11-12-2009, 10:46 AM
I’ve had inquiries on how the kids are doing on their treatment for Tritrichomonas Foetus (TF) so I thought I’d just share it with you all.
We started treating the 3 raggies last Thursday, 5 November. I intended on beginning on the 4th, but mama was still very nervous about undertaking this adventure and I just couldn’t pop that first pill into their little mouths. I have read nearly every medical abstract, article and snippet of information I can find on this parasite and of course paid very close attention to the drug therapy, but even after going to the extreme of educating myself about the parasite and drug, after phoning others who have had very similar frustrating experiences and have treated, some using the much higher dose than what is currently recommended, I was still emotionally unable to take that first step. One would have to know my life history, which I’m not about to share, to understand my mindset.
After I received the diagnosis I was of course initially relieved that we had found a cause for the intractable diarrhea but then the relief turned to anger. Anger at the veterinarian community where I live that allowed this to continue as long as it had which ultimately left one with severe diarrhea to the point she began to drop weight. They were provided documented proof that the parasite was a possible cause for their symptoms but were uninterested or still in willful denial about TF. The suffering she endured should not have been allowed to happen. She had 24 consecutive days of explosive diarrhea that completely exhausted her and we had no hope for relief in site.
I made arrangements to stay home during the duration of the treatment. I wanted to be near them incase of any emergencies. From all that I read, if “initial” reactions are caught early and medication stopped, it could prevent any serious complications. I didn’t want to take any chance that if a reaction were to occur I wouldn’t be there to catch it. I sure didn’t want any life threatening issues to arise as I’ve sadly lost all trust in the clinics I’ve dealt with so far.
Nov 5:
The first pilling of the kids went without a hitch tho I immediately experienced the worse case of heartburn imaginable and hit the medicine chest. They of course were immediately provided a treat following their dose, which in this house is canned pumpkin. They LOVE the stuff. I don’t think I slept much that night, as I had to wait for the spouse to get home to help so the pilling took place at around 6 pm. I worried if I slept and something happened I wouldn’t be there for them.
Nov 6:
Early that morning Madisyn presented us with a fairly formed stool. It was quite odd looking, mottled with blood (which she had been passing since it started in her) and seemed almost as tho some of it was coated. Perhaps the medicine? Or maybe the TF leaving the colon? Maybe mucus? There was NO smell. Another thing that jumped out at me was the diameter of the stool. Since she got sick, she never had anything larger around than what would come out of a tube of toothpaste. However what she passed was what I would consider normal, the diameter of like the short chunky tootsie rolls, but all pretty much in one length. I anxiously awaited deposits of the other two. Phoebe didn’t make her deposit until nearly 7 PM. Phoebe’s was just like Madisyn’s and the runs were gone! She went from squirts to nearly formed in around 24 hrs after the medication. Sam followed close behind Phoebe and his was just like his sisters. In only 24 hours after medication we’d gone from 40 to 50 poo leavings a day from the group to only 3. Unbelievable!!! It was at that point I felt I made the right decision for our family and suddenly my drug treatment anxiety left.
Nov 7:
All went well and the kids each went only once. Form was better, but we had a bit of smell again, color remained the same, a bit odd. Not too bad tho. Madisyn still had some blood intermingled in hers.
Changes I noticed –
Phoebe no longer sat around in that all too familiar position they do when they don't feel well, drawn up, sometimes even when she walked around. She now seemed relaxed and stretched out when resting. No constant running to the litterboxes. Bum looked much less irritated and the redness was nearly gone.
Maddy and Sam seemed more active, alert and playful and stayed active all of the previous day until late afternoon without benefit of naps.
While I considered them active and playful before treatment, this is a whole new experience. I’ve never seen them fly through the house like this before and for such long periods of time not resting until 2 in the afternoon. Perhaps TF was affecting them more than I realized. They are definitely feeling their oats and I see no rest for me in the near future. They have now decided to bathe again. There was little grooming going on for the past month.
Nov 8:
All continued to go well, stools looked better. Madisyn still had a bit blood in hers. Energy levels remained extremely high…….I need help. It may be time to consider hiring a furkid entertainer.
Nov 9:
Again, all went well, stools continued to improve and no noticeable odor. Maybe we have the TF on the run. Energy levels continued to rise……oh when will they tire!
Nov 10:
Stools looked mighty fine! No smell, pretty firm and we had a BULLET or two. Yeeehaawwww! Yeah, I know, I need a life, but you have no idea what this means to them and to me. They hopefully are on the road to wellness. I’m considering adding a jungle gym. Do they make them interactive?
Nov 11:
Phoebe’s poo is exceptional! Not quite bullets, but much drier and it broke apart before landing. I noticed NO smell, and color is getting back to normal and no noticeable blood. She’s still not squatting, stopped when the really bad runs started, but maybe one day she’ll do so again. Madisyn and Sam’s look good too. We’re almost there. I feel bullets coming.
The boxes are for the most part unused with mostly wee balls. Madisyn seems to be a two a day gal and the others are appearing to be once a dayers. Unbelievable! Be still my heart. Half way through the treatment and no drug reactions thus far and for that I am extremely thankful. Activity levels remain high. I think I need to start going to the gym so I can get into condition and be competitive with the kids.
