It’s been a long five years (aka, Trixie’s Story)

Just over five years ago, I adopted Trixie and Pixie after losing my previous cat, Max, to Intervertebral Disc Disease (IVDD.) A few months after adopting them Trixie went back to the vet for a persistent cough, and that started a long, challenging spiral of health issues for her. Now, after yet another new vet, and yet another new diagnosis, we finally have some answers and are making progress towards her recovery.

Settle in, because this is a long one. TLDR: significant behavior changes, repeated infections, chronic pain, and significant food allergies are not normal for cats, and it takes a lot of advocating for them to find the cause.

As I mentioned, when I adopted the girls Trixie had a slight but persistent cough, and not long after I moved to a new town her cough got worse and so off we went to our new vet (Vet 1) to find out why. The new vet came highly recommended, but unfortunately turned out to be a real mistake. They did manage to diagnose her cough as chronic asthma, but not before scaring the hell out of me claiming it could be Heartworm Associated Respiratory Disease (HARD) first based on their viewing of the x-rays, which was later dismissed by the radiology experts. After the initial scare, they handed me a link to a random website to “research” asthma in cats, and started her on a Prednisolone course along with heavy duty antibiotics in case it was an infection and to see if her cough resolved. Thus began her long, downward spiral as the antibiotics made her very sick and she lost considerable weight over two weeks. The Prednisolone stopped her cough (temporarily) but also caused a massive upper respiratory infection due to her suppressed immune system. About halfway through the Prednisolone course we went back to the vet for a follow-up, and I noted her sneezing and watery eyes, and how poorly she was feeling. Nothing was done, and I found out later the notes from that visit declared she “tolerated well” the medication. That was when I started the search for another new vet, as the outcome of that discussion was the vet’s declaration that even though an inhaled steroid is the preferred and most recommended treatment for cats, they refused to prescribe it and were planning to keep her on Prednisolone. Two days later, we ended up at the nearby walk-in vet clinic (Vet 2) on a Saturday morning as her sneezing and breathing issues had gotten worse, whereupon the vet at the walk-in clinic diagnosed a massive upper respiratory infection and prescribed a different antibiotic, and also noted that the prescribed dose of Prednisolone from Vet 1 seemed “high.” The walk-in clinic was not set up to manage chronic illnesses, so they recommended the Blue Pearl specialty vet (Vet 3) in a nearby town, along with finding a new regular vet.

After some research, I located a cat specialty vet two towns over, and booked Trixie an appointment with them (Vet 4) as well as with the specialist vet (Vet 3.) Unfortunately the specialist visit didn’t have anything remarkable to assist, just going over the protocol for a cat with asthma, and recommending a steroid inhaler, which our new regular vet was willing to prescribe. While Trixie finished out the last of the Prednisolone course and we waited for our appointment with Vet 4, I started making the household changes necessary to help reduce the risk of increased asthma attacks. The biggest item was no more aerosolized fragrance, that includes cleaning solutions, plug-in air fresheners, perfume, and essential oil diffusers (and many essential oils are unsafe for cats anyway and should not be diffused when they are present.) So I started making my own cleaning solution, got rid of the ancient perfume I never wore anyway, and tossed the last old plug-in air freshener which I rarely used because it triggered my migraines. Next up was finding a low-dust kitty litter, and despite all the marketing claims I discovered that none of the clay litters were truly low-dust. We experimented with pellet litter for a while, but Pixie flatly refused to set foot in pine pellets, and the paper pellets got gross and stinky much too quickly. Eventually I found a corn and cassava litter which was low dust, clumps well, doesn’t track too badly (except when Finn uses it) and the girls like.

Our first visit with Vet 4 was also not very remarkable, other than the very helpful recommendation for a mail-order pharmacy in Canada to use for the inhaled steroid prescription. The inhalers prescribed to cats are an older type originally used for people, but the newer medications for people are much better and as a result, the older style is more expensive and hard to find. The average cost for one inhaler from a US pharmacy is about $150, possibly more, and an inhaler only lasts for 30 days. The Canadian pharmacies beat that cost by quite a bit, shipping 3 inhalers for about $220. I ordered an AeroKat chamber which allows adaptation of the inhaler for use with cats, as well as the first batch of inhalers from the pharmacy.

A side note: when I adopted the girls, one of the first things I did was sign up for pet insurance for them, because after losing Max to IVDD I never wanted cost to be a consideration in potential future treatment. After much research I chose Healthy Paws as the carrier, with a $250 annual deductible and 80% reimbursement for all covered services. Non-covered services include regular (office) exams, dental work, and pre-existing conditions. During the course of Trixie’s diagnosis, Healthy Paws covered all the submitted claims without complaint, and were excellent to work with. However, once her asthma was diagnosed, it was marked as a pre-existing condition because she had a cough when I adopted her and before the insurance coverage started. This is unfortunate for me, but perfectly reasonable for coverage, and in the years since they have continued to cover thousands of dollars of claims for her other health issues without any trouble.

