PJ has a sore face :(

I don't know what the vet's obsession with Metacam is. We see about 8 different vets at the clinic we go to(they all have experience with PJ and communication is very thorough, so I'm happy with them) ranging from fresh grads to nearly retired veterans, and all of them insist that Metacam is safe and effective for cats "in very small doses". It's the first painkiller they go for with most situations when short-term pain relief is needed. When PJ had her dental surgery at the end of August, she got a shot of Metacam at the vet and was sent home with 2 liquid oral doses. I never gave her the 2 additional doses, because that's when she became ill(eventually leading to the hospitalization I mentioned earlier) The vets insisted that all the trouble we had back then was probably due to a bad reaction to the anaesthetic(isofluorane) and in the future they would explore other options before opting for surgery because of this. But I'm more wary of the Metacam.

When we talked about the painkiller idea, I asked if there's anything besides Metacam we could try. They said they have Tramadol and other painkillers, but they aren't comfortable giving them to a senior cat because of potential side effects affecting cardiovascular and respiratory performance. A friend of mine was on Tramadol once, and he became obsessed with some candles(which weren't lit) because apparently they were doing a dance to put out the fires on their heads...so I don't think I would want PJ taking Tramadol, either. I never found out what the "other" painkillers were, but the vet I talked to at the time seemed almost horrified by the idea of giving them to a senior cat. What's up with that? Is it safe to give any painkiller to seniors?

I would not ever use Metacam on any of my cats. Will dig up some threads for you to read on the subject. I know of too many cats who went into renal/liver failure from Metacam, never to recover. There is a safer alternative - http://sunnysidevetclinic.com/Articles/buprenorphine.htm

I would definitely look into a different diet and possible allergies. There are other kitties here on TCS with ear and head symptoms and their vets are saying allergies as well. I would try that route before you go and spend mega bucks on the specialist and the scan.

Some info. so you can make your own decision:
http://www.thecatsite.com/t/256923/metacam
http://www.thecatsite.com/t/254155/question-about-metacam-and-other-painkillers

Okay, I talked to the diet specialist at the clinic and she did up a plan for us to start with for an elimination diet. She said it shouldn't take long to see results if it is indeed a food allergy, since it appears to be a minor reaction if it is. Hopefully PJ won't turn her nose up at the plain boring food.

Next time talk of painkillers comes up, I will ask about buprenorphine. I'm not sure why they think Metacam is safest. I realize other painkillers can have dangerous side effects, particularly in seniors, but PJ's blood work is always good and honestly it seems like metacam has a much higher frequency of dangerous side effects than the alternatives do...but, I haven't examined any research on any of them myself so I'm not sure.

So I "went to" my school's (online) library to dig up some scientific information about metacam and cats so that I could bring something substantial to the table when I next talk to the vet about it....and I was very disappointed. There was plenty of research to be found, but the majority of it was either completely focused on effectiveness rather than side effects, or riddled with serious statistical flaws. Most studies suffered from terribly small sample sizes, and very few bothered to provide complete data sets or statistical value summaries. There were also many which made bold conclusions about the safety of the drug without any evaluation criteria for side effects, and to my horror I even found some which excluded subjects from their data who had undefined "adverse events" following their treatment and then bragged about not finding any clinically significant side effects in their studies. Seriously?? I found a total of 2 studies, out of hundreds, which I approved of as being scientifically sound. Both have conflict of interest statements. One of them received funding from Boehringer-Ingelheim, who I believe produces metacam, and the other received funding from a competitor of Boehringer-Ingelheim. The money has to come from somewhere, though, and the contents of the study are more important to me. Both studies indicated metacam to be safe(it had a negative effect on some blood tests, but not to a dangerous degree) in very small doses for short-term treatment, but  neither of them included any cats older than 10 years and neither of them recorded follow-up data any more than a day after the completion of treatment. Even though blood work was good(enough) right after treatment, I wonder about how things may have gone with the cats even just a few days later, since levels were not optimal at that point.

This is just ridiculous. How can anybody make a sound judgement on anything that has been so poorly researched? Why has this drug even been approved? Does the FDA not hire statisticians to assess the reliability of drug research? I'm curious now to see how buprenorphine compares.

Sadly that sounds like a very high percentage of research, particularly in the drugs market (animal or human).  The money is very often sourced from companies who have a vested interest in the end product whether that be direct or indirect, visible or masked. It is a sad indicator of the world we all live in.  As with most things, read around and look for diverse sources, it is all too easy to pick out what you are looking for and miss out on something vital which is in a slightly different place.  PJ is lucky to have you checking everything out: at some point you have to put some trust in 'experts' in the field he needs and go with something recommended. The chances of the experts offering that care doing some up to date reading and researching of their own when they know they are likely to be questionned by you is much greater.   Keep it up but don't get lost in it and forget your own studies - unless you want to change your subject!  I'm sure PJ doesn't want to go back to starting uni' again when finals are right around the corner.     (I remember having the cleanest apartment ever for a few weeks before I sat my finals, and the cat hadn't been played with as much in her whole life - she was 2 at the time.  Avoidance seems to take over for some reason).

