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 - 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?

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.

Tomten's Birthday

"...for us physicists believe the separation between past, present, and future is only an illusion, although a convincing one." ~ Einstein on the death of his friend Besso

Just wanted to drop a note to say that Tomten & Gizmo celebrated their 6th birthday last week! Yeah! Happy Birthday Tomten & Gizmo! For those of you who are newly diagnosed and feeling at a total loss. I wanted to share that bit of news. Tomten was diagnosed July 1st 2012 with dry FIP. He has been on the feline interferon and pred ever since. While he has his good days (totally normal mischievous Devon Rex) and his slow days (sleeps all day and scares us to death) his quality of life seems good. We never thought we would see this birthday so we celebrated with a nice long walk outside on his leash, a can of tuna fish, and plenty of cat nip! I don't know how long he has but we treasure each day! Thanks to everyone who helped him see this birthday! ~ Cassie (details of treatment here )

Many happy returns to Tomten and his littermate Gizmo (who doesn't have FIP)! Cassie is so thoughtfully posting his updates to keep our spirits up  as we watch the steady stream of kittens dying from FIP on the FIP fighters facebook community.
This month Mihoshi Barner - the little Ferret with FIP who has been on PI for over a year, passed away leaving a very sad owner behind. Ferrets do not live as long as cats so in ferret years I wonder how old he was? Mishka was 27 in accelerated cat time when she died, which is some sort of cold comfort. Tomten and Gizmo are the equivalent of 41 human years old wow, nearly middle aged by the catyears calculator ( in the right column menu overthere ) - no wonder he's catnapping all day. Hiphip hooray! Kill Da virus!

Gizmo on left Tomten on right

New Years Tomten

"Winters come and summers go, year follows year. but as long as people live at the old farm in the forest, every night the Tomten will trip around between the houses on his small silent feet."

Cassie from New Jersey just updated Tomten's status and the news is great!

"Hi everyone,

I just got back from Tomten's ultrasound. Good news. No GI tumors. His Lymph nodes are still enlarged but have visibly shrunk since last September's scan.

Bad News: Dr. Harrison who has secured the the Virbagen Omega from the UK and helped Dr. Ratti with his treatment plan is leaving Animerge for Chicago. (Good news for all the felines in Chicago!!)I have reached out to Dr. Ratti to see if she can take over ordering his meds. I bought a 24 week supply so hopefully we have some time.

I have also suggested to Dr. Ratti we do the feces PCR to see if he is is still possible for the virus. Though my bank balance might want to defer that for a few weeks as the ultrasound and 24 week supply of his liquid gold was steep!

He had a great weekend. Wrestling with his brother, counter surfing, hunting bugs... Right now he is cuddled up next to his brother Gizmo and the two of them are on the ottoman looking out the window at our lake and watching the geese. Its too cute.

I hope everyone's furry friends have a good day as well.

Cassie"

The Christmas Tomten

“Winters come and winters go, Summers come and summers go, Soon the swallows will be here.” thinks the 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.

Mishka has been going 4 months on the FIP roller coaster. She's on Feline interferon twice a week and a weekly abdo drainage and one week into a trial of PI to see if we can tip the balance over toward life.

There are a few other kittens diagnosed around the same time still alive and well including Tomten - who is named after a scandinavian gnome who talks to the cat in tomten language, "a silent little language a cat can understand."

Nov 2012 "Our biggest fear in the storm was how to keep the feline interferon cold when we lost power. (My vet is importing it from the UK). Jan 1 will be the six month mark so we are thinking about doing another ultrasound then to see how everything looks. Knock on wood Gizmo also seems ok. Not sure how Gizmo would ever handle it if we loose Tom as they are inseparable." ~ Cassie

Gizmo and Tomten, the darker kitty who has FIP, live with the Hallbergs in New Jersey USA. He was diagnosed back in July 2012. His mom Cassie posts updates to the FIPcat support yahoo group. In october his dosages were prednisone 2mg daily and Feline Interferon injections .4ml weekly. Now it is down to every 2nd day for the prednisone and every ten days for the interferon.

