On February 8th, I posted the first in a series of entries to help you, a handsome Siamese, resolve your problem with spraying. As you can imagine, it will take some hard work on both our parts (and on the parts of your purrsons) to help you turn the situation around, especially since it has been going on for four years.
Feline urine spraying is considered a social problem because it is usually something in your social environment that requires adjustment in order to address the issue. You require a three-pronged approach: 1) changes to your physical environment, 2) a behavioural modification program, as well as 3) the use of a drug to lower your anxiety and set the stage for your to learn how to cope with the situation that set your spraying off in the first place.
If your problem had just started, it may have been able to be resolved without drugs. And some cats and their purrsons would prefer a non-drug alternative (such as a homeopathic remedy, a flower remedy or an herb). But you have been spraying for 4 years. The longer it goes on, the more likely the problem is to spread.
Since both you and your purrsons are frantic and you have been using a drug, We must deal with the matter of drugs.
Please bear with me as I provide a medication overview for the benefit of other readers, along with specific advice to you.
The Range of Medication Options
Many of the drugs used to deal with spraying fall into the category of anti-depressants and were developed originally for human use: they remove anxiety in some way. There is good reason to give an anti-anxiety drug, because anxiety is often a basic part of the problem.
Clomipramine (a tricyclic antidpressant, brands of which include Anafranil and Clomicalm). I know that this is the drug you take. Did you know that Clomicalm was originally developed for dogs who have separation anxiety? It is now used for cats as well.
Buspirone (a nonspecific anxiolytic/serotonin agonist whose trade name is BuSpar). It is particularly useful for dealing with spraying that is part of intercat aggression, so it might have come in handy when you were having problems with Nixon. It also increases confidence. It is a more expensive drug and it can take 4 to 6 weeks to reach safe, steady levels in the blood. So purrsons will not see results for about a month or so.
Amitriptyline (a tricyclic antidepressant whose trade name is Elavil). It facilitates normal social functioning; but may increase appetite and thirst.
Diazepam is a benzodiazepine whose brand name is Valium. It inhibits anxiety and increases appetite. Some cats cannot take it, because of problems with their livers. While it interferes with learning and short-term memory, it sure helps you relax.
Nortriptyline is also a tricyclic antidepressant made under the name Pamelar.
And there are progestins (megestrol acetate; medroxyprogesterone acetate) which are used as the drug of last resort because they are associated with a host of potentially serious side-effects. Still they have their place. Males may respond better to the use of this drug than females.
Obviously this is just a brief overview of some of the drugs used in cases like yours, Indy.
Most drugs have associated side-effects and these are useful to know in advance. The most common side-effects include:
- Changes in appetite.
- Changes in activity level (notably lethargy) until you have adapted to the drug.
- Interference with or from other medications or supplements, depending on the circumstances.
- Gastro-intestinal upset (vomiting, diarrhea).
It usually takes some time to adapt to receiving a drug and for the first few days many of my colleagues who have taken such drugs find they are somewhat sleepy and uncoordinated. However if this continues for more than a few days, it likely means that the dose is too high and a phone call to the vet is very much in order to adjust it. On the other paw, some of my colleagues noticed no such effects: they were purrfectly fine from the first day. And the lack of a need for a few days of adjustment might be an indication that the dose is too small.
It may also take a while for your blood levels to stabilize, meaning that the drug has been received long enough that now your blood is on an even keel. You need to be patient. You need also to ask your vet what the usual adaptation period is.
Selecting the Best Drug for the Circumstance
It isn't always easy to select the drug that would work best. Different drugs work in different ways. Some are better than others, depending on the situation. But it is often difficult to understand fully the factors in your situation which are relevant. So you must have a vet you trust and have confidence in, to guide you.
Your vet will likely take the following into account:
- the basis of your problem, coupled with his or her knowledge about and experience both with feline behaviour problems and with using a particular drug. The ability of your purrsons to specifically and accurately describe the situation is essential (and too often, they themselves don't know what is or is not relevant so your vet needs to be good at interviewing to pull the data from them).
- your health status and medical history because certain drugs may not be in your best interests to take.
- the results of a baseline blood profile to ensure that any liver or kidney issues are identified because drugs are processed through these organs. Some blood results influence which drugs can be safely given. In some cases, the vet also recommends a baseline EKG. (If your are on a drug for more than, say, 6 months, the vet will repeat the medical tests just to ensure your body can handle it.)
Indy, I understand that you have had bloodwork. Good for you!
Two Things You Should Know About Drug Selection
Some of us do well on one drug and not one another; but you really cannot tell that in advance. You may need to try it in order to find out.
