Gus - pentoxifylline success part 1

Gus is the kitten of a pregnant shelter cat who was kept by hs mother's foster carer Nicole after she rehomed his mom and siblings. He was a more mature cat, and physically strong when he started getting sick. He never got very dehydrated or stopped eating so he stood a much better chance when Nicole went in to bat for him with Prednisone and Pentoxyfilline. These anti inflamatory drugs are easy to get and relatively cheap. pentoxifylline was an early choice for treating wet FIP that didn't pass trials - we still tried it, as have others on the facebook group.

Gus was a big cat- at 2 yrs old, he was 13 lbs! At one point, I sensed something wasn't right with him. He seemed lethargic (wouldn't interact with new kittens, in the past we had called him "Uncle Gus" because he always took the foster kittens under his wing, grooming and playing with them). He also felt bony along his spine- and his belly was bloated. I will admit, I wasn't too concerned at first. I thought worst case scenario, maybe he had gotten worms from one of the foster kittens he loved to groom. After a few weeks when he was still wasn't being his usual self, I took him to the vet.

October 26, 2103 The day my world crumbled.

I went in expecting a Dx of Giardia or a tapeworm... relatively easy fixes. Instead, I was told Gus had wet FIP. The vet actually withdrew fluid on the spot from his belly and showed it to me - thick, yellow, protein filled fluid. And he weighed 10.5 lbs. Still hate myself for not noticing the huge weight loss.All his lab values were abnormal , and he had a fever to boot. 

Initial lab work

I cried ( that is an understatement) in the exam room for about half an hour before i was gently escorted out.The only hope the dr. could offer me was palliative prednisone to improve appetite and the kind offer to come to my house to do the euthanasia when the time came.

I immediately started him on pred, and frantically searched for a second opinion/treatment options. A friend of mine worked for a local vet, and she told him my story. I reached out to him, and after a lengthy phone consultation he mentioned a drug called Pentoxifylene. He said it might help prolong his life. It's a drug normally prescribed for humans, for autoimmune disorders. A pharmacy in Arizona (Diamodback Drugs http://www.diamondbackdrugs.com/contact-us/) compounds it into animal dosages. I brought Gus to see him in the hopes that he would disagree with the original Dx. He broke my heart when he said all signs pointed to wet FIP and he couldn't go against my primary vet's Dx. BUT - he suggested the Pentoxifylene, saying it could potentially help prolong his life.

After 9 months on prednisone and pentoxifyllene Gus visited this vet again. His A/G ratio which had been very low, was back up and the other values that had been abnormal were all good.

New lab work

All lab values were normal, and the ultrasound showed NO fluid in his abdomen. His old chart had a WBC of 30,000 and very abnormal liver/kidney functions. And a fever. His WBC is now 9,000, within normal limits. He is also back to his playful mischievous self, a very happy cat. The difference between the two was amazing. The vet said if he did not know Gus's history he would say he was a perfectly healthy cat.

I am grateful for every day I have with him, and I don't mean to offer false hope. I know FIP is a terminal illness. All I know is that he is seemingly happy healthy and no longer shows any signs of the disease. Part of me hopes he was misdiagnosed, but another part of me hopes that maybe he did (does?) have this dreadful disease and there is in fact, hope. I am slowly weaning him off the meds while monitoring him constantly for any signs of a relapse. My heart goes out to everyone who is dealing or has dealt with this terrible disease. I'm fully aware Gus may be (probably is) living on borrowed time. I just feel like I need to share this in the hopes that it can help another.

 Gus part 2 http://onecatlife.blogspot.com/2015/05/gus-pentoxyfylline-success-part-2.html

Gus - Pentoxyfylline success part 2

Continued from part 1 http://onecatlife.blogspot.com.au/2015/01/gus-pentoxifylline-for-fip.html
Gus's foster carer Nicole kindly answered my questions in detail - texting on a phone! That's dedication for you.

Diet- no special diet. Gus always ate just Purina dry indoor formula. Once he got his Dx, he was spoiled rotten and I added canned friskies plus whatever protein I happened to be having for dinner- shrimp, ham, turkey, ect. Whatever he wanted. He was never put on an antibiotic that I can recall. When Dr. Ciance of Allenwood veterinarian hospital (in Allenwood NJ 732-528-7444) Dx'd  him she put him on 2 ml of pred a day to stimulate appetite and make him feel better. She also prescribed doxy ( doxycycline? a  broad spectrum antibiotic ) in pill form but I couldn't get him to take it, and her opinion was to not force it on him, let him enjoy his remaining time. We may have tried liquid, I can't recall. But he was never on antibiotics for an extended period of time.

Uncle Gus

Then I took him to Dr. Falk (Ocean County Veterinarian Hospital Lakewood NJ ). He was so kind and compassionate, even recommended a support group for me. He looked at the initial bloodwork and agreed that it looked like FIP. (see Gus's labs in previous post) He suggested adding pentox in addition to the pred. So, he was on 2ml of pred and 1 ml of pentox daily. This went on for about 5 months, the whole time Gus very slowly lost his belly bloat, gained muscle tone, and became more energetic. The two meds combined cost about $90/m from Diamondback, including shipping. (60 ml bottle of chicken flavored prednisolone and a 30 ml bottle of chicken flavored Pentoxifylene.) Always got the meds in about 3-4 days flat rate mail but I do believe they offer offer expedited shipping as well. They were great and very easy to deal with.

