Tomten - PCR negative for FIP

oh dear dredged out of my drafts so it's older than this by months but rest easy Tomten seems to still be fine as far as I know. This was written before Dr. Plotnick gave Cassie his helpful email in .

"The News I have been hoping for is finally here..... Dr. Ratti just called me a few minutes ago. UC Davis Vet Hospital just called her. Acting on Dr. Addie's advice she has sent a PCR of his effected tissue to a researcher there. The verdict is this is not FIP!!!!!! (second time in his six years I have heard that and its just as sweet the second time around. First time it was herpes when he was a kitten).

Since we had tested him last year when he first got sick for Lymphoma they have ruled that out. The current hypothesis is he has some foreign bodies embedded in the intestine that has caused the granulomas and with surgery maybe there is still a chance. Because it will be a complicated surgery (two granulomas) and he is weak she wants him at a full service surgery center with access to ultrasound equipment at the operating table and the 24 hour critical care. She will be researching Redbank and Garden State Hospital. Because Tomten is somewhat stable, not getting worse but not getting better she wants us to wait until after the Holiday week so where ever he goes they will have a full staff.

I am elated by the news but terrified for him. He will die without the surgery and with it at least I know he has a chance. He is truly a fighter. In his six years I have been told he is dying 4 to 5 times and he battles back. I hope he has it in him one more time.

The foreign body theory makes some sense to me as he has a bad habit of eating wrapping paper ribbon, rubber kids toys, and straw etc. As much as we try and keep these out of the house they sometimes slip in unnoticed. 3 months ago my son brought home a party favor bag and we didn't realize it was tied with wrapping paper ribbon. He got it ate , got sick and passed it... but I can't help but wonder if he didn't pass all of it. Ditto there have been numerous other incidents over the years so its possible.

Sorry I am rambling on today... A lot of emotion. We have been in Limbo with FIP for so very long." ~ Cassie

I don't know what to say other than Tomten is one sick cat. His fur has not been so shiny and nice apparently for the past month. One has to wonder if the interferon is contributing significantly by holding the herpes at bay or in some other way. I don't suppose you should just withdraw it after all this time - but the latest news on Tomten was he pulled through again and in  Cassie finally got some diagnostic insights and peace of mind from a very  unexpected source read on - where-do-you-go-when-your-cat has stumped all the vets?

Pikachu - a wobbly cat

Pikachu does not seem to have FIP although one vet he was taken to made this diagnosis. He was a wobbler (ataxia) because his brain or inner ear ( vestibular system responsible for balance) had damage after a viral illness but is getting better on PI (polyprenyl immunostimmulant) since early Nov 2012 " For the first few months, his ataxia waxed and waned, but now all that remains is a head tilt and the deafness. The head tilt seems to get worse/more exaggerated when he has a UTI or some other issue affecting his general health. He is doing really well now, although it took months to recover, and he still has a few neurological deficits. My only worry is that the virus may reactivate in his system and he won't be able to fight it off again"

"He was first diagnosed in September/October 2012. We took him to an emergency vet because he was ataxic (wobbly) and had nystagmus (shaking eyes). They originally diagnosed him with Idiopathic Vestibular Disease and said it would resolve within two weeks. When he didn't get better, we got a referral to a neurologist who did an MRI, Spinal Tap, FIP titer, toxoplasmosis test, etc., and said it was in his central nervous system and diagnosed dry FIP. After he became ill, we noticed he had lost his hearing completely. We were basically told to say goodbye to him, but you can't give up as long as you have hope. 

The neuro was ready to give up on Pika and really had no interest in PI or Dr. Legendre. I found the information on Dr. Legendre's success with PI and PUSHED the neuro to contact him and write the rx for the PI. Even after he contacted the university, he called me back and told me it was too costly and I should just put Pika down. It was unbelievably frustrating! I'm soo glad I didn't follow his advice. Even if the PI didn't help his situation, it certainly must have boosted his immune system in general and definitely didn't hurt him. " Kathleen Maki Potts

 She sent his results to the FIP fighters for opinions.

 "Pika's A/G ratio is 0.9. Anything above 0.8 almost always rules out FIP. A positive titer for FIP only means exposure to FCoV. It is not predictive of FIP. An extremely high titer, along with other suspicious lab results would make me think different. Also the 7b ELISA was negative. I would definitely explore some of the CNS stuff and it looks like your vet is doing a good job and looking at other things. You can always print out Dr. Addie's flowchart and provide to your vet if they start to explore the possible diagnosis of FIP again. The slightly elevated liver values can just be dehydration or a low grade infection."

Moki is a 'famous' facebook cat who seems to have a similar mystery wobbly problem but which didn't resolve, also initially diagnosed as FIP.

Murphy - misdiagnosis of wet FIP

Mischievous Murphy from Germany is a kitten successfully treated for bacterial peritonitis which was initially mis-diagnosed as FIP in April 2013 when he was 8 months old. Fortunately Jennifer did not give up. She found a second opinion from another vet, who although she could not rule out FIP even though his abdominal fluid tested negative for coronavirus, committed to save him and went for treating the treatable in the face of uncertainty. Murphy was given Suanatem (Metronidazole and Spiramycin) and recovered quickly.

This continues the series on misdiagnosis. Please make sure you check out Dr Addies's diagnostic algorithm's for FIP on treatment page before losing hope. And donate to FIP research which is working towards a fast and reliable diagnostic tool. In australia this is University of Sydney with Jaqui Norris.

