Tomten - Where do you go when your cat has stumped all the vets?

A: a cat specialist - case solved by Dr Plotnick! http://manhattancats.com/
The first blog post on I wrote on his case was the Winter Tomten "Yuletide " the midpoint of winter - the cosmic balance between life and death". I feel like we are poised on such a tipping point - and i cant help thinking being in the southern hemisphere the december solstice signals the descent." If you want to follow his story in graphic detail use the labels to find the other posts but now for the news i should have updated months ago! Tomten was originally thought to have FIP around the same time as Mishka. He had already started feline interferon so I drew a lot of strength from the kindness of Cassie answering my emails 2 years ago. For Cassie the drug was a really really big ask as it is hard to import to the USA as well as super expensive. 

"He who asks a question is a fool for five minutes; he who does not ask a question remains a fool forever." - Chinese proverb

 So glad her persitence paid off: June 2014 Cassie posted -

Finally a possible explanation for Tomten's illness. Ok I have truly crossed over to crazy cat lady. While making Tomten's next appointment for his Cardio check up I began feeling frustrated that he still has no diagnosis. So I broke down and submitted an e-mail to Cat Fancy magazine's ask the doctor. I felt a bit silly but figured what could it hurt? 

My 7 year old Devon Rex has stumped all the vets he has seen. 2 years ago he stopped eating, started throwing up and was hiding. An emergency trip to the local ER showed that he hadgranulomatous tumor in his intestines. An aspiration of the tumor ruled out lymphoma and based on his blood work he was diagnosed with dry FIP. He was put on feline interferon and methyl prednisone and sent home to die. Only a “miracle” happened and he appeared to get better over the course of two months. Three months after diagnoses scans showed that his tumors had disappeared through his lymph nodes remained swollen and abnormal. 12 months after the first tumor appeared he stopped eating again. Scans showed 3 new granulomatous tumors one of which was in danger of perforating his bowel. At this point his vet moved him to an excellent large regional vet hospital. They consensus was that he didn’t have FIP (based on his longevity). Since he was no longer responding to the feline interferon the thought was to do surgery to remove the tumors. All 3 tumors where removed in a double bowel resection and subsequent gram staining of the tissue was negative for FIP. He appeared to recover for a bit and then went into a tail spin hiding and not eating. He was placed back on the methyl prednisone and within a week was recovering once again. 3 months later he developed an ear polyp and infection and lost his balance. A month of antibiotics and dedicated ear cleaning and he recovered much of his balance but his counter surfing days where behind him. When he was being evaluated to remove the ear polyps it was discovered that his heart had become greatly enlarged and he was in heart failure. We made the decision to leave the ear polyps and focus on managing his failing heart.

Tomten has been lucky to have better care than many human beings and we are very grateful to his vet teams, who have given him an additional two years of life. The vets have all been unanimous that what ever is causing his health problems is an unknown and perhaps is some sort of an autoimmune disease? While we have tried to make peace with the fact that we will probably never know what is wrong with him its hard not to wonder if we took him somewhere else would someone know what is causing his condition? And could we do anything to stop it other than to treat each symptom as it comes up.

Dr Plotnick's Reply:

I think the ear polyps and the heart disease are separate issues. Devon Rexes are at increased risk of developing hypertrophic cardiomyopathy, which is the heart disease I suspect he has. As for the intestinal disorder, it sounds like your cat has granulomatous enteritis. This is a mysterious illness. Inflammatory bowel disease is a common disorder in cats. With IBD, most cases are due to infiltration of the intestines with either lymphocytes and plasma cells, or with eosinophils. These are types of inflammatory cells. Every now and then, we see a case that doesn’t fit into this pattern. We see what they call granulomatous inflammation. In these cases, the intestines are infiltrated with lymphocytes, plasma cells, macrophages, neutrophils..a whole mishmash of inflammatory cells. It often affects a discrete region of the intestine, rather than diffusely infiltrating the intestines. (Diffuse infiltration is the more common scenario.) (The disease has sometimes been called “regional enteritis” because it affects a discrete region of the intestine). FIP likes to cause granulomatous inflammation, but not all cases of granulomatous inflammation are due to FIP. When granulomatous inflammation is seen on an intestinal biopsy, the specimen should be stained with a special stain that detects coronavirus in the tissue. If the stain comes back positive, the cat has FIP, and the prognosis is terrible. If the stain comes back negative, it rules out FIP. However, the prognosis for granulomatous inflammation in the intestine is unknown. It’s a mysterious disease that no one has really figured out. Some people try steroids, and they work for some cats, in some cases. Other people suggest surgically removing the affected area. There are no big case studies of cats with this type of enteritis, so we don’t really know what the best treatment is. Unfortunately, I think the best approach is the one you’ve been doing, i.e. treat the symptoms as they come up. With him having heart disease, steroids are not recommended because steroids expand your cat’s blood volume, which can put a strain on the heart. I’m not sure how you would treat another bout of granulomatous enteritis if it were to develop again. Good luck with him. I hope he does well.