Nov 12:
WE HAVE BULLETS! Madisyn and Sam have produced some mighty fine bullets this morning! Phoebe is withholding her deposit but after yesterdays I have no doubt she too will join the bullet brigade. Only 7 doses to go and maybe then I can breathe.
They are currently racing through the house and I have a feeling it will continue throughout the day. They have taken to now exploring new things, both good and bad. I would now compare their behavior to the "terrible twos". Of course what one doesn't think of one of the others will take it from there. My heart is happy at the moment and I am so thankful that this treatment will soon end and then maybe we can all move on as a healthier family.
UPDATE 19 December:
On the ninth day, while on medication, I noticed a bit of a change in the smell, diameter and form which remained through the rest of treatment. They still only produced one or two stools a day. The smell would come and go as the days passed while on medication.
On the sixth day after the medication was finished, our oldest once again deposited the mudpile with horrible odor, tho I believe it was not the same smell we had grown accustomed too. This smell made me gag. The next day the other two did the same thing. I phoned the vet and relayed the latest. We decided to retest on their 15th day after completing their medication. By the time the test day came, two of the three were back to full blown runs. We received the re-test results on the 11th of December. The results for two of the three were negative, but the other came back “suspect”. Our vet phoned the lab and it was explained that on the PCR if 2 bars show it’s a positive and if no bars shows it’s negative. The suspect test result had 1 bar showing so they are going to rerun it. From my vets explanation to me, she said that since they had previously tested positive they felt they needed to rerun this one test. They had some equipment breakdown, so they were unsure when to expect the rerun test result. We had hoped we’d hear a test result yesterday, as it begins on a Monday and finishes on a Friday, but no call came and the vets office never phoned the lab to find out the status.
After the samples were sent, our vet put the kids on fortiflora and it did seem to help the form some, tho we often still have stinky poo. They are each going a minimum of 4 times a day now, mostly soft serve icecream and much narrower than they had been while being medicated and for the few days after treatment. Bum baths are once again a daily ritual. Our vet believes that their colons have been damaged by the TF and that things will not improve. She is at a loss as to how to proceed to help them, should the final test result come back negative.
I’m trying to come up with some options I can run by my vet. One question I have is should I try with holding all food for 24 hrs to let the gut rest? Of course they would have water. I’ve read on some sites that it has helped with some kids regarding diarrhea. After resting the gut, what food should I try? More of the same? Or a total change? We already have runs and loose stool.
If we don’t rest the gut, we thought about transitioning them to another diet. They are free fed a mixture of RC Kitten, Eukanuba Kitten and IAMS Hairball (equal portions of each). The kids range in age from 6 months to 10 months. I did ask her about possibly trying a commercially prepared raw diet for awhile to see if that would help them and maybe settle the colon. She did not recommend I go down that road. Of course, this is the first vet I approached, begged and then demanded that they test for TF, as they were one of "TF is only found in cows" vets, so I take her immediate alarm of feeding raw with......a grain of salt. I have fed them cooked chicken and rice and it didn’t seem to help and they have been on canned pumpkin twice a day for quite some time. If I back off the pumpkin they go from loose to runs.
Prior to the TF diagnosis, they had been tested, retested, reretested for giardia, etc, cultures were done and PCR Diarrhea panels. That’s why I feel that if they had more than one issue going on, we would have found that before we found the TF and that maybe it’s just colon inflammation now?
Anyway, I have to do something. Having one special needs kid is hard, but with 3 we are emotionally spent. I was thinking maybe we should try grain-free? But there are so many foods out there I wondered if any of you have a favorite one we could try. My vet suggested I phone some manufacturers about foods for sensitive colons for kittens. With all the diarrhea we’ve had for months we’ve been hesitant about feeding canned but I don't know how feeding them canned can make them any worse then they are now.
I was so hopeful with the initial result after starting the medication that we could all move on, but I’m at a loss now how to at this point. So, if these were your kids, what would you ask your vet to do?
UPDATE: 1 January 2010
Well, we’re still waiting on the “rerun” retest result (since the 11th of December). Still no word from the university through our vet as to the status either which is making me a bit unhinged and our vet too.
While the Vet’s Best seemed to be helping somewhat, I decided to contact a holistic vet clinic 60 miles away for another opinion. I thought maybe they might know of some magic herbs or possibly acupuncture that might give them more relief or complete resolution of loose stools. The clinic hadn’t heard of TF but did look it up in a book. They had multiple vets but would rather have a certain one look at them and they would be gone for another 10 days. So being the impatient mama that I have become, I contacted my rescue gal and we came up with a plan. We decided to make some diet changes immediately. We rested their tummys for 12 hrs and began feeding them Tuesday morning their new kibble, Life’s Abundance (LA). LA was created by a veterinarian. It contains no artificial flavors, no artificial colors, no corn or corn gluten and no wheat or wheat gluten. It also contains some digestive enzymes which I thought might help them. We are also giving them ¼ can of the LA wet food in the evenings. Along with this we are giving them 5 pieces each of two different supplements they also sell. Much to my kids dismay, they are no longer getting their pumpkin fix nor am I giving them the Vet’s Best supplement. The first morning we left the house without them having their pumpkin, I thought a riot was going to breakout. Those poor, sad little faces. I felt guilty all day and wondered what surprises would await me when I got home from work. Would the stools be worse?
