Cat Eye/optic Nerve Problem: Dilated Pupil, Bulging, Droopy Eyelid, Discharge

[Furballsmom]

After your appointment, would you want to talk things over with your old vet?

We're sending you all of our good healing thoughts and prayers!

 

[mayadot]

Just as a general update: I scheduled an MRI for Wednesday so hopefully I can help Nub manage any discomfort until then and that will at least give more information. I'm seeing some other strange symptoms, like licking his paws a lot all of a sudden, but it's hard to know what's going on. He's still on the antibiotics (Doxycycline) as well, so it's very hard to know what of his current symptoms is being caused by that, what might be caused by his regular arthritis (which he generally manages well with Adequan), and what might be caused by whatever he's going through right now.

Nub and I thank everyone for all of the support and shared experiences, and please send good healthy vibes Nub's way.

 

[mayadot]

After your appointment, would you want to talk things over with your old vet?

We're sending you all of our good healing thoughts and prayers!

Yes, I tried calling my old vet last week but she was out of town until tomorrow, so I'm hoping she calls me back. I can't help but feel guilty though as we moved away so she has no obligation to help anymore.

Thanks so much again.

 

[Furballsmom]

No obligation, but I'm guessing she thinks highly of you and will call you just as soon as she is able.

 

[mayadot]

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Reducing the dosage of the Gabapentin would certainly reduce the sedative effect. I wonder if you could find that point where the pain is controlled without too much sedation....? It seems like a worthy discussion to have.

Like you, I'd rather have a woozy, comfortable cat than seeing him in pain.

I used Gabapentin as one of three pain control drugs when Stryker was in hospice care. The other two were buprenorphine and Metacam. He was perfectly at peace and pain-free for several months. This protocol is known as "multimodal" pain management. It uses different acting drugs to target different pain receptors. And, one of its features or results is that the amount of each drug is reduced. Stryker was completely "himself" throughout that period.

I don't know if this will provide an understanding, but here is a chart showing 3 different classes of drugs - one is chosen from each class to provide wide spectrum pain management:

LINK:
Focus On Pharmacology | Management of Chronic Pain in Cats​

I think I suggested earlier that the 'euphoria' effect from the bupe may be related to the dosage that was used.

Speaking of Metacam, just by coincidence I was listening to a presentation earlier today by a Board Certified Anesthesiologist in which she indicated that the use of Metacam has been under re-review over the past few years and is now considered an integral part of modern pain management protocol. I took from that that it is very likely we will see a feline Metacam come onstream in the US and the whole black box listing business relegated to history. Metacam has long been licensed for cats in other major jurisdictions.

So again, the Metacam, carefully dosed according to those protocols, is both safe and effective, even in cats with kidney disease.
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Sorry one more question white shadow! When you started the Gabapentin, did Stryker also have wobbliness, lethargy, or other sort of drunken side effects? I had been told that these can go away over time, but Nub has taken it a few times in the past and several times over the last few days and I haven't noticed any decline in side effects.

Thank you.

 

[Furballsmom]

Hi! How are things going today?

 

[white shadow]

When you started the Gabapentin, did Stryker also have wobbliness, lethargy, or other sort of drunken side effects?

No - no 'drunken sailor' symptoms such as unsteadiness, falling, the 'wobblies'. And, he remained alert throughout that entire period. It's more difficult to evaluate lethargy, though, because of the buprenorphine and the effects of the condition itself. He certainly became less active toward the end. The more I think back, I seem to have a memory of needing to increase 'pain control', and a discussion with the Vet when she suggested increasing the Gabapentin because increasing the bupe would likely only make him sleepy.

I'll dig out the dosing information from then. That will be easy, though I'll have to see if I can pull out the records for his weight.
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[mayadot]

No - no 'drunken sailor' symptoms such as unsteadiness, falling, the 'wobblies'. And, he remained alert throughout that entire period. It's more difficult to evaluate lethargy, though, because of the buprenorphine and the effects of the condition itself. He certainly became less active toward the end. The more I think back, I seem to have a memory of needing to increase 'pain control', and a discussion with the Vet when she suggested increasing the Gabapentin because increasing the bupe would likely only make him sleepy.

I'll dig out the dosing information from then. That will be easy, though I'll have to see if I can pull out the records for his weight.
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Thank you for this. I think Nub is just very sensitive to these medications. I've been cutting Gabapentin capsules so it has been hard to be perfectly accurate with dosing, but today I asked the vet to order me compounded liquid so that I can be more accurate. Last night I gave even less than 25mg which is supposed to be the lowest effective dose, I'm not sure exactly how much it was but I'm guessing something like 15mg, and while the side effects were less, they definitely were still there—wobbliness, sleepiness, confusion, drooling, etc. I think it does help him with pain but I wouldn't want him to live like that long term. I'll try the liquid form at very small doses to see how he reacts to those, and consider trying a Gabapentin/Buprenex combo to see if maybe that takes the Buprenex off of Gabapentin for him, or will talk to the vet about Metacam at very low doses if it comes to that. He's around 13 lbs, for reference.

Thanks again.

 

[mayadot]

Hi! How are things going today?

Hi Furballsmom, thank you for checking in.

Nub actually seemed a little better today, not in terms of the eye itself which still looks the same, but in terms of seeming like he was less painful/uncomfortable. I'm sure he still feels something, but he was more active around the house today and seemed in better spirits, so I opted not to give him the Gabapentin today to test out how he does and give him the opportunity to stretch his legs, get some sunshine, etc., as he's been mostly curled up in his carrier when I've been giving the Gabapentin to him. He seemed more himself, I saw him grooming himself normally for the first time in a bit, etc.

