden on my way back home) from the side he just crunches with no problem...when I give it from the front, this is when it falls out of his mouth...
And this happens with dry food...so it seems it does not relate to teeth but to his tongue...
So, it may be neurological, as the vet said...
I actually found the name of the nerve: hypoglossal nerve, which is responsible for moving food around when chewing...
I read it may repair itself, but as with the nerves it takes time...
So, I think to have a better picture, I will not add any extra medication. I do not see him being in pain when eating, but rather inability to move food around his mouth...
Wet and soft food is different, as it does not require so much movement in the mouth...we have tested out different varieties of wet food and we are happy with the selection of food and treats...I just need to feed him more often, as he does not have any dry food anymore...it will make it a bit difficult if I decide to go for holidays, but nothing planned at the moment...
I will buy some fish every so often and cut it to a very small pieces so he can manage well with processing it.
I will not expose him to any dry treats for some time, as he really gets distressed after being unable to process them...

Hopefully, we will not have any set back of the primary problem, namely the mass under his tongue ..
 

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Rysiek

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Yes, he doesn’t seem to have an obvious issue tearing the box which is interesting compared with eating but it is still a mystery as to why this is the case.
My neurology colleagues have looked at the videos and looked through his history and my report findings and have suggested that feline orofacial pain syndrome (FOPS) could explain the signs reported. They advise that this syndrome is often precipitated by oral lesions, including dental disease, so agree that it might not be a bad idea to get the input of a dentist (although they would have expected some abnormalities on the CT scan as well). In the meantime they recommend a medication trials with gabapentin as we have discussed as it may be some form of trigeminal neuralgia, but note that overall the condition is poorly understood, and of course being a syndrome, it is likely to have multiple underlying possible causes. They advise that although an MRI may identify inflammation in the trigeminal nerve to confirm this that this is not always 100% and it obviously involves additional anaesthesia and considerable cost as well so they would try the gabapentin first and failing this then could attempt a neurological examination, MRI and blood calcium sample as they note that sometimes low blood calcium can cause facial rubbing but wouldn’t be the top of the list given this is primarily an eating issue.

The FNA samples from the lymph nodes and tongue have also come back and are inconclusive for any abnormalities so there is no sign of cancerous cells or other clear abnormalities here which matches our expectations.

In conclusion I would recommend the next steps to be a 2 week trial of gabapentin medication to see if this improves things. If no changes then assessment by a veterinary dentist (via the referral I have already made) would likely be sensible and if they are still unable to find any changes then MRI and neurology assessment would be last option of investigation.

I hope this information helps and will keep fingers crossed that we see a difference following the gabapentin
 

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I think that the neurologist is making sense and is approaching this conservatively, both of which are good. Great that the FNA did not show any conclusive cancer.

Are you reconsidering the gabapentin? The chewing of a box is a mystery. Do you notice anything different about how he chews the box versus how he tries to eat hard food?
 
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Rysiek

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I think that the neurologist is making sense and is approaching this conservatively, both of which are good. Great that the FNA did not show any conclusive cancer.

Are you reconsidering the gabapentin? The chewing of a box is a mystery. Do you notice anything different about how he chews the box versus how he tries to eat hard food?
I think biting and spitting the cardboard box is just this:"biting and spitting"
When dry food, it gets in a front of his mouth and then it seems that he cannot move the food around his mouth, make a pulp and swallow, this falls out of his mouth...exactly when I give him grass from the front, it falls out, if I give him from the side, he is able to munch it and move to the back and swallow...
So the way I see it, it is a middle part of his tongue, the part that is responsible for moving food to the back and also assist with chewing ...
When he eats soft/wet food it seems easier, as does not require making a pulp (it is already there in the wet food)...

I am still unsure about gabapentin, they just called from my local vet as they ordered it...
He has been much happier, more alert...I do not like to medicate him...unsure at the moment...

We have a dental appointment for 28th August, 2 hours journey, but this is the only specialist service of this type in Scotland...we will go, of course...
 
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Additionally, I bought some CBD oil for cats, I am really hesitant to give him gabapentin, he does not appear in a lot of pain...
 
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As I see no signs of pain, neither distress, I will postpone gabapentin, I will get him for his third dose of Solensia as planned, as my vet said this is helpful in managing other than arthritic pain as well..

He has been medicated since April, I need to observe him a bit more and leave gabapentin for a stronger pain (hopefully not!)...
 
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Just a thought, but when reading on fops Facebook support group, I have noticed many different treatments suggested by vets and some of them work and some don't. It is almost like "trial and error".
It was suggested to me to put my cat on gabapentin, which is a very potent neurological drug to treat epilepsy, moreover after prolonged use it causes some dependency, hence, it is difficult to stop and causes some withdrawal issues.
I am not saying I will never use it, but for now I cannot see my cat being in such pain that requires a potent medication...
He has been on Solensia, received two shots and I have decided for now to give him his third dose...my local vet said that it helps with no arthritic pain as well.
We are just tapering steroids, so far so good...
He has been medicated over the last couple of months on a few occasions, such as sedation, general anaesthetic x2, moreover antibiotics and steroids and some painkillers...His blood already shows increased creatinine levels, which will require further investigation.
I am happy that CT and biopsy did not show any cancer under his tongue...
We still have an appointment with a dental clinic, but I will review it closer to the time, as this is a huge stress, two hours journey + general anaesthetic or sedation + assessment...

I have read many of the posts in the Facebook group and the problem is real and really extreme and with auto-mutilation as one of the features and other symptoms...Really 😢 sad to watch some of the videos...

But the choice of treatment makes me wonder if there is actually no well established consistency in the approach from the medical profession...As it seems the problem is a kind of mystery...
And then, very potent drugs are used...
At the moment I want to postpone this, as my cat does not show symptoms of being in pain.
He has had problems with eating a dry and chunky food since his dental cleaning and this makes me wonder what happens during the dental cleaning that triggers/exacerbates this problem?

I want to make sure that I understand the options for treatment well...

In humans in a chronic pain they use tricyclic antidepressants in a lower dose, such as amitriptyline, so to calm the system down...
If this is a disorder that affects nerves, surely using some meds that calm the system down should make a difference...
Perhaps, also using some remedies based on a more complimentary approach?

I don't know, I may need to use some stronger meds in the future, but I cannot see the reason for this now...the vet said to use it and then "we will see if it helps"...
I rather leave my cat on wet soft food, as this seems to work for the time being.
He also has his intriguing habit of biting and spitting cardboard boxes, sometimes doing this in an extensive manner and a few times a day...it is almost as if this provides some time of soothing for him...it has never exacerbated his symptoms...so, I leave the box for him (we tried for one week to remove the box, just thinking that this might have contributed to the mass under his tongue, but he was really unhappy), the box is close to his bed, so he switches between a soft bed and his hard chewed around box...

Maybe I am not right, but I just don't want him to be overmedicated...
At the moment his symptoms are mild therefore it is easier for me to think of our options through...I know, if it was severe, as I saw on some of your videos 😿, I would think differently...
 

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fionasmom

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You are being very logical and if you are concerned about the gabapentin, you can always begin to administer it later if you think that he needs it. The sight of that chewed box is almost humorous. It seems as if it has to be almost like a pacifier to him.
 
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Rysiek

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Yes, the box serves the function of self-soothing

He just had a small attack, unsure what happened, he just ran distressed to the living room, rolling his tongue...it lasted a couple of minutes only, but he was distressed for a longer period...in such situations he does not like to be held or stroked...
He is ok now...
😿
 
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