Dear TF Felines,

I was happy to see your website on t.foetus. I learned of Dr. Gookin after running my own search to figure out what was bothering my male purebred Singapura, Tahji, who was ill almost within 6 months of bringing him home from the cattery. He was brought home at 15 weeks of age.

Tahji had many symptoms, the least of which was diarrhea. His primary problem was nearly complete disinterest in food, cyclical depression and malaise, and frequent vomiting. The real clue to his illness were his unusually intense smelling stools, which were so bad that I found myself nearly gagging from the odor. Occasionally there was blood in the stool. He was pathetically underweight. He also had epi-gastric reflux (waking up in the middle of the night and vomiting.) He was taken to his vet and diagnosed with giardia. (There is great similarity between giardia and t.foetus when looking at it under the microscope!) We went through treatment and the giardia came back. My vet told me it looked like drug-resistant giardia which she thought was a bit unusual. I began to question the findings.

I began researching Tahji’s symptoms and found Dr. Gookin’s work. Dr. Gookin’s description of t.foetus sounded like it might be a match to Tahji’s illness. I then brought Dr. Gookin's research papers to my vet and sent stool samples to Dr. Gookin to be tested via PCR, and Tahji was positive!  At the time he was found positive, there was no medication known to cure t.foetus, although Dr. Gookin was in the middle of some clinical (medication) trials, but the results were not yet known.

Meanwhile, Tahji was moderately to significantly ill, and one of the biggest concerns was his significant anorexia (lack of appetite) and generalized irritable bowel disease (IBD) symptoms. Although Singapuras are small by nature, he was clearly emaciated. Tahji was taken to a very well-known Internal Medicine Veterinarian in Manassas, Virginia who performed an endoscopic exam which showed abnormal thickening of the gastrointestinal track. These symptoms—along with irritable bowel—are often secondary to t.foetus because the t.foetus causes irritation to the gut. The objective of the endoscopic exam was to rule out other diseases or growths and figure out the best course of treatment. We concentrated on easily digestible diet sources and medication to stimulate his appetite. Tahji refused to eat the specialized diet so the only course was via appetite stimulation. To this day, he will only eat Fancy Feast which my general veterinarian calls "the cocaine of cat food".

Tahji and I hobbled along, never knowing if he was going to have a fair day or bad day. I wondered constantly if I was going to lose him. In mid-September 2006 Tahji began a very sudden and intense bout of diarrhea. As I said earlier, diarrhea was never Tahji’s main symptom. But on this day, it clearly was! His stools were repeatedly liquid! I panicked and contacted Dr. Gookin again. By this time we discussed the possibility of putting him on a trial of one of the medications she was experimenting with. Dr. Gookin suggested in his case, NOT to put him on the Ronidazole (RDZ), but rather, Tinidazole (TDZ)—the other drug Dr. Gookin had in her trial that—at the time—since it showed some promise. Because RDZ was showing neurotoxic side effects, I did not want to further compromise his weak state.

Prior to beginning treatment all litter boxes in the house had to be washed and sanitized with a bleach solution. Tahji then began a 10-day course of treatment with TDZ which was finished on November 2, 2006. Rather than subjecting Tahji to the EXTREME bitterness of TDZ in a liquid formula, I found a compounding pharmacy who would fill the prescription in clear gel capsules (contact information below). My other cat, Grace, a recently acquired flamepoint siamese rescue kitty, had to undergo treatment too, even thought she never showed symptoms. The biggest problem Tahji had with TDZ was that his stools hardened up so fast that he could not evacuate, and he had to be taken on two separate occasions to his veterinarian for enemas. At least his empty tummy and intestinal track made him a voracious eater for a few days!

To date, I have not yet re-tested him for t.foetus but he is very very slowly responding with more interest in food; showing more alertness and playfulness and looks much healthier. IT IS ABSOLUTELY CRITICAL TO REMEMBER THAT IT IS UNKNOWN WHETHER TDZ WORKS AT THIS POINT, BUT IT REALLY HELPED ALLEVIATE THE DIARRHEA (and other symptoms over 3 months time). Although Tahji could stand to put on a bit more weight, he is far from emaciated. When he goes in for his distemper shot, we will take a fecal smear (via loop) and see if anything shows up, BUT REMEMBER that if the poops are formed (which they are now), a loop or even culture is probably going to be negative. The best most definitive test remains PCR (Dr. Gookin’s lab).

Because Tahji has been so immuno-compromised for most of his life, I would NOT CONSIDER RDZ as a possible option UNLESS full-blown diarrhea returns, and then only after very careful consideration. I urge everyone to read Dr. Gookin’s “Owner's Guide” to understand the implications and contraindications of treatment with RDZ. Dr. Gookin’s website also contains other valuable information on t.foetus (which you will find mid-way down the page).

