Q: My cat Tesseract, now 8 years old, has Eosinophilic Granuloma Complex (primarily manifesting as lip ulcers) and has been dealing with this since she was less than a year old.

She is on a maintenance dose of Prednisolone every other day and even on this will have "breakthroughs" where I must up the dose and then taper back down. I have noticed that whenever she has had to take antibiotics (this was before she was on Pred regularly) she never had an issue with the ulcers emerging.

I have tried fish oil (she gets some daily), have tried L-Lysine (seemed to help for a while and then not), tired antihistamine (Zyrtec) and have her on a regular flea regime.

How concerned should I be about long-term Pred use? Are there other options for treatment I could consider?

She hates being medicated but I use a flavored oral suspension and that has helped-I can also hid pills wrapped in pill pockets and placed in bonito flakes with good effect.

Additionally, she has become so vet phobic that she has to be anesthetized for exams and blood work and this is very concerning to me. I saw your comments about gabapentin use and wonder if there is a protocol for use that I could share with my vet?

She is terrifying at the vet and is a friendly sweetheart at home. It is heartbreaking to see how frightened she gets.

What is a Tesseract and is prednisone safe for her!

What an interesting name for a cat! It’s awesome!

Wikipedia says “In geometry, the tesseract is the four-dimensional analog of the cube; the tesseract is to the cube as the cube is to the square. Just as the surface of the cube consists of six square faces, the hypersurface of the tesseract consists of eight cubical cells"…and the rest is above my brain pay-grade.

It’s also the name of this band:


Let’s see. Dressed in black.


All dudes.


Look like they haven't seen the sun in a while.


Sooo...I bet they are Swedish Prog metal!

A quick check on wikipedia says….

Ahhh - prog metal yes, but they are English, not Swedish. I almost had it.

You, my dear cat person, have done a really really good job trying, evaluating, and not giving up. Even when the going has gotten tough (i.e. Tesseract needing to be anesthetized at the vet).

You make a very interesting observation about the antibiotics - when you used them, the ulcers emerged less. It makes me think of trying Phytosphingosine. Phytosphingonsine is another famous swedish prog metal band….NO JUST KIDDING!!!

Seriously though, it makes me think that it would be useful to a topical product with that ingredient in it. Douxo makes them for application for cats. Spot on or the mousse would work. The idea is that it helps rebuild the skin barrier, to become more resilient agains skin lesions. And when you can become more resilient, I call this “steroid sparing”. The more resistant to the granuloma’s we get, the less drugs we need to control them.

I’m assuming that if your cat agreed to try new food, then you tried a hypoallergenic food trial as well.

Some cats do well on Atopica. It won’t have steroid side effects, but can come with side effects of it’s own, and tastes disgusting.

Some vets have used Cerenia (the anti-nausea drug for cats). It also has an anti-inflammatory and pain reducing properties.

Medicine works like that - so many things get used for other purposes, all off-label. Dermatologists will use approaches that I’ve never tried (less common medications or approaches), so there is that if things got really out of hand.

How concerning is the prednisolone use in terms of side effects?

  • If you have to be at full dose always, or need to go higher in time, that is of concern.
  • If you can wean it down, and still get a nice effect for your cat most of the time, so she has less discomfort, and better quality of life, then I am for that.
  • If you can put in as many “steroid sparing” strategies while using the pred (which you are),  then even better.

I think I have had one cat turn diabetic with steroid use…in 11 years. But I also never use the stuff indiscriminately (i.e. non-stop refills without knowing what is going on with my patient). So it’s not an everyday event.

I saw your comments about gabapentin use and wonder if there is a protocol for use that I could share with my vet?

Yes! If your cat is terrified, you can talk to your vet about the following: 100mg gabapentin the night before the appointment, and 100mg the morning of the appointment (you want to give it a few hours before she goes in). Then, I always try to combine this with another stress reducing element. You’ll need to test this in advance. It could be a thundershirt, towel wrap etc. Maybe your cat wants to be held and stroked while getting a blood sample from her back leg. Maybe she wants none of that and needs the security of a towel. Maybe the less we restrain her, the more she will let us do. Maybe we have 5 minutes to get everything done, and beyond that, she’s done.

I’ve had cat’s go from impossible to work with, to completely possible to do xrays or take bloodwork without anesthesia. It works to a point.

To make it work we gotta:


If it doesn't work that day, forget the anesthesia and let her sleep it off. If it does work, then she will thank you for it!

Good luck!