He's still showing some other symptoms as well, mostly big sneezes that seem to almost startle him, but I was told that's normal with something pressing against the eye, that it's probably also pressing against his sinuses. I've also seen him doing some excessive grooming of his paws in the last few days (though less today thankfully), which I'm guessing is not a direct symptom of the eye but to do with stress from everything going on.

Meanwhile, I'm keeping him on the Doxycycline antibiotic at least for a few more days to see if it does anything, and we have an MRI scheduled for Wednesday, which will hopefully give us more information as to what's going on and (fingers crossed) how we can treat it. Otherwise I'm just kind of taking it day by day and trying to make him feel as comfortable as possible while we wait for the MRI.

 

[Furballsmom]

Oh my goodness, mayadot , I have been thinking about you and your baby all day. Thank you so much for the update, I'm tickled beyond words (although I seem to be typing plenty of them LOL ) to hear that he got some sun, groomed, and has been feeling better.
As you said, day by day, but wow, what a wonderful little fighter you have!!

 

[mayadot]

Oh my goodness, mayadot , I have been thinking about you and your baby all day. Thank you so much for the update, I'm tickled beyond words (although I seem to be typing plenty of them LOL ) to hear that he got some sun, groomed, and has been feeling better.
As you said, day by day, but wow, what a wonderful little fighter you have!!

Thank you thank you Furballsmom He is SUCH a little trooper, it's unbelievable.

His eye is still doing what it's doing, and I know he's not feeling 100% (he hasn't been bringing mouse toys every night like he usually does, and he still hasn't had interest in playing), but he does seem to be feeling at least a little better and being more active and himself. I felt helpless seeing him unhappy and just kind of having to wait for the MRI, so I'm grateful for any improvement. Meanwhile we've got our fingers and paws crossed that tomorrow's MRI goes smoothly and safely, and hopefully gives us some answers and good treatment options.

 

[Furballsmom]

And I for you as well, .

 

[white shadow]

I'll dig out the dosing information from (back) then....I'll have to see if I can pull out the records for his weight.

Ooooooops! I need a to-do list!

OK - Stryker was getting about 35 mg twice a day.....and, as I said, Metacam and buprenorphine as well. I don't have a record of his weight at the time, though, but I'd guess at about 10 pounds. I was using a compounded liquid at the time as the only available product here. The taste was quite unpleasant apparently (caused salivation), so I had to immediately follow it up with some honey water to clear his 'palate'. I seeing now that capsules are available and apparently palatable, so I would opt for using those.
.

 

[mayadot]

Update:

Well there was a bit of a stressful and unfortunate situation with the MRI machine yesterday and they weren't able to get Nub in for a test, they ended up keeping him overnight and ran the test this morning.

Just heard back from the neurologist who said that it's looking like he has a tumor behind his eye, most likely meningioma, which is a tumor that is benign in the sense that it doesn't grow aggressively or spread to other parts of the body, but nonetheless presses on the brain and ultimately leads to loss of brain function. Sometimes these are surgically removable, but in Nub's case, it's not

The only treatment option in that case is radiation, either used more aggressively to try to completely shrink/eradicate the tumor, or used in smaller doses for palliative care to extend quality of life for a little longer. It sounded like both cases may have success, but you never really know of course. I need to meet with a radiation oncologist in order to get more details about what the protocols are, what the risks are, and what the potential benefits vs. costs are. I was told by the neurologist that the more aggressive radiation is either something like a few weeks of 5 day a week treatments in small doses, or a few weeks of once a week doses in large doses. The palliative option is more like a few weeks of small doses once or twice a week. I'm meeting with the oncologist later this afternoon so I'll hopefully have more information then, but of course if anyone has experiences with radiation treatments, I would love to hear them.

I may start a new thread to ask about radiation specifically if that's okay? Thanks so much for everyone's support.

 

[mayadot]

Ooooooops! I need a to-do list!

OK - Stryker was getting about 35 mg twice a day.....and, as I said, Metacam and buprenorphine as well. I don't have a record of his weight at the time, though, but I'd guess at about 10 pounds. I was using a compounded liquid at the time as the only available product here. The taste was quite unpleasant apparently (caused salivation), so I had to immediately follow it up with some honey water to clear his 'palate'. I seeing now that capsules are available and apparently palatable, so I would opt for using those.
.

Thanks white shadow . I was giving him the capsules but actually just ended up ordering compounded liquid because trying to cut the capsules precisely was proving to be a real pain, and it's easier to dose small, more precise doses with a syringe. Good tip on the water, I'll keep that in mind. Thank you again.

 

[white shadow]

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mayadot - have you ever used the old precursors of these forums - the 'mailing lists'?

Yahoo still offers these up.

I'm asking because, if it's experience with radiation therapy, then the most likely place to find it in volumes is likely to be the specialized online community of people who are managing their kitties' cancer. It's been active for the past 19+ years with more than 3000 members and their cats.

You'll find them here: Feline Cancer Support Group. Just click on the purple + Join Group button.

If you go to check them out, I'd recommend that you get a new separate email address to use exclusively for the group (Yahoo works well) - that will help you keep track of the information flow. The format may take a little getting used to if it's new to you.
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[Furballsmom]

Thank you so very much for taking the time to update us!! My prayers will be with you all the way

 

[Saber_Wing]

Appreciate the update! I've been keeping an eye on your story, and I'm thinking of you and Nub! I hope radiation proves to be the answer, and more beneficial than harmful

 

[Furballsmom]

How are things?