# feline friendships - cat drooling and licking her chops often



## catonalake (Mar 10, 2015)

Dear Forum: My name is Cathleen and live in Rhode Island. I've always loved cats and have two currently. Both are over 15 and I am thankful to have then in my life. I stumbled upon this site while searching for some symptoms my female, Winnie, has been experiencing. I'm waiting for blood work from the Vet and pray for the best.

In any case, I really appreciated the information, support and camaraderie on this site and so I decided to register. Please say a prayer for my Winnie.

All the best to everyone! 
Best, 
Cat


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## 10cats2dogs (Jun 16, 2013)

Welcome Cathleen, I hope and pray Winnie will be OK....
It's always so scary, when we don't know what's wrong...
(((HUGS)))
Sharon


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## Jetlaya67 (Sep 26, 2012)

Welcome to the forum. I hope your Winnie is okay. Sending prayers your way.


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## MowMow (Nov 6, 2010)

Welcome. I'm sorry to hear your kitty is sick and so glad you've taken steps to help it get better!

When you get the bloodtest results scan them and post them on here. We have some VERY knowledgeable members who can give you tons of information and help!


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## catonalake (Mar 10, 2015)

Thanks for the warm welcome!

I heard back from the vet today. I don't have the physical report but will post when I do. The doc shared that Winnie's creatine is a little high, potassium low and whatever the counts are for kidney health is normal but on the higher end (2.0). 

Based on her symptoms, drooling and licking her chops often, she recommended pepcid for nausea. She also recommended a diet of 80:20 wet: dry ratio.

I initially brought her to the vet after i noticed bad breath and drooling, but the vet confirmed her teeth were fine, but that she may have had an infection due to plaque buildup he removed with his fingernails. We gave her antibiotics for that clindamycin) but the drooling continued even 2 weeks after the antibiotics were done. The smell was gone though (whew). I brought her back but he seemed annoyed about my concerns, so I sought a second opinion.

The second opinion confirmed her teeth are great, but what was interesting is the doc couldn't get her jaw opened very wide, even with a tongue depressor. She recommended the blood tests. I'm glad I had the tests and will see if the pepcid helps. I may be just overly optimistic, but after just 1 dose, she seems to be drooling less! Script direction is to Give her .25 mls 2x daily.

Thanks for your pr-ayers. 
!


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## Azerane (Feb 26, 2015)

Hello and welcome. Best wishes for Winnie.


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## laurief (Jun 22, 2008)

Welcome, Cat, to the Cat Forum. From what you have shared in your posts so far, it sounds like your old girl is likely in Stage 2 kidney disease. This is a very common disease in older cats, and there is much that can be done to maintain your girl in comfort and reasonable health for a significant period of time ... esp. since she has been diagnosed fairly early.

Stomach acid build-up is common in CKD (chronic kidney disease) cats and causes the nausea that your vet is treating with Pepcid (lip licking is a typical indicator of nausea in cats). In addition to the Pepcid, you can reduce stomach acid accumulation by feeding your girl more frequently throughout the day, if possible, and as late into the night as you are awake. Also, give her one of those Pepcid doses right before you go to bed. That will help minimize acid build-up overnight.

Your vet should also have told you to start supplementing her with potassium gluconate. Low potassium can seriously weaken her hind end and negatively affect her appetite. It's important to get her potassium back up above 4.0 on her bloodwork to avoid these problems. Potassium gluconate can be purchased without a prescription, but you should discuss dosing with your vet.

Do post Winnie's lab results as soon as you get them, and be sure to include the lab's reference ranges for each blood value, as they will vary from lab to lab. We need to see the reference ranges in order to put her results into proper perspective.

In the meantime, here is a link to what most CKD caretakers consider to the our "bible" of CKD information - Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat
The site can be overwhelming at first, but it is an invaluable resource that you should bookmark and visit often. The more you learn about CKD, the more successfully you will be able to manage Winnie's health.

Kudos to you for getting a second opinion! Any vet who acts annoyed by your concerns over your cat's health isn't worth your time or money. Ditch that dude and find a vet who will partner effectively and respectfully with you.

Laurie


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## catonalake (Mar 10, 2015)

I am not sure how to read this, but here is a link to the results. http://1drv.ms/1GL1THL

I uploaded the pdf to onedrive.

I noticed her tongue seems oddly on one side as if she cant lick the other. Im not convinced she doesnt have something going on in her outh. Seems the pepcid isnt really working.


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## catonalake (Mar 10, 2015)

So some news. Looks like some bleeding on the same side of her mouth that she drools. 

Not a lot of blood, but i can see it is pink. 

Bringing her back to vet saturday.


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## catonalake (Mar 10, 2015)

Did the pdf link work? Just curious


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## 10cats2dogs (Jun 16, 2013)

Cat,
It did open for me....I had to download it first, then open it in an 'office' app, on my phone!
Now...if I was one of "THE ONES" who really knew how to read these kind of reports...you'd be more on the way to understanding it too!
Hopefully Laurie F. will see this! She's excellent at Reading these reports!
All Paws Crossed for Winnie!
Hang in there!
Sharon


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## laurief (Jun 22, 2008)

Yes, the pdf file does work ... sort of. When I opened it the day you posted it, I was able to view the entire report, but right now, I can only see the first page of it.

