Important Note to Cat Owners: This page was written early in the treatment of FIP, when knowledge and access to drugs was scarce. Today, your own vet is fully capable of administering the treatment and saving your cat. For the best up to date information on treatment protocols and drug availability in Australia, please visit the page of Turramurra Veterinary Hospital.

Back at the start I supported you when you were breaking the law. I even put my reputation on the line and stood up for you against threats of prosecution. My attitude was “let them try; they wouldn’t dare.”

For back then if it wasn’t for you, many cats with FIP would have died. You provided an essential link between desperate cat owners and an illegal, yet life-saving drug. You allowed vets to offer their support without having to procure the drug themselves and risk their careers.

For this I will always be grateful. But there was still the problem of the law.

The issue with GS being illegal wasn’t so much the risk to vets or cat owners. It was that not enough people would ever hear about it. Most cats with FIP were still dying, because neither their owners nor their vets knew any different.

I was flat out treating FIP cats back then, but I knew I was seeing only the tip of the iceberg. There’s nothing heroic in saving only a few when you know the rest are missing out. But it was the best we could do.

That’s why I was ecstatic when some very clever people developed a legal alternative: compounded TGA-approved remdesivir. Australia may have even been the first, all thanks to them. Suddenly we could talk freely, share our experiences and read about FIP treatment in national vet publications.

Update: We now also have access to pharmaceutical-grade legal GS- 441524 tablets. These are around 2/3 the price of remdesivir injections, and easier to give for most cats.

At the time I thanked the providers of GS such as you, and bid them farewell. With all gratitude, your job was done, and a brighter future dawned of treatment for all. At least this was what I hoped.

At the same time I feared the opposite: that your enterprise would have too much momentum, self-belief and financial commitment to just shut up shop. And this is what has actually happened. What was once a blessing has become a curse.

Now every time I start a new cat with FIP on treatment, I have the same discussions. Once cat owners get given the diagnosis and start researching, they still find you. Except now you say things like:

• GS works better than remdesivir
• GS is safer
• GS is cheaper

None of these, by the way, are true. New survival rates are at least as good, costs much the same, and the BOVA remdesivir we use stings far, far less. The best that can be hoped for with GS is equivalence, which itself is big ask for a drug that has no quality control or oversight. And one which still requires owners to break the law and hope no-one notices.

You who were once happy to work with vets have made yourself into our opposition. You appear to want FIP cats to be split off from the veterinary mainstream. And judging by your Facebook posts, you are quite successful at doing it.

It’s not just that your treatment is no better. Owners of newly diagnosed cats need tremendous levels of hands-on support to learn to give the injections effectively over the 84 day course. You cannot offer that. Your drug cannot be claimed back on pet insurance either.

I don’t know if you have a financial incentive, but I hope not. And before I get the understandable accusation of hypocrisy, hear this: I am in the possibly unique position of having had a significant drop in my income due to remdesivir. After all, I was probably the only Adelaide vet working with cats on GS, and now everyone uses remdesivir.

By continuing when you should have stopped you are fighting the future and defending the indefensible. Your law breaking is no longer excusable now that it’s not in the best interests of cats or their owners.

You need to end this. Preferably while I can still remember that gratitude.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

Note: this in no way is a criticism of the use of GS in countries without a reliable and economical supply of remdesivir. I am happy to engage in an open online debate in the comments section below but not via private messages.

Here I’m going to give you a very simple trick to recognise when a cat is struggling to breathe. If you do it successfully, your cat will probably be OK.

How To Tell If A Cat Has Breathing Problems

Unlike dogs who are regularly exercised, cats can hide respiratory distress for a long time. But there’s one thing they can’t hide: the fact that they are breathing faster and faster.

A sleeping or a resting respiratory rate greater than 30 breaths per minute is almost always abnormal. This is usually the earliest and most sensitive sign of breathing problems. The problem is that it isn’t natural for cat owners to notice.

This is often the only sign. However, sometimes you might also see:

• open-mouth breathing
• noisy, raspy or wheezy breathing
• frequent coughing or hacking
• obvious chest or stomach heaving
• upright, tense posture

Cats with breathing trouble usually can’t breathe when lying down. The picture above shows the typical posture of such a cat: hunched and upright, not relaxed.

In contrast, even young healthy cats can have rapid or heaving respiration, or even breathe with their mouth open. However, this should only happen for a few minutes after vigorous exercise, and never at rest.

How To Measure Resting Respiratory Rate

The trick is to understand that the rate of breathing changes with activity or stress. Therefore, it can’t be done just any time and you need to know what to look for.

Resting Respiratory Rate should be measured when your cat is at their most relaxed. They need to be unstimulated and preferably even asleep. This is when they are breathing at the slowest they can, and this is what you measure.

Now count the number of breaths over 60 seconds. Most cats have a normal value between 15 and 25, but this can be higher in hot conditions.

If you can’t see your cat breathing at all (but they are alive!) then the rate should be OK. Cats with respiratory issues usually have more laboured or heavy breathing which is easier to see.

What Causes Laboured Breathing?

These are the most common three reasons for a cat to be consistently breathing faster than 30 breaths per minute:

• heart disease
• chest infections
• asthma

They all need urgent attention, but they all can be treated.

I’m not expecting cat owners to watch their cats breathing every day, but whenever you suspect a problem it’s a great thing to do. For certain cases (like cats with heart murmurs), it’s something I ask owners to do as an early warning.