That is why you need to know the side-effects and receive any warnings about effects that indicate that the drug is unsuitable. Vomiting is one example. You may need to switch if you experience an undesirable side-effect or if the drug is not working (yes, that does happen). For example, my colleague Tang was taking Clomicalm to deal with anxiety. It did nothing for him. Switching to Prozac gave him the results he needed. Now he is drug-free.
Some drugs can be delivered in a form which avoids a particular side-effect. For example, one of my colleagues (who had to adjust to a new cat companion) threw up on Elavil. But my guess is that if he had received it in a transdermal gel (which bypasses the gastro-intestinal system), this might have been avoided. So it depends.
Dosage may require adjusting. There is a range of dosage for a particular drug (based on body weight), but some of us require a somewhat different dose than was originally recommend.
For example, I happen to be particularly sensitive to certain drugs. During my last bout of pancreatitis the dosage on two drugs I was taking had to be lowered because I was hallucinating and became very vocal and restless; adjusting the dosage in one case, required special formulation (into very small capsules - done by a compounding pharmacy). But it made all the difference and I was able to get the benefits of the drugs without the problems.
In your case, Indy, the prolonged lethargy and loss of your coordination of your hindlegs when you started Clomicalm suggests the potential for dosage reduction - which is what your purrsons have done. In any such case, monitoring by your purrsons and close discussion with you vet should be able to resolve issues like these.
While many drugs come in (or can be made into) various forms, most are dispensed as pills. Why? Because it tends to be the most common and thus least expensive form. But that doesnt' mean that it is the best form for you.
You rely on your purrson to dispense the pill to you. But not every purrson can easily pill a cat. And if every time you are to be pilled your anxiety rises along with that of your purrson, or you struggle, or you spit the pill out, what then is the point?
Indy, I know you are pilled and that you do not particularly enjoy it. Read on and figure out if there might be some other option you would prefurr.
Attention felines! If this is your chosen option, make sure your purrsons know how to pill you properly. Otherwise they will find the pill on the counter or the floor later in the day. Or they may find their arms shredded as they attempt to prop your mouth open.
In my opinion, your vet or a member of the clinic staff should show your purrson how it is done. Your purrson should have a chance to practice - under the supervision of a good piller. There are videos that can help. Click on Pill video 1, Pill video 2 and Pill video 3.
Another option is to hire a vet tech (say from your clinic) to come to your home and help. I made arrangements for this when I had to take Famotidine (a pill for acid reflux that needed to be split). Over the course of 10 days, a vet tech came to my home to teach Himself how to do it, including sharing her 'trick' of giving me about 1/2 ml of water in a syringe by mouth immediately after I had swallowed it, to help wash the pill down.
The first two days, Himself watched while she did the deed and described what she was doing. Then he started to try, under her supervision. Slowly he gained confidence because the tech was able to give him immediate feedback so he could correct what he was doing. And before the week was over, he was able to manage on his own. This made it far less stressful for both of us.
Because he was no longer anxious about pilling, I behaved like a purrfect lady. And once he got good at it, I wasn't even able to spit the pill out or otherwise hide it! Something in which most of us have great expertise. When he was anxious, I must admit to squirming, dancing around and generally being a brat. But with confidence, he relaxed and then, so did I. Besides with confidence, he was much faster, too.
So fellow felines, if your purrsons are not comfortable with pilling, I would suggest that they consider pilling lessons.
Many purrsons will try to put the pill in your food in the hope that you won't notice. This isn't always effective because pills taste 'funny' and are sometimes bitter and then we refuse to eat. Pills that are split or crushed are often the most easily rejected because they are so bitter. And some pills should NOT be taken with food (which the vet should tell you in the first place). If it is okay to do so, have your purrson put the pill in a very small amount of wet food and ensure you are hungry so you will eat it up.
Pill pockets (from a pet supply store; some vets carry them too - a package is usually less than $10.00). As the name implies, these are pockets made of a soft snack food into which the pill is inserted to make it yummy on the outside. The key is to use tweezers to stick the pill in the pocket so your purrsons' fingers don't have ANY of the pill smell on them - because we cats are very sensitive to smell and that would cause rejection; then the purrson should use fingers (NOT those tweezers - which would have pill residue on them) to close the pocket.
When I was ill, I tolerated a pill pocket if my medication is given in the morning when I'm really hungry. And I got Himself to remove a little of the pocket because it is too large for my discriminating palate.
Pill Splitting: Sometimes the pill is too big and needs to be reduced in size. Save yourself a pile of trouble and get a pill-splitter at the drug store. They are not expensive and they cut beautifully (compared to using a knife which often leaves a jagged edge or shatters to whole darn thing.)