If I remember correctly, there's nothing that raised any big red flags for me in her bloodwork, other than the low potassium which could be corrected with a potassium gluconate supplement mixed into her canned food. Her creatinine may indicate early stage kidney disease. It's important to note that creat does not typically elevate above the reference range in bloodwork until at least 2/3 of kidney function has already been lost. So your cat's creat value of 2.0, although still within the lab's reference range, is likely to indicate some degree of kidney disease. Was a urinalysis run? That can help with a kidney diagnosis, as well.

I'm more concerned about what you have posted about her mouth. Drooling is not typical of kidney disease, and neither is blood from the mouth. It's also concerning that she apparently can't open her mouth fully. If I were you, I'd get her to a veterinary dental specialist for a thorough mouth exam. A cat's mouth really can not be thoroughly examined without sedating the cat, and I assume that has not been done. Bleeding, drooling, and inability to fully open the mouth raises a concern of oral cancer for me. But I'm particularly sensitive to that possibility because I lost one of my cats to oral cancer a couple of years ago. 

Laurie


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## catonalake (Mar 10, 2015)

It is a mass in her mouth.


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## catonalake (Mar 10, 2015)

So i am at the emergency animal hospital. They were able to get a good look without sedation (Winnie is a really good cat) and found a mass that is encompassing part of her tongue. They are going to Sedate her to take a needle aspirat and suggest that the location may reveal difficulty In removing. I'm hoping that some steroids and pain meds may help... A little worried the sedation will trigger kidney issues. I'll keep you all posted and appreciate your advice and input... You are all so wonderful.


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## laurief (Jun 22, 2008)

As long as they are sedating her, you should request a tissue biopsy, not just a needle aspirate. A biopsy will provide a definitive diagnosis. A needle biopsy will not. Also, make sure they give her fluids during and after the procedure. That will keep her blood pressure up and help protect her kidneys.

Laurie


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## 10cats2dogs (Jun 16, 2013)

Cat,
Have them look at the possibility of Stomatitus...this can also cause severe mouth and throat ulcers...
(((HUGS))) and Prayers, 
Sharon


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## catonalake (Mar 10, 2015)

I realize it is likely they won't learn much from a FNA, but I was concerned about how she would respond with the effects of a more invasive tissue biopsy - esp given she is already having a hard time eating and drinking. Given the amount of time i had to make the decision on that, opting out was the only one I could come up with at the time.

i'll pick her up later and hope they can find something with the fine needle aspiration and further assess if the mass is something that is potentially removable. initial thoughts on that from the vet indicated it is encompassing a large portion of her mouth and not something that could be removed.

perhaps steroids and some pain meds will help her be comfy when she comes home...

thanks again for all your support and wisdom...


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## catonalake (Mar 10, 2015)

oh and they will be giving her fluids - i confirmed that with the vet - They are very good at Ocean State Veterinary Specialists...


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## 10cats2dogs (Jun 16, 2013)

Oh Cat...
(((HUGS))) and Prayers for Winnie, as you wait on the results...
Sharon


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## catonalake (Mar 10, 2015)

this is an old pic - but Winnie is a female orange tabby (on the left in this photo) and Pooh is on the right.

Winnie is 16 and Pooh is 14 now but i think they were closer to 9 and 7 respectively in this


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## catonalake (Mar 10, 2015)

oops - that pic didn't post - here is a direct link to it


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## Arianwen (Jun 3, 2012)

Welcome. Have they done a dental check?


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## 10cats2dogs (Jun 16, 2013)

Awww...they look so comfy cuddling, I love the Ray of Sun playing on Winnie's fur...
Pooh is Adorable too!
Sharon


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## laurief (Jun 22, 2008)

catonalake said:


> it is encompassing a large portion of her mouth and not something that could be removed.


How could two different vets have presumably looked at her mouth carefully enough to assess the condition of her teeth and NOT NOTICE such a large mass in her mouth??? I hope you will be ditching those other two vets and finding one who has a lot more on the ball than either of them did.

I hope that the mass is just a very large pocket of infection that is curable with the proper antibiotics, but I fear that the aspirate will not provide a definitive diagnosis either way. Winnie has already spent two weeks on Clindamycin, which is considered the antibiotic of choice for oral infections. That would seem to point to something other than infection as the source of the mass.



> perhaps steroids and some pain meds will help her be comfy when she comes home...


If it is oral cancer, prednisolone and a pain med will keep her as comfortable as possible for now. You should also consider having the vet teach you how to administer subQ fluids at home so that you can keep her hydrated until it's time to let her go. If she can't drink, she will quickly become dehydrated, and that will make her feel quite ill. That, at least, is one discomfort she won't have to suffer if you administer fluids at home.

I am very sorry for what you and Winnie are going through.

Laurie


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## catonalake (Mar 10, 2015)

Hi Laurie - 

I learned the tumor is located in the bottom portion of her jaw where the tongue meets the gums and toward the back of her mouth - and, unfortunately, the test was consistent with squamous cell carcinoma. 

right now am home with her and she is doing well after the light sedation that allowed them to do the procedure - i have some high calorie food for her and the prednisone and gabapentin

I learned this to be a locally aggressive condition - so even if the other two vets were as able as the young doctor who treated her today, perhaps it may not have been big enough to see ... or perhaps Winnie was just ready to show the doctor today.

