Ok. So, last week we started Rufus on his kitty Prozac (generic name fluoxetine). I've decided to start with a very conservative dose, mainly because I was terrified of some unforeseen adverse reaction to it. I worked from home last Tuesday, July 13, and he got his first dose. The funny thing is, he is a Pill Pockets JUNKIE. So, giving him the Prozac is easy AND I can do a little clicker training at the same time! His dose is 2.5mg daily. The smallest the tablet comes in (and it's an oblong kind of tablet, not round) is 10mg, and I'm not going to lie - cutting those suckers evenly into quarters is a major hassle. I bought a pill cutter for that purpose, but it's useless on a pill of this size and shape that has to be quartered. Sigh.
My biggest concern before starting the Prozac centered around one particular potential side effect called serotonin syndrome. When Grady was a few weeks away from his 19th birthday (and I'll remind everyone here - in addition to being the Methusaleh of cats, Grady had been being treated for Chronic Renal Failure (CRF) for nearly a year and half by this time), he seemed to take a downward turn. I had long been attuned to watching his overall demeanor - energy, appearance, grooming, eating, drinking and litterbox habits. He'd been not eating enough, and it was concerning. I took him to the Hope Clinic, and they prescribed a little bit of Mirtazipine. Mirtazipine itself is an antidepressant, but in cats, it's known to stimulate appetite. I was approaching desperate at that point, and when I went home, I gave him the Mirtazipine (it need only be given once every three days, which, if your cat doesn't have a reaction from it, is a bonus) and prepared his food. Within 20 minutes I knew something was badly wrong. He was drooling great gobs of thick, clear drool. He was howling. It was obvious his respiration was extremely elevated. His pupils were dilated. I couldn't get too great a heartrate reading, but it was elevated as well. I rushed him back to the veterinary ER. He was having a rare reaction to Mirtazipine - serotonin syndrome. All they could do for him was admit him, give him the "antidote" (which is cyproheptadine, another appetite stimulant that uses the OPPOSITE effect) and some activated charcoal. They stuck him on an IV and he was in the vet hospital for two days. It was during this time that - coicidentally - they found the tumor in his kidney. My poor baby - we knew treating cancer in a nearly 19 year old kitty who already had kidney issues and whose cancer was IN the kidney was not going to happen. But the vet told me to bring him home - he wasn't in pain - and just make him comfortable and spoil him rotten, which I did. But it took him another full day after coming home to really get back to being Grady. That Mirtazipine almost killed him.
So, when I saw "serotonin syndrom" as a potential side effect of kitty Prozac, I was understandably concerned. I've been giving Rufus his daily dose and then watching him like a hawk.
The most common side effect of Prozac is constipation. So, all kitties are getting the equivalent of about 1/4 of a tsp. of plain canned pumpkin mixed into their wet food daily, which helps keep the poop hydrated and movable. I thought - "there's no WAY these cats are going to eat canned pumpkin". But I bought a can anyway and added it to their food last week. They WOLFED it - all of them. I also got a neat trick years ago from the feline CRF webiste suggesting that I store unused canned pumpkin (once the can is opened) in an ice cube tray and then freeze them into pumpkin cubes. All four cats go through a little less than a cube a day, so I defrost one by putting it in the fridge in the AM for use with the PM feeding. The things we learn.
All cats are still physically separated and on a rotating schedule. Bella out, Rufus, Feats & Meatball in the front bedroom. Rufus, Feats & Meatball out, Bella in the office. You get the drift.
This weekend begun the food portion of our retraining. The behavioral vet said that step one (after medication) was to get all household cats oriented towards food as a reward and not as a given. This means that they're all fed several times a day (5-6 times) for 20-30 minutes at a pop. In theory (and probably in actuality), they'll learn to anticipate the food and perceive it as a treat rather than a given. But I feel bad not having food down for them!
The goal is to go ahead and continue the medication, continue clicker training when possible, continue to get Rufus used to the harness (hilarious - I'll have to post a video of that), and start Bella on the BusPar (that starts today or tomorrow). Then, next weekend, Rufus will have to start taking his meals in the dog crate. Two weeks after that, Bella comes into the room and eats with him with Rufus in the dog crate. This should allow plenty of time for the Prozac to start having its desired effect and for each individual change to be phased in gradually so as not to upset everyone with too much change too quickly.
Keep your fingers crossed for me!