This is a gel applied to the skin on the inside of the upper ear where it is easily absorbed into the bloodstream. It is gently rubbed in by your purrson (who needs to wear a rubber glove or disposable finger cot, to s/he doesn't get a dose of the drug as well).
Many colleagues prefurr this method if they hate receiving pills (or their purrsons hate pilling). And it is a good way to avoid gastro-intestinal upset (like vomiting and diarrhea) because the drug doesn't need to pass through that part of the body before being absorbed into the bloodstream.
A gel is likely to cost more than a bottle of pills. But unless family finances are so tight that your purrsons have to choose between using a gel and paying the mortgage, this can be a good way to go - unless you absolutely detest having your ears rubbed. I vote for selected a compounding pharmacies that dispense this in a pen-like container that clicks out an exact, pre-measured dose so it becomes easy to give.
Some drugs come in liquid form that can by syringed into your mouth. The liquid is drawn up in a syringe (without the needle) and squirted into your cheek pouch (rather than down your throat). This is best under the following circumstances:
- the dose is small,
- you are comfortable doing this,
- the liquid is either tasteless or has a pleasant (to felines) flavour.
Many liquids are bitter which defeats the purpose! But some drugs can be flavoured in cat-pleasing varieties (like tuna or chicken). You need to make sure that if it is specially compounded, that the flavour is one suitable for cats and not children; what self-respecting cat would want orange? You need to make sure BEFORE you go this route, that the flavouring completely masks the taste of the drug. Otherwise your purrsons will complain that its a pain under the tail to dose you. And you will likely squirm and foam at the mouth on receiving it.
I receive Meticam (an anti-inflammatory) by liquid and it is delicious because it tastes like honey. Meticam is best taken with a small meal. So I get a few treats beforehand, then the syringe, followed by a few treats as a reward. I find this to be most satisfactory.
Some drugs come this way but unless you have a member of your household who is a nurse or doctor, don't bother. Many vets won't allow needles to be dispensed unless you have a chronic condition that requires them and your purrson is trained in their use and disposal. Diabetic cats who require daily doses of insulin are often the ones who receive their drug in this way.
Some drugs come in a patch that is left on the skin for some time - just like those nicotine patches for purrsons who want to quit smoking. The drug releases over a longer time period. Some cats who require long-term pain medication receive it in this way.
It is very important that the patch be placed in such a way that you cannot pull it off. In your situation, I doubt that it is worth it - even if it was available.
In short: Drugs often come in more than one form. You need to select that one that is best for you - especially when using a drug that you will be taking for some time. And most drugs used for your problem are given for 6 to 12 months. My colleague, Moby, who was a champion sprayer of 17 sites in his apartment was on Clomicalm for an even longer period. The good news is that spraying is a thing of the past in his life. (See my entry, No More Urine Spraying! Moby's Update, of 3/3/11. You can follow Moby's whole story by putting his name in the search box on the left of my blog.)
Vital Information BEFORE You Take Your Drugs Home
Your purrsons should have all the information about this drug that they could possibly want. Remember: knowledge is power. I have put a checklist of things to ask about at the end of this entry.
Remind your purrsons that if they are at all uncertain about the seriousness of a particular behaviour or symptom from the drug, they should call the vet ASAP! Better safe than sorry. The purrsons who procrastinates about this could be putting you in danger.
Remember the essentials: Right drug. Right form of it. Right dose - consistently given. And don't forget: If you try one drug and don't get results (after a suitable time period), don't be afraid to try something else.
Monitoring and Follow Up
I have already talked about monitoring in my previous entry. You need to keep records. Your purrsons might think they know whether or not the drug is working - of course, they will have a general idea. But it is far more helpful to keep daily records of your spray frequency at each of your spray sites. You will be amazed at what evidence they provide.
Of course, your vet will want you to keep in contact. Many vets want you to touch base about every 6 to 8 weeks. In fact, many dispense drugs so that you only have enough for this period and have to request a refill. It is a good way for them to keep tabs on the situation.
Long-term use of a drug usually means that the vet will want blood work, to ensure that your organs are handling the drug well. The frequency of this depends on your situation (on you, the drug used, and your vet).
Weaning You Off the Drug
At some point, you may decide that you no longer need the drug. You MUST consult with your vet about a weaning process. Going cold turkey is not a recommended way for all drugs. Often your system needs to adapt to a drug-free state and you do this by systematically reducing the doses and/or frequency.
