Polyps/Feline Orofacial Pain Syndrome

[fionasmom]

I am sorry that there has been an episode; however, I think that the vet is right and if it is TGN and infrequent that dosing continually with gabapentin is not necessary. You have to see how this plays out in the future to make that decision.

I do have CBD oil in the house for my cats, so I am not trying to discourage you. Most companies which sell it specifically for animals will have dosing instructions, but it does interact with other medications and interrupt pathways. It can make another medication either stronger or weaker, depending. The Natural Vet might be able to help with this. I don't know where Scotland stands with prescribing CBD products. Until recently in CA, vets could only marginally discuss it, but now they can recommend it. I am not sure if that includes prescribing it, but that is not your problem. My point is that you may or may not get direct answers about it.

In dogs, metacam and CBD are known to have serious interaction issues and CBD is often recommended as an alternative to metacam. Depending on what you are reading, the interactions can be fatal in dogs, so I would definitely not start CBD with the metacam. There are lots of seemingly reliable lists online from veterinary and drug sites that do discuss interactions and you might have to start to check these out yourself to be on the safe side.

 

[Rysiek]

I am sorry that there has been an episode; however, I think that the vet is right and if it is TGN and infrequent that dosing continually with gabapentin is not necessary. You have to see how this plays out in the future to make that decision.

I do have CBD oil in the house for my cats, so I am not trying to discourage you. Most companies which sell it specifically for animals will have dosing instructions, but it does interact with other medications and interrupt pathways. It can make another medication either stronger or weaker, depending. The Natural Vet might be able to help with this. I don't know where Scotland stands with prescribing CBD products. Until recently in CA, vets could only marginally discuss it, but now they can recommend it. I am not sure if that includes prescribing it, but that is not your problem. My point is that you may or may not get direct answers about it.

In dogs, metacam and CBD are known to have serious interaction issues and CBD is often recommended as an alternative to metacam. Depending on what you are reading, the interactions can be fatal in dogs, so I would definitely not start CBD with the metacam. There are lots of seemingly reliable lists online from veterinary and drug sites that do discuss interactions and you might have to start to check these out yourself to be on the safe side.

This is very helpful, thank you. I will not start CBD, as he is still on metacam. I will try again to taper metacam, really slowly (0.1 at a time or even less for one week, and then another drop). I tried this before but in the second week he re-started his symptoms, avoiding dry food and hiding away. After reinstating, he was back to his normal self. The dental vet said that some animals are on it for life, only I need to do blood tests regularly...

I registered with natural vet's already and they said they will contact me, I guess after new year. I intend to make appointment with them, as he needs to have his blood test repeated anyway (on last visit on 12Dec he had the results bordering with anaemia and a bit increased sugar level).
I need a more holistic approach to his health. There must be some ways of naturally decreasing his sensitivity, so the nerves will not be irritated so much.

I don't know what are the regulations on CBD in UK, but when I mentioned this to two vets, they somehow dismissed this...

I almost have managed to taper omeprasole, as there was a suggestion that his mouth ulcerations may have related to the acid reflux, this hypothesis was dropped after my vet consulted with a gastro vet. But I think omeprasole may have contributed to his anemia, as this is what happens in humans...

I will be preparing to a tooth brushing routine, as he has a tendency to a tartar build up which contributes to gingivitis and mouth ulcerations. I will start with a gentle massage, I bought some finger-tips and some dental tissues...
This will be tricky...I bought some sprinkles to his food as apparently they help with the tartar build up Plaque & bad breath Archives

I feel really sad, as he has such a difficult start in his life up to when he was one year old, being left on his own for hours and crying, additionally being fed with a poor quality food, so he was hungry.
When he arrived to my place, he avoided any contact and when I intended to stroke him he was just getting up and walking away. I took him over one year to learn that touch is ok...I also changed his diet to a good quality food...
We have our usual habits for being closer, always on his terms, but it is so good to see him cuddling to my arm, or just being close on a couch when I watch TV...

But, since April this year we have been on a health related rollercoaster...
And now, what the vets said seems like confirmed diagnosis and this is sad...

 

[fionasmom]

He is living an amazing life with you and I believe that cats live in the present, not necessarily recalling the past as a human might.

It is good that you will have the consultation with the holistic vets as it will be, at least, another piece to the care that you are giving him. Omeprazole is considered to be higher risk in cats than famotidine might be.
Antacids – IBDKitties
This is from the IBD Kitties website; if you can wean him off of the antacid it might be a good move...but there could be some "ifs" there.

The plaque product is interesting and I hope that it is helpful. One more thing about CBD oil, keeping in mind that I don't know what you have access to in the UK and also that there are stricter standards for additives and the like in Europe. In the US, it is one of the most pesticide ridden crops that there is. If you can get an organic oil, if it really becomes something that you use, it would be a good idea.