I confess my giving the other two vets the benefit of the doubt there, but i am with you on ditching them just the same - that is for sure... and i already have a new vet for the future.... 

so ... still fighting tears here - but i will monitor her closely and work on ensuring Winnie is comfortable for as much time as the Lord let's me... and i'll be looking for a vet in RI who will do a house call when she shows signs that it's time for me to leave her at the other end of the rainbow... all in all a solemn day, but I'm thankful in knowing she is still healthy enough to to stick around with me - even if it means she is a little "drooley"

i'll keep you posted on her condition - and really appreciate your advice and compassion.

Best,
Cat


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## 10cats2dogs (Jun 16, 2013)

Cat,
I'm so sad for you and Winnie:'(
Enjoy the time you have with her, and spoil her silly, let her eat whatever yummies, she loves...
We're here for you, anytime you need to vent, or share your fears...here, you will NEVER hear..."It's just a cat"...
Many, many of us, have lost our beloved kitties, because of one thing or another...we know the pain, all to well...
(((HUGS))) and Prayers, 
Sharon


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## Speechie (Dec 2, 2013)

Just read this thread, I am so sorry your sweet girl has cancer. I pray that you have some good quality time to hold her, snuggle, and just be together...
Hugs from NH- it is never easy to face this kind of thing, but you are not alone...


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## jking (Feb 22, 2014)

Cat,

I am so sorry about Winnie  Like Sharon and Speechie said, we all know the pain you are going through and we are here for you. You are not alone.

Judy


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## catonalake (Mar 10, 2015)

Does anyone here have any thoughts on Artemisinin?

Been doing some research online.

also going to talk with a holistic vet for ideas to compliment her current meds withnatural ways to keep her confy

here is one thread that a found referencing the herbal treatment.. there are plenty more out there. 

https://pathwithpaws.com/blog/2011/...-and-integrative-treatments-in-dogs-and-cats/ 


here is Winnie sleeping so comfy 

hope all is well with everyone


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## 10cats2dogs (Jun 16, 2013)

Cat,
Winnie looks so cozy and comfy, so very, very sweet!
(((HUGS))) and Prayers, 
Sharon


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## laurief (Jun 22, 2008)

Cat,

I am very sorry for Winnie's diagnosis with FOSCC (feline oral squamous cell carcinoma). As I noted earlier, I lost my Noddy to FOSCC about 2 1/2 yrs ago. It was a very fast growing tumor. I lost him just weeks after diagnosis. From your description, it sounds like Winnie's tumor is already more advanced than was Noddy's at the time of his diagnosis. I'm not telling you this to upset you, though I expect it will. 

My point is this. Whatever you want to attempt in the way of treatment, do it immediately. This tumor won't wait for you. That said, I doubt if you'll be able to do anything other than try to keep Winnie as comfortable as possible until it's time to let her go. 

You have my deepest sympathy.

Laurie


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## spirite (Jul 31, 2012)

I'm so sorry to hear this Cat.  Just looked at the pics, and she's a beautiful little lady - Pooh is adorable too (love their names!).

How is Winnie seeming today? Sending hugs to you and a big face mash to Winnie.


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## catonalake (Mar 10, 2015)

Thanks for all your thoughts and prayers.


She is responding well to the prednisone. Today is day 3 at .45 ml and i will cut back to .2 on Thursday.

I'm only giving her the gabapentin at night since she doesn't seem to like that at all.

she still eating dry food and does seem to like her max calorie food as well. but she's not eating as much as she used to.

The holistic vet is coming this morning at 10:30. she said she hasn't heard of Artemisinin but I'm hoping she did a little research since I told her about it on Monday. I'm waiting on an order from Holly Pharmaceuticals artemin50 and will share how that works.

I've been combing and brushing her and showering her with catnip making her comfortable. I think poor Pooh is getting jealous! Trying to make time for him too!


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## spirite (Jul 31, 2012)

What did you think of the holistic vet, catonalake?


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## catonalake (Mar 10, 2015)

I think she was nice, but I felt she wanted to sell me her supplements vs approach it holistically. Then she said she wouldn't treat while on prednisone. She said that it would be hard to tell if the treatment was working. So I felt like it was going to be a trial and error and didn't feel comfortable. Of course she said it would take a lot of time to review her history and come up with a plan. I guess i was confused.

She seemed to think Winnie was not as bad as most she sees at home, but couldn't tell me what her success rate was in treating cats with this condition and also didn't seem to know very much about FOSCC

I told her i wanted to research the supplements and noted both had liver. Having read the Artemisinin is best if taken on an empty stomach but that foods with high iron could impact effectiveness, i declined the supplements and felt like she wasn't happy about that.

Guess I'm not sure what to think.

I called a holistic doc in NC who said they would work with me even if i was giving her the prednisone. They do all their treatments via phone. Dr. Charles Loops. They even shared a suggested dose of the Artemisinin. 

Got her some great all protein, no grain food today. Better than Iams as that is all filler She ate that and really enjoyed it. Hard to tell if she is in pain. I think she is and I'll give her gabapentin again tonight. She is enjoying getting spoiled. Pooh is cuddling with me now while Winnie is sleeping upstairs on the bed. Soon I'll join her. 

Giving her the artemesinin was a challenge. Still researching the best way to get it in her. Maybe a pill pocket... It's not water soluble so maybe mixing in some fish oil and using a syringe? 

Doing my best to stay positive.

Thanks for checking in.

Hope all your feline friends and families are all fine!!
Best,
Cat


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## spirite (Jul 31, 2012)

Cat, I just looked up artemisinin because I'd never heard of it, and I looked at the link you provided. You might want to be really careful with it. The study that's cited in the article was out of U Washington, and what popped up on my google search was the U Washington website: Artemisinin and Cancer - UW Bioengineering 

The first sentence is "The Department of Bioengineering and University of Washington do not advocate the use of artemisinin to treat cancer."

