Self-mutilation After Tail Amputation

[kittykorner]

At the end of June, my 2 year old 5 pound cat Izzy (who has bad balance since birth) got out into our garage somehow, climbed our refrigerator, then fell onto her tail/back. After taking her to the vet, there was no saving the tail because it was completely severed in the sacral area so it was amputated. She has no tail stub, it's completely smooth in her back area. She has full function of her bladder and bowel, although we do find a few "surprises" every so often lol.

The only problem is that she is self-mutilating herself right above the amputation line. The vet told us that her nerves seemed to be stretched and not severed, but they're in bad shape. We're currently giving her Gabapentin but all that does is knock her out cold so she obviously won't chew. She has an e-collar on but I just feel so bad for her, she can't play like she used to, or groom at all.

Some people have said to put her down to end her misery...but I can't do it! She has recovered so well, has full function of her bowel/bladder, eats like a pig, and tries to play as best as she can. The only problem is the chewing. I feel like as her pet parent I owe her a chance at life! I'm just wondering how long the nerves will take to heal? Is there a chance she'll never stop chewing? Are there any other remedies instead of the e-collar? I need help please!

[CarolC]

I think others will be along soon to comment, but I just wonder...with such a small cat, only 5 lbs, she is half the size of many cats. I wonder if the dose of gabapentin needs to be adjusted. I think I would ask the vet about that. You may need to get one of those wonderful little pill cutters at the pharmacy and give her a little less. It seems like you ought to be able to find a dose for her weight that will help with the chewing but not zonk her out? Can you ask the vet about that?

The Veterinary Drug Handbook lists the dosages recommended by various doctors, there is a range.

[kittykorner]

The vet told me that the dose given is at the highest range right now. I'm only giving .5 mL of it once a day (at night so she can sleep better). I have given her a lower dose at one point to see how she does but it seems like it doesn't work because she just keeps chewing.

[critters]

I agree about the dosage adjustments. Buddy used gabapentin in the same way for the same reason after his SCI, and it worked WONDERS. Admittedly he was a bigger boy, but it seems to me that there should be a happy medium somewhere between drugged and mutilating. Is it a liquid that you can easily adjust the dose? If not, I suggest having it compounded that way until you find a range that works.

[kittykorner]

Yes, it's compounded into liquid form. Supposedly tastes like peanut butter too which I can smell haha.

Critters: How exactly did Buddy's body react to the medication?? Did you give him the intended measured doses where he'd get zonked out then lower the doses slowly until you found the happy medium?

[CarolC]

You say she has had bad balance since birth. That's interesting.

Here is what it says in Plumb's Veterinary Drug Handbook, 7th ed., p. 459, if you want to discuss this with the vet. I'm just going to copy the whole section, and I will proofread it but my transcription may contain mistakes.

CATS:
For ancillary therapy of refractory seizures:
a) 5-10 mg/kg PO q8-12h (Podell 2006), (Munana 2010)
b) 5 mg/kg PO three times daily (Pearce 2006)
c) 10-30 mg/kg PO q8-12h (Mariani 2010)
As an analgesic:
a) 1.25-10 mg/kg PO q24h (once daily) (Hardie 2006)
b) For adjunctive treatment of chronic or cancer pain: 3 mg/kg
PO once a day (Lascelles 2003), (Hardie et al. 2003)
c) For adjunctive analgesia associated with neuropathic pain:
While suggested range for cats is 2.5 - 5 mg/kg PO q12h, this
author starts at 5 mg/kg and increases (up to 10 mg/kg) if no
effect seen in two hours. May be a higher requirement in cats
for post-seizure or CPR vocalization and thrashing. Wean off
slowly or patient may experience worse pain. Reduce in renal
insufficiency. Usually the limit of dosing is reached when pa-
tient is sedated. (Mathews 2006)
d) Most VIN consultants recommend doses of 5-10 mg/kg PO
2-3 times a day for analgesia (Rishniw 2007)
e) 50 mg (total dose) per cat 1-3 times a day (Postner & papich
2009)

[...]

Client information
Clients should report any significant adverse effects such as atax-
ia or hypersomnolence

5 lbs is only 2.26796185 Kilograms

[critters]

We started Buddy at a dose then upped it.

[kittykorner]

Just checked her medication, she's on a 40 mg/mL suspension taking .5 mL of it once a day.....should I be going up on the dose?? I guess I could try giving her the medication in the morning to see how she is during the day. I just don't want her to b sleeping 24/7 on the meds, she's quite an active little girl.

[CarolC]

My advice would be to call the vet on Monday and discuss it, but this way you will have some background information. I would not mess with the dose without the vet's approval. I would be sure to mention how small this kitty is, and that she is zonked with the current dose (the information says to report hypersomnolence). If s/he does not have an answer right away and needs to research it, s/he can call you back, but that way you should have your answer on Monday and hopefully it will not require an appointment. If it was my cat, I think I'd probably be asking the vet if I could try a smaller dose twice a day, but I don't know, that's only my .

Does she have a clear plastic collar, or one of the nice blue flexible collars?

[kittykorner]

I have been keeping my vet updated with Izzy's condition. He's been talking to his neurologist colleague for me who is saying that I can up the dose so she doesn't chew anymore but one of the prime side-effects is lethargy, as I've been seeing. He said that I can always lower the dose a bit to see if it works a bit better but I'm just not sure if it'll work. Is there a chance she'll never heal from this??

[CarolC]

I'm hoping critters will be able to comment further. I am not a vet and cannot predict how long it might take her to stop chewing. My layman's opinion is that the problem will get better, mainly because we've had so many people post here with pets chewing and I don't remember any being on medication permanently. I would just give it time, because nerves do heal, they simply do it slowly, more slowly than broken bones for example. Here is a statement from a veterinary medical text about the problem of chewing related to peripheral nerve damage (in this case a leg).

The denervated limb must be protected from mutilation until evidence of reinnervation is apparent. Such protection may be provided by padded bandages, splints, or moldable cast material. In some cases, self-mutilation of the denervated portion may be attempted and may be correlated with early stages of axon growth and reinnervation of sensory-deprived areas. Conservative management, accomplished by a protective bandage, side brace, bucket collar, or muzzling, is usually sufficient to prevent further damage.

I am not sure of the exact publication date of this text but it looks like it may have been the early '80's. The use of gabapentin is fairly recent compared to that and has been a godsend. I remember even on this board when pets were chewing and no medication was given. There were all kinds of foul tasting preparations you could try putting on the foot that were supposed to taste so awful they would prevent chewing, but nothing really worked that well till they started using gabapentin. Possibly the neurologist would have a better idea of the timeframe?

[critters]

With Buddy, he stopped pretty quickly. We tried tapering him off once, but he started biting again. We continued longer then were able to taper him off for good.