 

[Rysiek]

He is living an amazing life with you and I believe that cats live in the present, not necessarily recalling the past as a human might.

It is good that you will have the consultation with the holistic vets as it will be, at least, another piece to the care that you are giving him. Omeprazole is considered to be higher risk in cats than famotidine might be.
Antacids – IBDKitties
This is from the IBD Kitties website; if you can wean him off of the antacid it might be a good move...but there could be some "ifs" there.

The plaque product is interesting and I hope that it is helpful. One more thing about CBD oil, keeping in mind that I don't know what you have access to in the UK and also that there are stricter standards for additives and the like in Europe. In the US, it is one of the most pesticide ridden crops that there is. If you can get an organic oil, if it really becomes something that you use, it would be a good idea.

Thank you. He is off omeprasole, as per today!
I was aware that it impacts on poor absorption of nutrients; hence his blood results showing some anemia despite of a good quality of food...
As his mouth ulceration was so severe this was added to deal with any possible of irritation from a possible accident reflux. This had been ruled out, so we stopped omeprasole...
He is now on metacam only (0.55ml). I am.not happy with this, but when I tried to taper (really slowly) his symptoms were back...I will attempt once more with the taper, cutting down as little as 0.05ml each time, every week ...
Last time I did 0.1ml taper and when we reached 0.2taper, meaning he was on 0.3ml, this is when he restarted acting in the way that suggested some pain. After reinstating he was back to his usual self...

As to his nervous system sensitivity and his childhood traumatic experiences, I am aware it is not like with the humans (meaning memories, flashbacks etc), I believe that early childhood experiences make a kind of template response, so the nervous system is activated quicker, His childhood trauma sets some different thresholds, so for him, he is sensitive to stimulus and even playing and getting excited may trigger him...as if he cannot regulate his response, so the nerves misfire and cause the pain...of course stress is the factor, and as I will need to move house in around one year I am really concerned...I guess I will need to give him gabapentin...

Around February we need to have his blood results rechecked, possibly with the natural vet's, or I have another veterinary practice in mind, but have to call them first...

Hopefully, we will have quiet night tonight, not much noise from fireworks...

 

[fionasmom]

I completely agree that any early experiences may have altered his response to his environment even though he knows that he is completely safe with you.

You are doing the best you can for him, medication-wise. He can't be in pain and even those medications which are considered less than desirable do not cause problem in most cases and might be necessary in others.

Around here, New Year's Eve is now second only to the Fourth of July for noise and fireworks. I hope that yours is more quiet.

 

[Rysiek]

I completely agree that any early experiences may have altered his response to his environment even though he knows that he is completely safe with you.

You are doing the best you can for him, medication-wise. He can't be in pain and even those medications which are considered less than desirable do not cause problem in most cases and might be necessary in others.

Around here, New Year's Eve is now second only to the Fourth of July for noise and fireworks. I hope that yours is more quiet.

This is so sad, I saw him approaching some new toys, as usually getting them to his mouth, and then leaving them and his playground...
Also, I have noticed that dry food may be a trigger...
It is almost four weeks since the extraction, so I guess this has healed...

I feel despaired...

On a good note, we had no fireworks at all last night!!!

I bought him a little backpack carrier, thinking about getting him out somewhere quiet, some country walk...
He loves, since I unpacked it yesterday...
Today he just there to sleep...just as if having his little cave...

 

[Rysiek]

I wonder if we could add to my thread subject "fops", if other people have similar problems it would be easier for them to find...

 

[fionasmom]

He is so darn cute with that little white area on his face. Have you been able to get out yet with the carrier? He certainly appreciated that Christmas present.

I can update the thread title to show feline orofacial pain syndrome.

 

[Rysiek]

He just had another attack again ...I gave him buprenorphine...I will give it in the morning as well...it seems that something got over-sensitive...
I will write to a dental vet again...
It is strange as the attacks coincided with stopping omeprasole or maybe it is just a coincidence...
I am so sad today...

He spent at least two hours in the carrier...I want him to get used to it first, so he considers it and a safe space ...

 

[fionasmom]

You both have to be upset as this has gone on for over 6 months despite your best efforts to get this resolved. It could be that he will need some kind of medication, even the bupe or gabapentin, to support him. I know that you don't want him on these long term, or the metacam or omeprazole, and I don't blame you. As for a connection with the omeprazole, I don't know but the dental vet might have an idea if that could be a player. Do you think he needs an ongoing maintenance dose of something like gabapentin?