Somewhere, (the WHO site maybe) there was also mention of the possibility of neurotoxicity if the dose is too high. 

Are there any other holistic possibilities?


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## 10cats2dogs (Jun 16, 2013)

Cat,
Keeping you and Winnie, in my thoughts and prayers♡♡♡♡
(((HUGS)))
Sharon


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## catonalake (Mar 10, 2015)

Dear all thanks for your thoughts and prayers.

Hi Laurie -thanks for the concern re: that sweet wormwood extract Artemisinin. I did see that post on the UofW site, but i also appreciate they do that for liability reasons. And every "supplement" mentions warnings that the stuff is basically not good for anything. -my background is information technology and, interestingly, the "not good for anything" disclaimer is listed as notation for open-software to avoid liability issues for the folks that choose to use it. we live in such a litigious environment!

i figured i have nothing to lose really, and i spoke with Dr. Loops who indicated that he has helped others who have treated their cat using that herb.

for more info on this, i found this video on Artemisinin - it is interesting as it also outlines how they rediscovered it in the 70s and covers some of the testing that was performed. I'm sure it is not the panacea, but her fate is clear given what we know about FOSCC, so a harmless plant extract, in my opinion, that has been proven to have little or no side effects is a safe option to try.

https://www.youtube.com/watch?v=FT8rUsZz4Qo

On another note - i called the animal hospital and they said they would do do some research on it... i'll have to send an email to them. 

My main reason to call was because of the issues i was having giving Winnie the gabapenin - really, it was like absolute torture. i have to get her to let me put .4ml in her mouth and that is not an easy task, in spite of how "small" that amount seems. When i spoke with Dr. Loops (hollistic doc in NC) he suggested buprenorphine as an alternative - so inquiring into this at the animal hospital, they were open to it and gave me 3 days of this stuff (1.4ml) for - get this - at a whopping $53!! the advantage to this is i only have to get her to take .14ml of this and she is actually not that bad about it! i am pleased and will pay the extra to reduce her stress, my stress and, most importantly, keep her pain at bay.

i may have to travel to NC for work (totally unrelated to the Dr. Loops thing) so it may be a challenge giving her meds while i'm away - my bf is not good with this type of thing but he's been a peach at helping me give her meds by keeping her still on the table while we pet her and reassure her, then sneak some stuff in her mouth! Maybe my mom (retired nurse) would be open to helping for the one or two days' i am away. 

i appreciate it is just a matter of time - my goal to make sure she is comfy and when she stops eating completely, i'll just have to do the right and ethical thing..

i know i'm bouncing all over the map here - just sharing what's on my mind freeform.. thanks for reading and taking it in.

while it may seem so matter of fact the way i share these thoughts, i know you all get the emotional stuff that comes along with the ride here and i really appreciate your compassion, thoughts and prayers. 

Best,
Cat


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## Arianwen (Jun 3, 2012)

Just want to offer you support and sympathy.


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## laurief (Jun 22, 2008)

Cat, 

I'm not the one who offered the link and concern about artemisinin. That was Spirite. I doubt if artemisinin will do anything significant for Winnie, but I agree with you that you've got nothing to lose in trying it. If it can slow the tumor or in any way make Winnie more comfortable, it's certainly worth using.

I've never used gabapentin on any of my animals. I gave Noddy Tramadol for pain, but buprenorphine would, I believe, have a similar effect.

Your matter-of-fact tone is reflective of your knowledge that you have to keep it mentally and emotionally together in order to be able to best manage Winnie's condition. Been there, done that, completely understand. You're doing a great job for her.

Looking back over my earlier responses in this thread, I see that I neglected to provide you with a link to Colorado State University's Animal Cancer Center. This center offers free telephone consults with their veterinary oncologists. You may want to take advantage of this service, since they should be able to answer any questions you have about available treatments, both traditional and alternative. You will get the most out of your consult if you email or fax copies of ALL of Winnie's lab reports, xrays, ultrasounds, other diagnostics, and clinic exam notes to the Cancer Center prior to the consult. Here's the link:

Colorado State University Flint Animal Cancer Center - Fort Collins, Colorado - Consult Service

Hang in there,

Laurie


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## catonalake (Mar 10, 2015)

Ah thanks, Laurie. Appreciate that link and also your pointing out my misreading the name on that post!

I found i may have trouble getting another script for the pain med buprenorphine as it is a controlled substance. I'm not going to go into details around the disappointing conversation I had with the animal hospital today, but I plan to talk to the manager on monday ... since the doctor that saw her is on vacation until march 30th, they don't even have anyone to help me.

I'll plan to call the other vets i brought her to. Perhaps they will at least feel obliged to help me keep her comfortable.

I will look into the consult and get the full reports as soon as i can.

She hasn't been eating much. No surprise with having reduced her prednisone to .2ml on Thursday per the instructions ... and perhaps the pain meds Are playing a factor.

While she's appearing comfy, drinking water and resting i would like to see her eating.. 

Have a great weekend with your human and furry families. !


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## 10cats2dogs (Jun 16, 2013)

OMG Cat!
They're that strict with the Bupe?
I hope you do reach the manager...
Poor Winnie, it's important she be on some kind of pain management medication...
See how they feel about Tramadol, as an alternate, till you can get the 'Buprenorphine' issue settled...
(((HUGS))) and Prayers for you and Winnie, 
Sharon


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## laurief (Jun 22, 2008)

catonalake said:


> I found i may have trouble getting another script for the pain med buprenorphine as it is a controlled substance.