Don't get me started on the FDA...LOL! We need them, but we also need a serious overhaul of their office so to speak.

My understanding of metacam and adverse effects has to do with multiple dosages and/or overdosing. Hopefully others can shed some light on this drug, I know @LDG usually has good info on this kind of thing.

MServant said:

  Keep it up but don't get lost in it and forget your own studies - unless you want to change your subject!  I'm sure PJ doesn't want to go back to starting uni' again when finals are right around the corner. 

   (I remember having the cleanest apartment ever for a few weeks before I sat my finals, and the cat hadn't been played with as much in her whole life - she was 2 at the time.  Avoidance seems to take over for some reason).

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Haha actually I originally wanted to major in medical biochemistry, but a prof of mine offered me some great opportunities on the condition that I choose microbiology instead! But I know what you mean about the clean apartment thing. Always doing things that seem like work but secretly aren't important....

Good thing most of my courses this semester are computer science! Easy stuff. Seems like a random minor, I know, but it's fun and doesn't take up nearly as much of my time as other science electives would.

WOW  I just finished talking to a vet who actually proposed buprenorphine right away without me saying anything. So the whole clinic isn't caught up on metacam after all. When I mentioned that, he seemed confused as to why anyone would recommend metacam for PJ after what happened last time she had it! And this is one of the guys who just finished vet school. His focus is on cats, though, so that probably helps.

So I'm going to pick up a 3 day prescription for buprenorphine(liquid oral) from Dr Awesome tonight and see how that goes. We're still going to try the elimination diet, though. The painkiller thing is really just to prove to the vets that PJ is feeling pain, so that they can stop looking for reasons that she might be experiencing a "behavioral" change or just doesn't like being petted on her head anymore. I wish I could just show them what's really happening, but alas PJ is not herself at the vet.

prairiepanda said:

WOW I just finished talking to a vet who actually proposed buprenorphine right away without me saying anything. So the whole clinic isn't caught up on metacam after all. When I mentioned that, he seemed confused as to why anyone would recommend metacam for PJ after what happened last time she had it! And this is one of the guys who just finished vet school. His focus is on cats, though, so that probably helps.

So I'm going to pick up a 3 day prescription for buprenorphine(liquid oral) from Dr Awesome tonight and see how that goes. We're still going to try the elimination diet, though. The painkiller thing is really just to prove to the vets that PJ is feeling pain, so that they can stop looking for reasons that she might be experiencing a "behavioral" change or just doesn't like being petted on her head anymore. I wish I could just show them what's really happening, but alas PJ is not herself at the vet.

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I completely understand. Years ago I took Grey in because she had sporadic labored breathing starting the day before. Auscultated her, nothing. I finally said, "OK, I'm the crazy cat lady so be a sport and take a chest X-ray please?" He agreed and was stunned to find a thymoma that took up half of her chest cavity. Sometimes, the crazy cat lady isn't that crazy after all.

I hope the buprenorphine gets you some answers.

Does anyone here have experience giving oral buprenorphine? I just gave PJ her first dose and it was harder than I expected. It probably wasn't a good idea to let her smell it first! Normally I don't have any issue with oral liquids, but this one's not supposed to be swallowed(I'm under the impression that it's safe to swallow, just not effective if swallowed)...I was instructed to administer it either under the tongue or between the cheek and gums, whichever is easier for me. I tried with my pinkie finger first to experiment, and decided the cheek method would work better for PJ. But I ended up having to pin her down to do it, poor thing

I have a lot of experience giving buprenorphine to cats by this trans oral mucosal route.

  Under the tongue is nearly impossible with most cats that are conscious!    The cheek method is easier for most cats.  you just have to slide the oral syringe at an angle between the cheek and the teeth and very slowly drip the Bup in.   Very slowly because as you know,  you don't want her to just swallow it because it is absorbed very poorly via the GI tract,  but in cats it is absorbed very well via the lining of the  mouth.

Sometimes I gave it in 2 stages,  gave him a break in between.

Hopefully many cats will learn that this is strange but you're not actually trying to kill her or hurt her.  

But if   PJ may have some oral problems,  or something else going on causing pain in her face,   that may also be very difficult.     If you really have trouble,  you could ask the vet about injecting buprenrophine, because it works well that way too.  

