Tongue ulcer - help

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Angule
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Tongue ulcer - help

Post by Angule »

I moved to a new state 2 months ago, and my cat didn't adapt well to the move. I took her to the vet a couple times for not eating or grooming herself, and they said it was stress. Then she completely stopped eating, took her back to the vet, and a different person there diagnosed her with a tongue ulcer. I feel like it was probably there the whole time, and they missed it. It had gotten so bad that half her tongue was missing. The picture the vet took of it is horrible. They gave her an injection of antibiotics, pain meds, and mouth wash.

I took her back a week later, and they said it was healed and likely not cancer. Her symptoms hadn't gone away though, so I made an appointment for today with a different office for a second opinion. That vet put her under anesthesia to get a better look at it, and she let me in the room. It was so horrible. The tissue under the skin was so swollen that the vet could not fully extend her tongue. The left side of the tongue is a lot thicker than it should be. The right side of the tongue (where the ulcer was) had healed, but the tongue had separated. There was an extra flap of skin that wasn't connected to anything, and it looked jagged on the edges. I broke down crying.

I adopted her in 2005. They told me she was between 5 and 8 at that time. Assuming they were correct, she's between 17 and 20 now. She's truly my best friend, and I don't know what to do. The vet told me that I should start thinking about saying good bye to her.

They don't know if it's cancer. They could do a biopsy, but they said that would be painful for her. With her age, they likely would not treat it even if it was cancer. I have the option to put a feeding tube in her neck, and that terrifies me. Feeding her through her neck make me cry, and I don't know if I'd be able to keep it clean and do what's needed for that. I feel selfish saying that. I also don't know if that would make her completely miserable. I personally myself would not want to have a feeding tube if I'm ever that sick.

She still greets me at the door. She talks to me for at least an hour when I get home. She sits on my lap and cuddles with me. But she's so skinny. She was over 7 pounds when we moved here. Now she's 5.5 pounds. She tries to eat, but she drops the food out of her mouth. She uses her paw to help her. She doesn't groom herself though, so I have to wash her every night. She's still using the litter box like normal.

If there's a chance she could get better, I'd do whatever it took. Feeding tube, anything. But if she's going to continue to get worse, I don't know where that line is. The vet today couldn't tell me. Looking at her tongue, I can't imagine how painful it must be. But if she's in pain, I don't understand why she's still full of energy. She will sit on my lap looking in my eyes, and I've talked to her for hours today. I know it sounds silly, but I feel like she can understand me. I have such a huge bond with her. I keep asking her what she wants me to do, and she can't talk back. But she trusts me and loves me, and I hate having to make this decision.

She has an appointment with the original vet on Monday for a follow up, and then an appointment with the second vet for next Saturday. I think it's especially hard since I'm getting mixed messages. The first vet told me last week that she was healed and doing great. But then I saw the tongue myself today, and it's not healed. The second vet told me that I need to think about her quality of life.

I've been laying with her crying all day today. Anyone gone through this? Any advice?
booktigger
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Re: Tongue ulcer - help

Post by booktigger »

I'm so sorry you are in this position, I agree about not putting a feeding tube in, I'm not sure how much quality of life she would have then. I've only had experience with oral cancer, my cat was eating till an hour before his final visit (although like yours, he was loosing weight because he couldn't eat enough) but his had started bleeding, so the decision was kind of easier. When you go back to the vet, I'd ask them what they would do if it was their cat. Good luck.
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Kay
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Re: Tongue ulcer - help

Post by Kay »

this is very sad, and a situation most of us on here have been through at least once - some of us many times

it does sound as if you are near the time when you will have to say goodbye to your friend - she may not be suffering greatly at the moment, but starving slowly to death is not a painless procedure, and especially so if she wants to eat, but can't - but I did find this on the internet http://www.pethealthnetwork.com/news-bl ... t-a-tongue which might give you some hope

you might want to risk an operation if the only alternative is euthanasia - you need to chat with your vet about it

I would advise from my own experience to judge her level of discomfort when she is not interacting with you - when my boy was suffering with a large tumour I thought he was not in pain because he would purr and rub me when I spoke to him, but when I took some photos from the other end of the room I saw from them he was haggard and ill and undoubtedly suffering
Angule
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Re: Tongue ulcer - help

Post by Angule »

I saw that article last night actually when I was researching everything I could about tongues. I'm going to ask my vet tomorrow if surgery is a possibility. I'm guessing if it was, they would have brought it up with me though?