Tramadol is also a controlled drug, so you'll be likely to run into the same problem with your current vet clinic. But Winnie will require pain relief, so you must find another clinic to go to that will give her what she needs.



> She hasn't been eating much. No surprise with having reduced her prednisone to .2ml on Thursday per the instructions ... and perhaps the pain meds Are playing a factor.


Is she getting prednisone or prednisolone? If she's getting prednisone, you should have her switched to prednisolone. Cats can't utilize prednisone properly. Also, why on earth is your vet reducing her pred dose? I could understand if she was being treated for anything other than cancer, but I don't understand the reasoning behind reducing the pred dose for Winnie. Has your vet given you an explanation? If not, you should ask for one.

Laurie


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## catonalake (Mar 10, 2015)

Yes, it is Prednisolone - not prednisone - my bad

i will certainly ask, however, that doctor is on vacation for two weeks and won't be back until March 30 - and i'm told that no other vet at that animal hospital will cover for her - and that i'd have to take her back in - that is when i admitted to myself that this requijred revisiting with a manager. that is what i'll do on monday - and also ask for more insight into why the dose was reduced.

in the meantime - i''ll circle back with the other two vets and see what they can do... the last thing i want to do is stsuff her back in a car for a ride to the vet to be poked and prodded again when we KNOW what the prognosis is. frankly i am livid.

anyway - i may up her prednisolone to 2.5 but i am not a vet and don't know what the implications will be for that moving forward (e.g. perhaps the dosage would be dangerous ??)

maybe i'll write a letter ot the manager tonight (without typos LOL) and state my caase that way.

i am so very disgusted with that facility and the fact that they don't have anyone covering for a doctor that has given a terminal prognosis but the facility has no protocol for coverage. shameful

i'll ask about the tramadol.. o9r at least other options - mosstly something that is an anti inflammatory as well as a pain killer.. 

she is doing ok - i just gave her another artemisinin (50 mg capsule) and some butter.. it was tricky - but even though it was to be given on an empty stomach i had to offer some kind of treat - tuna fish - and she ended up eating more of that than i thought she would - i think having some nutrition in her now is more important that the effectiveness of that herb at this point. she is sleeping soundly and looks pretty comfy right now.\


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## laurief (Jun 22, 2008)

catonalake said:


> i may up her prednisolone to 2.5 but i am not a vet and don't know what the implications will be for that moving forward (e.g. perhaps the dosage would be dangerous ??)


I'd discuss that with a vet before changing the dose. As a rule, you always want to give the lowest effective dose of pred for the shortest period of time possible. But Winnie is terminal, and the pred is probably the only thing both keeping her eating AND having any effect on slowing the tumor's growth. I just don't see the advantage of reducing her pred dose now. I think the benefits of the higher dose outweigh the risks at this point. But again, this is something that should be discussed with a vet.



> i am so very disgusted with that facility and the fact that they don't have anyone covering for a doctor that has given a terminal prognosis but the facility has no protocol for coverage. shameful


I agree.



> i'll ask about the tramadol.. o9r at least other options - mosstly something that is an anti inflammatory as well as a pain killer..


Pred is a potent anti inflammatory, so as long as the dose is adequate, Winnie is covered there. But she does need a pain killer.



> i think having some nutrition in her now is more important that the effectiveness of that herb at this point.


I agree. It wasn't the cancer per se that made me euthanize Noddy when I did. It was the fact that he couldn't eat adequately, and he was quickly starving. If I could have gotten adequate nutrition into him, I could have had him with me a bit longer. But I couldn't stand by and watch him starve to death. Get food into Winnie as long as you can.

Laurie


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## catonalake (Mar 10, 2015)

Thanks, Laurie - i called the animal hospital and was appalled at the response - and there was no manage on so i have to wait until Monday.

here is the letter i wrote - i'll lave the location of this facility and the manager's name anonymous ... when i hear back i will reveal more:


Dear Ms. xxxxx:


I am writing to request your assistance around cancer pain management for my female, short-haired cat, Winnie. Winnie was assisted on Saturday, March 14, just one week ago. To this point, I have had nothing but the kindest words to share for the staff at your facility and the services she received. Even prior to arriving at YYYY, your phone staff was extremely pleasant, helpful and compassionate. 

I have the utmost respect for Dr. zzzzz and your team of specialists. Dr. zzzzz was compassionate and patient, fielding dozens of questions from me as I made an effort to understand and evaluate the options for next steps and consider what was in the best interest for Winnie.

I will not take your time summarizing the tests or the report; I trust you have that information readily available. However, I am sure you appreciate my sadness in learning the prognosis and recognize my obligation to do what I need to do to keep her comfortable. When the time comes, I am prepared for the need for humane euthanasia.

With all this said, and knowing Winnie is not quite at that point, this leads me to this email and my request for your assistance, particularly given that Dr. Mulligan is out of the office and on a well deserved vacation until March 30.

Unlike the Prednisolone, administering the Gabapentin has been very stressful and unpleasant for Winnie. On Friday, March 20, I called with these concerns and asked about alternatives. Once again, your staff was extremely helpful and compassionate; a script for buprenorphine was approved for a 3 day supply just to see how it works out for her and I picked it up that evening. I was so thankful for the responsiveness of the team and, once again, the pleasantness of the staff on the phone and at the front desk.

