Fezzik - a story about ringworm
26 June 2017
The problem with a sick animal is that they can’t tell you their symptoms. The vet can make a more educated guess than you can, but it’s often still only a guess. The internet is full of horror stories that make it clear your beloved pet has an incurable condition that either means they won’t be with you much longer, or that your finances are going to be ruined by vet bills for however much longer it takes for the condition to run its course. And even if you have insurance, after a while the insurer will disown the animal because they realise they’re going to be paying out more than they’re bringing in.
It’s also expensive to take the animal to the vet only to be told there’s nothing really wrong with them as far as can be ascertained, and that’s why we don’t always take them as soon as we should, with hindsight.
Fezzik is a perfect example of how hard it is to work out what to do. He’s an all-black, male, half-Siamese with an impressive medical history; his record on the vet’s computer is, apparently, the most extensive in the practice. Most of the entries start with “been in fight”, because that’s the sort of cat he is. So when his appearance started to deteriorate, it was far too easy for us to just attribute it to general wear and tear.
The first symptom was fur loss. It was especially noticeable in the area between his ears and eyes, but this was a general thinning assumed to be a sign of age. His fight-damaged ears were next, becoming almost completely bald. Then the end of his nose lost all its fur, becoming slightly scaly and, importantly, sensitive to touch.
There were other symptoms. He would periodically shiver all over, as if cold, even when that seemed unlikely to be the case. Bizarrely, whenever he rose from a seated position, he would shake one of his back legs, as if he’d got it wet. We also noticed that Fezzik was using the litter tray instead of going outdoors, something he’d never done voluntarily before, but we didn’t see any significance in this. He also stopped biting our dog, which was usually his way of telling us we weren’t feeding him fast enough, or that he wanted somebody to open a door for him, though sometimes he did it just for fun. At this point, he was seen by a vet, who could find nothing wrong.
However, his condition progressed swiftly now, and before long he was losing whole patches of fur on his face. The shivering continued, the leg shaking progressed to all his legs, and any attempt to stroke him caused him to shake his head in distress. In his next visit to the vet (a different one this time), the possibility of ear mites was suggested, and his ears were found to be full of a horrible black detritus that needed sluicing out with oil twice a day. Fezzik didn’t enjoy this. As for the fur loss, the vet diagnosed ringworm, and advised a test, involving brushing Fezzik all over with a new toothbrush, especially in the affected areas. The toothbrush could then be analysed to show if the ringworm fungus was present.
Ringworm, we found, was a fungal infection, with no obvious cause but perfectly treatable. The toothbrush test was chosen because the alternative might have to be a biopsy, where a chunk of ear would be removed. We were slightly relieved to discover the test was negative, but this left the question of what was wrong with our cat, who was losing more fur daily. The fur loss was clearly distressing for Fezzik. Apart from the cosmetic effect, there was an irritation in the skin that he scratched constantly, making it worse.
The next visit to the vet gave us a tentative diagnosis. This time he was seen by yet another vet, who listened carefully to what we said, and looked closely at Fezzik’s feet, something nobody had previously done. They were sore and cracked; this was why he kept shaking them. Ear mites were now ruled out. Fezzik probably had one of two conditions: Lupus, or Pemphigus, conditions much more serious than ringworm. As these are both auto-immune diseases, he was prescribed steroids, though even if these worked, the long-term prognosis wasn’t good. He had a life-shortening condition. Reading up about these conditions on the internet, it seemed as if the diagnosis was probably correct, as he exhibited most of the symptoms.
We were warned there would be side-effects from the medication, such as weight increase, but this was really the best option for him at this time. So we fed him his pills and hoped for an improvement, but we didn’t see any.
The steroids didn’t work, and Fezzik’s condition deteriorated ever more rapidly. He had now lost almost all the fur from his face, neck and shoulders. His skin was sore, and he could barely see out between his swollen eyelids. He should have responded to treatment by now if the diagnosis was correct.
It was time to get an expert opinion, as the vets at our usual practice weren’t really familiar with the auto-immune conditions. Fezzik now saw an expert (and very expensive) dermatologist, who thought he was looking at a case of ringworm, but when told that this had been ruled out, concurred with the suggestion of an auto-immune disease and said that all we could do was increase the dosage of steroids, which would put him on the maximum amount. Any side-effects, we were told, should be reversible. Our cat would get better and the expert wouldn’t need to see him again.
So, even more pills for Fezzik. But he didn’t get better. In fact, he got worse, which we hadn’t thought possible. He was now a very miserable cat indeed, barely going outdoors, and spending most of his days on our bed, curled up underneath a fur rug. His claws rotted, and many fell out. Normally a talkative cat, he was utterly silent. It would be hard to imagine a more sick-looking cat.
Back to the expert, who was surprised to see the return of Fezzik, mystified why the treatment hadn’t worked, but still as inclined as he had been on the first visit to diagnose ringworm. He took some fur samples (which he’d done on the first visit, but it would appear he forgot to do anything with them) and told us we should have a result in three weeks.
More waiting, and more deterioration. A week later, we went back to the regular vet for an emergency evening appointment. We needed answers and felt Fezzik couldn’t wait; it wasn’t fair to let him suffer in this way. By an incredible coincidence, a minute or two after the vet started to look at Fezzik, his phone rang. He was on call for emergencies that evening he said, so did we mind if he took the call? We didn’t mind. The call was from the dermatologist, who had just got the results and confirmed that Fezzik had ringworm after all.
The treatment for ringworm isn’t quite as expensive as the dermatologist’s fees, but it’s still a bit of a shock to discover that it costs £215 or so for a full treatment, and this was one more procedure the cat didn’t like. He had to be dosed every day for a week, then a week’s break, another week’s dosage, another week’s break, and then the final week of medication. Fezzik didn’t like it, and fought furiously when we tried to squirt a syringe full of Itrafungol into his mouth – it took two of us to hold him – but it quickly had the desired effect.
The steroids had made him worse because they prevented Fezzik’s own immune system from combating the infection, and we were concerned that the damage done was so extensive that he might never recover to his previous state of health, but the Itrafungol started to produce results in the first week.
Thankfully, his fur has grown back, and his fur now looks better than it has in two years or so, which makes us wonder just how long he had been fending off the slow onset of his disease. He’s also got his claws back (it’s amazing how fast they grow!), and his voice. No shivering, no paw or head-shaking. The surest sign of his return to health is that we had to take him back to the vet again last week. He’d been in a fight. He’s also biting the dog again. Back to normal, then...