Our kids usually are by the door when we come into the house and then after a love session they quickly head to the litter boxes. The first night after the diet change was no different. Phoebe’s stool was VERY loose, not quite runs, but darn close. Sam’s was actually pretty good and Madisyn’s was somewhere in between. So, a couple quick bum wipes and we were good to go. They seemed to enjoy the wet food and had no problems eating their 2 new supplements. I anxiously awaited for morning to come. Since they’ve never had anything but kibble, except when we tried cooked chicken and rice, I wasn’t sure what to expect after they ate canned food. I don’t think I slept much worrying about them having extremely loose stools during the night or come morning.
I got up and checked the boxes, normal ritual around here and much to my surprise, no poo. I put on some coffee and they decided to each make a deposit. All were somewhat formed stools much to my relief. They did eat a generous amount of the kibble during the night as the bowls were all low. We decided to replace the pumpkin time with one of the supplements and that seemed to make them and us feel less like they were being deprived.
Upon our return from work the evening of day 2, they made their usual deposit and I found only one poo from during the day. So, we have slowed down the frequency of stools, which has to be better for them. Now maybe they’ll actually absorb some nutrients from what they do eat. For months now I’ve felt like all I was doing was removing from the litter boxes the entire amount of food they consumed.
We are now on the end of day 4 and I have to say, they are doing better. Frequency is still minimal and the stools are more formed than not. We don’t have bullets but I’m encouraged more now than I was with just the Vet’s Best and pumpkin and hairball formulas, etc. So, that’s the scoop. I'm hoping that in time, their colons will settle and we will once again see bullets flying around here. If it gets no better than what we now have, then at least it should be manageable lifelong for them and for us. We of course still hope that in the weeks that pass they will continue to improve. Thanks again for all the support in our continued effort to heal our kids.
UPDATE: 18 January 2010
Well, I wish I had better news but after my last update, the kids once again sank into the dark deep whole of diarrhea more than formed stool. I contacted the lab to inquire once again the status of the rerun test. Several hours later, my vet phoned. We were told late last friday the stool sample had been destroyed through some reagent while trying to clean it up to retest. Of course there were apologies all around, etc., but we've waited weeks for the lab to get back up and running and now have further delay as a new sample has to be sent. Our little cherub cooperated this morning and I'm off to the clinic to get it on it's way. The earliest we expect results now is 29 January. At this point I’m not sure what I hope for, a positive test which would explain why nothing has helped and to have to risk treatment again with the drug or a negative test which means either there is still another medical cause yet to be determined or perhaps permanent damage to their colons.
I continue to hear from others who have confirmed TF, suspect TF or need information to share with their vets. Somehow they are comforted to know that there are others out here that are battling the same stool issues. I wish they'd post about their experiences, but I understand why some do not. It is a very trying ordeal, day after day, and I guess most feel others would find it hard to comprehend how difficult this situation is to deal with. I guess one of the sadest parts of all this is that many of the breeders of these folks I hear from have had no support or communication from them once a diagnosis is made or when trying to get information from the breeder on if they themselves are experiencing stool issues. It's like these breeders clam up and cut the cord. It further frustrates those that are trying to either find the source of the infestation or need help in seeking diagnosis and treatment. I applaud these parents for their diligence and doing the best they can for their kids.
I emailed NC State asking if they have recent statistics on TF they have published or if they are capturing any for later publication, but have received no response yet. I'm curious to know how many tests have been run, what were the results, is it more common in one part of the country than another, do purebreeds seem to test positive more than domestics, what are the numbers of followups, i.e., retests to confirm treatment success or failure, and if failure not due to drug protocol, what possible theory do they have for failure, etc.
We took such care to ensure our kids were DNA tested for HCM, current on vaccinations, etc, but little did we know that such a difficult parasite was lying hidden in the depth of the colon. If we were to adopt today, I would not without having our prospective kitty tested for this and assurance from the breeder, in the contract, that the kitten was TF negative. I regret not getting pet insurance, but am unsure just how much of this expense would have been covered anyway. So for those of you here who are adopting little ones, please be aware that TF is real and tho not much research has been done to observe the infected colons that have gone untreated there have been several studies which showed the penetration of the colon tissue much deeper than was thought which some feel could re-emerge years later as irritable bowel disease or irritable bowel syndrome.
Off to the clinic…….once again!
UPDATE: 6 February 2010
Retest Result - Last week we received the retest results for our “suspected TF” child and it’s negative. I must say the negative test result completely took me by surprise and the word shocked still doesn’t match my magnitude of emotion at hearing the test result considering they were all back sliding again. I know something is very wrong and expected confirmation that TF was still the cause and to eliminate that through this last result brought immediate depression. We also had been previously told that even Dr Gookin had expressed an opinion a few weeks ago that she was sure the test would be positive but wait for the result.
As of this date, all have returned to full blown diarrhea and the smell, that wonderful familiar smell. After popping up and down all night last night (and countless other nights) to scoop poo, wipe bums and cry, I’m sure we are still dealing with TF despite this last negative PCR. Only a parent of another TF kid can understand what I’m talking about. The aroma is distinct and forever etched in my nasal memory banks. At first whiff now it sickens me and I can only wonder what they must think and how they deal with all this. This morning each sniffed the other, bums covered in poo, and then immediately tried to cover their siblings as they knew what they smelled definitely needed to be covered. If this weren’t so sad it’d be funny. I couldn’t wait for dad to wake, I had to drag him from his bed for kitty bath time.