So now it was time to convince Trixie to use her new inhaler twice per day, and with a little bribery from tuna Churu treats, it was accomplished surprisingly easily. She was more than happy to breathe in her Aerokat mask for two puffs twice per day, as long as she got some Churu treat afterwards. The inhaler helped reduce her asthma symptoms, but she was still not fully recovered from being so sick from all the medications from Vet 1. Around this time, I decided to fully embrace my Crazy Cat Lady persona and adopted Finn from the same rescue where I adopted the girls. Finn’s tale is one for another time, but he brought additional challenges because he and Trixie absolutely did NOT get along, mostly due to Trixie’s behavior and what turns out to be an extreme dislike of other cats.

A few months into her new inhaler, Trixie was breathing better but still not gaining weight, hiding, and having significant behavior problems that included attacking the other cats, peeing in sinks, and sometimes even attacking me. In addition, she absolutely could not be touched anywhere other than her head without causing significant pain. A follow-up email to the cat specialty vet (Vet 4) to inquire about solutions resulted in the comment that she was “too young for chronic pain” which, as anyone who lives with chronic pain knows, is a complete crock of shit. Around this same time one of the other vets at Vet 4 also mis-diagnosed Finn with a non-existent eye problem, so off I went in search of yet another vet, complicated by the start of the pandemic and many vets offices being overbooked or not accepting new patients. In the meantime I convinced Vet 4 to prescribe Gabapentin for Trixie “for anxiety” so that she at least got some relief from her chronic pain.

More research into possible new vets anywhere near my small town was not encouraging. I was very nearly at the point of hauling Trixie to our original vet an hour north in my old town, when I happened upon a review for a chain vet clinic two towns over which specifically mentioned pets with asthma. Normally I prefer small, independent vets, but decided to give the chain vet (Vet 5) a trial run with a follow-up on Finn’s (non-existent) eye condition. Vet 5 correctly diagnosed that he did not have the eye condition noted by Vet 4, and instead has conjunctivitis due to chronic feline herpes, which is common in rescue cats and generally does not require treatment as long as symptoms are mild (more serious symptoms should always be checked by a vet, but that was not Finn’s situation.)

So with the new vet vetted, I booked an appointment for Trixie to get some insight into her chronic pain, which was causing her to have behavior issues and not eat enough. Vet 5 did what I presume to be a thorough examination of Trixie, as they weren’t allowing pet parents in the office at the time. And based on the examination and our discussions of her symptoms, diagnosed Trixie with Feline Hyperesthesia Syndrome. FHS is sometimes referred to as “Twitchy Cat Syndrome” and can have many levels of symptoms from simple chronic pain, “rippling” skin along the back, hair-pulling and over-grooming, all the way up to full-blown seizures. Trixie was on the “mild” end of the spectrum, with her touch-sensitive chronic pain and rippling skin. Gabapentin is the first and preferred treatment for that, so her dose was continued and she seemed to be making improvement. One of her worst triggers for pain was getting mats in her undercoat, so I started working with her to allow regular brushing. When I started, she would swipe at my hand with claws out if I tried to brush her, so I simply set up a routine to sit on the floor with her, run the back of the brush over her shoulder, and reward her with a treat. Over the course of year, she gradually improved and eventually I was able to fully brush her underside, and even carefully remove any mats that formed behind her front legs. Even now, however, she still does not allow more than light brushing on her back legs due to her continued issues.

Through all the time of teaching her to allow brushing, she continued to have behavior issues, chronic ear infections, and pee in sinks. Then one night around 2am I woke up to find her peeing blood, and continually going between sink and litter box with little result. This being a common symptom of a UTI and possible urinary blockage, off we went to the ER vet and got her on a course of antibiotics. A month later, it happened again, and this time when we followed up with our regular vet she noted there were no signs of infection in any of the lab samples, and diagnosed Trixie with Idiopathic Cystitis. IC is considered a behavior or stress-based condition, that a stressed cat’s bladder becomes painful and inflamed and causes them to strain, pee blood, and go outside the litter box. To combat this, Vet 5 added an SSRI to the regime, and recommended increasing the Gabapentin dose if needed.

Shortly after this, both girls were diagnosed with yeast ear infections and so we had 7 fun-filled days of ear drops to apply twice per day. Towards the end of the series, just as Pixie’s ear infection seemed resolved, it was their “Gotcha Day” and we celebrated with an extra can of special tuna cat food for their lunch. By the next morning, Pixie’s ear infection was back, and I realized that both of them were reacting to fish proteins. Finding cat food that is free of both poultry and fish is quite a challenge, but I managed to put together a meal plan based on rabbit and duck for the girls (Finn was already on rabbit kibble.) This led to significant improvement in Trixie’s symptoms, and although she still needed heavy doses of her daily medication her behavior was much better.

