Update on Cat with Feline Hyperthesia Syndrome

adventureme

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I posted a little while back about my cat Binky who developed FHS back in October 2013 and wanted to give an update on what has worked/not worked in terms of medications. Just to recap, Binky has constant muscle spasms/twitching and excessive grooming due to the spasms. She first started on Fluoxetine (Prozac) with a 0.6ml dose (liquid) once a day. She did well on this for the first month or so but her symptoms came back. She was then given (in addition to the Prozac), Prednisolone with a 5mg dose twice a day. This combination also worked but again after a few weeks her symptoms came back. I tried to switch the liquid dose of Prozac to the transdermal gel applying it in her ear but this was not absorbing well and her symptoms got really bad again so I then switched the Prozac to a pill which just so your aware costs the most money as it has to be compounded to the specific dosage. Seeing that the Prozac was not working so well she was introduced another medicine called Gabapentin with a 25mg does twice a day. I decided to wean her off the Prednisolone as it was not doing anything for her and started giving her the Gabapentin along with the Prozac. This combination of meds seemed to work great and I was so excited to see her back to herself but this was short lived once again. A month later the symptoms came back and the veterinarian wants to introduce another medicine Phenobarbital on top of the Prozac and Gabapentin I am worried this will be too much medication for my poor girl she would require 2 pills every morning and 3 every night – how the heck is that even going to be possible? It’s hard enough just trying to give her the pills I give her now every morning and night. I have to disguise the pills in food and treats but it’s now become a real problem and she is fighting me when I’m trying to get them all in her mouth to swallow and I try petting her first and do my best to make it the least stressful but if I don’t try closing her mouth when I get the pills in, they will fall out the sides of her mouth and stick to the sides of her fur when they fall and then it’s even harder to get them back in her mouth. I can’t believe this is going to be my life for the rest of my girls life every single day but I love her with all my heart and will do my best that’s all I can do. I’ve decided to increase her dosage of Prozac to 1 ½ pills once a day and 1 ½ of the Gabapentin pills twice a day which is so far keeping her symptoms at bay for now. I will see how this goes and if her symptoms come back again I will have to decide on whether to add the Phenobarbital or maybe try just giving her this and eliminating one of the others. I don’t know anymore – I trust the vet as he has a lot of experience (did my research) but really 3 meds for a cat how am I going to afford this all every month I don’t know.
 

susank521

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I feel so badly for you and Binky and hate that you're having to go through this. I had been following your other thread and was hoping that no news was good news. Have you given any more thought to trying the amitriptyline that Tina23 had mentioned? At some point we all reach the place where quality of life (for both you and Binky) has to be weighed against possible side effects. 
 
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adventureme

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I am going to talk with the vet again next week to get Binky on the Phenobarbital. I did a lot of research and the Amitriptyline is not something I am comfortable giving her. Although I will find out what the vet thinks about this medication for her. I hear it’s all about trying to find what works and that it may take a year or more to get the right meds and dosage levels. My sister has a dog that suffers from seizures and it took her 2 years to find the right meds that work. Although I do sometimes wonder if the vet just keeps adding all these meds for the money they make off me every month. Surely there has to be 1 or 2 meds that will work together to control her symptoms without killing her kidneys or liver in a few years. This is the most stressful thing to deal with every day. It’s always on my mind – trying to research what else I can do or if there is some new development in treating this type of condition. Thank you for thinking about me and Binky – it’s nice to see people out here who care.
 

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Just a heads up Phenobarbital can be VERY hard on the liver.  I don't really have a lot of experience with Hyperesthesia so I don't have a lot to offer.  I do know that some people have had success with Amitryptylline. 
 

susank521

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I can only imagine the stress you're experiencing.
 The roller coaster ups and downs, always watching for the relapse, it's awful. Right now she is on Prozac and  Gabapentin? It's obvious how much you love Binky. She's so fortunate to have you looking after her, searching for the right medication combination. Bless you for trying so hard. Just a reminder to keep a journal about the medication start/stop/dosage/results. After a while, just the frustration of trying to recall the trials can make you want to throw your hands up in the air. And on top of everything else, there is the pilling. It such a pain.  

I'm sure you've already tried many different ways, but there's some good suggestions here: http://www.thecatsite.com/t/246066/pilling-success-my-new-trick  

Much like the medication, it's a question of finding what works for Binky. Lots of prayers for both you and Binky.
 