TF Outreach - While we were waiting for our retest result, several weeks ago I contacted a veterinarian out of country who has seen TF in his clinic and in those he bred. He confirmed some of my own assumptions and it was nice to hear from someone educated to back them up. In his country, TF began to appear in 2005 in pedigrees, i.e., Maine Coons, Ragdolls, British Short Hairs and Bengals. In his experience, even kittens that had been hand-reared after 24 hours with the mother have been infected, leading him to believe infection could occur at or very near to birth. He also said that there does appear to be some natural resistance to infection, as whole litters of kittens were not always affected. He mentioned it was possible that kittens wouldn’t show signs of diarrhea until after they had been re-homed which means breeders could be spreading the disease unknowingly. He said the more he looks for TF the more he finds and the true prevalence of the condition is likely to be high. He advises breeders to maintain strict biosecurity.
Testing/Treatment – My new TF contact said he’d found that even some kittens heavily infected with TF have produced “false negative” PCRs. He’s found that by taking samplings of stools over the course of ten days and pooling them together before taking a snippet of this “pooled stool” to send off for testing has greatly reduced the number of “false negative” PCR results. I’m still not clear on how he maintains this “pool” but will ask him to clarify this in my next novel, I mean short plea for help. He said from my description “his gut tells him they still have TF” and he recommended we retreat them at (30 mg/kg) for 3 weeks and increase the fiber content of their diet, something like Hills ID or ZD or similar. He stated he had a 100% resolution in stools following this protocol and he’s so confident that his catteries are TF clear that he guarantees that his kittens are TF free at point of sale.
Low level of infection - After this last test result I’ve been searching for stats on “false-negative” PCRs for TF. In all that I’ve read, a “positive” is just that, but at no time will a “negative” result prove or guarantee that the eradication is complete. There is a recommended retesting protocol and it’s believed if over the course of retesting (for periods of over a year) if none are found to be positive and they remain asymptomatic, then they should be okay. If they remain negative but are symptomatic (diarrhea) then look for coinfection or retest for TF again.
In some of what I’ve read, if the infection rate is “low level”, again, it could go undetected. The PCR test we used showed in a 2002 paper that it had a detection limit of 100 percent in samples that contained 100 organisms per 200 mg of feces but only a 90 percent detection in samples with 10 organisms per 200 mg of feces. The size of the sample sent for testing is about the size of a lima bean (400 to 500 mgs) so I guess if it’s low level, you have a much smaller chance of getting that small bit which contain the organisms. Maybe one would have to wait for the blood and mucus to return before it may be high enough to detect? Since they have active symptoms, one would think it would show up, but then again, I guess that’s not always the case. I do know on the initial submissions all contained mucus. TF likes to bind to the Mucus so maybe that’s why we found it the first time.
What to do - Since I’m not one to “treat” for things that can’t be proven, but given the rapid deterioration of the stools this past week, that may be the path we take. The financial and emotional burden has been great in first getting the diagnosis (the most expensive) to treatment, retests…….etc. After reading about “low level” infection and the likelihood of “false negative” PCR tests and my correspondence with my new found vet, I find it difficult to continue to pay for tests that may or may not show infection while they continue to suffer with intractable diarrhea. They were positive for this, they continue to have diarrhea (6 days after the previous treatment) so it would seem likely to me that we are still dealing with TF. If we are to believe the previous test results and repeated test results on all other known causes of intractable diarrhea (yes, diarrhea panels via PCR) then it seems likely to me that what they did test positive for is a higher probable cause. But then like the TF PCR, these other PCR tests for the normal parasites too have their failings.
I’ve gone over all this in short conversations with our vet. Sometimes I think she wishes we’d move on as in try another clinic……..as she’s as frustrated as we are at this point. She is more than willing to prescribe medication once again despite the negative test results and for a longer period of time if that’s what we desire. I will give this more thought………
As always, thanks for your support and well wishes……….
UPDATE: 13 February 2010
Perhaps I should rename this thread “The diary of a mad cat mom” as the stool issues and the impact on our lives is making me a bit crazy and depressed. I’ve not felt this helpless since I became chronic with my own illness on 21 May 2001. You may notice I just posted my 6 Feb update. I didn’t post my last update because it’s very hard to sound hopeful to others dealing with this. I hate to burden others with our trials and tribulations as I’m usually a very private person and keep things to myself and I’m not sure any of my ramblings are helpful to others, but for those so inclined, read it if you wish.
We’re still trying to remain optimistic about all of this, but as each day passes it’s nearly impossible to do. I’d say we are pretty much as we were pre-diagnosis regarding their stools. I reluctantly clipped their breeches last week to help in daily cleanups. I will be contacting our vet on Monday and discussing our options - retreat without positive test, purchase pouches to do some daily sampling for her to interpret, or let it run its course which doesn’t appear likely that this will ever end. Dad just arose from bed and Maddy is a mess……..so off to the tub we three go. Each night I dream of finding the answer only to wake up at that precise moment of what it is……..