By spotting a subtle increase in your cat’s respiratory rate, you’ll take what would have been a dire emergency and make it just another health problem.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here. The information provided here is not intended to be used as a substitute for going to the vet. If your pet is unwell, please seek veterinary attention.

Note that this article is not about lumps on the skin of cats. Those need a checkup at the vet to know what they are.

Five cats were presented to a veterinary teaching hospital with abdominal masses that could be felt during a routine exam. They all had the classic signs of intestinal obstruction: vomiting, listlessness and not eating.

The two eldest cats died. One, because her owner thought it was cancer and had her put down. The other, due to a delay in treatment, most likely due to a similarly fatalistic attitude.

The diagnosis in these five cases was a hairball. A thoroughly treatable problem.

Types Of Stomach Lumps In Cats

Part of the problem here is a lack of good quality information. I can find no research paper which looks at how common different lumps of cats are. So this list is based on my experience alone.

Hairballs

There are sporadic reports in the literature of hairballs causing gastrointestinal obstructions, and I have seen them too. Risk factors might include:

• A long coat
• Skin and coat problems
• Poor health for another reason

It’s worth noting that the cat who was euthanased had none of these risk factors. And the big danger with a hairball is that it feels exactly the same as a tumour.

Visit this page to read about hairball treatment and prevention, but in only a few minutes you’ll know how to recognise one.

Feline Infectious Peritonitis

You can read about FIP in more detail here, but one of its forms causes abdominal masses or tummy lumps. Clues that lumps in the belly might be caused by this dry form of FIP are:

• a young cat
• a persistent fever
• a longer course of illness

Once again, these are only generalisations. I have seen FIP in older cats with no fever too.

Followers of this blog will know that there have been recent and exciting changes to how we treat FIP. What was once a death sentence is now survivable for the majority of cats. All the more reason to get that diagnosis.

Lymphoma

Lymphoma is a tumour of one of the cells of the immune system. This is probably the diagnosis we fear the most, because it’s mostly a death sentence. Attempts at treatment are often very disappointing.

It’s true that abdominal lymphoma is one of the most common cancers of cats but there’s no way you can be certain just by feeling it. And I only see a few cases a year, much less than I see FIP.

Other Abdominal Masses

Of course, the abdomen is a complex place, and so there are many other less likely causes of lumps in the belly. Here are just some:

• Tumours arising from any of the organs or tissues
• Foreign bodies like surgical swabs, grass seeds or swallowed string
• Enlarged kidneys from ureteral blockage secondary to stones

Diagnosis Of Abdominal Masses

There’s one test that should be able to distinguish between all these causes: ultrasound. It’s neither difficult, invasive nor terribly expensive.

• A hairball will show itself as a mass inside the stomach or intestine containing large amounts of gas
• FIP mostly causes many irregular masses in the mesentery between the intestines
• Lymphoma can be the same, or a single larger mass like pictured, and easily diagnosed by ultrasound-guided needle biopsy
• Enlarged kidneys, abscesses or other tumours are usually just as obvious

Some vets may prefer to do CT, MRI or even exploratory surgery. All of these are good, and a whole lot better than not trying at all.

Going back to that paper at the start, it’s important to look at who published it. Although they don’t say so, most or all of those cats were probably referred from other vets. Whenever I read this I always think: “great, but referral is only the tip of the iceberg”.

Many more cats could have had similar experiences at private veterinarians and we would never know. But against this very negative outlook is a very positive one.

20 years have passed since this study was published. In that time ultrasound has gone from a referral procedure to one that nearly every vet practice can do well.

Therefore, despite my warnings, I’m confident that we aren’t euthanasing many cats with hairballs any more. But it requires a positive attitude, too!

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

The paper I mentioned was:
Barrs, V. R., Beatty, J. A., Tisdall, P. L. C., Hunt, G. B., Gunew, M., Nicoll, R. G., & Malik, R. (1999). Intestinal obstruction by trichobezoars in five cats. Journal of Feline Medicine and Surgery, 1(4), 199-207

After all, part of the reason vets use it so much is because we think you want us to.

What Is Convenia?

Convenia is a long-acting broad spectrum antibiotic called cefovecin. Once injected, it attaches to blood proteins and works for up to 14 days.

When Convenia first came on the market it was a godsend, or so we thought. Here was the answer to all those cats and dogs who just couldn’t be given pills. And to our fears that owners would miss antibiotic doses.

And in truth it is a remarkable antibiotic. It’s generally safe, highly effective and not too expensive in smaller animals like cats. For these reasons it’s changed the very nature of veterinary practice around the world.

So where’s the problem? It’s right there in the name.

Convenia Is Too Convenient

There are two good reasons why cefovecin is usually not the best antibiotic, but no others are so easy to administer. This leads are some of the following thoughts a vet might have:

• I bet this cat is hard to give tablets to
• I doubt this owner can give the medication any other way
• If I use it I’m more confident that my treatment won’t fail
• Owners prefer it when I give their animal a shot
• My boss says I have to give Convenia for this
• If I don’t give it, they’ll go elsewhere

And some of these could even be true. So, faulty as it is, it’s the popular choice. Even for things we just shouldn’t be using antibiotics for at all, like:

• simple diarrhoea
• cystitis (lower urinary tract signs) in young cats
• routine surgery or dentistry

There’s also the added pressure that once we make up a vial, it needs to be used within a time limit or we throw away several hundred dollars.

So what were those two reasons it’s not so good?

1. Convenia’s Side Effects

When Convenia came on the market, vets were understandably excited. It opened up a whole new way of treating difficult cases. But fairly soon we started to hear stories of adverse reactions.