Dr. Arnold Plotnick

I've asked Cassie for an update - i know some on the facebook group had reccomended the raw diet as she was investigating IBD - Irritable Bowel Disease.  

PS. I love Dr Plotnick's idea of a cat only vet - cats hate the fuss and stress of a regular clinic full of dogs. Poor Mishka's worst moments were not from FIP so much as the 'system' - I won't spoil this feelgood post with the details of that - contact Dr Plotnick http://manhattancats.com/

Tomten - thoughts on inflammation

"drink the wine drink the wine- music, good friends, I'm not dyin' today" ~ Tori Amos

Tomten has been doing the Lazarus cat dance back from the brink for past eight months. He was heading downhill in late June and a surgery was performed hoping the granulomas were from a foreign body like string. However he crashed after the surgery and was very poorly for several weeks.

"Tomten continues to fight but is growing steadily weaker. He has taken to spending the entire day in a pile of stuffed animals in the kids play room. My husband can get him to eat a little bit. He is becoming wobbly on his feet. My husband is still hopeful and when he eats I am too but in my gut I think he is in his final weeks."

But his vets didn't think he was in pain, didn't toss in the towel and a week later on July 26th he turned the corner with last ditch antibiotics, steroids and high energy paste.

 Cassie wrote - "I am scared to to even post this in case it jinxes us but Tom has had a great two days. Since going on the last ditch antibiotics and back on pregnazone (sic) and the high calorie paste he is feeling so much better. He is eating!! He is hanging out with us and Gizmo instead of hiding in the stuffed animal pile. When he got sick last year we did 3 things. Interferone, prednasone, and a course of antibiotics for the herpes which was bad. Since surgery Tom was off the pregnazone and he had antibiotics on the operating table but none since. Keeping my fingers crossed he is turning a corner but too scared to hope. Is it possible he has 18 lives?"

I wonder if I've been underestimating the support antibiotics can provide an ailing cat - even if it's not the primary illness, knocking down the numbers of bacteria multiplying out of their normal range due to host debilitation, may allow the cat enough space to muster his reserves for the fight. "lipo polysaccharides (LPS ) from many bacterial species will initiate acute inflammatory responses in mammals". Maybe we should have tried harder with Mishka's lump.

So his ultrasounds didn't show any other lumps - he went back to happy and active. And Cassie was back to square one diagnostically.

"He continues to do well since the antibiotics and the return to Pred. I caught him playing kitty smack down with Gizmo last night first time in 3 months. I don't know who was happier Gizmo or me. I think Gizmo was letting him win since he out weighs Tomten 3 to 1 at this point. Tomten couldn't have a more loving brother. Now that I have him back again my thoughts are turning to how do I keep him alive and delay the granulomas from coming back. I started doing some internet research trying to figure out what besides FIP causes granulomas and responds so dramatically to antibiotics and prednisone. I came across Inflammatory Bowel disease (IBD). The literature says its rare but can cause granulomas."

 Some informational links and my thoughts on IBD and inflammation:

• http://feline-nutrition.org/health/feline-inflammatory-bowel-disease-nature-and-treatment - My gut feeling (haha a pun) is that Feline Irritable Bowel its not far off human IBD. What you eat determines the gut microbiome. We have a little human friend who had to have a fecal transplant to get rid of his awful colitis. He is a very sick boy who is now off all his meds! Anyone with Crohn's disease or colitis who wants to get cured contact Dr Borody in Sydney.