 

[Rysiek]

You both have to be upset as this has gone on for over 6 months despite your best efforts to get this resolved. It could be that he will need some kind of medication, even the bupe or gabapentin, to support him. I know that you don't want him on these long term, or the metacam or omeprazole, and I don't blame you. As for a connection with the omeprazole, I don't know but the dental vet might have an idea if that could be a player. Do you think he needs an ongoing maintenance dose of something like gabapentin?

Thank you for your ongoing support..
I am writing to my dental vet, so she will get back to me at some point after holiday period.
For the time being, I added buprenorphine twice a day 0.15ml. Just to break up the pain cycle we have definitely entered...
It is so sad to see him approaching his toys, and somehow knowing that the "cause pain"...
I have also stopped any dry treats...

It is a mystery...I saw some videos with other cats having fops, and his attacks are much milder and sporadic...
Of course, if he requires a maintenance medication I will give it to him...

 

[fionasmom]

He looks adorable, sitting there with his massive toy chest!

 

[silent meowlook]

He is adorable! N

 

[Rysiek]

He had another small attack again during the play time......

Each time I hope there will not be another, and then it comes...
It is usually short, and I managed to distract him, but now he has withdrawn to the bedroom and does not look in pain, but I am not sure...

I have not given him buprenorphine this time, as it does not seem in pain at the moment...

So sad

I wrote a long email to the dental vet, but I don't think she has worked over the Xmas/new year...

As the attacks are sporadic and short I hesitate with medicating him, but he may need a maintenance meds and as it seems metacam is not enough...

 

[fionasmom]

As the attacks are sporadic and short I hesitate with medicating him, but he may need a maintenance meds and as it seems metacam is not enough...

I absolutely get that you don't want him to be overmedicated and there may be fine line where he is not really uncomfortable and the episode passes without the medication.

 

[Rysiek]

I absolutely get that you don't want him to be overmedicated and there may be fine line where he is not really uncomfortable and the episode passes without the medication.

Exactly, he just went to bedroom, slept a bit and got up refreshed, ate something and wanted to play again...
We both need to learn how to play and when to stop...

 

[Rysiek]

My vet's answer:
"It is possible that he may have trigeminal neuropathy, similar to FOPS but less severe in symptoms and clinical signs. Treatment for this would be to medicate him with Gabapentin. Metacam will help with inflammation and pain relief and if it reduces the clinical signs then he can be on it long term. The oral buprenorphine can also be used to help with pain relief. This can just be stopped and started in cats with no side effects.
I think at this point whatever food he will tolerate and eat is best for him. If it is wet food then he will need regular prophylaxis to keep his teeth healthy.
I still don't think he has FOPS. The clinical signs of FOPS are the cats attacking their face often before or during eating. Its very severe and cat will self mutilate due to the pain.
The ultrasound guided trigeminal nerve block is reserved for refractory cases of FOPS when medication will not help the clinical signs. We would reserve this until he is medicated with gabapentin and pain relief. It is a highly complex procedure, which can have side effects, therefore it is reserved for severe refractory cases of FOPS.
Zylkene is a calming nutraceutical for cats. It can help them if they are anxious or nervous. I would be happy for you to give this to him. There is no known relationship between FOPS and stress however as we are not dealing with stress some of Ryshu's clinical signs may be stress related."

 

[fionasmom]

That is certainly a thoughtful email and it sounds as if she is leaving certain decisions up to you based on your observation. She is also willing to provide whatever medications seem to help. I would not rule out that stress can make everything worse, but I see the point she is making in his case.

Where are you inclined to go with this? There must be a point where he can be comfortable, but not overly drugged.

 

[Rysiek]

That is certainly a thoughtful email and it sounds as if she is leaving certain decisions up to you based on your observation. She is also willing to provide whatever medications seem to help. I would not rule out that stress can make everything worse, but I see the point she is making in his case.

Where are you inclined to go with this? There must be a point where he can be comfortable, but not overly drugged.

Thank you. We are going to stay with metacam and if necessary buprenorphine. I don't want him to be drugged on gabapentin. When he had an attack, it is usually short and then he withdraws, sleeps for some time and then he is back to be active, as normal...
I have not witnessed a full attack with him, as I saw on the videos with other cats ..

 

[Rysiek]

I have noticed that he has some problems with his appetite. Today morning I gave him his usual food, he wanted it, but then smelled and turned away from his bowl. Also, he used to eat it all before and often he just licks from the surface and leaves it.

He slept all day yesterday. Just got a bit active in the evening.

Also I wonder if this possible that metacam is better tolerated than loxicom? I am aware they both contain the same medication but may have different fillers? Maybe it is a coincidence but he started acting like this since metacam was replaced with loxicom...

Perhaps I need to get him back on omeprasole...

Don't know what to do anymore.