A note about compounding pharmacies. Both TDZ and RDZ are EXTREMELY BITTER. To make it easier for you to administer and FAR LESS stressful for your beloved kitty, I highly recommend compounding the stuff into clear gel capsules (versus putting the medication in liquid). I found a local compounding pharmacy and the owner, Marc Isaacson, an absolute saint to work with.  Marc promised me that he would use the smallest gel caps possible. Both of my cats had to be precisely weighed before the prescriptions were written. In any case, the pharmacy is expensive, but it was absolutely worth it; here is the link: http://myvillagegreen.com/. They are located right across from the National Institutes of Health in Bethesda, Maryland.

If you decide to treat with either medication, my personal recommendation is to give the medication in the early evening, about 20-30 minutes after the evening meal. This way, you’ll have the rest of the evening and overnight hours to watch for any unusual reactions. If reactions occur, they will generally occur sooner rather than later.

Tahji and I are indebted to Dr. Gookin for her guidance. Anyone reading this can provide a great service to all cat owners by making copies of Dr. Gookin’s “Owner’s Manual” and distribute to veterinarian offices where you live. I have disseminated her findings to a number of veterinarian offices and clinics and encouraging them to share this information at clinical case conferences. Up until now, so few veterinarians have known about t.foetus and cats are being misdiagnosed all the time with giardia or other illnesses. I also sent Dr. Gookin’s website to a Singapura cat listserv group on yahoo. I plan also to send her weblink to The Cat Fanciers Association (CFA), since they are the premiere organization to breeders.

In closing, I was glad to find your website and hope your little critters continue with good health!

Best wishes! --Isabel


Quite a few people have mailed me to ask about Tahji's progress, so I am happy to add this email from Tahji's parent, Isabel.  Feb 2008.

Hi Leah -- 

So very nice to hear from you!  Yes, thankfully, Tahji is doing quite well, overall.  I don't remember the date, but it's been within the year, when he went in for a check-up to his general vet, and while there, we took a stool culture and he was free and clear of any/all parasitic issues.  I guess the question is, if there is absolutely no parasitic activity in his stool via microscope, and he is asymptomatic, is he truly free of T.foetus, or is this still only confirmed by PCR?  This is a question for Dr. Gookin, and I'd place my bets that Dr. Gookin says it remains only confirmed by PCR. 

I might add that his recovery was very, very slow for the first year after taking TDZ, which seems unlike the cases on your website which suggest more rapid improvements over the short-term.  This might be because I believe all the cases on your site took the medication RDZ, which showed significant efficacy in Dr. Gookin's studies, when compared to the outcomes of cats on TDZ.  (Again, Dr. Gookin suggested Tahji go on the trial of TDZ, not RDZ.  We were quite concerned about the neurological effects of RDZ on Tahji.) We are now about a year-and-one-half since he took TDZ. I haven't been in touch with Dr. Gookin in quite awhile, and I wonder whether there are newer trials with larger cohorts that have upheld the data she reported. 

When I suggest slower recovery, it isn't that he showed gross symptoms of T.foetus, but just more subtle issues, like cycling appetite and energy. (The horrible stinky stools, tho', went away almost immediately.)  Tahji has grown more "even" over time and for longer periods of time, and most of the time now he seems pretty happy.  The only rough time we had within the last 6 months was when his appetite began to reduce to about 30% over two or three weeks, and it turned out that he would no longer eat his food unless I bought it in the small cans (versus the larger can).  When I examined the food, it turns out that there really is a consistency difference.  Oh well, such for his finickiness! 

I might add Tahji still gets cyproheptadine gel in his ear 1x/day because he's never been a big eater, although he does show more interest in food since the TDZ trial. (The disinterest in food might be learned behavior, since he had T.foetus as a young cat, and when he ate, it likely always made him feel sick.)  Otherwise, Tahji is holding his weight; plays and competes for attention with my siamese rescue Grace, and is completely spoiled rotten.  I will try and send you an updated photo at some point. 

If you like, please feel free to post this as a "Tahji Update" on your website.  I am truly warmed by the inquiries you've received about him, and I am delighted to report such good news. 

Please stay in touch and if there are specific questions routed to you about Tahji, I would be pleased to respond. 

Hope this note finds you well and all your cats thriving. 

Regards -- 

Isabel

Update July 2008:

The photo to the right was taken in early July.  As the photo will show, he looks a bit like a chipmunk because of his full jowls.  This photo is indicative of his weight gain; he's been able to maintain his weight without the fluctuations experienced when ill with t.foetus.  The other good news is that Tahji is completely off of cyproheptadine (appetite stimulant).

For the latest information on diagnosis and treatment of TF please read: AN OWNER'S GUIDE TO DIAGNOSIS AND TREATMENT OF CATS INFECTED WITH TRITRICHOMONAS FOETUS.