Good Yule Tomten and family! Here is a video interpretation of the children's book 'The Tomten' to enjoy http://www.youtube.com/watch?v=ABMDcIJp784

Wednesday, December 12, 2012

Hi everyone- sorry its been a while since I posted. Hurricane Sandy did a number on our internet.

Tomten continues to do well. He will be at the 6 month mark since his initial diagnosis on Jan 1st 2012 (Big Day!!!) So for everyone who is new to this site and feeling at a total loss (That was me 6 months ago) there is hope!

For the most part he continues to do well. He is now on the feline interferon injections once every 10 days plus Prednisone every other day. The last two weeks he was a bit withdrawn and less active but the last two days he seems back to himself. (we live in total dread when his behavior changes the least little bit)

I took him and his brother Gizmo for their annual check up last Saturday. His regular vet (he also sees an internal medicine specialist who is leading the FIP treatment) was amazed by him. We decided to never vaccinate him again so as not to stress his immune system. She also took some blood to run a blood pannel. Both Vets agree that they want to rescan him again in January to see if the intestinal mass is still gone and if the lymph nodes are still inflamed.

I think his blood pannel looks much better: The Alb/Glob ration has gone from .44 back in July to .9. Which I think means no longer consistent with FIP. They key change is the alb which in July was 2.2 and now is 4.4. The glob hasn't changed much, its gone from 5.0 to 4.9.

There are some parameters that are really high but Dr. Harrison (the internal medicine vet was pleased. Marlene I would love to get your thoughts on it....

Bets wishes to everyone,

Cassie

Tomtens blood panel

CHEM 21 with COMPREHENSIVE CBC : CHEM 21 (1272)
Test Result Reference Range Low Normal High

ALK. PHOSPHATASE 6 0 - 62 U/L

ALT (SGPT) 35 28 - 100 U/L

AST (SGOT) 30 5 - 55 U/L

ALBUMIN 4.4 2.3 - 3.9 g/dL HIGH

TOTAL PROTEIN 9.3 5.9 - 8.5 g/dL HIGH

GLOBULIN 4.9 3.0 - 5.6 g/dL

TOTAL BILIRUBIN 0.0 0.0 - 0.4 mg/dL

DIRECT BILIRUBIN 0.0 0.0 - 0.2 mg/dL

BUN 37 15 - 34 mg/dL HIGH

CREATININE 1.2 0.8 - 2.3 mg/dL

CHOLESTEROL 142 82 - 218 mg/dL

GLUCOSE 114 70 - 150 mg/dL

CALCIUM 11.8 1
8.2 - 11.8 mg/dL

PHOSPHORUS 4.2 3.0 - 7.0 mg/dL

CHLORIDE 118 111 - 125 mEq/L

POTASSIUM 3.7 3.9 - 5.3 mEq/L LOW

SODIUM 157 147 - 156 mEq/L HIGH

A/G RATIO 0.9 0.4 - 0.8 HIGH

B/C RATIO 30.8 HIGH
INDIRECT BILIRUBIN 0.0 0 - 0.3 mg/dL

NA/K RATIO 42
HEMOLYSIS INDEX N 2

LIPEMIA INDEX N 3

Comments:
1. RESULT VERIFIED BY REPEAT ANALYSIS
2. Index of N,+,++ exhibits no significant effect on chemistry values.
3. Index of N,+,++ exhibits no significant effect on chemistry values.