We started treating the 3 raggies last Thursday, 5 November. I intended on beginning on the 4th, but mama was still very nervous about undertaking this adventure and I just couldn’t pop that first pill into their little mouths. I have read nearly every medical abstract, article and snippet of information I can find on this parasite and of course paid very close attention to the drug therapy, but even after going to the extreme of educating myself about the parasite and drug, after phoning others who have had very similar frustrating experiences and have treated, some using the much higher dose than what is currently recommended, I was still emotionally unable to take that first step. One would have to know my life history, which I’m not about to share, to understand my mindset.
After I received the diagnosis I was of course initially relieved that we had found a cause for the intractable diarrhea but then the relief turned to anger. Anger at the veterinarian community where I live that allowed this to continue as long as it had which ultimately left one with severe diarrhea to the point she began to drop weight. They were provided documented proof that the parasite was a possible cause for their symptoms but were uninterested or still in willful denial about TF. The suffering she endured should not have been allowed to happen. She had 24 consecutive days of explosive diarrhea that completely exhausted her and we had no hope for relief in site.
I made arrangements to stay home during the duration of the treatment. I wanted to be near them incase of any emergencies. From all that I read, if “initial” reactions are caught early and medication stopped, it could prevent any serious complications. I didn’t want to take any chance that if a reaction were to occur I wouldn’t be there to catch it. I sure didn’t want any life threatening issues to arise as I’ve sadly lost all trust in the clinics I’ve dealt with so far.
Nov 5:
The first pilling of the kids went without a hitch tho I immediately experienced the worse case of heartburn imaginable and hit the medicine chest. They of course were immediately provided a treat following their dose, which in this house is canned pumpkin. They LOVE the stuff. I don’t think I slept much that night, as I had to wait for the spouse to get home to help so the pilling took place at around 6 pm. I worried if I slept and something happened I wouldn’t be there for them.
Nov 6:
Early that morning Madisyn presented us with a fairly formed stool. It was quite odd looking, mottled with blood (which she had been passing since it started in her) and seemed almost as tho some of it was coated. Perhaps the medicine? Or maybe the TF leaving the colon? Maybe mucus? There was NO smell. Another thing that jumped out at me was the diameter of the stool. Since she got sick, she never had anything larger around than what would come out of a tube of toothpaste. However what she passed was what I would consider normal, the diameter of like the short chunky tootsie rolls, but all pretty much in one length. I anxiously awaited deposits of the other two. Phoebe didn’t make her deposit until nearly 7 PM. Phoebe’s was just like Madisyn’s and the runs were gone! She went from squirts to nearly formed in around 24 hrs after the medication. Sam followed close behind Phoebe and his was just like his sisters. In only 24 hours after medication we’d gone from 40 to 50 poo leavings a day from the group to only 3. Unbelievable!!! It was at that point I felt I made the right decision for our family and suddenly my drug treatment anxiety left.
Nov 7:
All went well and the kids each went only once. Form was better, but we had a bit of smell again, color remained the same, a bit odd. Not too bad tho. Madisyn still had some blood intermingled in hers.
Changes I noticed –
Phoebe no longer sat around in that all too familiar position they do when they don't feel well, drawn up, sometimes even when she walked around. She now seemed relaxed and stretched out when resting. No constant running to the litterboxes. Bum looked much less irritated and the redness was nearly gone.
Maddy and Sam seemed more active, alert and playful and stayed active all of the previous day until late afternoon without benefit of naps.
While I considered them active and playful before treatment, this is a whole new experience. I’ve never seen them fly through the house like this before and for such long periods of time not resting until 2 in the afternoon. Perhaps TF was affecting them more than I realized. They are definitely feeling their oats and I see no rest for me in the near future. They have now decided to bathe again. There was little grooming going on for the past month.
Nov 8:
All continued to go well, stools looked better. Madisyn still had a bit blood in hers. Energy levels remained extremely high…….I need help. It may be time to consider hiring a furkid entertainer.
Nov 9:
Again, all went well, stools continued to improve and no noticeable odor. Maybe we have the TF on the run. Energy levels continued to rise……oh when will they tire!
Nov 10:
Stools looked mighty fine! No smell, pretty firm and we had a BULLET or two. Yeeehaawwww! Yeah, I know, I need a life, but you have no idea what this means to them and to me. They hopefully are on the road to wellness. I’m considering adding a jungle gym. Do they make them interactive?
Nov 11:
Phoebe’s poo is exceptional! Not quite bullets, but much drier and it broke apart before landing. I noticed NO smell, and color is getting back to normal and no noticeable blood. She’s still not squatting, stopped when the really bad runs started, but maybe one day she’ll do so again. Madisyn and Sam’s look good too. We’re almost there. I feel bullets coming.
The boxes are for the most part unused with mostly wee balls. Madisyn seems to be a two a day gal and the others are appearing to be once a dayers. Unbelievable! Be still my heart. Half way through the treatment and no drug reactions thus far and for that I am extremely thankful. Activity levels remain high. I think I need to start going to the gym so I can get into condition and be competitive with the kids.