Cefovecin contains the same base structure as penicillin, and so allergies can occur. When they happen with other antibiotics, we just stop them. With Convenia, blood levels are known to persist for 65 days.

That’s an out of control roller coaster you can’t get off.

However, let me be absolutely clear. It is still an excellent choice in three situations:

1. Resistant infections
2. Severe life threatening illness
3. When cats simply will not allow other medications to be given

Serious reactions are rare enough that when my cat was sick, I still chose Convenia to get her better. The daily fight to get her to take the pills was ruining our relationship. But perhaps if I’d known then what I know now I would have tried harder.

2. Convenia’s Wider Effects

Nobody has ever come to me with what I am about to say. I have learnt this only by finding the information myself. It’s the silence of a guilty status quo that needs to change.

It turns out that cefovecin is a “highest priority critically important antimicrobial”. It’s supposed to be a third line antibiotic, only used after the first and second choices fail, or after culture and sensitivity testing. This is when you swab and grow a bacteria to work out which antibiotics it’s sensitive to.

A recent Australian study found that vets were only performing cultures 0.3% of the time. Even when they did they always started the Convenia before the results anyway.

I am included in this behaviour. It can be hard to convince an owner to spend the extra 100+ dollars on testing and the results take several days to get. Usually you just want to get on and treat.

Why Does It Matter?

Antimicrobial resistance affects us all. We tend to blame doctors for overprescribing, or the agricultural industries, but people in glasshouses shouldn’t throw stones. The rate of antibiotic resistance in dogs and cats is comparable to that in humans and certainly higher than farm animals.

The use of third-generation cephalosporins like cefovecin is known to lead to the development of multidrug resistant organisms in people. Convenia is probably a worse offender due to the long ‘tail’ between 14 and 65 days when antibiotics are present in the body at sub-lethal doses to bacteria. This is a boot camp for resistance.

The problem isn’t just for ‘society’. If I give your cat Convenia when I could have used a first or second line antibiotic, their resident flora will probably develop resistance too. That means important antibiotics could fail later when we really need them, even possibly for you if you pick up those bacteria.

So What Should We All Do?

The path out of this mess is actually quite simple. Here are some suggestions for cat owners:

• Proactively tell your vet if you think you can give oral medications. We are often time-pressured so you might find you don’t get a choice otherwise.
• Even if you think you can’t, you mostly can. Common diseases like hyperthyroidism and chronic kidney disease tell us that every cat owner can do it when the chips are down.
• If it still seems impossible, visit my page on giving cats tablets. You’ll see that I stress the importance of roping in a second person to help, even a neighbour.
• As a last resort, most practice nurses will give tablets or injections for no extra fee if you come down at a set time.
• Antibiotics aren’t just tablets. Most can be made in liquid form, which is generally easier. And would you believe that giving a daily injection is easiest of all once you know how. Most recently a 90-year-old client of ours totally aced it!

For vets, who are in the driving seat it’s even easier:

• Vets should ask owners about their capabilities and wishes. If owners want to try we should give them support from the practice.
• We need to take a good hard look at whether some conditions really need antibiotics at all. Part of the problem here is our tendency to be risk averse (see below*).
• If antibiotics are needed, we should ask ourselves whether we can use one of low or medium importance instead.

By saying all this I don’t want to set myself up as a saint or criticise other vets. Until recently I was using Convenia way too much, often for the wrong things. The authorities can’t criticise either until they’ve made a decent effort to get the information in front of busy vets.

After all, they’re the ones who registered it, allowed it onto the market and then stepped away.

Sources

Hardefeldt, L., Hur, B., Verspoor, K., Baldwin, T., Bailey, K. E., Scarborough, R., … & Gilkerson, J. (2020). Use of cefovecin in dogs and cats attending first‐opinion veterinary practices in Australia. Veterinary Record, 187(11), e95-e95

Norris, J. M., Zhuo, A., Govendir, M., Rowbotham, S. J., Labbate, M., Degeling, C., … & Ward, M. P. (2019). Factors influencing the behaviour and perceptions of Australian veterinarians towards antibiotic use and antimicrobial resistance. PloS one, 14(10), e0223534

Singleton, D. A., Rayner, A., Brant, B., Smyth, S., Noble, P. J. M., Radford, A. D., & Pinchbeck, G. L. (2021). A randomised controlled trial to reduce highest priority critically important antimicrobial prescription in companion animals. Nature communications, 12(1), 1-14

The National Centre for Antimicrobial Stewardship

* One problem we don’t talk about enough is the pressure vets feel to practise defensive medicine. I recently treated a limping dog whose owners told me at the outset they wouldn’t have xrays done. So I treated the dog the best I could and when the dog turned out to have bone cancer (as I suspected), they made a complaint anyway. This sort of attitude gives us very little room for manoeuvre to not use antibiotics. If we are wrong even 1% of the time, we could still be held responsible.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

Canine ehrlichiosis is cause for considerable alarm for the millions of dog owners around the country.

The arrival of Ehrlichia in Australia has been devastating for some remote dog communities. However, there is no reason to panic, and prevention is easy.

Here I’m going to help Australian dog owners to understand the risks, and know how to easily prevent it.

What Is Ehrlichiosis?

Ehrlichiosis is the disease caused by a tiny bacterial blood parasite called Ehrlichia canis. It’s spread by the bite of a tick, and specifically Rhipicephalus sanguineus the Brown Dog Tick.

