Any hope/positive outcomes for probable chronic FOPS.

[IPYF]

For context, just over a year ago, my cat (she's a large medium hair tabby probably aged about 6) stopped eating and we went through a frustrating and ultimately ineffective tranche of expensive interventions with a variety of vets. More information is here: 4 Year Old Cat Has Stopped Eating.

TL;DR after tooth extractions were ineffective, she responded to gapabentin and was eating and comfortable for just on a year and a bit, before beginning to show signs of reticence again in April.

She has since begun twitching (ears and paws), is exhibiting near constant head shaking, exaggerated difficult chewing, and she now has a sore and unhappy affect (antisocial, lethargic, constant backward ears), which has become increasingly stressful to observe. We returned her to the specialist vet, did blood and a mouth x-ray. Bloods were all normal range and x-ray saw nothing. We tested antibiotics and meloxicam both of which were entirely ineffective.

The next recommendation was to see a neurologist who indicated that we were probably looking at FOPS. They indicated it was common for cats with FOPS for treatment to become ineffective over time and that FOPS was 'very difficult'. They recommended an MRI which is prohibitively expensive, and as I understand it, if the diagnosis is FOPS, they won't be able to see anything and it'll just wind up being a horrifically expensive photo, so at this stage I have refused the MRI. The neurologist recommended trying pregabatin, which we have been administering this week, and it has also been ineffective.

I've been trialing softer foods to try and relieve her mouth, but this just leads to diarrhea within 12-24 hours which has necessitated bathing. I'm at my wits end and think that all of this investigation and trialing is only really going to result in one logical outcome. I know there are other drugs that can be trialed, but most are strong and result in severe sedation, which is no sort of life long-term for a young and usually happy and friendly cat.

I guess I'm just looking for some sort of hope, or advice, because I'm quickly approaching the point of being beaten, at which point we'll have to look to a decision about quality of life.

 

[Jcatbird]

Don’t give up hope. Roots are extensive in cats and can inadvertently be pushed upwards into nasal or orbital cavities the mandibular canal or have other complications. A bit of root could have been missed? It’s complicated. A fistula can form too. I’m sure there could be other possible things to investigate. Maybe it’s not FOP after all! Hoping right along with you!

 

[mrsgreenjeens]

Did you do the teeth extraction originally using an Veterinary Dentist or your regular Vet? If your regular Vet, would it be worth a try to consult with an Veterinary Dentist? They are much better versed with issues of the mouth and might have some suggestions just in case there is a bit of root or fistula in there causing this pain. Here is a website that lists the ones located in the United States: AVDC Veterinary Dentist Directory

If the issues is NOT with her teeth, then you could fork out the money for an MRI and see if the medication works for at least a little while to give her some quality time.

 

[IPYF]

The extractions were done by a regular vet, but the mouth xray, done by the specialist vet, has indicated that they did a very good job. There is one retained root on the xray, but the specialist vet is extremely confident that this wouldn't be the problem. It certainly wouldn't cause the symptoms we're seeing.

 

[Jcatbird]

I know that humans and cats have different issues but I want to tell you about something I experienced. After an extraction I had a bit of infection. The surgeon attended to that but the pain became worse. Very, very long story made short, it took a biopsy of the bone to reveal the infection had penetrated the bone. That is most commonly seen in diabetics in their feet! ( I am not diabetic) I saw an infectious disease specialist who was very sympathetic but replied that the usual answer was amputation and since this was in my upper jaw.... he could not help me. The outcome was thought to be fatal. I had a little daughter who was handicapped and she only had me. I sought help everywhere! I finally, in desperation, emailed the Director of the Dental dept. at a Medical College.. Three days later he replied, “ I think we can help.” Hope! Now, you cannot tell what I experienced by looking. Part of my upper jaw was cut out and I was treated with antibiotics. It took much time and the next step would have been a hypobaric chamber to allow better blood flow to the bone but that was not required. Because this surgery was done in a Medical School, costs were lower. It was not a proven remedy but it worked! Now, the surgeon and other specialists I had turned to for help are using this treatment for others. I don’t know if a cat can have Chronic Sclerosing osteomyelitis but I suspect it’s possible so going to a Dental vet or even Vet School might give you new insight. Sometimes we just need one person with an idea. ? I still hope for a better answer for you.

 

[IPYF]

I appreciate the advice, but at a point I need to stop looking for additional opinions from more and more vets, because then you're just going from one person to the next, all of whom are happy to take $100-200 to tell you that they cannot be sure from the outside of the cat, and that taking a look on the inside is a few grand. I was recommended to a specialist vet who I do trust, who referred me to the neurologist who said the same thing. The other option is to go the cat dentist route (another option offered early on), but this would require me to dismiss the advice of the specialist vet who indicated that the issue almost surely isn't dental, the advice of the vet who originally did the extractions who didn't think that the slightly damaged teeth she pulled would have been causing the issue, and the neurologist who has also seen the report and scans. Unfortunately I don't see the point, and if they all say based on experience that one little retained root isn't the issue, then I kinda have to agree with them, or pretend I know better than a whole squad of doctors. I'm not wired that way I'm afraid.

 

[Jcatbird]

I certainly understand what you are saying. There is a point where you must put trust in the ones who are trained to know about these things and it sounds like you have great confidence in those you have consulted so let me just say that I am sorry that you and kitty have been going through all this.

 

[AnnaClaire]

Hi,
I wondered how you and your kitty are getting on? My 12yo Burmese was diagnosed with FOPS about 18 months ago and after a double tooth extraction has been treated with gabapentin twice a day for the past 9 months. It is administered as a cream on her ear (produced by a compounding chemist at high expense) as she despised the taste of the drug and refused food when it had the drug mixed in, or injected into her mouth mixed with water.

The gabapentin seems to have good effect but she still does have symptoms sporadically and I just wish I could help her as it does seem to distress her. I have feliway which I believe helps to some extent as I think stress (eg me going back to work after working from home for months, another cat hanging around the house) is a definite trigger.

She has always been of a nervous disposition and is showing signs of arthritis which the usual treatments haven’t seem to have helped. She’s my baby, a total sook, and I just want her to have the happiest retirement possible

My vet has said basically feline-specific illnesses don’t get as much research as say canines because they are more difficult to assess the effectiveness (with cats’ tendencies to hide pain) and a smaller market for treatment. It seems relatively common but zero understanding of the condition. If anyone has any success stories of how to decrease discomfort for our gorgeous companions I would love to hear them!