• http://www.2ndchance.info/inflambowelcat.htm Although i dont have direct cat experience with IBD per se I noted our other pets have better skin on a proper raw diet, which I imagine reflects the state of the gut as it is basically the same as skin - both are made of epithelial cells. Mishka was the big diet fail - i always thought she'd come a cropper on dry food diet but figured (wrongly) I had time to transition her to a 'better' diet. Wrong again - commercial petfood is just wrong, I had no idea it was all so dreadful until she got ill. Now i know even the tinned food, though 'complete', is still highly inflammatory.

• http://raypeat.com/articles/nutrition/carrageenan.shtml  - carageenan is seaweed - not meant to be eaten by cats but it's the thickener in most commercial petfood. It is known to incite inflammation, in fact it's used experimentally to do just that when you need to make a wound to test a cure on!  I have no idea why they dont use gelatin instead, which is anti inflammatory and being connective tissue supplies all the right things for building connective tissue for both humans and animals http://raypeat.com/articles/articles/gelatin.shtml

 

Dorothy - Somewhere over the rainbow

Today I got the news that Marcelo's cat Dorothy has also lost her 8 month fight with wet FIP.  Marcelo is in Brazil, not a native english speaker so it was hard to piece together her story. From what I gather Dorothy had a litter of kittens and developed wet FIP of the abdomen last year around the same time as Mishka. The effusion resolved on corticosteroids and human interferon by late october 2012 when Marcelo wrote to the facebook group for advice:

"Hello everyone, news on Dorothy condition. She is still doing fine, playing and eating, but she is not gaining any weight, is there anything I can give her as a supplement to food? Thanks for any help you can share."

Members reccomended Nutrical and a change from her kibble diet to something like Hill's a/d. John Robbie's mum reccomended colostrum powder (which I then started to give to Mishka who was not a fan of Nutrical as JR has been doing fantastic on PI) 

 "I've used Colostrum powder mixed wither with some water (force feed if they won't drink it) or added to wet food. I have used it on John Robie since he's eating well, but I used to give it to my FIV+ cat when he started declining as well as to unhealthy rescue dogs and cats. It really helps with weight gain and overall health and builds a healthy immune system."

Dorothy was given Nutrical twice daily. On November 22 it seems she was also started on PI and the steroids were weaned. In december 2012 she was on 1.0 ml Interferon and reduced from 2 ml to 1.5 ml of PI. but Marcelo did not say  how often she was taking these. In January the dose was further reduced to 1ml of PI and still 1ml of Interferon. In february after Mishka died Dorothy was still alive and very well. "Dory is better than ever, she is still on PI and Interferon, also on Nutri-cal. She seems to be in normal health now."  

Alas she suddenly crashed - like Mishka. Perhaps this is the best that PI can do for wet FIP, perhaps it's better to just leave it out and use the steroids early with interferon.

"My friends, yesterday was a very sad day for me and my wife, Dory health was downhill since last week, it was fast and cruel, so we had to put her to sleep. It seem that even miracle cats ends like this with this terrible disease."
Goodbye Dorothy dear ... if anyone deserves to wake up in heaven FIP cats do.

"Someday I'll wish upon a star And wake up where the clouds are far behind me."

 

Madiera

“Some people don't really know enough to make a pronouncement of doom” ― Norman Cousins, Anatomy Of An Illness

Madiera is a year old kitty who had spontaneous resolution of ascites. She was diagnosed with wet fip end of march 2012 around 12 weeks of age.

It is lovely to read about a genuine recovery that demonstrates the bodies natural healing compared to healing that is often termed 'spontaneous' but where the patient has worked jolly hard at repelling the problem. I am reminded of Remarkable recoveries - a speech by Ian Gawler - he recovered from osteogenic sarcoma and his story kickstarted a holistic cancer cure movement in Australia. i think i read in Ian Gawler's biography "the dragon's blessing" something like spontaneous remission - there was nothing spontaneous about it!