It's frustrating that two separate offices are telling me different things. The first told me that she's fine, and the second recommended putting her to sleep. Of course, the second one also did anesthesia to look at it better, and she's clearly not healed.

I know, personally myself, I hate medical procedures. I just had my own biopsy, and was miserable. There's a part of me that wants to try every possibility. Get her a biopsy and feeding tube, maybe surgery, see what happens. But then there's the other part of me that wonders if that's fair to her with her age, and if I'm being selfish.

I also don't know when the right time is. I don't want to keep her alive if she's miserable and in pain, but I also don't want to put her to sleep if she's not miserable and in pain.

How do you know with a cat? She slept on my lap all day yesterday, and then slept in the bed with me all night. She tried to eat breakfast and dinner. When I saw her tongue, it looked incredibly painful. But how do I know if she's actually in pain? I wish she could talk to me.
booktigger
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Re: Tongue ulcer - help

Post by booktigger »

Ultimately if you can't treat her tongue, she will starve to death, which may not be painful, but I'm sure that isn't what you want for her
Angule
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Re: Tongue ulcer - help

Post by Angule »

Has anyone ever done a tongue biopsy? I think knowing if it was cancer or traumatic injury would help me to make a decision, but I don't want to be selfish by making her go through a painful biopsy. If it's an injury that could heal, I'd do the feeding tube.
booktigger
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Re: Tongue ulcer - help

Post by booktigger »

I'm sure someone on here has, I opted not to do a biopsy as it wouldn't have affected the outcome.
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Lilith
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Re: Tongue ulcer - help

Post by Lilith »

Hi Angule, how did it go on Monday?

I'm sorry I can't add anything; one of my lot died from mouth cancer and the vet advised palliative care; I think we did the right thing - in her case; every case is different ... a couple of days before she died she snatched, gobbled, my Chinese takeaway, prawns, rice, you name it. But on the morning of her next vet's appointment I knew it was the end for her. I took her to the vet just to be on the safe side though. She passed out in my arms in the surgery and we let her go.

I think you do know when it is time. This sounds very vague and it's hard to describe, but you do.

Thinking about you and your girl x
Angule
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Re: Tongue ulcer - help

Post by Angule »

She went back to her original vet on Monday, and the vet said she saw healing. I'm not sure how much I trust that though. It looked horrible to me on Saturday when I saw it, and she was fighting the vet on Monday so I couldn't see much. They gave her another shot of antibiotics.

The second opinion vet from Saturday sent photos to a surgeon this week, and he told us that he can't repair the tongue. The only thing he can do is completely remove the tongue. So, that helped me decide against a biopsy. If it wasn't cancer and the tongue could be fixed, then doing the biopsy would be worth it. Since the tongue can't be fixed and she's between 18 and 20 years old, I don't want to make the end of her life miserable.

Oddly, she's eating more since the appointment on Monday. I wonder if it's the antibiotics making her feel better. My plan is to give her as much love as possible until it's time. I still don't know how to know when it's time though. I don't want to put her in more pain than necessary, but I don't want to say goodbye before I have to.
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Re: Tongue ulcer - help

Post by Antonio »

Angule, I' really sorry for you and your cat and for not reaching your thread before.
Your situation sounds much like mine some months ago.
My cat Lola did have an oral cancer. It was treated with every therapy possible, we stopped it for a while but then it revived more angry than before, just like they warned me about.
As the time went by, her tongue was attacked by the cancer and it got eroded until only a section of it remained.
Though the situation was desperate and hopeless, my cat kept fighting like a lion and was very attached to her life. I decided to go for an E-tube, the tube in her neck, as you say, but this experience was short lived and my cat died 48 hours later.
Not for the tube, but becasue she was really at the end.

If I were you and your cat is still pretty lively, I'd go for the tube.
It's a shock passing her food via a tube with a syringe. My cat had a stomach tube (a tube straight into her stomach through her abdomen) for several weeks. At first I was horrified by it, but after the first two times I got used to it and everything was fine.
Following the procedure, the tube was always clean and working. My cat was happy when I fed her through that tube and would purr at me. Despite the terrible manouvre I would feel good after her meal.