CHEM 21 with COMPREHENSIVE CBC : CBC COMPREHENSIVE (1272)
Test Result Reference Range Low Normal High

WBC 6.3 4.2 - 15.6 K/uL

RBC 8.07 6.0 - 10.0 M/uL

HGB 12.8 9.5 - 15 g/dL

HCT 39.7 29 - 45 %

MCV 49 41 - 58 fL

MCH 15.9 11.0 - 17.5 pg

MCHC 32.2 29 - 36 g/dL

% RETICULOCYTE 0.1 %
RETICULOCYTE 8 3 - 50 K/uL

NEUTROPHILSEG 58.8 35 - 75 %

LYMPHOCYTES 30.5 20 - 55 %

MONOCYTES 5.0 1 - 4 % HIGH

EOSINOPHIL 5.4 2 - 12 %

BASOPHIL 0.3 0 - 1 %

AUTO PLATELET 192 170 - 600 K/uL

ANISOCYTOSIS SLIGHT
REMARKS SLIDE REVIEWED MICROSCOPICALLY.

ABSOLUTE NEUTROPHILSEG 3704 2500 - 12500 /uL

ABSOLUTE LYMPHOCYTE 1922 1500 - 7000 /uL

ABSOLUTE MONOCYTE 315 0 - 850 /uL

ABSOLUTE EOSINOPHIL 340 0 - 1500 /uL

ABSOLUTE BASOPHIL 19 0 - 100 /uL
_______________________________

14 December  2012

I love CR!!!! Cure is better but I love Clinical Response.

His total protein has gone up from 7.2 in July to 9.3. His Calcium has also gone up from 7.7 to 11.8.

He is eating well. Tomten has always lived to eat. I notice he sometimes now eats smaller amounts and then goes back and finishes it off 15 minutes later. In July his weight fell to 8.0 lbs he is up to 9.6 lbs.

Unfortunately he is addicted to fancy feast cat food which I fear may not be the most healthy but per Dr. Addie's recco I am supplementing it with a teaspoon a day of either Applepaws chicken, Tuna, Salmon. And he is getting raw steak 3 times a week. (Which he loves!!!) Makes up for the injections which he is increasingly getting more agitated about.

I will keep you posted on the scan in January.

For everyone who is new to the site and feeling hopeless (that was me in July- after all this was his second diagnosis of FIP- the first being a misdiagnosis when he was a kitten and actually had herpes. And I figured he couldn't get lucky twice and this was it). Hang in there! There is hope. Every day I have with Tom is a gift. I don't know how many we will have but we all treasure each day we have with our goofy fur ball and his brother.

Thanks to everyone for your continued support!

Cassie
__________________________________

22 September 2012

Subject: [FIPCatSupport] Update on Tomten- still doing well

Hi Everyone,  Its been a while since I posted. I contacted Dr. Addie and she agreed to consult with Dr. Harrison to see if Tomten really has or had fip and if he does to give us some advice on how to manage him since he is doing so well on the feline interferon. Now I am just waiting for the two to connect. Knock on wood he continues to do well. Went for a walk on his leash today outside and he was in kitty bliss!We are so grateful to still have him with us.

Dr.Addie was extremely helpful she suggested we immedietly take him off the L-lysine paste he has been taking for herpes since he was a kitten. Apparently, it interferes with the L'argine uptake. She also recommended we add raw red meat to his diet which Dr. Harrison is open to. So he is now getting chopped steak everyday and canned salmon from COSTCO. The steak is expensive but compared to the feline interferon a relative bargain! I also just ordered some applaws from amazon.com. Hopefully they will like it. His brother is super finkly and they really love their fancy feast but I am increasingly concerned I am feeding them yummy junk food. So we will see how it goes with the applaws.

Tomten is doing great but he is losing patience with us jabbing him every week. Upsetting for me as my once "velcro cat" is now nervous every time I pick him up that he is going to get jabbed. So hard because we can't explain it may be whats keeping him alive. But that being said the weather today was amazing and he loved going out for a walk with his brother.

One super goofy FIP moment is the family has taken to singing to Tomten and his brother Gizmo every night the "Kill the virus song" Modeled after Elmer Fudd's of bugs bunny fame "kill the wabbit song". I don't know that its helping but makes us all laugh and that seems to make the cats happy.

best thoughts to everyone, Cassie

14 January 2013 - click here for Tomtens update Great News!