I called today to share my appreciation and inform your staff that the switch to buprenorphine was a positive one for Winnie. I inquired into how I should plan to manager her pain after the 3 days supply was up and also inquired about Dr. Mulligan's suggestion around stimulating Winnie's appetite as the reduction in the steroid, per the instructions I was sent home with, have negatively impacted her appetite. This is where I hit a dead end and where I trust you can help.

I was made aware that buprenorphine is a controlled substance and was then informed that I would need to bring Winnie back in if she still had pain after the 3 days were up. I explained that Winnie's condition is terminal and that my goal is to help her manage her cancer pain as best I can and asked if anyone had reviewed her file prior to making this return visit a requirement. I was informed that no other doctors were covering for Dr. Mulligan while she was out and that your facility does not provide long term care. The bottom line is, just one week after being diagnosed with a terminal condition, I was shocked to learn that I would have to bring Winnie back in and/or wait for Dr. Mulligan's return to discuss pain medication, steroid script questions and the potential for an appetite stimulant.

Ms. xxxx, with all due respect, and considering the prognosis, I trust you can appreciate this putting me in a position which challenges the consideration for my beloved cat's needs, adding undue stress and fear and presenting obstacles in ensuring her cancer pain is minimized. 


I appreciate your time in reviewing this inquiry and I look forward to hearing back regarding what you feel is ethical and right given this situation.


Thank you in advance for your help with this matter.

Respectfully Yours,

Cathleen 

and
Winnie


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## catonalake (Mar 10, 2015)

i will reveal the facility, manager and doctor ... just thought i'd give the mgr an opportunity to redeem the facility first ... although leaving me hanging about q's around her prednisolone are really pissing me off. i gave her .3ml today - screw it - she is doing ok.. no pain med this a.m. just to see if she'd eat. no luck but she's drinking.

we'll see.. the upcoming week may be a difficult one for me.


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## laurief (Jun 22, 2008)

That's an exceptionally well-written letter, Cat. If you don't get the response you need, I assume you will be contacting another vet clinic to seek help for Winnie. 

I feel for you and Winnie.

Laurie


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## catonalake (Mar 10, 2015)

Thank you, Laurie. 

I'm exhausting all avenues for my Winnie-Binnie!

here are some pics taken of her enjoying some sun this am with a fresh catnip plant just inches away and a nice view of the birds and squirrels... life is good

http://1drv.ms/1HkpCLQ


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## 10cats2dogs (Jun 16, 2013)

Cat,
A very well written letter!
I'm so sorry for what you and Winnie are going through...
It's a rough enough time, as it is...the last thing you should have to be worrying about, is having to do battle...just to be able to get the pain meds, to manage her pain, for the time she has left...
Haven't they heard of Hospice care?
(((HUGS))) and Prayers, petpets for Winnie,
Sharon


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## catonalake (Mar 10, 2015)

thank you, Sharon!

i hear you.. we'll see what happens on monday... will keep you posted

Best,
cat


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## 10cats2dogs (Jun 16, 2013)

Winnie looks so content there...
She's Beautiful!


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## laurief (Jun 22, 2008)

It's wonderful to have a warm, sunny spot to nap in when winter holds the out of doors in its grip. 

I hope that tomorrow delivers sensibility and compassion to the vet clinic. 

Laurie


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## kbear (May 12, 2013)

I saw this article today on a dog forum and thought of you. it works for cats also:

Turmeric's 'Smart Kill' Properties Put Chemo & Radiation To Shame


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## catonalake (Mar 10, 2015)

Thank you!

So i spoke with the manager and we have a plan.

at the animal hospital now picking up the pain meds.

It it's such a struggle to get Winnie to eat but she has taken in some today but still not enough to make me feel more comfortable...

Keep you all posted! 

Another sunny day but still to cold to melt the snow in spite of spring

I will look until the tumeric. 

Best,
Cat


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## 10cats2dogs (Jun 16, 2013)

Cat,
I'm happy you got something worked out with the manager, to control Winnie's pain...

A Bullet type blender, is great for pureeing any canned food, into a Cat Food milkshake...easy to lap up, or put in a feeding syringe...
Walmart has some small ones, for under $20.00...
Just a thought...
(((HUGS))) and Prayers, 
Sharon


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## laurief (Jun 22, 2008)

Sharon just posted pretty much what I was going to post, so I'll just reiterate her post. I, too, am very glad that you got the pain med issue worked out.

Any kitchen blender can puree canned cat food (esp. the pate styles) into a thick, smooth gruel that Winnie may find a lot easier and more comfortable to lap up. Try different consistencies by adding a little more or less water, and try different temperatures. It may be most comfortable for her if you can match it to her own mouth temp (approx 101 F), though she might prefer it cooler. Or she may prefer canned pate style food cut into bite-sized chunks with no water added. Or she may prefer canned foods that come in slices or bits or chunks in gravy. Or she may prefer kibble. Just try it all, but don't overwhelm her with multiple plates of food at one time, or with too much of one food at a time. Offer her small meals as many times a day as you can manage.

Hopefully the pain med will make it more comfortable for her to eat.

Laurie


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## spirite (Jul 31, 2012)

Oh, I'm glad to hear the clinic saw reason and that you were able to get the pain meds. How does Winnie seem to be feeling?