It causes some or all of the following signs:

• Fever and lethargy
• Swollen glands
• Discharge from the eyes and nose
• Fluid swelling of the legs and genitals
• Bleeding excessively (seen as red patches on the skin & gums, blood noses or cloudy eyes)

Death is possible in severe cases.

The Spread Of Ehrlichia In Australia

Until recently, Australia was thought to be the only continent whose dogs were free of the disease. Then, in 2020, it was found in sick dogs in the Kimberley, and then more widely across Western Australia, the Northern Territory plus a single case in far north SA. Currently there have been in excess of 300 cases and dog numbers in some remote communities are reported to have dropped by one third.

The map shows the approximate locations of positive reports. It also shows where the tick that carries it is found. As you can see, there’s a lot of Australia where the disease could still spread.

In response, governments have instigated control programs and are preventing the movement of dogs from known areas. Currently the chance of a dog getting ehrlichiosis is still very low. However, everyone who lives in these areas or travels to them should be aware of the risk.

Prevention Of Ehrlichiosis

The risk of your dog catching ehrlichiosis is closely related to two things:

1. The chance of being bitten by a Brown Dog Tick
2. The chance of that tick carrying Ehrlichia canis

Therefore, tick control measures are very important for dogs wherever ticks are found in the Northern Territory, Western Australia and far northern South Australia. There is less concern in Queensland, but most dogs east of the dividing range will still need to take paralysis tick treatments.

Movement Of Dogs

If you are travelling, avoid taking your dog into known infested areas unless absolutely necessary. Once you do, keep an eye on state government regulations before leaving the area or crossing state lines as the situation is likely to change rapidly.

For example, If you plan on moving your dog into southern WA from the shires of Broome, Derby-West Kimberley, Halls Creek and Wyndham-East Kimberley, you now must:

• Email animalbiosecurity@dpird.wa.gov.au with your details (name, address, email, phone number), your dogs’ details (name, age, sex, breed, microchip number), product and date of tick treatment and details of destination for the dog (you can also fill in and email a dog movement notification form)
• Ensure that all dogs being moved are healthy
• Apply one of the tick treatments mentioned on this page during the seven days before moving your dog
• Keep a record of the tick treatment for six months after the movement
• Contact the Emergency Animal Disease Hotline on 1800 675 888 if your dog becomes unwell following movement

Prevention Of Brown Dog Tick Attachment

In Brown Dog Tick areas, follow these precautions:

• Avoid areas where free ranging dogs are seen to congregate
• Keep grass short in dog yards and avoid walking in overgrown places
• Get a pest controller if ticks are found in your yard
• Check dogs daily for ticks; read how here
• Use good tick control products
• Contact local vets for more information; ticks also transmit Babesia and Anaplasma

Brown Dog Tick Control In Dogs

The prevention of ehrlichiosis requires a different strategy to tick paralysis. Whereas in tick paralysis, it’s OK if a tick attaches as long as it dies quickly, in ehrlichiosis, we don’t want the tick to attach at all.

Therefore, we use surface insecticides that can act before the tick begins to feed. Currently, there are four available in Australia:

1. Advantix spot on
2. Seresto collars
3. Preventic collars
4. Kiltix collars

Of these, I recommend the first two, as they have been experimentally shown to prevent the transmission of Ehrlichia canis to dogs (references below). However, we don’t stop with these alone.

The cornerstones of good tick paralysis prevention are the new tablets like Simparica, NexGard and Bravecto. Their outstanding efficacy and safety means that they should be used as a second line of defence. The fact that they work better for paralysis ticks shows that once the tick attaches, these are the products of choice.

I hope you can now see that preventing ehrlichiosis is not difficult for the average dog owner. But finally, let me say one last thing: if your dog gets it, doxycycline is a simple and cheap treatment. Just so long as it’s started straight away, recovery is all-but guaranteed.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

References

Note: the distribution map for Rhipicephalus sanguineus was constructed from the first reference, with the addition of recent reports from northern South Australia. The Ehrlichia incidence reports were compiled from state government sources (I have not included a Northern Goldfields report due to vagueness about its location).

Chandra, S., Ma, G. C., Burleigh, A., Brown, G., Norris, J. M., Ward, M. P., … & Šlapeta, J. (2020). The brown dog tick Rhipicephalus sanguineus sensu Roberts, 1965 across Australia: Morphological and molecular identification of R. sanguineus sl tropical lineage. Ticks and tick-borne diseases, 11(1), 101305

Dantas-Torres, F., Capelli, G., Giannelli, A., Ramos, R. A. N., Lia, R. P., Cantacessi, C., … & Otranto, D. (2013). Efficacy of an imidacloprid/flumethrin collar against fleas, ticks and tick-borne pathogens in dogs. Parasites & vectors, 6(1), 1-8

Fourie, J. J., Luus, H. G., Stanneck, D., & Jongejan, F. (2013). The efficacy of Advantix® to prevent transmission of Ehrlichia canis to dogs by Rhipicephalus sanguineus ticks. Parasite, 20

Jongejan, F., Crafford, D., Erasmus, H., Fourie, J. J., & Schunack, B. (2016). Comparative efficacy of oral administrated afoxolaner (NexGard) and fluralaner (Bravecto) with topically applied permethrin/imidacloprid (Advantix®) against transmission of Ehrlichia canis by infected Rhipicephalus sanguineus ticks to dogs. Parasites & vectors, 9(1), 1-14.