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Just a heads up Phenobarbital can be VERY hard on the liver.  I don't really have a lot of experience with Hyperesthesia so I don't have a lot to offer.  I do know that some people have had success with Amitryptylline. 
My vet agrees. She sees Pheno as a last resort. My Boo is now on Gabapentin and Amantadine for his FHS and generalized pain of unknown origin. This combo is currently working 
   but my vet said that Amitriptyline could be added to the mix if needed. The Amantadine is only a temporary drug and he'll be taken off that when it runs out. Gaba is a short-lived medication and the effects start to wear off after 12 hours, so its best to give it at exactly the same time every day.

I mentioned in another FHS thread that there's an herbal/homeopathic product for pets called EaseSure. It is not a cure-all. It helps Boo if I give it to him right at the beginning or during an FHS episode, but it does not prevent them.

It wouldn't hurt to add in Feliway diffusers to create a sense of overall calm.

As to the pilling, I use clear empty gel caps purchased from Amazon. I bought both # 4 and # 3 sizes from the Empty Caps Company. Pills are very bitter. I put everything into an empty gel cap and coat them with Nutiva coconut oil to help them go down easier. You can also use a little butter if your cat doesn't have sensitivities to it. I wouldn't be able to pill my cats as much as I need to if it weren't for the gel caps. Keep your fingernails cut really short so that you can only feel the pad of your fingers (sorry ladies).
 

susank521

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Now that you mention it @GoHolistic  I remember reading a post of yours before regarding your pilling method and thought what an excellent idea that was. Thanks for the reminder!
 
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adventureme

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Thanks for letting me know about the Phenobarbital. My sister has to give this to her dog every day along with some other med for dogs only to control his seizures. She had to get his blood tested I believe in the beginning every few months for the first year to see if the drug had an affect on his liver. He seems to be better now that he’s on the drug but does still get occasional seizures. Maybe with felines it’s different and depending on the dosage as well. Binky’s vet is really trying to find the right combo – lowest dosage with the best results. If I have to keep her on these 2 meds (Prozac and Gabapentin) and just have the dosages increased a bit in order to not have to put her on the Phenobarbital I will try that first. For the last 2 days, Binky has responded well to her regular dosage of the Prozac and Gababpentin (I had increased it a little for a few days as her symptoms were back and constant). So far she is doing well and I have not seen any symptoms YET. What I think may be happening but I’m not 100% sure is that she was not getting all her meds and was spitting parts of the pills out which may be why her symptoms came back. I do try to watch to make sure she swallows the pills but she is so darn sneaky and will make it look as though she did swallow them (I see her swallowing) but then I find a piece somewhere later on the floor. I don’t always find pieces of pills so I think she got all her meds but I can’t be certain sometimes. This is what makes it so difficult. I really have to try to watch her after pilling her but she runs off and goes and sits somewhere that I would have a hard time getting her from. My biggest battle as I mentioned in my other post is trying to find the best way of giving her the meds. I have tried all three types such as liquid, transdermal gel, and pills. The liquid seemed to be the best just open her mouth and quirt it in but it’s hard because the Prozac is so bitter and when she tastes it in her mouth she starts to gag and when I look over at her when she runs off, it’s foaming and hanging off her mouth and I just cry and walk over with a wet cloth to wipe it off. The pills I think are maybe easier but having to give 2 of them is hard. I have to come up with more creative ways to hide them in different things. I do roll them in a bit of butter or roll them up with a little bit of turkey or ham deli meat but it’s trying to get them in her mouth and have her chew and swallow them that’s hard and she fights me all the way every time. Are the gel caps safe to be ingested every single day? My cat will need to be on her meds her entire life, this condition is not going to go away. Sad that all I can think about is how the heck I’m going to give her the next round of meds and that this is the way it’s going to have to be for a very long time but I have to do it – I’m her mom and she depends on me to make her feel better. I wish they had better treats for cats that you could place pills inside as she hates the Greenies ones. They only worked for the first few days then she caught on that there were pills inside. Thanks everyone for your comments, suggestions, and compassion it really means a lot to me.
 

goholistic

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Are the gel caps safe to be ingested every single day?
Yes. They are certainly much safer than the meds themselves! Sebastian is an extremely sensitive pancreatitis/IBD kitty, but he has no issues with gel caps and I pill him twice a day.

Good luck and lots of vibes. 
 
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