Saturday, January 9, 2010

A Journal of the Plague Year, 8 — The End?

Our vet's office called this afternoon to tell us that the third and final cultures on our ringworm-stricken kittens are negative. Officially, we have a cure!
H O O R A Y !

Our adult male, Snalbert, still has an unfinished culture — it's still got an "unidentified fungal contaminant" after 35 days. He has no signs of ringworm, and our vet is assuming it's not ringworm because the lab can identify that. So we're declaring an all-clear final result. Ringworm cultures normally take up to 21 days to develop. At this point, we've got to be out of the woods. 

 Because our apartment is coated in plaster dust from recent (even longer-awaited) repairs, I will be cleaning like mad, one more time, for the next few days: removing Christmas decorations, dusting the ceiling molding, wiping down the walls, dusting everything in sight with a damp cloth, and vacuuming and damp-mopping the floors. Cleaning the kitchen and bathroom. 

Then we'll put everything back to the way it was before the plague began, back in October, which seems like years ago. Curtains! Persian carpets! Pillows! I can't wait. What a long, strange trip it's been. This experience changed me. I evolved from being dazed with horror to getting a grip, then eventually took some control of the situation and learned to laugh among the spores. For example, there was the day I found this little creature in the cats' toybox:


It took my brilliant professor husband quite a while to figure out why I was laughing so hard, even as I was waving it under his nose on my finger. Here was Our Enemy himself, Ringo the Ringworm, looking more like the Grinch than I had imagined.

Once I started breathing again, and threw myself into the cleaning and treatment routine, it began to seem almost normal. As normal as having cats who reek of gunpowder and embracing the design aesthetic of the Indian bedspread can be, that is. It certainly helped that we humans never caught it. And neither did the Persians, who are supposed to be very susceptible. I spent far too many hours reading all I could about "feline dermatophytosis," including a lot of garbage fiction on sites trying to sell me expensive sets of products promising to cure it in a few days but with no supporting studies or much information at all, except for brief, first-name-only testimonials.

Eventually I figured out who the vet experts are, and tried to follow their advice. The recommended treatment is stinky, potentially dangerous, time-consuming, and annoying. But our vet said it works. And apparently it does. Possum's nose is dazzlingly white again. A few tiny black spots remain on Wendy's ears, but they could be part of her calico patterning for all we know.

 Naturally, I will be paranoid about ringworm for the rest of my life. Visiting cat shelters will feel like a dangerous excursion instead of like fun. Fostering kittens — a little fantasy I had — is entirely out of the picture. And I will soon begin worrying that the ringworm will recur — maybe near Wendy's incision, if we are really unlucky. Or a nasty-looking spot will show up on one of the other cats, some weeks or months from now. Or on us. Ringworm spores can live up to two years! But we did follow the treatment plan and it brought the desired lab results so, just for tonight, I'm going to try to relax and pretend it was all a very bad (and smelly, expensive, and exhausting) dream. Tomorrow, I'll get busy with all the new cleaning and worrying.

Ringworm may be out of the house but it will always linger in the back of my mind.

6 comments:

  1. Hi,

    I just found your blog! I have two kittens that I adopted about a month ago (now about 16 weeks old), and they arrived with ringworm. Luckily we knew they had it so they've been contained in one room (with no rugs, draperies or upholstered furniture). I can't believe you never caught it since the two humans in my house, including me, both had it within about 10 days. We don't even let those cats sleep with us, only visit them for a couple of hours in the isolation room. Makes me wonder if some ringworm is more virulent than others? Anyway, we are doing the lime-sulfur dips ourselves, weekly, thank goodness the kittens don't seem to mind it too much. The only thing we are NOT doing, per the Shelter Medicine fact sheet, is a systemic antifungal. The lady from the rescue association told us not to, and, so far, the vet has not recommended it either (one vet visit to date where the vet basically seemed to say that systemic was not necessary, and she knew that both humans had contracted it). We are applying topical Lamisil (from our human prescription) to the bald patches (which are actually very few, mostly on the tail). I wonder if we're just wasting time, not using the oral meds? We use a UV light to monitor fluorescence, and it does seem to be getting less and less, pretty much none on one cat who might be almost free of it now. Do you think we should push our vet to give us oral meds, or is it possible that we can beat this with time, lime-sulfur, and topical Lamisil? Any words of wisdom? Encouragement?

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  2. My hat is off to you for adopting kittens despite ringworm AND for doing the dips yourself! I'm in awe of your courage. If we had known about Wendy's ringworm, we wouldn't have adopted her — and missed out on wonderful Wendy.