Nov 12:
WE HAVE BULLETS! Madisyn and Sam have produced some mighty fine bullets this morning! Phoebe is withholding her deposit but after yesterdays I have no doubt she too will join the bullet brigade. Only 7 doses to go and maybe then I can breathe.
They are currently racing through the house and I have a feeling it will continue throughout the day. They have taken to now exploring new things, both good and bad. I would now compare their behavior to the "terrible twos". Of course what one doesn't think of one of the others will take it from there. My heart is happy at the moment and I am so thankful that this treatment will soon end and then maybe we can all move on as a healthier family.
UPDATE 19 December:
On the ninth day, while on medication, I noticed a bit of a change in the smell, diameter and form which remained through the rest of treatment. They still only produced one or two stools a day. The smell would come and go as the days passed while on medication.
On the sixth day after the medication was finished, our oldest once again deposited the mudpile with horrible odor, tho I believe it was not the same smell we had grown accustomed too. This smell made me gag. The next day the other two did the same thing. I phoned the vet and relayed the latest. We decided to retest on their 15th day after completing their medication. By the time the test day came, two of the three were back to full blown runs. We received the re-test results on the 11th of December. The results for two of the three were negative, but the other came back “suspect”. Our vet phoned the lab and it was explained that on the PCR if 2 bars show it’s a positive and if no bars shows it’s negative. The suspect test result had 1 bar showing so they are going to rerun it. From my vets explanation to me, she said that since they had previously tested positive they felt they needed to rerun this one test. They had some equipment breakdown, so they were unsure when to expect the rerun test result. We had hoped we’d hear a test result yesterday, as it begins on a Monday and finishes on a Friday, but no call came and the vets office never phoned the lab to find out the status.
After the samples were sent, our vet put the kids on fortiflora and it did seem to help the form some, tho we often still have stinky poo. They are each going a minimum of 4 times a day now, mostly soft serve icecream and much narrower than they had been while being medicated and for the few days after treatment. Bum baths are once again a daily ritual. Our vet believes that their colons have been damaged by the TF and that things will not improve. She is at a loss as to how to proceed to help them, should the final test result come back negative.
I’m trying to come up with some options I can run by my vet. One question I have is should I try with holding all food for 24 hrs to let the gut rest? Of course they would have water. I’ve read on some sites that it has helped with some kids regarding diarrhea. After resting the gut, what food should I try? More of the same? Or a total change? We already have runs and loose stool.
If we don’t rest the gut, we thought about transitioning them to another diet. They are free fed a mixture of RC Kitten, Eukanuba Kitten and IAMS Hairball (equal portions of each). The kids range in age from 6 months to 10 months. I did ask her about possibly trying a commercially prepared raw diet for awhile to see if that would help them and maybe settle the colon. She did not recommend I go down that road. Of course, this is the first vet I approached, begged and then demanded that they test for TF, as they were one of "TF is only found in cows" vets, so I take her immediate alarm of feeding raw with......a grain of salt. I have fed them cooked chicken and rice and it didn’t seem to help and they have been on canned pumpkin twice a day for quite some time. If I back off the pumpkin they go from loose to runs.
Prior to the TF diagnosis, they had been tested, retested, reretested for giardia, etc, cultures were done and PCR Diarrhea panels. That’s why I feel that if they had more than one issue going on, we would have found that before we found the TF and that maybe it’s just colon inflammation now?
Anyway, I have to do something. Having one special needs kid is hard, but with 3 we are emotionally spent. I was thinking maybe we should try grain-free? But there are so many foods out there I wondered if any of you have a favorite one we could try. My vet suggested I phone some manufacturers about foods for sensitive colons for kittens. With all the diarrhea we’ve had for months we’ve been hesitant about feeding canned but I don't know how feeding them canned can make them any worse then they are now.
I was so hopeful with the initial result after starting the medication that we could all move on, but I’m at a loss now how to at this point. So, if these were your kids, what would you ask your vet to do?
UPDATE: 1 January 2010
Well, we’re still waiting on the “rerun” retest result (since the 11th of December). Still no word from the university through our vet as to the status either which is making me a bit unhinged and our vet too.
While the Vet’s Best seemed to be helping somewhat, I decided to contact a holistic vet clinic 60 miles away for another opinion. I thought maybe they might know of some magic herbs or possibly acupuncture that might give them more relief or complete resolution of loose stools. The clinic hadn’t heard of TF but did look it up in a book. They had multiple vets but would rather have a certain one look at them and they would be gone for another 10 days. So being the impatient mama that I have become, I contacted my rescue gal and we came up with a plan. We decided to make some diet changes immediately. We rested their tummys for 12 hrs and began feeding them Tuesday morning their new kibble, Life’s Abundance (LA). LA was created by a veterinarian. It contains no artificial flavors, no artificial colors, no corn or corn gluten and no wheat or wheat gluten. It also contains some digestive enzymes which I thought might help them. We are also giving them ¼ can of the LA wet food in the evenings. Along with this we are giving them 5 pieces each of two different supplements they also sell. Much to my kids dismay, they are no longer getting their pumpkin fix nor am I giving them the Vet’s Best supplement. The first morning we left the house without them having their pumpkin, I thought a riot was going to breakout. Those poor, sad little faces. I felt guilty all day and wondered what surprises would await me when I got home from work. Would the stools be worse?