She lives with Nicole Griffin-MacKenzie who sent this picture in to the FIP fighters Facebook group (our correspondance copied with permission)

August 19 2012

This is a pic from now, 5 months later and the fluid is still completely gone. ( she loves showers ) we are very blessed. Just wanted to share because I feel there is hope

NICOLE: She's not on anything just takes pedialyte 3x a day for her stools to stay normal. The first time she was tested by the veterinarian it was with a sample from the fluid in her abdomen, then dr Legendre requested a second test to be done ( due to the fluid disappearing ) and again the tests pointed to FIP , we were going to do the PI and that's why we were speaking to Dr. L but he stated to let it be if she is doing so well
Still doing great ( knock on wood) October 8 2012

• 

  NICOLE: We got her in February, at 8 weeks so she will be a year next month. We didn't change her diet at all. We stuck with the same kitten food that she was on. The only thing we changed was giving her pedialyte. When we thought she had weeks to live I we were giving her a tablespoon of vanilla ice cream at night but that changed as soon as we noticed her abdomen going down. She was urinating a lot during this time ... Which I'm sure has nothing to do with it

  November 27, 2012
• ME: wow what brand vanilla icecream! who knows you may have stumbled onto THE CURE. i'm only half kidding. the urine was the fluid going out. what breed is she? there is 'spontaneous resolution' ie her immune system kicked in on its own; thymus gland is still there i think at 8 weeks, it is not so active in older cats. when did she get sick?

  November 28, 2012 at 12:09pm
   
• ME: i better explain my self about the vanilla icecream - if you read the anatomy of an illness as perceived by the patient by norman cousins and see what he did. i have been searching for the equivalent of funny things for a cat. icecream may be the thing.

  November 28, 2012 at 12:11pm
   
• 

  NICOLE: I think it was hood Boston vanilla bean

  November 28, 2012 at 1:03pm
  
  Madiera was still well and taking her 3xdaily pedialyte when Nicole sent me copies of the tests in December 2012.

• 

  open in a new window and use the zoom function of your browser

  otherwise download from here - Madiera's blood tests

  
  

and here is Madiera all grown up in Jan 2013 - a sleek young lady

UPDATE MAY 2015 - Madiera is still a happy healthy cat!

Noms

 

Food does not come in a pyramid for Mishka, just - Noms or Antinoms. (nom = sound cat makes head down in plate of  yummy food "nom nom nom") Strangely curcumin extract. ground eggshell, the appallingly black fulvic minerals, and Dr Wheatgrass extract which all cause my human child to gag are acceptable cat condiments.

Noms - fish, roast chicken, roast lamb, mashed pumpkin, Kraft cheeseslices,whey powder, raw egg yolk, grass and wheatgrass even though this sometimes makes her gag or even throw up (the kitty equivalent of alcohol? so nom i don't care about hangovers?)

Antinoms -raw meat, beef, ascorbic acid, spirulina, glandular, Hills a/d, chicken liver, beef liver, liver powder, liver flavouring, did i mention liver?

Tish's list is of course the complete reverse - except for spirulina - evil green pond sludge which no one except me thinks is acceptable. Mishka will reject the entire plate of food if it contains a particle of antinoms the size of a nailhead.

So of course a raw diet is just what the doctors Addie (FIP research), Lipkin (virus hunter) Kremer (HIV expert below) ordered for our purebred princess. Ziwipeak (airdried meat - fits into the definition of a raw diet as it avoids high/low temp processing ) and raw eggyolk are the closest she gets to a primal diet.

