ToraPOOP: A project about love

The world will never appreciate it. But this is my biggest accomplishment in life.

Toraman

Toraman is my 14-year old male mackerel tabby who has been diagnosed with Feline Hyperesthesia Syndrome (FHS) ~2.5 years ago. When stressed, Toraman mutilates himself (he started with his ears, but now it is usually his tail), and as he’s biting his tail, he can’t hold his muscles and pees. FHS is a “blanket” diagnosis that is given after a bunch of tests (food allergies, ticks, fleas, parasites, cardio problems, tumors, etc) have been checked for, and nothing explains the situation. Anti-depressants are commonly prescribed. Any event that can trigger stress in the cat (eg, another cat, a dog, a deer out the window, a new person in the house, loud noises, etc.) triggers an episode of mutilation, where the cat acts in a way best described as “possessed by demons”: starts to groom himself obsessively, pulls hair out, and then starts to chew his body and bloodies himself.

For the last 2.5 years, Toraman was living with his father while I was abroad. Ever since he started showing symptoms (03/16), his father took him to the best vets and animal hospitals near Boston, and had him checked for food allergies, ticks, fleas, parasites; had biopsies of his skin, cytology of his ears; and along the course, Toraman was prescribed steroids, amitriptyline, apoquel, convenia, clomicalm… Nothing stopped his episodes of self-mutilation. The only way to manage him appeared to be leaving him with the cone all day long to avoid having constantly open, bloody wounds (and also to prevent him from peeing every time he chewed himself).

[Now that I think of it, those fancy vets in Boston never diagnosed him with FHS. As Toraman’s father and I google’d the symptoms, we found that diagnosis.]

Six months ago I moved back to the US and Toraman moved in with me. The first thing I did was to stop the Amitriptyline, because it wasn’t improving the FHS symptoms in any way, and I wanted to see the “real” behavior of the cat underneath. Next, I started to keep an hourly behavior log on Toraman. Based on that, I observed that almost all his mutilation episodes are +/- 30 minutes of pooping. When he was outside of this window, he was an angel. Once I saw that, I started monitoring his poop. I observed that (TMI from here on – don’t read if poop makes you uncomfortable):

  1. Toraman roughly poops every other day, and swings between constipation and mild diarrhea.
  2. When Toraman is constipated, he does not have the urge to mutilate himself.
  3. Mutilation episodes begin when his poop becomes soft.

I was excited, because I was onto something. I observed this swinging pattern between hard and soft poop at least three times, and it started to become predictable when he would mutilate himself. I even gambled and started leaving him home alone without the cone on the days I expected a hard poop or no poop (low-probability of mutilation). This way, Toraman started to get more and more time without the cone, and that made *me* much happier.

Disappointment with vets

Next, I took Toraman to a local vet near Princeton, NJ where I live. I took him specifically for an acupuncture session, because at that point I hadn’t fully understood his condition and had reasons to believe acupuncture could provide him some relief. Well, not only did it not do anything, but the vet tried to get me to commit to it weekly ($100/session) without any convincing evidence it would be worth the $ for me, and the stress of riding in the car weekly for Toraman. Then, she tried sell me this “Loop” thing for pain/arthritis – without any evidence Toraman has arthritis, and said if all else fails, we can start him on opioids !!!  For what??? There was no attempt of diagnosis, just “we’ll throw this at it, maybe it’ll work”. Worse: I mentioned to her that I was keeping an hourly behavior log on Toraman, and said I thought the episodes were correlated with pooping. She corrected me and said: “defecating”, and then practically said something along the lines of: “Don’t get us involved in that, we can’t analyze behavior logs!”

Yes, Project toraPOOP was born out of my frustration with vets. It seems that vets can run *expensive* tests, prescribe pills, operate complex instruments, read charts after a test, but do they too often fail to read the cat?  Certainly the last, very disappointing vet visit we had is heavily influencing my comments here, but why didn’t any of the 3 good vets we’ve seen in the last 2.5 years think to say: “Why don’t you observe his behavior for a few weeks? Maybe his attacks are not random?”

Shitty days

For 40 days (so far), I kept Toraman’s diet the same to the gram. Every one of those 40 days, I picked up his black gold from the litter box, weighing it, photographing it in a little desktop studio I built (with a color standard and all), feeling it to get its texture according to the Bristol Stool Chart, and logging all that into a spreadsheet. And the data are talking. The poop tell me in numbers exactly what I observed in his behavior: mutilation is correlated with soft poop days.

Vitals
Toraman’s episodes of mutilation seem to be correlated with soft poop days (with Bristol score above 3). But he sometimes attacks his tail when there’s a scab close to falling off; it must itch. Those are also counted as attacks.

Tomorrow

Tomorrow is our big day, and this is why I finally feel ready to publish project toraPOOP: we are going to an internal specialist. One whose name was given to: “Who is the best internal specialist in NJ?”. I am betting my money that I am the only client she’ll have who will walk in with a month of poop history. But if not for this history, what can she diagnose within 1 hour of appointment time? Especially when it is likely that Toraman won’t produce a poop sample while we are in the office visit.

What am I expecting? Sure, as soon as I walk out, she will text all her friends that a crazy lady walked in with 40 days worth of photos of her cat’s poop. But I am also expecting that she’ll tell me Toraman has IBD, or his gut microbiota are messed up, or he has some other colon or gut disease, and will do the relevant tests, and will prescribe the relevant pills/probiotics/foods and it will only get better from here. [Note: I also sent Toraman’s poop sample to animalbiome.com, but have not yet received the results.]

Realistically, fixing Toraman’s gut will probably not cure his FHS entirely. But, it will remove a daily source of stress for him, and make it much easier for me to manage him. He is suffering, and because I love him so much, I am suffering, and neither of us can go on like this.

Torapoop_April

CalendarDraft_May
Bristol_stool_chart

Toraman's diet has been fixed for the last 40 days down to the gram.
Toraman’s diet has been fixed for the last 40 days down to the gram.

 

https://youtu.be/Xh9denSYHSk

Memorable ones

The prior night, he ate up all his regular food, and stared at me with hungry eyes, so I gave him a 1/4 can of a treat. This was not a brand he had been eating in the last month, so I think that's what led to the "30 gr" dump to the right.
The prior night, he ate up all his regular food, and stared at me with hungry eyes, so I gave him a 1/4 can of a treat. This was not a brand he had been eating in the last month, so I think that’s what led to the “30 gr” dump to the right.
Smallest one.
Smallest one.
The piece on the left has some wrinkles on it. Is that the shape of his intestines?
The piece on the left has some delicate wrinkles on it. Is that the shape of his intestines?
How do you make two dumps that are so different from each other in the very same day?
How do you make two dumps that are so different from each other in the very same day?

Behavior Log

The behavior log I kept is what led me to monitor Toraman’s poop. Funny enough, when I started that log, I did not keep track of his poops. But later when I went back and analyzed all the red and orange areas, the relationship between the litter box and agitation/mutilation became clear.

Keeping an hourly behavior log (as much as possible when you have to go to work) was what led me to monitor the litter box more closely.
Keeping an hourly behavior log (as much as possible when you have to go to work) was what led me to monitor the litter box more closely.

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