Expert: Jessica - 9/9/2011

Question
QUESTION: I have an adult, male Persian cat. His name is Darcy. I don't know how old he is because I inherited him at a house I used to rent (he was left by the previous owners, and they asked if I'd take him). He seemed a few years old when I got him, and I've had him for another 3 years on top of that. He was happy and playful for a couple of years. Whenever I moved, was in grad school, and was busy planning my wedding, he seemed to get much less playful. I figured it was because of all the changes and because I had less time with him. His playfulness has never perked up though. He is VERY easily stressed. Changing furniture or bringing him to the vet makes him very stressed out. About a year ago he suddenly started having days (spread far apart) where he started moaning and just looked like he felt awful. He would lie down slowly and carefully like he was in pain. His whiskers would also twitch, his face would twitch, and his body would have light jolts where he would kind of bounce really quick. The vet ran lots of tests and couldn't find anything abnormal. They decided to try giving him phenobarbital, thinking that maybe he had epilepsy. The medicine has helped a lot. He hasn't had any major episodes like before.For a while, he just didn't seem to feel good though. Some days were worse, and he wouldn't even move around or eat. For the past couple of months though, he has been doing so much better. He still isn't playful, but I can tell he doesn't feel bad, he's perky, and he eats good. At his recent vet visit, the veterinarian noticed that his inner ear looked irritated (it had been bothering him also), so she gave him Tresaderm. The first couple of times I put the medicine in his ear, he seemed fine. Then the 3rd or 4th time, he took off running like someone had lit a fire to his tail. He was running erratically, like he had no control of himself. He was running into walls and just seemed scared to death. I didn't know if the medicine was just cold in his ear and scared him or what (I do warm it a little in my hands though). When I gave it to him again, he seemed fine. Then the next time, he took off running again with the same erratic behavior. I decided that it must be irritating his ear. I have never seen him act like that. Now having given that background information, I'll get to what I'm concerned about right now. I stopped giving him the medicine the day before yesterday. He's an inside/outside cat, and yesterday he was lounging outside. I have an outside cat that he gets along with MOST of the time. I also have another inside cat that does NOT get along with him. They both have claws, so I have to keep them separated. My other one has attacked him before, and he doesn't even try to defend himself. I am working on slowly integrating them. Well, the inside cat was roaming freely about the house since Darcy was outside, and I went to step outside. Darcy heard the door open and tried to race in, but my other cat would undoubtedly have attacked him, so I put my foot in the door opening to stop him, and my foot hit his head. :( It wasn't too hard, but I don't know if I hit his hear or what. He took off running even crazier than before. He was just racing without hardly any control of himself and running into everything. My house is elevated on stilts, and he raced down the stairs (I was scared he going to fall), and he ran into the outside cat. The outside cat, in turn, attacked him. He then ran back upstairs. I was horrified, and when I approached him, he was hissing and growling at me. He never does that to me. I picked him up, and he just kept hissing and moaning, and I was afraid he was going to attack me. And he's usually attached to me and loving. I set him back down, and for no apparent reason, he took off again, bumping into things and wobbling as he ran. He ran off into the yard, and I went to him again, and he hissed and moaned. I decided to give him a little time to calm down. Then I couldn't find him for a few hours. He finally showed back up on the carport, and he hissed and moaned at me again. I just picked him up and brought him inside. When I set him in the door, he acted all freaked out and tried to run back outside, but I shooed him in. Then he just stood in one place and looked all around the house like he was scared of something. He looked dazed. I got him some food, and he only took a few steps toward it. He seemed like he just couldn't walk well. Then he tried to go upstairs, but he stopped after only two stairs. His legs were all wobbly. He just sat down. I brought the food right to him, and he hissed at me at first, but then he ate it. A couple of times, he stopped eating, brought his paw up like he was going to walk upstairs, then turned back and looked around the room with that dazed look again, then went back to eating. When he was done, he started up the stairs, but he was wobbly. He ran into the wall, then he stopped and sat down and stared at the wall like he was confused by it. After a few seconds, he tried again and made it upstairs to his little cat box that he loves. He let me rub on him without hissing then. He slept there most of the night, and at some time in the night he got up and got into the bed with me. His attitude seemed to be back to normal. He's back to loving and no hissing, but he can't walk well now. His legs just slip out of from under him. He puts weight on them and has hopped up onto the couch fine, but when he's walking, he just falls down. :( Earlier, I took a quick step in his direction, and he started to run like he was scared, but I stopped and got into a calming voice and told him it was ok. He stopped running, but he looked scared and his pupils were big. If he had hurt his legs, I wouldn't think he'd be able to hop onto the couch and put weight on them. And all legs seem to be affected. Could the running be some other kind of epileptic seizure? If so, how could the ear drops have led to it? Or could his slipping legs be related to blood sugar? And maybe his seizures have been related to blood sugar all along? I just don't know, and I hate that this happened. It's always one thing or another, and I just want him to feel good and be happy. Thank you so much for your help.