Stanneck, D., & Fourie, J. J. (2013). Imidacloprid 10%/flumethrin 4.5% collars (Seresto®, Bayer) successfully prevent long-term transmission of Ehrlichia canis by infected Rhipicephalus sanguineus ticks to dogs. Parasitology Research, 112, 21-32

Here you can find the latest information on the risk to Australian dogs and what you can do to reduce it.

Basic Facts About Leptospira

Leptospirosis is the disease caused by several related bacteria but particularly Leptospira interrogans (‘interrogans’ means ‘asking’ because they sometimes look like question marks).

It comes in many different varieties, but the two that matter most to Australian dogs are australis and copenhageni.

• Australis is found mainly in the coastal wet tropics of Australia from Mackay in Queensland through the Northern Territory and into Western Australia
• Copenhageni cases can be found in lower numbers but throughout Australia, with recent outbreaks recorded in Sydney and Melbourne

Both are spread via the urine of infected animals (especially rats) in water, soil or foods. Infection is more common in dogs living near wet areas.

Signs Of Leptospirosis

Many dogs infected with leptospira show no symptoms, though some will be passing the bacteria in their urine. Those that become unwell usually develop a fever, stop eating and might have vomiting, diarrhoea and dehydration.

More serious disease is caused by multisystemic organ failure. A classic sign of leptospirosis is the simultaneous appearance of liver and kidney damage, but eye or brain involvement is also possible, as is coughing up blood. Affected dogs commonly have yellow tissues, called jaundice.

Leptospirosis in Australia is unlike other countries due to the different varieties involved. When disease occurs here, it is extremely serious. Mortality rates exceed 50% for dogs with liver or kidney involvement.

How Common Is Leptospirosis?

In tropical northern Australia, leptospirosis is more common during the wet season of summer and autumn. In a North Queensland study, 40 dogs were diagnosed over a 5 year period. Risk factors were believed to include living in the cane-field regions, near dairy cattle or around rat populations.

In temperate southern Australia, the risk is generally lower, but in 2019 and 2020, hotspots were identified in some capital cities. Whether these represent better awareness of existing infection or new outbreaks only time will tell.

In Sydney, dogs have mainly been diagnosed in the inner-west from Newtown to Surry Hills, plus a case each in Balmain, Crows Nest and Paddington. In Melbourne, a few cases have been seen mainly in the eastern suburbs near Ringwood. Although numbers are hard to assess, we are probably talking about 20 in total.

Below is a recent study of dogs from shelters throughout Australia. These results should be viewed with caution as they may not be the dogs at greatest risk, especially in the tropics.

Which Dogs Need The Leptospirosis Vaccine

There are vaccines against both varieties of leptospira available in Australia. Whether these should be used is a matter of assessing the local risk.

In southern Western Australia and South Australia, there currently seems no reason to vaccinate unless travel is planned to an endemic area.

In Victoria, vaccination may be indicated in a few suburbs of Melbourne. However, case numbers have been low and sporadic, so please talk to your vet about the local situation at the time.

In New South Wales, vaccination is being recommended in a 5km radius around the suburbs mentioned above. Individual risks probably have a lot to do with the prevalence of rats in each suburb so once again, a discussion with your vet is a good idea. Outside of Sydney there may be hotspots, such as the north east coast but your vet will keep you informed.

In Queensland, vaccination is not commonly performed south of Sarina, near Mackay. Exceptions might be areas close to green cane cutting. Even to the north, the risk will depend on your dog’s lifestyle, but vaccination is generally a good idea.

Vets in the tropical Northern Territory almost all advise current leptospirosis vaccination.

Prevention Of Leptospirosis

Vaccination is important, but it’s not the only answer to prevention, mainly because australis and copenhageni are not the only strains present.

1. Prevent drinking from unclean water sources
2. Avoid dogs swimming in stagnant water
3. Control rats by eliminating food sources and nests (not by rat poison)

These guidelines are sensible everywhere, even in Perth or Adelaide. Not only do they prevent other illnesses, they insure us against the future. Lepto is an emerging disease and there’s no reason to think it won’t appear in unexpected places. For example, Switzerland (hardly a tropical country!) is currently battling the australis strain too.

Lastly, it’s important to mention that leptospirosis is also a serious disease of humans, though transmission from dogs is extremely unlikely. Most people probably catch it the same way they do, from water and soil contaminated with animal urine. Symptoms mimic those of any severe flu-like illness.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

Miller, R. I., Ross, S. P., Sullivan, N. D., & Perkins, N. R. (2007). Clinical and epidemiological features of canine leptospirosis in North Queensland. Australian veterinary journal, 85(1‐2), 13-19

Zwijnenberg, R. J. G., Smythe, L. D., Symonds, M. L., Dohnt, M. F., & Toribio, J. A. (2008). Cross‐sectional study of canine leptospirosis in animal shelter populations in mainland Australia. Australian veterinary journal, 86(8), 317-323

Plus: Local media articles and veterinary websites from the Northern Territory, Queensland, New South Wales and Victoria.

I’m sorry that I do not have local information for cat owners outside of Australia.

Now read on!

The nightmare is almost over. Until very recently, a diagnosis of Feline Infectious Peritonitis was a death sentence. Either a slow, lingering decline or a decision to euthanase and spare the suffering. This happened to around 1% of cats, most of them kittens.

Then it was discovered that certain antiviral drugs could not only improve the symptoms, they could actually bring about a cure. But there was still a hitch.

