Tuesday, 30 April 2013

Tam

Tam is a beautiful "Neva Masquerade" or "Colour Point Siberian" who is currently in remission from possible wet FIP (lung) living in France with Virginie. At the end of January 2013  6 month old Tam was diagnosed by her regular vets with wet FIP.  FIP specialist Dr Addie is in France and she is also consulting on the case.
Tam had trouble breathing and a high fever up fever up to 40°C. Her lungs were full of filthy lemon yellow liquid drained twice in 3 days. Amazingly she responded rapidly to antibiotics and prednisone, looking quite well by day 5, and perfectly healthy by day 18.  As you can see Tam is still a picture of health and beauty in April.
Happy May 1st ("Lily-of-the-valley" day for us in France) from Tam!
As usual poor Virginie went through the terrible agony of despair and uncertainty of how to proceed surrounding a diagnosis of FIP which I hope to help ease by chronicling some cases. There are some differences in Tam's presentation to Mishka's which I'll list later.

The Siberian is one of the 3 forest cat breeds that were originally wild breeds from Russia. From Tam's case I have also learned of the new Russian drug Skulachev ions (Visomitin, SkQ1)and eventually also found exemplary breeders Forest Wind who provide a 10 year genetic health guarantee including for FIP! (See breeders database for contact details.) Tam had four and a half shots of Feline Omega Interferon,  a lot of raw beef and is on two drops daily of "Skulachev ions" which are a targeted mitochondrial antioxidant currently used for human eye diseases in Russia. (A similar item Mitoquinone is more frivolously applied to the face to cure wrinkles by the New Zealanders. The lower regulatory hurdles for cosmetics allow the fast tracking i suppose.) Her latest blood tests show significant drop of the AGP level ( a non-specific marker of inflammation raised with infection) compared to 3 months ago.
Virginie tells her story:
Tam, a female 6 months-old kitten is healthy, but little bit more tired as usual. Breath seems heavy. 10 pm, we're trying to think this could wait open hours, but no, something is not right, we went to vet emergency : fever is there, and liquid in chest too.
the day after (saturday), x-rays confirmed the pleural effusion. On Monday (day + 3), we sent blood and pleural liquid to the Vet. University of Glasgow for a FIP profile.
Results are "clear" : for my vets, FIP is confirmed. So prednisolone + antibiotics in routine treatment for supporting the kitten.

Last week X-rays (day + 10) shown improvement : liquid is still there, but far reduced.
At day+18, Tam is as healthy as a kitten could be, ... running in the garden, purring on our laps, eating a lot, fighting with our 6 others cats (all have been coronavirus tested, and are negative to mild-loaded).

We are waiting to start feline interferon treatment (the bottle is ordered)
Or is it something else as FIP-cats are not likely to run the way she is (according to other breeders I asked for advices) ???
There was no bacterial culture of the effusion sample sent to Glasgow University for a FIP profile as suggested in the comments of the lab report so some question marks remain as to whether she had a bacterial infection since there was a high white cell count seen. Dr. Diane Addie has slight reservations about the diagnosis of wet FIP (perhaps based on Tam's speedy response to antibiotics and prednisone?) Tam's own vets are sure what they saw in January was a kitten with wet FIP.  "at that time, we were convinced it was FIP and no hope left, we didn't ask [for the culture]. Later when Tam was so well, it was too late : no more liquid remained (no more in Glasgow, and no more in Tam's lungs !)" The vets nicked a vein when drawing off the effusion, so Virginie says a little bit of blood may be the cause of the high cell count but personally I have reservations about the logic. Looking at it the white cell count seems too high compared to the red to be from simple contamination. Also really if they were so sure it was FIP then why send off an effusion sample all the way to another country for an expensive test? and furthermore especially  on a tight budget wouldn't it make more sense to go for the bacterial culture because you'd have a fighting chance of a good outcome if you treated for it? They gave Tam antibiotics for FIP - I'd think they'd want to be sure it was the right one, or is that just the standard response for a cat with a fever? Mishka had the high fever and mild cold like illness months before she got fluid in the lung (and belly.) At that stage there was nothing to culture except perhaps a straight blood sample. She spent a night at the vet's and was given a shot of a long acting antibiotic.  Months later when she presented like Tam with a day's worth of extreme difficulty breathing the vet drained the chest urgently - it was a transparent fluid amber tinged with blood from the needle. She analysed Mishka's effusion sample in house for cells and protein. Based on that excluded infection - she didn't request the sample be sent for further testing.