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

 

Tomten might not have FIP

Goodnews/badnews update from Cassie nearly a year after Tomten was diagnosed with dry FIP and put onto interferon highlighting the difficulty with diagnosis:

"Tomten is hanging in there. I gave him the last of my interferon on Thursday night and now I am in a waiting game for the shipment to arrive from UK. I am praying it will be here on Monday. I injected him last week on Thursday, then Sunday then Thursday again. Just like last year after an injection he clearly responds for a few days so I am anxious to get him back on an every other day regimen. By Wednesday of this week he was spending all of his time in his favorite cat bed only getting up to use the litter box. He is eating but was being fed with "room service" several small amounts a day. After we injected him... he woke up at 3:30 am and got into bed with us. Friday am he woke up and followed me down to the kitchen to eat his breakfast. Last night he cuddled downstairs on my lap and even carried his favorite toy around for a few minutes.... its amazing to see his response after the injection so now we just have to pray we get the interferon quick!

On another positive note.. Dr. Ratti connected with Dr. Addie and shared Tomten's history... Dr. Addie doesn't think its FIP but has suggested another lymph node PCR biopsy but this time using a lab in California with a researcher who is has a lot of experience with FIP. Dr. Ratti is beginning to wonder if he could have a foreign body lodged in his intestine which could be causing the granuloma.. Here is to hoping we get the interferon fast and its not FIP."

just click the cloud button for the other posts about Tomten.

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.

Alfie

FIP is notoriously hard to diagnose if it is dry form - but even the wet form does have a differential.

Dear all,
Today we had to say goodbye to our 11 week old baby Alfie. 3 days ago he started to get sick; his appetite was gone, he was lethargic, I could feel his spine and ribs while his tummy felt "healthy" as if he just had eaten.

All these symptoms worried me, so I went with him to the vet the day after. They took blood samples to send to the lab. The abdominal puncture fluid was clear, colourless and not stringy.

The following day we got back the results from the lab and they were not consistent with fip. Today, we took him to a clinic for an ultrasound, a Rivalta test and an analysis of the puncture fluid. The Rivalta test was very clearly negative and through the ultrasound we learned Alfie had a congenital disorder; his pericardium contained not only his heart but also a big part of his liver... This is not a inherited disease but "just" something in the embryonic development that went wrong :(

Without surgery there was no chance for Alfie, so we didn't have a choice but to give him this chance and left him there for surgery later today. Unfortunately Alfie was already too weak or maybe just too young too cope with the anaesthetics and died even before the surgery could start. Obviously we are very sad about this...

For three days I lived with the sadness, stress and insecurity that a lot of you have been through too when you discover your kitten might have fip. I have been in contact with some of you and I searched the internet for information about fip and differential diagnosis while at the same time I was afraid to believe it could be anything else but the much dreaded fip... It's for this reason that I want to share Alfie's story. If you think your kitten might have (the beginning of) wet fip, insist on all the tests at once. Blood and puncture fluid analysis, Rivalta test and ultrasound of abdomen and thorax, because my Alfie is proof that this can give some of the symptoms presented by fip.

PS On the picture you can see Alfie in better days... We miss him so much :(

from Cattery SmittenKitten

Dr Pedersen's comments on expensive diagnostic tests

"Okay, I'm not going to do many graphic pictures, but I do not understand why veterinarians have so much trouble diagnosing it like me, okay. I do not understand it because there are just the two forms. There is the wet form and the dry form and sometimes there is a little intermediate as they can switch from one to another and you can catch them in that transition stage, but people seem to have a hard time making this diagnosis, and like Al said, if you have a young cat from a shelter cattery that has a distended abdomen and has this yellowish, mucinous fluid that contains the right kind of inflammatory cells, high protein… gee, what else is this? What else can we call it? And the problem that we have is that because the diagnosis of FIP as I said, once they become clinically apparent, they’re going to die, okay, and I tell you right now, they’re going to die. There is no treatment. Okay… that I know of, that has been successful to reverse this thing. Okay, so basically because it’s a fatal disease, people especially veterinarians, and especially owners and especially pathologists; do not want to tell you that this is a fatal disease. They say, just as Al says. You get tired of seeing a path report that describes, there's a clinical history just like FIP, lesions that cannot be anything but FIP and then they say, characteristic of FIP, typical FIP. What does that mean? You tell me, does it have FIP? Just tell me.

And so, the problem is that in any of these kinds of diseases where there is a 100% mortality and believe me, owners are just as guilty because owners will push that risk, and is there a chance that it is this, or it is that, toxoplasmosis is one million, you know, is it the mycosis, one in a million, you know, all of these things, and so, they are always grasping for stuff and they are pushing it, and the more they push you, the more diagnostic tests that you ask for, and the problem is that hardly any of those diagnostic tests are 100% correct. And so, even the PCR test maybe only 80%. Immunohistochemistry might be 70-80% depending on what you do. The blood work is not 100%. They are all just little things that help you make the diagnosis, but there is not a single test that’s simple, short of taking a biopsy or taking some fluid, and doing a specific test by a lab that knows what they are doing, which is another problem, okay, to get a decent result back. And then, you know, then there are still veterinarians refusing to believe that antibody titers are not necessarily diagnostic, so they will continue to do the FIP virus serology on a whole bunch of cats. One cat will die of FIP in the cattery. They will test every cat for $30 or $40 a cat, and then they’ll get the results back and then they will say, “Well, I don’t know what they mean.” So then they’ll call me up. Well, I didn’t order 50 serologies at $50 a piece, you know, and so they wanted a free consult, you know, as far as I never charge for consults, but they want a consultation as to what that test means, well, no veterinarian should ever ask for a test that they do not know how to interpret it.
If the results come back [Applause] if the results come back and they can’t interpret it, why the hell did they ask for it in the first place?"  from WINN feline foundation 2011 FIP symposium