These antivirals weren’t licensed in Australia, and therefore illegal to import and use. So the only cats who survived were those whose owners and vets were prepared to take the risk. My own veterinary association shamefully advised against their use, despite the evidence.

All that has ended for Australian cats.

We apologise that for legal reasons we are unable to assist outside of Australia.

Remdesivir: A New Hope For FIP

You’ve heard of remdesivir. It was rushed through TGA and FDA approval due to promising results in the treatment of COVID-19. What’s important about remdesivir is that it’s almost identical to those black market drugs like GS- 441524.

Except this time it’s freely available with a valid prescription, and has all the quality controls we expect from licensed drugs. Vets still need to warn you about ‘off-label’ use, but this is the same discussion we have whenever we pick up a human drug (which is often!)

Preliminary trial work in Sydney has produced excellent results. So now we have a drug for all. I estimate that less than 5% of cats with FIP a were previously being saved using GS. We should now see all owners getting offered the chance, and most taking it up, though cost issues still exist.

Costs Of Remdesivir Use In Cats

As you can imagine, it’s an expensive drug. A rough estimate is that a course of 80 days’ treatment costs around $8000 to $10000

However, dose for dose, this is very similar to the prices people were paying for black market GS- 441524 of unproven purity or efficacy. This time, if a cat is insured, the insurance company is likely to pay for it as well. Read a longer comparison of GS and remdesivir here.

Based on our experience, 84 days of treatment should bring about a cure in the large majority of affected cats. It’s administered as once-daily subcutaneous injections, but don’t be put off. Everyone can do it, and we are happy to show you how.

UPDATE: By late 2021, we had successfully treated around 30 cats, with only a single failure in a neurological case. Doses of remdesivir are now higher than initially recommended. We now also have access to pharmaceutical-grade GS- 441524 in tablet form, which is both a little cheaper and easier to use for some owners.

Protocols remain at 84 days. Those going onto tablets are recommended to start with injections for the first 4 weeks.

We are all thoroughly indebted to the work of Dr Richard Malik DVSc PhD FACVSc FASM and the feline research team at my alma mater The University Of Sydney.

We are also indebted to the volunteer groups who, by taking on the risk, have helped many cats back to health. Their job is done, and we’re grateful.

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By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

Once you know it, a lot of other common cat illnesses start to make sense.

To understand the special nature of cat diseases, you need to look at how they began. So stick with me! What I’m about to discuss could be the most important health issue of cats.

How Diseases Evolve

The basic idea is simple: that all parts of nature, even bacteria and viruses, are governed by natural selection. The ones we’re talking about here are the harmful ones, which we call pathogens.

Just like animals, any pathogen will only pass on its genes if it can survive and reproduce. Therefore, it needs to adapt to its environment in order to spread itself the best.

If the environment is a cat’s body, it faces a challenge that human and canine pathogens do not: the semi-solitary lifestyle.

Infectious diseases of people and dogs jump around merrily from host to host because there’s always another new victim nearby. That’s why we both get diseases that don’t exist in cats, such as:

• influenza (canine flu has so far been kept out of Australia)
• whooping cough (kennel cough by another name)
• measles (a milder relative of distemper)

And the list could go on, nearly always of severe but short-term infections.

How Cat Pathogens Differ

Cat diseases needed to be trickier to survive. They evolved back when cats might have been at a density of only one per square kilometre. Under these circumstances, the ‘fast burn’ of dog diseases would have fizzled out long before they found another host.

To survive, feline pathogens needed two new skills:

1. Persistence for a long time in the host
2. Mild symptoms so the animal kept spreading them

And there you have it: the asymptomatic carrier. A cat that looks OK, even feels OK, but carries and passes on pathogens to other cats.

Cat Diseases Spread By Carriers

Have a look at these diseases of cats carried by asymptomatic spreaders:

• Herpesvirus cat flu
• Calicivirus cat flu
• Feline immunodeficiency virus
• Feline leukaemia virus
• Feline coronavirus
• Chlamydia
• Plus many more gut and respiratory infections

As you can see, nearly all of the important pathogens of cats are here. And I suspect there are others we haven’t found yet.

Take for example, this very common new kitten scenario. Tiger might be living the comfortable life of a middle-aged house cat, but he’s in for a shock. Within a week of a healthy new kitten arriving, he’s got a fever, won’t eat and stays curled up on the bed.

What’s he got? Most of the time it doesn’t appear on our tests, but it certainly came from the kitten, who never looked sick at all. Tiger will get better, but no one saw it coming.

Signs That A Cat Is A Carrier

Cats carrying a contagious disease might look perfectly fine, but here are some clues you could see:

• watery eyes
• sneezing and nasal discharge
• coughing
• gingivitis and stomatitis
• intermittent diarrhoea
• stunted growth or reduced activity
• frequent unexplained illnesses

In other words, anything. But often he or she might just as easily look perfectly healthy.

Cat Breeders and Shelters

You can start to see why cats and kittens often come to you not right. Diseases adapted to spread well when cats are far apart will spread like crazy when cats are brought together.

This is probably why the neighbourhood stray has her kittens in the shed or under a bush, and rarely in the same place twice. There’s no chance of doing that if you’re a breeder or rescue shelter. The best you can do is reduce the problem.

Good breeders and shelters will attempt to minimise contact between cats, and identify resident carriers. Tests are available for every listed disease. However, I can tell you that some shelters and breeders clearly do better than others.

Cat Boarding, Cat Cafes & Hoarders

Now I also hope you can see why I’m so critical of some cat boarding. If cats are mixed, or even if they share a space without it being cleaned, they often come back with more than you bargained for.