 I have used it both ways .   I had a cat who was very impatient about restraint and in a way it was easier to give him a shot.

Great vet!  I'm sorry to hear giving the medication is causing her distress.  I agree with Maekaew that it could be pain in her face that is making it even harder and I hope you manage to find a way to minimise this while putting the syring to the side of her cheek.  I'd hold off changing her food until you can see if the medication helps too, so you know which thing has helped - or if it's both.

Hope you see your PJ back to  her cuddly usual self soon.  

There haven't been any signs of mouth pain, unless the head pain is linked to that, which is a possibility. But PJ hates getting objects in her mouth in general. I have to scrub her teeth with my fingers rather than a toothbrush. I'll have to make sure I go slowly next time, though. I'm used to giving her medication as fast as possible to reduce her stress. It seems to have worked, though! She presses her head into my hand/face when I pet her, just like she used to The drug(haven't started the food yet) also has her purring almost nonstop! She only stopped purring when I have her the second dose. Normally she only purrs during one-on-one snuggle time!

I wish the drug could solve the underlying problem, though. I love to see PJ so happy and relaxed, but we still haven't addressed the issue, whatever it is...

Despite there being no progress in identifying what this is, if nothing else it gets her comfortable and lets you (and other people) touch and feel around the areas that seem to be causing her pain without distressing her.  Hopefully she will rest better too, and that will be good for her overall health.

Is she still drooling or had that stopped before the medication?  I guess once she has shown relief from pain on the medication, if there are no other changes in her symptoms you could start to impliment the exclusion diet to start that process?

When I brush Mouse's teeth I always use the finger brush not a proper little tooth brush as I think that would be too much for him on a 2 x a day basis - the enzyme paste works fine with the silicone thimble for us.  He likes to chew my finger I think:-D  Unless it's under their control and they can bite it I don't think any cat likes things put in their mouth - neither do I come to think of it...

Oh yeah, I forgot to mention the drooling was only on that one day so I'm not sure what that was about. Also, before we started the painkillers PJ's sensitive area was starting to get bigger and she would have the same reaction if I pet her anywhere on the top of her head rather than just around her eyebrows. Now that PJ is feeling good, I've been prodding around her forehead again and everything still looks fine on the outside, but it's hard to get a really good look at the skin where the fur is really dense. There definitely isn't any redness, though, and no signs of bruising. What a mystery!

I think my kingsnake is getting jealous of all the attention PJ is getting; she's been particularly social these last few days. Maybe we should all study together!

Fingers crossed for you and PJ. I have no scientific or experience based advice to give you but I carefully read your thread. If I were you and I needed to follow my gut feeling, I would go with the nerve specialist.
Did the vet check her eyes? And was sinus eliminated?

My other thoughts would be. Is there any equivalent to human MRI for cats?

Maybe PJs getting tension headaches for you because you're too chilled and avoiding your study responsibilities?  They are such perceptive creatures, you never know!    PJ and kingsnake do not want to study, they want you to study so you can keep them in the upper crust manner that they would like to become accusomed! 

My brain continues to tick over on this one, it is so frustrating knowing she's experiencing pain and noone can identify what's causing it.  A fairly basic kind of thing but did the vet check PJs blood pressure?

djoe said:

Fingers crossed for you and PJ. I have no scientific or experience based advice to give you but I carefully read your thread. If I were you and I needed to follow my gut feeling, I would go with the nerve specialist.
Did the vet check her eyes? And was sinus eliminated?

My other thoughts would be. Is there any equivalent to human MRI for cats?

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There haven't been any new signs indicating sinus ailments(the blood work checked for infection, too), but it's something we will continue to monitor. So far the sinuses seem fine. You can get MRIs for cats, but it costs waaaaay more than a CT scan(which costs a lot to begin with) and usually a CT scan gives a half decent image of soft tissues. I don't think any vets in my area have an MRI machine, though, so even if we wanted to go that route it would be pretty difficult. But we have access to a CT machine if it comes to that.

 A fairly basic kind of thing but did the vet check PJs blood pressure?

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No, actually! Is there anything specific that would make you wonder about that? I will have it done next time I bring her in. That never really occurred to me. We didn't check her temperature, either. I think since her activity levels have been normal, we didn't really think about things like that. Might be good to knock another simple thing off the list.

BP was an off side because it's one of those insideous things that doesn't have many symptoms you'd pick up, esp in cats, and it's very common.  Headaches and iritiabity in humans before you get to the more frightening vascular bleeds that can happen in the eyes as well as brain.  Clutching at straws but if it is something like that she can get meds to control it, one of my girls was on hypertension meds for nearly 4 years, from the age of 18.