    I've heard that some ringworm IS more virulent than others. It's also particularly hard to eradicate in damp, hot climates. Here in Massachusetts, it (used to be) relatively rare. I hope Lamisil is working for you. We must have had strong immune systems.

    I suspect that your shelter lady advised against oral meds because your kittens were tiny and the drugs can be dangerous. The only drug our vet would use at 3-4 months was genuine Sporanox (not generic), for at least 28 days. It is supposed to "cure" them.

    My instinct was to attack with every weapon until we got clear cultures. Have you started culturing? As the fact sheet says, they can be cured while you still see lesions (especially if you're giving oral meds) and they can look fine and still be infected. Since it's got to be hard on them to be so isolated (kittens need more attention/human interaction than a couple of hours a day), I'd use Sporanox and keep up the dips — to get it OVER with, ASAP and get life back to normal.

    Good luck to you, and write back and keep me posted, please!

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  3. I certainly don't think I could use lime-sulfur on a full grown cat, and I can only imagine the challenge doing 4 cats at a time! Since we only have 2, and they are little, it's not so bad, and the room we have them in has old lino on the floor so we don't have to worry about getting the stuff all over the place while doing it.

    Thanks for getting back to me, I appreciate it! I feel we will have to make a decision soon about whether or not to do oral meds. I just wish it had been done while they were still in foster care, since then they would be cured by now. The foster humans (2 of them) also got ringworm, as well as her sister and mother, plus us. That's 6 human infections! Our cat's siblings (adopted by the foster mom) are now on oral meds. The resuce lady is a saint, of course, but I regret she did not choose to advise oral meds much, much sooner. Oh well. Hindsight.

    To answer your question, no, we have not had any cultures, unless the rescue lady did one early on before I was in the picture. I guess the vet didn't do a culture since we already had ringworm too, there was no need to culture at that point, obviously there was ringworm. I'm assuming we'll do cultures when we think it's cured, to confirm it.

    I feel the same way you do about the isolation room. Thank goodness it's large, sunny, airy, there are two of them so they play together, and we do make very frequent visits. I look forward to the day this is all a distant memory! I'll let you know how it all turns out.

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  4. Naomi, I couldn't mix up 1 cup of that solution without gagging! You deserve TONS of credit.

    I think kittens may be too tiny to safely take Sporanox before about 3-4 months. If you decide to try it, it can be messy. Ours was cherry-flavored and sticky. So we divided each dose into two syringes and gave them one after the other, which improved our chances of a kitten getting a decent dose instead spitting it all over us.

    Did you get a "free month" of ShelterCare health insurance when you adopted? We did, and it eventually paid for a lot of treatment, including cultures. I'm glad I activated it and continued it. We also saved on prescriptions at CVS with our AAA card.

    You might ask your vet if your kittens are big enough now to take generic terbinafine (Lamisil). This is fairly new and relatively expensive. We were able to give it to our older cats (one is just 6 lbs) and it's reported to be effective and quick-acting. I think you'd be doing "pulse therapy" — 2 weeks of a small daily pill, then 2 weeks off, then 2 more weeks of pills if you need to. You could do a culture after the first 2 weeks and see what develops.

    Whatever you decide, keep in mind that this really will be a dim memory someday. You'll shake your head in disbelief as you think of what you did and admire your healthy cats. And you may have saved your kittens' lives. Very few people are willing to do what you've done, and shelters and foster homes can get overwhelmed by an epidemic. Up here, shelters do mass euthanization.

    Please keep in touch, and thanks for reading my blog! I'm delighted to have "met" you!

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  5. Hi! We're not anywhere near out of the woods yet, but we've got them started on medication, which seems like a big improvement, so I'm feeling optimistic. We've got Itrafungol (which is Itraconazole) to administer once a day. Luckily we had to give oral meds with a syringe to our last cat so this procedure is not totally new to us. I think it's funny how much our story reflects yours. We too are having trouble reaching the vet to confirm the dosage and method (pulse, continuous, etc.). I researched the dose she prescribed, which works out to around 10mg/kilo. Looking on the internet at recent vet conference proceedings and shelter protocols, I know this is on the high-end for kittens, but not out of range totally so I'm going to go with it. In the meantime try to get ahold of the vet. I just felt the urge to update you, since I'm feeling positive about this today!

    naomi

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  6. Hi Naomi, thanks for your news. I'm glad you're feeling positive! Between the oral meds and the dips, you'll have it licked. And soon, I hope!

    What a pain that you're having the same problem we did about the dosage. I think that night in the ER at Angell was our low point; it was definitely the most surreal few hours of the whole experience.

    Soon all this will be a dim memory for you, too!

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