Signalment: 5 year old, M/N, DSH Feline, “Stewie”
Presentation: Presented in 2009 with mild stomatitis. Treated over the next four years with a combination of steroids, diet change, antibiotics, homeopathy and multiple pharmacologic analgesics as well as partial dental extraction. Patient also experienced feline hyperesthesia, constantly biting and chewing his skin, and was treated with amitriptyline as well.
Secondary to the long term use of steroids for his stomatitis, Stewie’s skin was very thin and tore easily, resulting in four episodes of skin tears/ wounds created by normal grooming
Complications from suturing these wounds and the placement of Penrose drains in his thinned skin resulted in further skin tearing. Despite extensive workup and therapies, Stewie’s stomatitis continued to worsen and by April 2013, he was anorexic and had experienced weight loss secondary to this. Additionally, he was withdrawn and painful and the owners were considering euthanasia due to his poor quality of life.
Dr. Smith outlined each problem and complication, adding that each new issue and its treatment seemed to complicate or exacerbate his other problems. “For instance, each skin tear seemed to increase the hyperesthesia, and Stewie’s attempts to deal with the hyperesthesia created more skin tearing. It was difficult to orally medicate him because his mouth was so painful. Weight loss also reduced his immune resistance. Stewie, who had been a lively, friendly cat, refused to get out of bed, eat or interact with the owners or the other cat.”
Treatment Details: Stomatitis – Open Mouth = 186 Total Joules (at 3W), Closed Mouth = 360 Total Joules (at 4W); Wound – 2×3 = 196 Total Joules to 45 cm2 area (4.35 J/cm2) at 2W
Stewie was initially treated 2 to 3 times weekly, decreasing treatment frequency as his condition improved.
Treatment Results: By improving the quality of his skin and decreasing his somatic pain, his owners felt his improved quality of life justified further [dental] extractions. …Laser treatment following his oral procedures allowed the gingival, tonsillar and lingual lesions to heal.
“By removing most of the remaining problem teeth and following up with laser treatment for post-extraction healing, Stewie’s appetite returned, he began to eat normally and put on weight. We were able to significantly reduce pain medication and completely eliminate antibiotics and steroids.” – Dr. Smith