Gus tolerated the pred well, he did NOT tolerate the pentox. I would say on average he would vomit 7/10 times after I gave it to him. Broke my heart. I tried mixing 1ml of pred with 1/2 ml of pentox 2x daily, that was a little better but he would still throw it up occasionally. I played around with the timing and what seemed to work best was giving it to him about an hour after he ate. 

( Note: when we tried Mishka on pentox we follwed the advice to use a cream - she had no upset other than she didn't exactly like cream smeared on her ears ) Please note how careful they were about not taking Gus off any meds until he was definitely better on bloodwork and they wean slowly.

He isn't on any meds at all now, hasn't been since October 2014. When Dr Falk did new bloodwork and declared him either misdiagnosed or "cured", we decided to ween him off all meds. I stopped the pentox almost immediately since he hated it so much- did every other day for about a week and that was it. I went much slower with the pred, as u know u can't just stop it cold turkey. I slowly decreased his dose over a month, down to 1ml, then did 1ml every other day for about 2 weeks, then 1/2 ml every other day for about a week, and that was it.

the Fab4 including Gus

I Have fostered about 75-100 kittens over close to 3 years... as far as I know none of them have ever been Dx'd with either form of FIP. I did have 2 pass away from dehydration and Giardia (they passed away 2 days after I had them, they were in very bad shape when I took them in). Every other cat/kitten has been a success story as far as I know. I have 3 other cats and none of them have ever had any major ailments -unless u count my 12 yr old Oscar just having 5 teeth pulled Poor guy.

Yes, I stopped fostering. I actually had 12 wk old brother and sister kittens in my house when Gus was diagnosed, I immediately had the rescue take them back (a friend's mother has since adopted them both)!

Gus is strictly and indoor cat. I live on a busy street. I fostered his pregnant mother and he has been with me every day since birth. My mother kept his mother and his sister, and I keep in touch with the woman who adopted his brother and other sister. As far as I know none of them have had any major health issues to date.

John Robbie

"My beautiful John Robie. Still doing well 8 months after his FIP diagnosis. He is a miracle thanks to PI. ( Polyprenyl Immunostimulant ) " ~ CatMom: Lisa Cone

7th Dec 2012

John Robie on the stove - a favorite place. 33 weeks on PI and still going strong!

Happy Catmas John Robie and Lisa!

The charming Jon Robbie is named after the antihero of "To Catch a Thief" since he stole Lisa's heart!

• John Robie (approximate BD of June 25, 2010). 

  "John Robie is an active 2 year old, curious, kittenish loving brat. His Dry FIP is concentrated in his intestines and it can be uncomfortable for him to poop (he meows in the cat box), but he's otherwise a normal cat and has even gained some weight. He actually looks (and acts) like a normal (but not fat) teenage cat. It is difficult to remember that he has a fatal disease. But, he's a feisty one and strong. He bounced back from exploratory surgery like it didn't even phase him. I think I knew then that he was going to be my fighter and he sure has.

  He was dumped in a parking lot at 5 weeks old and found by me. He's probably some exotic mix as he is VERY different from all of other street cats. He had terrible fleas and ear mites when I found him and a slight URI but was otherwise healthy. He was just going to be a foster, but he was too amazing and I fell in love, so he became a part of a household with 8 other cats. When he was a year old, I fostered 3, 4 week old kittens for a few months. He was always and indoor cat. He started losing weight in late March and we took him in to our vet almost immediately. My normal vet diagnosed FIP immediately and told me he had a few weeks tops. I have too much experience with vets not being proactive so I went exploring. A client of mine (I'm a pet sitter) had a recent great experience with a vet that works with pug rescue (I also have pugs) so I took him there for a second opinion. They were much more proactive, did exploratory surgery, took a biopsy and was willing to work with getting him PI. 

  That vet was Airport Irvine Animal Hospital Irvine, CA. They also started him on Prednisone, Trental (pentoxifylline) and an appetite stimulant right away. He responded pretty well right away to the meds. We got approved for PI and he started on that on April 7. I weaned him slowly off of Pred, but when we got to the point where he had stopped the pred completely, he started doing badly again. I upped the pred to normal dosage again until he stabilized again, then weaned him down to .25 mg every other day. He has remained on .25 pred every other day, 1/8 Trental every other day and PI every other day since then and it has been the perfect combination thus far. 

  Oh, one other thing...None of the 8 other cats in my household (who are older than JR) have shown any signs of FIP (yet), nor have the foster kittens that were "raised" by JR shown any signs of FIP. I hope it stays that way. " ~ Lisa

  
  

  Amen to that.
  

  April 2013 update:

  
  

  

  still doing amazing!
  John Robie is still on Prednisone at one year. A dose of .25 ever other day seems to be the ticket for him. He does NOT do well when he is off completely.
  

  May 2013 update:

  His update is currently in flux. He was stable on the same dosage of all 3 meds. We decreased his Pred and he took a turn for the worst.

  We upped it back up to the original dosage then slowly decreased it weekly. As of 2 days ago, he is started showing symptoms again with the Pred at .25 every other day.

  So now we have increased it again to .25 every day.

  Hopefully that will stabilize him.

  The trental and PI dosage remains the same.
   
  Fortunately John Robbie is back to his playful self on the daily prednisone. Please be cautious when the cat is doing well; they really do look normal and start perhaps fussing about medications so that people try to scale the medications back. I have collected several case histories of cats who have had problems when their doses were scaled back like Abbey. Oliver Mackinnon takes his 5mls of PI DAILY for 3 years and only now is starting to think about scaling back, Blade has been chugging along on his meds for 2 years - if it ain't broke dont fix!

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!