From what I can gather Tam only had 4 and a half doses of interferon beginning mid February spaced a week apart starting before being pronounced "in remission". Although Virginie says her vet is following the Isheda protocol it doesn't sound like it to me as that protocol begins with second daily injections. She wrote: 
March 16 Thanks. By now, Tam is still perfectly well. She received her 4th weekly interferon injection last saturday. Dr Addie adviced to continue interferons once a week ; but my vets told the published use of interferon is only 4 injections, and preferred to stop the interferons, to re-do a series in few months if needed. I really don't know what to do !!!
nothing has been published yet on the use of interferons in FIP cases : the manager knows about Dr Addie and Dr Jacqui's work, but as nothing has been validated, and against the lab commercial interests, she advised my vet not to continue interferon (because Tam is asymptomatic ; she is "completely OK", no sign at all of any FIP matter), and to re-do if needed later.
March 20 I was in touch with Diane Addie (I'm currently trying to translate the fip-book in French) ; the problem is that cases of remission already happened in the past without any interferons - and failures with interferons too : so it is difficult to affirm that interferons are really the key.
I read about Ishida and german study. I guess interferons may help, but just help, not cure.
I also have to take in account that going to the vet weekly is a trial for Tam : this will not help her, for sure (as soon as she sees the crate Tam is hiding deeply, running into a rush - she really suffers to go to the vet, I think she had a bad experience during her transport from her board cattery to my home, and it is not the time to re-educate her right now).

Money is not really the problem: I want to be sure this would be really useful.

She is doing well for 2 months now, there is no difference before/after these 4.5 (she received what remained in the bottle last saturday - just half a dose) injections of interferons. I even don't know if these made her good or not : there has been no improvement, as there was nothing to improve (she already looked like she was healthy five days after the first "FIP-day").

I'm not that convinced interferons are key in FIP case. Tam is eating a lot of raw beef, I wonder if this is not better.

We did 4 interferons injections (once a week) current march (she was still "healthy" before we started - actually, she was ill only few days, she soon got better, and better, despite her results at FIP-profile ).
On Dr Addie advice and with her help, we've just started to give Tam some "Skulachev ions" ; we asked for FIP-profile at Glasgow vet university just before we started, so maybe we could see a difference between before/after.
Yes there was a big difference,
  • from Alpha-1 AGP  2240 in Jan 
  • to 540 before SkQ1 
  • then 500 which is normal on april 22nd (after 15 days of skulachev ions) and Albumine/Globuline is 0.84
Even though AGP is not a specific FIP marker ( it is raised with other infections ) it is great news consistant with recovery - way to go Tam! Virginie says "Champagne!" Take home message may be that we are in danger of giving up too easily once the idea of FIP is on the table; repeated drainage and at a pinch it seems prednisone, antibiotics and don't forget the raw beef, are potentially able to cure something + they are cheap. Even interferon added to the mix did no harm to Tam. "I cannot affirm interferons, or skulachev ions have cured her; my opinion is that Tam has recovered on her own, we've just helped her. I cannot affirm either Tam is cured ; she is still here 4 months later, growing, eating, playing and her results are very encouraging, that's all"

 Update March 2014 A year later Tam is still alive and well.

Her photo also reminded me of FIP's link to another lovely spring flower, the snowdrop, Galanthus Nivalis which may hold a cure for both FIP and cancer. see 'treatment' page.

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