Our kids usually are by the door when we come into the house and then after a love session they quickly head to the litter boxes. The first night after the diet change was no different. Phoebe’s stool was VERY loose, not quite runs, but darn close. Sam’s was actually pretty good and Madisyn’s was somewhere in between. So, a couple quick bum wipes and we were good to go. They seemed to enjoy the wet food and had no problems eating their 2 new supplements. I anxiously awaited for morning to come. Since they’ve never had anything but kibble, except when we tried cooked chicken and rice, I wasn’t sure what to expect after they ate canned food. I don’t think I slept much worrying about them having extremely loose stools during the night or come morning.
I got up and checked the boxes, normal ritual around here and much to my surprise, no poo. I put on some coffee and they decided to each make a deposit. All were somewhat formed stools much to my relief. They did eat a generous amount of the kibble during the night as the bowls were all low. We decided to replace the pumpkin time with one of the supplements and that seemed to make them and us feel less like they were being deprived.
Upon our return from work the evening of day 2, they made their usual deposit and I found only one poo from during the day. So, we have slowed down the frequency of stools, which has to be better for them. Now maybe they’ll actually absorb some nutrients from what they do eat. For months now I’ve felt like all I was doing was removing from the litter boxes the entire amount of food they consumed.
We are now on the end of day 4 and I have to say, they are doing better. Frequency is still minimal and the stools are more formed than not. We don’t have bullets but I’m encouraged more now than I was with just the Vet’s Best and pumpkin and hairball formulas, etc. So, that’s the scoop. I'm hoping that in time, their colons will settle and we will once again see bullets flying around here. If it gets no better than what we now have, then at least it should be manageable lifelong for them and for us. We of course still hope that in the weeks that pass they will continue to improve. Thanks again for all the support in our continued effort to heal our kids.
UPDATE: 18 January 2010
Well, I wish I had better news but after my last update, the kids once again sank into the dark deep whole of diarrhea more than formed stool. I contacted the lab to inquire once again the status of the rerun test. Several hours later, my vet phoned. We were told late last friday the stool sample had been destroyed through some reagent while trying to clean it up to retest. Of course there were apologies all around, etc., but we've waited weeks for the lab to get back up and running and now have further delay as a new sample has to be sent. Our little cherub cooperated this morning and I'm off to the clinic to get it on it's way. The earliest we expect results now is 29 January. At this point I’m not sure what I hope for, a positive test which would explain why nothing has helped and to have to risk treatment again with the drug or a negative test which means either there is still another medical cause yet to be determined or perhaps permanent damage to their colons.
I continue to hear from others who have confirmed TF, suspect TF or need information to share with their vets. Somehow they are comforted to know that there are others out here that are battling the same stool issues. I wish they'd post about their experiences, but I understand why some do not. It is a very trying ordeal, day after day, and I guess most feel others would find it hard to comprehend how difficult this situation is to deal with. I guess one of the sadest parts of all this is that many of the breeders of these folks I hear from have had no support or communication from them once a diagnosis is made or when trying to get information from the breeder on if they themselves are experiencing stool issues. It's like these breeders clam up and cut the cord. It further frustrates those that are trying to either find the source of the infestation or need help in seeking diagnosis and treatment. I applaud these parents for their diligence and doing the best they can for their kids.
I emailed NC State asking if they have recent statistics on TF they have published or if they are capturing any for later publication, but have received no response yet. I'm curious to know how many tests have been run, what were the results, is it more common in one part of the country than another, do purebreeds seem to test positive more than domestics, what are the numbers of followups, i.e., retests to confirm treatment success or failure, and if failure not due to drug protocol, what possible theory do they have for failure, etc.
We took such care to ensure our kids were DNA tested for HCM, current on vaccinations, etc, but little did we know that such a difficult parasite was lying hidden in the depth of the colon. If we were to adopt today, I would not without having our prospective kitty tested for this and assurance from the breeder, in the contract, that the kitten was TF negative. I regret not getting pet insurance, but am unsure just how much of this expense would have been covered anyway. So for those of you here who are adopting little ones, please be aware that TF is real and tho not much research has been done to observe the infected colons that have gone untreated there have been several studies which showed the penetration of the colon tissue much deeper than was thought which some feel could re-emerge years later as irritable bowel disease or irritable bowel syndrome.
Off to the clinic…….once again!
UPDATE: 6 February 2010
Retest Result - Last week we received the retest results for our “suspected TF” child and it’s negative. I must say the negative test result completely took me by surprise and the word shocked still doesn’t match my magnitude of emotion at hearing the test result considering they were all back sliding again. I know something is very wrong and expected confirmation that TF was still the cause and to eliminate that through this last result brought immediate depression. We also had been previously told that even Dr Gookin had expressed an opinion a few weeks ago that she was sure the test would be positive but wait for the result.
As of this date, all have returned to full blown diarrhea and the smell, that wonderful familiar smell. After popping up and down all night last night (and countless other nights) to scoop poo, wipe bums and cry, I’m sure we are still dealing with TF despite this last negative PCR. Only a parent of another TF kid can understand what I’m talking about. The aroma is distinct and forever etched in my nasal memory banks. At first whiff now it sickens me and I can only wonder what they must think and how they deal with all this. This morning each sniffed the other, bums covered in poo, and then immediately tried to cover their siblings as they knew what they smelled definitely needed to be covered. If this weren’t so sad it’d be funny. I couldn’t wait for dad to wake, I had to drag him from his bed for kitty bath time.
