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Dr. B.
Dr. B., Cat Veterinarian
Category: Cat Veterinary
Satisfied Customers: 16230
Experience:  Small animal veterinarian with a special interest in cats, happy to discuss any questions you have.
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She has been vomiting, is dropping weight and her coat is

Customer Question

she has been vomiting, is dropping weight and her coat is looking rough.
JA: I'm sorry to hear that. Hopefully it didn't make a mess. Did the cat eat anything unusual?
Customer: the vet suspected FIP might be a possibility. Her blood work shows a high AST and CK but other enzymes are normal. The only other thing out of range is a high RBC - all of which seems to tell me.. the cat is dehydrated and possibly has muscle wasting from all the vomiting. A:G ratio is .8 which is disappointing because it seems that .8 is the big dividing line. If FIP is a diagnosis of exclusion then .8 doesn't really push anything in one direction or the other. her appetite is good. Stools are normal. she hasn't eaten anything unusual that I know of, and her littermate is not ill they are 6 years old, so old for FIP
JA: Is there anything else the Veterinarian should be aware of about the cat?
Customer: that's all I can think of. I switched her to grain free duck (they eat only canned food) as a novel protein in case it is diet related but at the moment we are sort of in a wait and see limbo. Her abdomen isn't enlarged, but we've had no xrays or ultrasounds done yet and so I don't know if they would show anything enlarged
JA: What is the cat's name?
Customer: Alice thank you
Submitted: 8 days ago.
Category: Cat Veterinary
Expert:  Dr. B. replied 8 days ago.

Hello & welcome, I am Dr. B, a licensed veterinarian and I would like to help you today. I do apologize that your question was not answered before. Different experts come online at various times; I just came online, read about your wee one’s situation, and wanted to help.

Again I do apologize that my colleagues could not aid you sooner, but can you tell me:

How long has she had these signs?

Did your vet check anything else besides the A:G ratio for FIP (ie a coronavirus titre, alpha glycoprotein, white blood cells, etc)?

Will you be having your vet ultrasound or xray her?

What treatments have they tried thus far?

Customer: replied 7 days ago.
The WBC and the various lymphocytes, eosinophils etc.. were all within the normal range.I am asking for X-rays and will take her to another facility for an ultrasound if needed. This is a small rural clinic and there is no ultrasound, but my old vet (recent move) has one at the office and it may be time to pack her up and make the drive.Coronavirus titre was still pending and I asked yesterday about the AGP as I understand it to be a good indicator.She has a follow up appt today so hoping to get some answers there.So far treatment has been mostly just fluids and an antibiotic, but I am growing frustrated as I feeling we are waiting a long time trying prove or disprove FIP and I would rather be a little more aggressive.
Customer: replied 7 days ago.
It's been close to 2 weeks. It took th first week to figure out who was vomiting. By now it has increased in frequency and as she isn't hiding it anymore it is pretty obvious which cat it is.She is separated now from her buddy but if it is contagious that was probably done too late. I really would rather put them back together as she is miserable without her sister.She does seem to keep the duck down a little better but hasn't been on that long enough to really tell anything and that could honestly be just wishful thinking.
Expert:  Dr. B. replied 7 days ago.

Thank you,

First, I would note that when we are diagnosing FIP, it is partly a diagnosis of exclusion but there are indicators. So, we’d want to see the coronavirus titre (though if its 0 or low, we’d be able to rule this out for Alice) and absolutely would want the AGP as well (since it tends to help support our concerns for these cases). Though thus far a lack of changes on the WBCs and the A/G ratio (its <0.7 where we worry about FIP) are leaning us away from this. And even a positive coronavirus titre at this point would make us more suspicious of exposure to the virus (common in cats) as opposed to active FIP. Therefore, not only does her age and her signs make this less likely, but so far the bloods are not supporting the condition.

Therefore, I completely agree with you on being more aggressive. Realistically, we’d at least want her on symptomatic treatment (ie anti-nausea medication, gastroprotectants +/- appetite stimulants if needed). Otherwise, I’d lean to an ultrasound for her at this point. While xrays are good for giving us a whole picture and letting us rule out foreign bodies (less likely at her age), we’d really want to think about an ultrasound. That way we can appreciate any masses, any changes to the liver or kidneys and check for thickening of the gut (IBD, GI lymphoma). As well, if we were desperate to fully exclude FIP, a fine needle aspirate of her mesenteric lymph node could be taken with ultrasound guidance for FCoV PCR testing to determine if that is really an issue here (though again it doesn’t sound like it is for Alice). In any case, that trek to her other vet (who’d be able to look at Alice with fresh eyes) would be ideal.

Overall, with all the information you have provided, this doesn’t sound like FIP. Vomiting and weight loss are very vague signs caused by a range of issues (ie bacterial or viral gut infections, pancreatitis, organ issues –less likely if they did a biochemistry blood panel too, cancer, IBD, foreign bodies, nutrient sensitivity, etc). So, at this point, we’d want to step up the symptomatic care for her and consider a scan to help us get to the root of this for her.

Please take care,

Dr. B.

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Expert:  Dr. B. replied 5 days ago.
Hi Amy,

I'm just following up on our conversation about your pet. How is everything going?

Dr. B.