The experts mention L carnitine which is the one amino acid I thought a carnivore would have trouble being deficient in. Turns out we can cook the nutrition out of anything; 

" dog and cat foods are extremely low in free L- Carnitine levels as compared with that found in raw ground beef. Most pets are maintained strictly on commercial pet food diets and are thus kept chronically deficient in L- Carnitine. " Lack of Carnitine causes muscle weakness including heart disease. http://meowmeowmom.wordpress.com/2008/05/05/the-carnitine-conundrum/

Carnitine is easy to get as a powder - but the acidic form has a sour taste which cats loathe. If you cannot pill a cat who won't eat raw try QUINICARN chicken flavoured powder Supplement For Dogs & Cats "Supports Body's Defense Against Physiological and Metabolic Stress" cat dose 250 mg daily

Kremer's Nontoxic AIDS Therapy and Prevention

I am slowly reading a scholarly work on HIV/AIDS by Heinrich Kremer, 'The Silent Revolution of the AIDS- and Cancer-Medicine' A complete summary of the book is available online - http://www.aliveandwellsf.org/kremer/ it has the lowdown on what kicks a system from th1 to th2 and how to prevent that; makes so much sense, like a universal theory of disease. I cut to the healing section yesterday. it has some reccomendations which may translate well to cats. the key is to avoid oxidative stress and support the glutathione levels in the body; FIP cats have low plasma glutathione. it is why dr addie wants us to add arginine to the diet for FIP as a couple of teaspoons of raw red meat a week - again i'm researching precise dose levels for supplemental powders as Mishka won't eat raw ( so much cheaper and easier if she would just eat the meat raw! Amino acid supplementation is fiddly - stuffing up ratios causes much more harm than good.)

NAcetylCysteine NAC another key antioxidant in the glutathione chain may also be useful both as treatment and preventative.
"N-acetylcysteine (NAC) is a chemically modified form of the dietary amino acid cysteine. Cysteine and NAC contain sulphur, which is key to protecting the body from damage by oxidation. Other sulphur containing antioxidants include alpha-lipoic acid and glutathione. Glutathione levels are considered the most reliable indicator of the body's resistance to oxidation, and NAC plays a role in glutathione metabolism. While touted by many supplement manufacturers as a precursor to glutathione, NAC probably has more of a sparing effect. That is, it neutralises oxidants in place of glutathione, allowing glutathione levels to be maintained." http://www.manorvets.co.uk/pet-sub-sub/972-n-acetylcysteine/

Having a girl's look

“There is nothing like looking, if you want to find something. You certainly usually find something, if you look, but it is not always quite the something you were after.” J.R.R. Tolkien

The long words really get to me sometimes "Bovine dialyzable leukocyte extract"? Is that a nice name for bloody extract of squished cow? There seems to be a possibility of a scam in the supplements labelled 'transfer factors' - some FIP cats are getting http://transferfactor-4-life.com/thesecretoftransferfactors.aspx
I think however there is legitimate research: As Prof Lipkin says - raw meat is full of goodies!

http://www.sciencedirect.com/science/article/pii/S156757690400219X
Bovine dialyzable leukocyte extract (bDLE) is a dialyzate of a heterogeneous mixture of low molecular weight substances released from disintegrated leukocytes of the blood or lymphoid tissue obtained from homogenized bovine spleen. bDLE is clinically effective for a broad spectrum of diseases. To determine whether bDLE improves survival and modulates the expression of pro-inflammatory cytokine genes in LPS-induced, murine endotoxic shock, Balb/C mice were treated with bDLE (1 U) after pretreatment with LPS (17 mg/kg). The bDLE improved survival (90%), suppressed IL-10 and IL-6, and decreased IL-1β, TNF-α, and IL-12p40 mRNA expression; and decreased the production of IL-10 (P<0.01), TNF-α (P<0.01), and IL-6 (P<0.01) in LPS-induced, murine endotoxic shock. Our results demonstrate that bDLE leads to improved survival in LPS-induced endotoxic shock in mice, modulating the pro-inflammatory cytokine gene expression, suggesting that bDLE is an effective therapeutic agent for inflammatory illnesses associated with an unbalanced expression of pro-inflammatory cytokine genes such as in endotoxic shock, rheumatic arthritis and other diseases.

Hoping the ever helpful Dr Norris will comment soon. The amazing claims for some supplements are worse than hair product ads. It pays to be skeptical and do your due diligence though the horrible knowledge that FIP is a rapid disease means this is a real dilemma. In hindsight I would like to erase the two week delay popping homeopathic drops on an intermittently febrile cat while I tracked down and checked out feline interferon (FOI). Hence I hope this blog will be helpful to others in some way rather than just more to read and worry over.