The same goes for cat cafes. They can work fine if the resident group is stable, like the ones I saw in Japan. However, if there’s a coming and going of cats, disease is inevitable.

The worst of all are hoarders. These are the people that think they’re rescuing cats, but what they’re really doing is hoarding them, usually made worse by uncontrolled breeding. The cats in these dysfunctional groups have almost no chance.

But these criticisms aside, when I see kittens from a shelter or breeder with runny eyes or sneezing, I hold my tongue. I want you to know it’s not ‘dust’ or ‘allergy’ but I don’t want you to blame them. I see these diseases as the price we pay for adopting any cats that aren’t strays.

I just want you to know because usually there’s something we can do to help.

Treatment Of Carriers

Whether or not kittens with sneezing and runny eyes can be treated depends on which pathogen is the ultimate cause.

Bacterial causes have a strong chance of success. Chlamydia in cats is extremely common as a cause of chronic sneezing and weepy eyes, and this can usually be cured with a very long course of antibiotics.

Therefore, I usually start with four weeks of doxycycline, and even longer if I get a good response. Ideally I will do a respiratory PCR test first, but as this does not always identify the cause it’s optional.

Viral causes either get better by themselves or remain present for life. Symptoms should settle down with time if a cat’s health is otherwise looked after. It’s certainly annoying when I can’t get rid of the symptoms, but it’s not the end of the world. These kittens still live long and happy lives.

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By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

What you are seeing here is not that older cats need more vaccinations. Instead, you are looking at a snapshot of a sweeping change in how Aussies look after their cats. These are the cats that have unsupervised outside access. And they are going down, fast.

Australia is rapidly changing into a nation that keeps its cats indoors. Using this data, we can document the change. Like this:

• 56% of cats were outdoors 10-13 years ago
• 50% of cats were outdoors 7-10 years ago
• 35% of cats were outdoors 5-7 years ago
• 35% of cats were outdoors 2-5 years ago
• 19% of cats were outdoors 0.5-2 years ago

A Quick Explanation

The AIDS-like disease of cats called FIV is only transmitted by a direct bite. Therefore, in the spirit of only giving cats what they need, its vaccine is not recommended in indoor cats. That includes those who only go outside under supervision.

On the other hand, owners of cats who venture outside alone are advised to add FIV vaccination to their core F3 vaccination. The disease is scary enough that almost everyone takes our recommendation. Then, once they start, they rarely stop, which is why those older cats are still getting it.

And there you have it: a shorthand way of seeing how many cats live inside and how many don’t. At least in our local bubble.

Why Are Cats Moving Indoors?

The trend is real and unmistakeable, but it’s against the preferences of most cats. It could even be said that their welfare is at risk by depriving them of the outdoors. So why do we do it?

There are lots of good reasons, which I’ll go through here.

Shelter & Breeder Advice

Probably the number one reason is the almost unanimous advice from the places where kittens come from to keep them inside. It’s rare for people to go against such strong advice, especially if they’re new to cat ownership.

This advice is especially important in the first few months, when cats might wander away and be lost.

Safety

Cats given outside access have a higher risk of injury, especially by motor vehicle, and a higher risk of death from all forms of trauma. They are also at risk from dogs, snake bite, pythons in northern Australia and coyotes in the USA just to name a few.

Tick paralysis is common on the eastern seaboard of Australia in free-roaming cats. Poisonings may be just as common inside but outdoor cases seem more serious. Top of the list is ‘secondary poisoning’ from eating poisoned rats and mice.

Diseases

All infectious diseases are more commonly acquired while outside. I’ve already mentioned FIV, but to this we can add the three components of the F3 vaccine, herpesvirus, calicivirus and parvovirus.

Then there’s feline coronavirus and chlamydia. There’s also the gastrointestinal parasites, especially giardia, roundworm and tapeworm. Finally, you can add Lyme disease, rabies and feline leukaemia virus depending on where you live.

Human Health

Outdoor cats are more likely to catch toxoplasmosis and bring it into the home. To them, it’s rarely a problem, but it’s a major concern in human pregnancy or immune deficiency.

Scary as it is, toxo is easy to avoid once you know how. If you are thinking of having children or know someone with poor immune function, read my guide to preventing toxoplasmosis in cats & people. Needless to say, among the many suggestions is to keep cats inside!

Nuisance

Cats are also a great way to really annoy your neighbours. My previous cat was outside, and never left the yard, but those that do often end up using next door’s as a toilet. Others might stress the neighbour’s cat/rabbit/bird or help themselves to someone else’s dinner via the cat flap.

Many people, including me, cherish the local wildlife and would get fairly cranky if they were being killed or even just scared away. This is especially important when living near remnant native habitats.

Cats who are outside at night will up the ante on all these points, and add the extra joy of noise. Of course, all of these vices are much more likely to be from unseen feral cats than a pampered domestic but if one goes outside he’ll always tend to get blamed. The same way cats get blamed for disappearing chickens.

Expense

Sometimes the hip pocket is the driver for change. Outside cats get in a lot more fights with other cats, and these end up being quite a drain on the finances. Each bad fight will require (at minimum) a course of antibiotics, but often surgery for a cat fight abscess.

To this everyday problem, add the threat of a week in hospital for tick paralysis or road trauma and you can see why the choice to stay inside is an economical one too.

Housing

The last reason is possibly the biggest one. As we move from large blocks to smaller houses and apartments, there often isn’t a safe way for cats to be outside.