TF Outreach - While we were waiting for our retest result, several weeks ago I contacted a veterinarian out of country who has seen TF in his clinic and in those he bred. He confirmed some of my own assumptions and it was nice to hear from someone educated to back them up. In his country, TF began to appear in 2005 in pedigrees, i.e., Maine Coons, Ragdolls, British Short Hairs and Bengals. In his experience, even kittens that had been hand-reared after 24 hours with the mother have been infected, leading him to believe infection could occur at or very near to birth. He also said that there does appear to be some natural resistance to infection, as whole litters of kittens were not always affected. He mentioned it was possible that kittens wouldn’t show signs of diarrhea until after they had been re-homed which means breeders could be spreading the disease unknowingly. He said the more he looks for TF the more he finds and the true prevalence of the condition is likely to be high. He advises breeders to maintain strict biosecurity.
Testing/Treatment – My new TF contact said he’d found that even some kittens heavily infected with TF have produced “false negative” PCRs. He’s found that by taking samplings of stools over the course of ten days and pooling them together before taking a snippet of this “pooled stool” to send off for testing has greatly reduced the number of “false negative” PCR results. I’m still not clear on how he maintains this “pool” but will ask him to clarify this in my next novel, I mean short plea for help. He said from my description “his gut tells him they still have TF” and he recommended we retreat them at (30 mg/kg) for 3 weeks and increase the fiber content of their diet, something like Hills ID or ZD or similar. He stated he had a 100% resolution in stools following this protocol and he’s so confident that his catteries are TF clear that he guarantees that his kittens are TF free at point of sale.
Low level of infection - After this last test result I’ve been searching for stats on “false-negative” PCRs for TF. In all that I’ve read, a “positive” is just that, but at no time will a “negative” result prove or guarantee that the eradication is complete. There is a recommended retesting protocol and it’s believed if over the course of retesting (for periods of over a year) if none are found to be positive and they remain asymptomatic, then they should be okay. If they remain negative but are symptomatic (diarrhea) then look for coinfection or retest for TF again.
In some of what I’ve read, if the infection rate is “low level”, again, it could go undetected. The PCR test we used showed in a 2002 paper that it had a detection limit of 100 percent in samples that contained 100 organisms per 200 mg of feces but only a 90 percent detection in samples with 10 organisms per 200 mg of feces. The size of the sample sent for testing is about the size of a lima bean (400 to 500 mgs) so I guess if it’s low level, you have a much smaller chance of getting that small bit which contain the organisms. Maybe one would have to wait for the blood and mucus to return before it may be high enough to detect? Since they have active symptoms, one would think it would show up, but then again, I guess that’s not always the case. I do know on the initial submissions all contained mucus. TF likes to bind to the Mucus so maybe that’s why we found it the first time.
What to do - Since I’m not one to “treat” for things that can’t be proven, but given the rapid deterioration of the stools this past week, that may be the path we take. The financial and emotional burden has been great in first getting the diagnosis (the most expensive) to treatment, retests…….etc. After reading about “low level” infection and the likelihood of “false negative” PCR tests and my correspondence with my new found vet, I find it difficult to continue to pay for tests that may or may not show infection while they continue to suffer with intractable diarrhea. They were positive for this, they continue to have diarrhea (6 days after the previous treatment) so it would seem likely to me that we are still dealing with TF. If we are to believe the previous test results and repeated test results on all other known causes of intractable diarrhea (yes, diarrhea panels via PCR) then it seems likely to me that what they did test positive for is a higher probable cause. But then like the TF PCR, these other PCR tests for the normal parasites too have their failings.
I’ve gone over all this in short conversations with our vet. Sometimes I think she wishes we’d move on as in try another clinic……..as she’s as frustrated as we are at this point. She is more than willing to prescribe medication once again despite the negative test results and for a longer period of time if that’s what we desire. I will give this more thought………
As always, thanks for your support and well wishes……….
UPDATE: 13 February 2010
Perhaps I should rename this thread “The diary of a mad cat mom” as the stool issues and the impact on our lives is making me a bit crazy and depressed. I’ve not felt this helpless since I became chronic with my own illness on 21 May 2001. You may notice I just posted my 6 Feb update. I didn’t post my last update because it’s very hard to sound hopeful to others dealing with this. I hate to burden others with our trials and tribulations as I’m usually a very private person and keep things to myself and I’m not sure any of my ramblings are helpful to others, but for those so inclined, read it if you wish.
We’re still trying to remain optimistic about all of this, but as each day passes it’s nearly impossible to do. I’d say we are pretty much as we were pre-diagnosis regarding their stools. I reluctantly clipped their breeches last week to help in daily cleanups. I will be contacting our vet on Monday and discussing our options - retreat without positive test, purchase pouches to do some daily sampling for her to interpret, or let it run its course which doesn’t appear likely that this will ever end. Dad just arose from bed and Maddy is a mess……..so off to the tub we three go. Each night I dream of finding the answer only to wake up at that precise moment of what it is……..
I'm glad everything is finally looking up and i hope it continues to.