I think you should make it clear that it is not a cancer. A biopsy is necessary, but it isn't painful. My cat had it done under anesthesia, the result came in 8-10 days and confirmed what it was.
The vets told me that my cat was in pain most of the time, but despite this she was always happy and lively, she would curl on my lap, she would go out for a short walk and meow at me and greet me at the door.

I did ask her what I should have done, if she wanted to go on like this or not. She had always been very talkative and clear in her replies and told me that she wanted to go on. An so we did.
She was being treated and followed by several vets. Some of them would tell me that if she was their cat they would have put her to sleep there and then, other told me to fight for her because she was fighting and this meant she wasn't ready to go. They told me that I would have seen a clear sign into her eyes, and honestly I couldn't see it.

She was nearly 17. She lost weight, partly because the cancer was asking lots of energy to grow, partly because she couldn't it enough. I used to give more calories a day than she should have got, I also supplemented her food with high energy supplement gels.
Water had to be passed through that water too, though my cat was still able to kind of licking some water from the bowl.

If you need to have more details or info about how it worked in my case, I am here to help you!
All the best and kisses to your cat.
Angule
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Re: Tongue ulcer - help

Post by Angule »

I'm still torn on what to do, but your description of your cat makes me feel even more that a biopsy and feeding tube isn't right for my cat. I would feel so horrible if she died a couple days after the surgery. I want her to die feeling safe and loved, and she's terrified of the vet. She loves exploring new places, and she's always explored the vet's office until Monday. On Monday she hid in the back of her carrier looking petrified. To me, that's her telling me no more.

I forced her to have bladder surgery a few years ago, and that was worth it. It was for her well being, even if she hated it. This I'm having a harder time justifying. She's so tiny, and she was so scared at the vet's office.

I don't think there's any right answer though. I want to do the right thing, and no option is right. I love her so much. I've been crying non-stop all week. This is the first time I've lost a pet. I'm not sure I can do this.
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MarySkater
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Re: Tongue ulcer - help

Post by MarySkater »

The first time I lost a pet, it was an elderly cat who was failing. I agreed with the vet that I would keep him until he wasn't enjoying life, and then I would have him put to sleep. With hindsight, I think I kept him too long. By the end, he was miserable all the time. The next time I had an older cat who was having some bad days, and some days when she seemed all right, I took her in sooner. I could have kept her longer, but I could see the bad days would get more and more frequent until she had no "good" time at all. It was hard on me - it makes me cry every time I remember it. But I stood with her and stroked her as the vet injected her, and she slipped away peacefully. I don't regret it.

One thing I would say, whenever you decide it's time for your cat, get the vet to come to your house. It will cost more, but it will be a valuable farewell gift for her.
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Kay
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Re: Tongue ulcer - help

Post by Kay »

I do so agree with Mary - my lovely Trigger died peacefully in his favourite bed at home - he even ate a bit of liver while the vet got everything ready

it helps such a lot with the grieving process if your final memory is of a peaceful passing
Angule
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Re: Tongue ulcer - help

Post by Angule »

Here's another question...

Her original vet isn't suggesting putting her to sleep. She keeps saying that it's healing and looking better. Her behavior is getting worse though, which is why I took her to get a second opinion last week. The second opinion vet put her under light anesthesia, looked at it more closely and took pictures, and recommended putting her to sleep. Took her back to original vet after that, and showed original vet the pictures. She still said it didn't look bad, and it's healing. So, I don't know which vet to use for her end. The original vet calls me every 2-3 days to check up on her. So either way I'm going to have to let them know. I'd like to use their office in the future for new animals, so I don't want to offend them by going somewhere else. But, I also feel guilty telling them that I want to put her to sleep since they don't seem to think she needs it.

I'm also wondering why they keep saying it's healing. I was in the room while the second vet had her under light anesthesia, and it looked horrible. I know my eye is untrained, but it didn't look like it was healing to me. There was literally a whole chunk of tongue bleeding and not connected to anything, which the vet could pick up and move back and forth. How is that healing?

I'm wondering if the original vet is saying it's healing because they feel guilty they didn't diagnose it sooner? I blamed them at first, but it's really difficult to see it in her mouth when she's awake.

Any thoughts on which vet to use?
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