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## catonalake (Mar 10, 2015)

thank you all for your support!

you are spot on with the food temp - she seems to like when i warm the food up a bit. makes it more palatable. glad to be able to spoil her while i can... life is so short and precious.

she also seems to like kibble - esp the less "healthy" kind  even dry she is downing it

she is also like small bite sized treats she can swallow almost whole - feeding her these small sized treats 1 at a time seems to be working... but i suspect she may be eating when i'm not paying attention... 

she is doing really well on the revised steroid .25 ml 2x per day of prednisolone (10mg/ml) and she seems to be comfy - giving her .14 ml 2 to 3 x per day of buprenorphine (.324mg/ml) - OMG that buprenorphine costs a fortune!! i spoke to the other vet who is much closer so i have a backup plan for the pain meds..

will try to put less food down .. maybe i am overwhelming her with "options" 

i am also careful to ensure Pooh (14 year old male) does not feel left out!

it is a pleasure to keep you all updated

Best,
Cat


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## 10cats2dogs (Jun 16, 2013)

Cat,
So Happy Winnie is eating!! That's a very good thing!
(((HUGS))) and Prayers, and PetPets for Winnie,
Sharon


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## catonalake (Mar 10, 2015)

I thought I would share the response I got from Colorado State University regarding foscc

My name is Dr. Yoshikawa, one of the radiation oncology resident at Colorado State University Animal Cancer Center. This email is to return your consult request for your cat Winnie.


This tumor is locally very aggressive and we usually do not see the tumor spread to distant organs such as lungs. Part of the reason may be due to the very poor outcome after attempt to control tumor locally. 


In many cases chemotherapy alone is not effective and surgical excision almost always leaves tumor cells behind (incomplete excision) and the tumor grows back very quickly. And base of the tongue is not a good location for aggressive surgery. Many cats lose their ability to eat/drink/groom after the aggressive surgery and require a feeding tube into their neck or stomach to support post-surgical period. 


We have done a clinical trial using a very precise radiation therapy (called stereotactic radiation therapy; SRT). Most cats showed quick response to the radiation (tumor shrunk) but the duration of the response was not very durable. Average local disease control was about 3months and average survival time was 100 days, not long. Advantages of SRT are that this is a single treatment (so can be completed in a couple of days. SRT requires CT images for radiation planning.), many cats showed minimal side effects, and they started feeling better quickly. The disadvantage of SRT are that it is expensive ($5,000-6,000), the effect was not durable, and if a large volume of the bone in the jaw and/or oral mucosa were affected by tumor (bone lysis, ulceration), there is a high chance that the underlying tissue (bone etc) will be exposed after the tumor shrinks. We feel that a better outcome is expected if the tumor is found when it is still small. But unfortunately the tumor is already big and damaging surrounding normal structures in many cases.


Regarding Artemisinin, it is still experimental level in veterinary medicine and bioavailability with oral administration in dogs is poor. No solid data regarding its safety and efficacy is available for cats. 


I am sorry for the diagnosis of Winnie. We are here to provide you more information if you want. And please do not hesitate to get back to me if you have any questions.

Winnie is still hanging on. pain meds and steroid are keeping her comfy. next week may be telling.

all the best,
cat


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## laurief (Jun 22, 2008)

Thank you for sharing this important correspondence, Cat. I'm sorry that there isn't anything terribly encouraging in it, but it sure drives home the importance of spending every quality minute you can with Winnie. I'm glad that the pain meds and pred are keeping her comfortable right now.I hope the pred will give you more time with her.

You're being a wonderful and loving caretaker in this difficult time, leaving no stone unturned in your attempt to help Winnie any way you can. I admire you for that.

Take care, and give Winnie a smooch for me.

Laurie


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## 10cats2dogs (Jun 16, 2013)

Cat,
Sending lots of Hugs and Prayers, as you and Winnie go through this time together, cuddle her, and spoil her...
Sharon


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## spirite (Jul 31, 2012)

Oh goodness. I'm sorry that the news isn't better.  At least the pred and pain meds are working and Winnie is comfortable. Give her lots of head scratches from all of us.


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## 10cats2dogs (Jun 16, 2013)

Cat,
Thinking of you and Winnie...
(((HUGS))) and Prayers, PetPets for Winnie,
Sharon


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## catonalake (Mar 10, 2015)

Thanks again for the support and thoughtful words.

Winnie is now on a higher dose of buprenex. .28ml Seems to be making her more comfortable, but she still is not eating much at all. She is also still on the Prednesolone. She tries to eat, but i know it must hurt so she gives up quickly. Syringe feeding is out. Too stressful and she has made it clear...she is not having it.

I have a running water fountain that she likes to drink from. She will sit there between 3 to 5 minutes. Leaving a foam in the bowl. I wonder if she is just rinsing her mouth. I noticed She does have an odor in her mouth.. I brush and comb her often.

How long should i let her go without eating? she still seems to have enough energy 2 walk around but I don't want to get to a point where her energy is so depleted.

She is enjoying Sun today by the catnip plants and the window overlooking the birds and squirrels. She purred while i Sat on the floor and held her, but i had to get up to work and she was happy to relocate to a bed i made for her right where we e sitting together. I am fortunate a have been able to work from home To care for her. 