Where iz my cheezeburger?

 " A great many things in my life would be different if only I could open the door to the refrigerator. "~ Henri, le chat noir

 

 Grains and carnivores - not a happy mix

It is nice to have Mishka back to normal - hunting around the house in the wee hours for snacks ... bang bang bang at 4 am opening cupboards, finding her in a pile of kibble ....

oh crap - waiting for the sound of puking

She was vomiting again on tuesday evening / wed morning. Perhaps it was a bit of plastic from chomping into the loaf of fruit bread on the bench, or the bread itself.  Thankfully settled by midday but for many hours I thought it was all over though she is stronger; still playing with me after 4 chucks! took five to take her down a bit, and she remained well hydrated. Previously one or two chucks made her a limp fur rag. She was examined and cleared by our vet for continued treatment, so drained again wed pm and perked up straight way as usual - so we put it down to scoffing kibble accidentally left out for the other cat on top of the illicit snacks. We are not serving even a  mouthful of this junk food even as a treat anymore though she does miss it since Friskies Indoor was all she ever ate when she came to us.

Mishka wasn't particularly fippy belly leading up to the vomiting so it caught me by surprise. Might be magical thinking but let's pretend the fluid is slowing down marginally. After a week we only drained 465 mls. The time before we took off that much after only five days. No hairball has come up, and also no grass yet even though she has also scoffed her nommy new wheatgrass today which astonishingly seemed to make her feel better almost immediately.

Firstly i stopped the curcumin and pentoxifylline cream since they can both upset the tummy with no difference in Mishka's constitution except she is happier ( the pentoxi cream was was getting increasingly unsettling applied even just twice daily instead of the required three. i wasn't going to renew the prescription as it hasn't made huge inroads into her disease for the emotional cost - just tried replacing it with curcumin as the anti-inflammatory. We haven't missed the prednisolone.

Curcumin extract suggested by a friend was originally rejected because i thought it would be hard to dose ( not true ~ she likes the flavour or ignores it but it stains fur pink! ) and I have read it may be immune suppressive although possibly in away that is ok For starters it hammers the TH1 and TH2 systems even handedly  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1810449/ 
Too many long words - waiting on comment by Dr Norris. We can't get Thorne brand Curcuvet in australia but herbs of gold sell an easy to get product containing the same bioavailable Meriva extract Thorne uses.

And still waaaiting for the customs clearance to get PI - come on Santa!

Lessons from Dr. Lipkin

"SARS was contained not because of a drug or vaccine but because we identified people who were infected or at risk, and we isolated them." ~ Prof Ian Lipkin MD

"When DISCOVER features editor Pamela Weintraub interviewed Lipkin last year, his dog, Koprowski was desperately sick. Lipkin had a treatment plan: not an antiviral drug or chemotherapy, but red meat. “It has antibiotics, it has growth hormone, it has everything"
Ian Lipkin is a virus hunter who was instrumental in helping China get control of SARS beginning with easy low tech things like soap and water for handwashing. He treated one of the first cases of AIDS successfully for a while with the new but existing technique of plasmapharesis to remove the antibody complexes that were causing his patients neurological symptoms.

Let's follow Lipkins lead and treat FIP with these things. Raw meat Mishka wont eat so until i can get hold of raw goats milk shes happily eating a kitty powershake - undenatured whey and colostrum powders, a teaspoon of each mixed with a teasoon of water daily, and raw egg yolk - yum!

FIP shares some similarities with SARS they are both corona viruses, and AIDS a disease of marked immune dysfunction.

Here's Mishka - Half the cat she was. She's leaking about 100 mls of fluid and protein a day into her peritoneum from damaged blood vessels - if we opened her belly up we would see little lumps called granulomas everwhere as the body tries unsuccessfully to destroy diseased cells that are nestled in the tissues like splinters. Collateral damage inflames the blood vessels - so far everything we have tried has not stopped this.
I have to wonder if plasmapharesis would have any success - UC Davis uses it for dogs with myesthenia gravis just as it is used in humans with this disease which inspired Lipkins AIDS treatment.