This is a veterinary matter. It is essential that you receive guidance from your vet on this.
Drugs are not a panacea. They are not magic. They cannot cure your problem by themselves. What they do is reduce the anxiety so that you can learn to manage your situation in a more appropriate way. But without changes to your physical environment and a behavioural program, the drug is unlikely to be successful. You really need all three. I say this because many purrsons use drugs as an excuse not to do the rest of the work (the cleaning, the space modification, and so on). Frankly, that is a recipe for failure.
Special Advice for You, Indy
Okay Indy, now that you have read this far you have a good overview about drugs and their uses. As I understand it, you have taken Clomicalm for some time. I have no idea how long 'some time' is. And I have no idea about what advice your veterinarian has provided.
I do know that you do not enjoy being pilled which is why I suggest you consider the possibility of receiving the drug in another form.
I do know that you receive the drug about once a week on an as-needed basis, as determined by your purrsons. I assume your veterinarian knows this and is in agreement. However I am concerned because I have never heard of this frequency of dosage being used. That doesn't mean it is wrong. It just means that in terms of my experience, it is unusual. For all I know, there may be special considerations.
What I fear is that by receiving the dose on such an ad hoc basis, there is little opportunity for it to be effective. It would not have the chance to stabilize in your bloodstream but would rather go up and down like a yoyo. I gather it gets you to 'chill out' because that is what it seems to be used for in your case. But exactly how is it affecting your frequency of spraying?
If this frequency of dosage is because the pill is too much for you, then please, please talk with your vet about a more reduced dose (or another drug) that you can handle on a daily basis.
Remember even if you take a pill, the dose can be reduced by compounding. That happened to me. I started on one-quarter of a pill (the smallest dose available) but it was too much for me. So it was compounded to cut even that dose in half, into very tiny capsules. And that made a huge difference for me.
Now Indy, I do understand that dosage is a veterinary matter. I am not a veterinarian. And even if I was, I am not your veterinarian. But you deserve a drug whose dosage and medication frequency helps you turn your problem around. And because of your special circumstances, I ask that you check with your veterinarian - yet again. Just to be sure.
And as promised, that checklist I mentioned, follows below my signature.
I wish you the very best. Stay tuned for the next installment of my advice to you - in the next few days.
Purrs from Greyce
QUESTIONS TO ASK YOUR VETERINARIAN ABOUT MEDICATION
1. What form(s) does this drug come in? (e.g., tablet, capsule, topical gel, liquid, powder, injectable – if pilling is an issue).
2. What changes can be expected, with using this drug? How long does it usually take before I should be able to notice some change?
3. How long does it usually take before my body will have fully adjusted to the drug? During the intervening period are there any symptoms to watch out for (e.g., lethargy, changes in appetite)?
4. What are the side-effects? How common are they? Will they last while I am on the drug or only until s/he I get used to it?
5. Should I call you if I notice any side-effects? Is it important that I call as soon as I notice them?
6. How often should I receive this drug (e.g., daily, twice daily, etc.)?
7. How do I administer this drug? Ask the vet to show you and well as tell you how – whether it is a pill, a liquid, a gel or whatever.
8. Can I crush it and mix it in food or a treat? Note: some can’t be crushed because the pill is too bitter; others must be given on an empty stomach; still others must be given with food to avoid stomach upset.
9. Is it okay to use pill pockets?
10. Is there anything I should NOT be taking, while on this drug (e.g. herbs, homeopathic remedies, supplements, specific food treats)? NOTE: You must tell you vet about all the supplements you may be taking - like fish oil, or extra fiber, or flower remedies. Many purrsons forget to do this on your behalf, but these can affect pharmaceuticals and they way they act in your system. Make sure you tell your vet in advance. And if you get the urge to add something to your routine later, make sure you ask your vet before doing so.
11. Should it be given with food? Sometimes it’s O.K. with food or if you have just eaten something. Others have to be given on an empty stomach which means you cannot leave the food bowl down between meals.
12. What should I do if I miss a dose?
13. What should I do if I accidentally overdose? Example: You upset the bottle and eat more than one pill.
14. What should I do if another pet gets the drug, instead?
15. What follow-up is required? When?
16. How long will I be on this drug?
17. How do I take myself off this drug? Note: It can be very dangerous to go off a drug cold turkey. Consult with your veterinarian FIRST, to keep you safe.
18. Who should I call if I have any questions or problems?
19. Who should I call if I have any problems AND the veterinary clinic is closed?
20. Is it okay to start the medication at the beginning of the week? That way if you notice side-effects you can easily contact the clinic during regular hours (since many have limited weekend hours).