Unfortunately that was about the time I was diagnosed with early stage breast cancer, and the year of surgery, chemo, and IV therapy that I went through caused significant stress and setbacks for everyone. During that time, a new local vet clinic (Vet 6) opened a few blocks from my house to rave reviews, and included in their offerings was a laser pain therapy treatment that Vet 5 and I both really wanted to try for Trixie but were unable to use due to her limitations from corporate. I booked Trixie an exam with one of the vets at Vet 6, and it went BADLY. With barely any information, and disregarding all the information I provided of her imaging history, he declared that she had IVDD, required a $3,000 CT scan to confirm, and would need a $5,000 surgery followed by months of recovery to resolve. We left that day without even a basic x-ray to back up his theory because he had caused her so much stress that she was fighting the technicians and they were unable to get imaging. In addition, his brutal exam caused her so much pain that it took her over a week to recover her full mobility.

But now I had a new fear, because Max had IVDD and it can cause not just pain but paralysis, so we went back to Vet 5 to get an updated set of x-rays. To my relief, they came back “unremarkable” and while x-ray is not the definitive diagnosing method for IVDD, it was sufficient to rule it out. However, during the physical examination, Vet 5 noted that Trixie had some tooth resorption and needed dental surgery to have the damaged teeth removed. This was actually good news, because it explained why she was still having so much trouble eating even on a 100% canned food diet.

In May, Trixie had her dental surgery and initially everything went well. Unfortunately following the surgery, the stress of her day at the vet clinic caused a flare-up of her chronic feline herpes, and resulted in an upper respiratory infection. Because of staffing issues at the office, I couldn’t get a callback from my vet, and at the follow-up exam they did not do a complete exam and only confirmed her gums were healing, so her infection continued unchecked. Not long after, she had yet another cystitis flare-up, which had been happening occasionally throughout the past year. This time, however, partway through the flare-up she became unable to move one of her back legs, and off we went to yet another ER vet (Vet 7.)

The ER vet ran labs and took x-rays and looked at the medical history I provided, and came back with the most surprising diagnosis: Inflamatory Bowel Disease. I am all too familiar with IBD due to Finn’s issues (another tale for another time) and Pixie had recently been diagnosed with it as well after she started throwing up last summer. But Trixie never threw up, and rarely had any apparent digestive problems. But clear as day on the x-ray she had considerable gas in her abdomen, and it was causing her so much pain that it was putting pressure on her bladder and making her unable to move her leg. Plus she had an upper respiratory infection, and a lung infection. We came home with a giant bag full of medication for two infections and her IBD, plus a need to follow up with a non-emergency vet.

Since Vet 5 at the chain clinic was having staffing issues and their appointments were at least three weeks out for availability, I took a risk and called the new vet clinic near my house again. Amazingly, they had same-day and next-day appointments available, and in the intervening months the terrible vet we’d seen there had departed. So we saw a new vet at Vet 6, and she was wonderful. Vet 6 was able to do an ultrasound and confirm the presumptive IBD diagnosis (the gold standard of diagnosis is a biopsy of the intestines, based on everything else going on I opted not to do one at this time) and also determined Trixie had yet another ear infection. They wrote a prescription for a hydrolized food called Hills Z/D that does not contain any unhydrolized poultry or fish, and after a bit of searching I was able to acquire some from Chewy.

After a challenging few weeks that included up to eight pills at a time, Trixie finally finished all of the new medications for all of her infections. I switched her over to the hydrolized canned food, and fortunately she likes it as she is known for being a bit of a picky eater. A few weeks after switching to the new food, she started showing so much improvement that we went back to Vet 6 to get a plan for tapering off the SSRI and reducing the Gabapentin dose.

Since her correct IBD diagnosis in June, Trixie has not had a single flare-up of her presumed idiopathic cystitis. She also has significantly less chronic pain and is behaving much more like a “normal” cat. She’s tapered entirely off her SSRI, and her Gabapentin dose has been reduced from 100mg twice per day, to 50mg once per day. Even the 50mg Gabapentin dose is on the high end, it makes her drowsy but she’s still having some anxiety during the day as she adjusts to being unmedicated after all these years, so that will be a slower taper before seeing if she no longer needs it.

While she is doing amazingly better overall, she is unfortunately still losing weight and having trouble eating enough food. So we’re headed back to the vet next week for some additional tests and to talk about adding some regular medication to manage her IBD, most likely a targeted steroid called Budesonide and probably some anti-nausea medication. Based on how well the targeted steroid has worked for Finn’s IBD, I expect it will result in significant improvement for Trixie as well.