Raven went to the vet again to try to get better control of her itching & hair loss. She got a steroid injection last month, and it worked well for about two weeks. As the drug wore off, she started licking & biting again and gave herself a few more bald patches. She’s also trying to barf up a hairball, but her 5 a.m attempt at that was unsuccessful.
You can see in this photo that the underside of her tail is missing a lot of fur. Her lower belly and back legs are also missing quite a lot of fur. Luckily, she does not have any rashes or sores on her skin.
Even with some missing fur, she’s still a beautiful kitty and she looked gorgeous in the late afternoon sunlight.
The vet and I had a lengthy discussion about options for treating Raven.
- Do nothing and let her be itchy, eat her fur, and be “naked”. This eliminates any risks from medications, but leaves her uncomfortable and at risk of getting a hairball that could cause a blockage in her digestive system. We ruled out this option because none of that is acceptable.
- Treat with steroids as we did before. Steroids are effective, but they come with side effects and long-term risks. We could use either a long-acting injection or daily pills. Both carry the same long-term risks and the injection has additional short-term risks (you can’t reverse it if something else goes wrong). We ruled out this option because I’m not comfortable with the long-term risks of steroids, particularly inducing diabetes. I have had a diabetic cat and it’s not something I want to risk with Raven.
- Treat with cyclosporine (drug name Atopica) that suppresses the immune system. It has been in use for many years in cats and can be very successful. But suppressing the immune system leaves the animal susceptible to other infections. It can also cause vomiting, and apparently tastes horrific and can become difficult to give. We ruled out this option because I felt the potential risks outweigh the benefits for Raven. To me, this was using a very powerful drug to deal with a non-critical problem. If Raven also had skin sores, I would give this option more consideration.
- Use a newer medication called Apoquel. It is a small pill given daily to suppress a specific part of the inflammation response. Unlike cyclosporine, it does not suppress the immune system, and it does not have the risks that steroids have. Apoquel is approved for use in dogs and is working quite well with minimal side effects. Apoquel is not approved for use in cats.
We decided to go with Option 4 – Apoquel. Since it is not approved for cats, we are using it “off label”, but that’s not uncommon in veterinary medicine. It’s also the first time my vet has used it in a cat, but he feels it is working very well in dogs and thinks it will be tolerated just as well in cats.
Neither my vet nor I are entirely comfortable being on the “cutting edge” of new drug therapies. We prefer to use drugs that have been used for a couple years so that the long term side effects and risks are better known. But we agreed to take a leap of faith give Apoquel a try. We’re hoping it will give Raven relief from her itchiness and fur ingestion, and she’ll tolerate it well. Paws crossed that the next few weeks brings less biting and some fur growing back.