Those that do are still usually confined. A lot of the cats I see now have small enclosed courtyards into which other cats cannot enter. The apartment dwellers of course have useful balconies, but I would be very wary of allowing them access without netting.

Living The Best Indoor Life

An indoor lifestyle on its own is all about what’s been taken away. Unless an effort is made, the loss of freedom could be worse than the benefits.

These days I have an indoor cat, and although I’m sure he’d disagree on the details, he has a good life. He’s a lot more fun too, just because he’s always nearby.

A lot of our ideas for keeping indoor cats happy came from my experiences. I’d love it if they help you too. And please add your ideas in the comments!

You might also like: Safe Plants For A Cat Enclosure

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By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

Like how many cats get it and how they pass it on. Or how to stay safe, especially if you are pregnant. And the disease itself in cats and dogs. We cover all these here.

The Toxoplasma Life Cycle

An understanding of the toxoplasma life cycle is essential to know how to prevent it in cats and people. The picture above, while a gross simplification, is a good place to start.

Toxoplasma gondii has basically two life cycles: one in cats that creates small egg-like oocysts, and one that creates tissue cysts in everyone else. It starts when an infected cat passes oocysts in their faeces into the environment.

These eggs can survive for months and end up being eaten by any variety of animals. In the new host, they hatch and multiply inside the cells until they form tissue cysts, especially in muscle and nervous tissue. There are three outcomes depending on the species involved:

1. If the eggs were ingested directly by humans they will cause infection and tissue cysts
2. If they were eaten by a human’s dinner (e.g. lamb) they might cause human infection too, depending on how the food is prepared
3. If they were eaten by a cat’s prey, they will re-infect the cat and could start another round of oocyst production

How Common Is Toxo In Cats?

Thankfully, any individual cat is extremely unlikely to be passing oocysts or be capable of infecting humans. Large studies of German cats have shown that only around 0.25% of lab samples are positive for Toxoplasma, or one in 400.

Even infected cats are low risk due to their fastidious cleaning habits. In one study, eggs could not be detected on experimentally infected cats seven days after they were passing millions in their faeces. This may be why it has been shown repeatedly that having a cat is not a risk factor for getting toxoplasmosis.

How Humans Get Toxoplasma

There is strong evidence for two main modes of transmission:

1. Eating tissue cysts from undercooked meat. This is probably the main way in developed countries.
2. Ingesting eggs from the environment. This is thought to be the most common way in underdeveloped countries.

A 2019 study right here in Adelaide found that the chance of toxoplasma being found in a portion of supermarket lamb mince was 43%. While we don’t have data for beef, pork, poultry, rabbit and kangaroo, we expect them to also be positive, but lower. It’s a simple fact that any animals that eat foods or graze pastures contaminated by cat faeces will regularly be infected.

How To Prevent Toxoplasmosis

Most humans who get toxoplasma will have few or no symptoms. However, if you are pregnant or have a weak immune system, the consequences could be devastating (see your doctor for more details).

You should do all of the following:

• Cook meat thoroughly to at least 67 °C (I understand this is considered ‘medium’)
• Wash hands, utensils and surfaces with soap and water after handling raw meat
• Wear garden gloves if digging, and wash hands well afterwards
• Wash vegetables before eating

Additionally, the following are sensible guidelines for cat owners:

• Wash hands after petting your cat before eating
• Feed cats only dry, canned or cooked foods*
• Avoid letting your cat hunt
• Empty the litter box every day (the eggs aren’t infectious for the first 24 hours)
• Get someone else to do it!

* As toxoplasma is killed by temperatures below minus 12 °C it is probably still safe to give chicken necks if they have been frozen first.

Toxoplasmosis In Dogs

Toxoplasma can’t create eggs in dogs so there’s a very low risk of their faeces being hazardous unless they eat cat poo. Probably an equally low risk is dogs rolling in cat poo and having the eggs on their coat.

Clinical toxoplasmosis as a disease of dogs is exceedingly rare. When it occurs, it usually affects the nervous system with vague signs such as behavioural changes, tremors, weak legs, or paralysis. However, in a young dog, especially with muscle wastage, it’s more likely to be caused by another parasite called Neospora.

Help! My Cat Has Toxoplasmosis

Toxoplasmosis in cats is a very different disease, with the following possible symptoms:

• Severe and generalised illness
• Trouble breathing
• Neurological signs like wobbling or a head tilt
• Eye infections
• Liver infection and jaundice
• Abdominal infection

Particularly at-risk groups are newborns, and cats who catch it after being immunosuppressed with cyclosporin or chemotherapy.

Diagnosis of Toxoplasmosis In Cats

The problem with such a range of possible symptoms is that almost any sick cat could have toxoplasmosis. This is made worse by the difficulty in getting an accurate diagnosis.

The only certain diagnosis is made by finding the actual organism in tissues or fluids. However, this is very difficult. Therefore, vets often make a tentative diagnosis if the cat has:

• a high IgM titre
• two IgG titres showing a four-fold increase
• exclusion of other diseases
• a positive response to treatment

Treatment of toxoplasmosis is via a range of unusual drugs such as clindamycin, pyrimethamine, toltrazuril or fluconazole. None work very well in severely unwell cats.

Vets will often use clindamycin when toxo is suspected, just to be sure. But most of the time, the problem is probably being caused by something else.

That’s because actual illness caused by toxoplasma is rare. Just like humans, most cats who get toxoplasma show no signs, and make a rapid and full recovery.

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By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.