ANSWER: Hi Lydia,

If the vet ran blood tests, a glucose test would have been included, so this should have ruled out high (or low) blood sugar as the cause of his behavior.

Seizures known as partial complex seizures can mimic normal behavior, but in an altered fashion. So I think if he was just walking around and bumping into things, or staring at walls, or hissing and growling for no apparent reason, this might explain the behavior. But the running up and down the stairs sounds too intentional to me, although I think you should certainly ask your vet about this.

I am wondering if your kitty might have a condition known as Feline Hyperesthesia Syndrome (FHS). It seems uncommon but is thought to be underdiagnosed, and it causes many of the symptoms your cat is suffering. Cats will suffer bad pain along the back, which causes them to have episodes where they will dash around the house as if trying to escape something. Many of them stare into space as if in a trance before or after. The cat will hide, and hissing and growling are commonly seen. It’s also interesting to note that Hyperesthesia Syndrome is thought to be related to a seizure disorder, and in some cases, it can actually escalate to true seizures. So the most common treatment is Phenobarbital. Additionally, stress seems to be a major trigger for most cats, so many vets find that anti-anxiety medications can be helpful, but all agree that minimizing obvious stressors in the home is imperative. Increasing interactive playtime and establishing a structured routine of feeding times, playtime and grooming time can help alleviate anxiety, too. It might be more than a coincidence that your kitty is prone to anxiety AND he seems to have responded to Phenobarbital a great deal. I would read up on FHS and discuss with your vet whether they think FHS might be a likely culprit in your kitty’s case.

Also, be sure to have them recheck his ear. Tresaderm can be dangerous if his eardrum has ruptured. Although this is uncommon, it could explain why he’s having some pain. Otherwise, the cold temperature might be the reason (I will usually place it in my pants pocket for a few minutes prior to applying), or if he has just been scratching his ear and there are fresh abrasions on his skin, the medication can sting.

Good luck!

Jessica


---------- FOLLOW-UP ----------

QUESTION: Thank you so much. I am going to read up on FHS. Darcy is due for blood work to check his Phenobarbital levels, so they want to check his ear again at the same time. Since he gets so stressed at the vet, he is EXTREMELY hard to handle. To do blood work, they like to give him a gas anesthesia. While he's under, they also groom him for me. He is very difficult to brush (he gets very temperamental about it), and although I do brush him, he still gets mats in his hair. I was wondering, given his seizures, how you feel about the safety of the anesthesia with him. My veterinarian says the gas is the safest way to put him under so that they can do the blood work and groom him, and he'll wake up quickly afterward. I just wanted to get a second opinion before I bring him in to have that done next week. What do you think? Thank you so much, Jessica.

Answer
Yes, isoflurane gas is generally considered the safest form of anesthesia and is good to use when light to medium sedation is required. Cats with a seizure disorder are usually okay to put under heavier anethesia when required, as well. But I don't think there's any big concern if your vet wants to use a little bit of gas to make his vet visit easier.