I just wonder .. at what point am I prolonging this for only my selfish reasons? Or is she really savoring these days? She seems to be. But do i wait until she is so uncomfortable that i feel pressed to do this? Or cut her last few good days short...
Sigh


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## laurief (Jun 22, 2008)

Cat, those are questions with which we all struggle when dealing with a terminally ill animal. I can barely make that decision with my own cats who I know intimately. No one knows Winnie the way you do. You know when she is enjoying her moments, and you will know when she is ready to move on. 

I hesitate to share my experience with Noddy with you, because it was such a painful goodbye for me. But perhaps I should share it, because it may happen similarly with Winnie. When Noddy was diagnosed, I promised him that I wouldn't help him pass until he was ready. But then he got to the point where he could barely eat, he was quickly starving, and blood was constantly dripping from his obviously painful mouth. In spite of it all, he was NOT ready to go. It absolutely ripped my heart out to betray my promise to him, but I could not watch him starving and in pain, so I had him euthanized here at home. It was traumatic for both of us.

I don't know if that is typical of FOSCC, but it seemed that since his mouth was the only painful part of his body, the rest of him was still up for the fight. I want you to understand the possible progression of this disease so that you can be prepared to make the heart-crushing decision, if that's what you decide you need to do, even if Winnie still seems willing to fight. 

I wish I could give you the answers you seek, but those answers are yours and Winnie's to determine. I'm so sorry.

Laurie


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## catonalake (Mar 10, 2015)

Thank you, Laurie.

I appreciate how hard it is for you to recount Noddy's and your experience... And your promise ... and that decision. I don't doubt you made the right decision.

I feel like Winnie is hungry. She goes around the house sniffing everything on the floor... Approaching her bowls, she goes from the high quality grain free dry to the tasty wet..then to another treat we got to tempt her.. Normally she would eat anything... But the last several days, She tries to eat... After one or two attempted bites, Walks away ... I know t will seem bizarre to say this,but her body language,to me, seems like she is Sadly Walking away because it hurts too much to try again. The running water fountain is the only relief she gets it seems... 

Tonight my bf brought white fish home. Soft and flakey, we both were hopeful. She was excited at first ...smelling it..After two bites, she gave up. It seemed she knew this was a new smell so maybe it wouldn't hurt.. But after a painful attempt, she made a slight growl in pain, then walked away dejected. 

Even after upping her pain med, it seems it has gotten to harder and too painful. I can't watch her starve so i will have to make the decision soon. I already have a contact who will come to the house when that time comes.

Today she was so sweet. I am glad she could enjoy the sunny day. 

Anyway, thanks for sharing and giving me a sound board... 

Sorry for being so depressing.


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## laurief (Jun 22, 2008)

I know. It's horrible watching the way they struggle with this malicious oral cancer. Noddy and I both suffered with it, as I know you are suffering with Winnie.

Try pureeing her favorite canned pate food in a kitchen blender with a small amount of hot water. Make it the consistency of a thick, smooth gruel that she can lap up without having to bite or chew at all. Check its temp and warm it in the microwave for a few seconds (stir well afterwards to evenly distribute the warmth), if necessary, to bring it up to her mouth temp (about 101 F). She might be able to lap that up without much discomfort.

Laurie


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## 10cats2dogs (Jun 16, 2013)

Cat,
It is ALWAYS hard to make that decision...
I lost two cats to Stomatitus, a few years ago...I didn't know then, what I know now...
All I knew then, was to try and get food into them, I tried everything, and my heart was breaking, listening to their sad moans and cries...I did know if they couldn't eat, it would very quickly lead to Hipatic Lipidosis...
I made the decision to let them Fly to the Bridge, so there would be no more pain...ever...for them...
And yes, I still tear up, when I think about my boys...
It is always gut wrenching and heartbreaking when we have to say goodbye...
Right now, my heart is breaking for you:'(
You are never alone here...to many, of us, fully understand...
(((HUGS))) and Prayers, PetPets for Sweet Winnie,
Sharon


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## catonalake (Mar 10, 2015)

so tomorrow is the day - she told me... and poor Pooh, 14 year old male has pretty much confirmed it

here is a nice video of her just two days ago that i was blessed to record - perhaps i enjoyed it more than she... but i think she was quite happy 

https://www.youtube.com/watch?v=O6pdFyFGdFU

i have several others too

Happy Easter all - thanks for your thoughts and prayers.

i will see her in Heaven

Amen

Best,
Cat


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## 10cats2dogs (Jun 16, 2013)

Cat,
I'm so sorry:'(
We're here for you...
The Rainbow Bridge will be waiting to Welcome Winnie...
Please feel free to Remember Winnie on our Rainbow Bridge thread...
Tonight, just spoil her, love her, and talk to her...♡♡♡♡
I watched the video...and I teared up...I'm so glad, she's had some sunshine to enjoy...
(((HUGS))) and Prayers across the miles...
Sharon


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## laurief (Jun 22, 2008)

My heart breaks for you, Cat. I'm so sorry.

It will be easier on Pooh if he has the opportunity to see and smell Winnie after her passing so that he can acknowledge her death. 

I'm just so sad for all of you.

I wish you a peaceful grief.

Laurie


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## NebraskaCat (Jan 15, 2013)

I don't know how anyone can watch that and not tear up. We've all been there and surely we will all be again. It's these special bonds like you have with beautiful Winnie that make it more than worth it. You can just see how content and trusting she is to know she's loved by you and that you will do right by her.


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## spirite (Jul 31, 2012)

I can't imagine how hard this must be. She does look so content in that video - so happy to be in her mommy's lap, with the sun shining on her. Sending hugs and wishing you lots of strength.


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