My cat is fighting for his life with chronic calicivirus

Question

My cat has been suffering from an ongoing calicivirus outbreak for the last 7 months. Anti-inflammatory pills don't help. He is barely surviving with cortisone which enables him to eat and maybe have 2 better days every 10 days. The rest of the time he sleeps and chokes on the ulcers only coming out of his bed to sit on us in the evenings when he purrs. About once a month, he has to be taken to the vet to have an antibiotic and cortisone injection when he gets to the point of refusing to eat altogether at home. We removed his teeth a couple of months ago too but that didn’t help. I don’t know what to do. The vet has run out of ideas, as well.

Answer 1

Your message here doesn't contain an explicit question, but I noticed the "euthanasia" tag and can kinda guess what you're going for here. Ultimately, this is an opinion based answer, and only you know your cat best. I know that doesn't help, and it doesn't make it easier. If your vet offers no next steps, it is hard to know what to do next.

Here's a few things you can think about that I hope helps provide some guidance:

Second opinion: It never hurts to get a second opinion on your cat. If this vet is out of ideas, it doesn't mean they are a bad vet. One person can't know everything, and other vets may have useful experiences or ideas. It sounds like your cat has the more severe strain of calcivirus, which isn't as common, and maybe another vet has had more experience. You can always ask your vet for referrals, most vets will understand.

Quality of life: Cats can't tell us in words how they're doing, but they tell us a lot in their actions, or inaction. You explicitly used the word "suffering". It sounds like you can tell your cat is not living his best life right now. You've probably known your cat his whole life. Look at his experience from his perspective. Ask yourself:

• Is he in pain, more often than not? Is he still able to find comfort during this?
• Is he still able to enjoy the things he used to enjoy? (He still seeks your company and purrs.)
• Is taking any extreme measures to provide comfort worth more potential suffering, from his perspective? (Think teeth extraction or frequent cortisone shots.)
• Do you consider the current measures you are taking for your cat as helping or prolonging?
• What is your cat telling you? (I think cats tell us a lot about how they feel, and the care they are receiving.)

Remember: Knowing what's best for a pet that is suffering is really hard. Sometimes we can't truly know. So, give yourself space and forgiveness and kindness in deciding next steps. I know your cat does, and will.

Answer 2

This is a difficult one. Sometimes supportive care as you are doing may be all that can be done.

Injectable steroids and injectable antibiotics tend not to be very effective for calicivirus, although I understand the inclination to use these in a cat with a painful mouth. Steroids can sometimes exacerbate viral disease although the anti-inflammatory benefits may outweigh those risks.

A couple of other considerations:

• Sucralfate liquid given by mouth can be helpful to treat ulcers (it works to coat the ulcers to help them to heal). It is more commonly used for internal ulcers (gastric or intestinal ulcers).
• Pain medication such as buprenorphine given in the cheek may be very helpful for the short term.
• Consider having a feeding tube placed for the short term. Esophagostomy tubes are generally very well tolerated in cats, and allows you to get the nutrition your cat needs while the mouth heals. It only requires a short anaesthetic to place the tube. The tube can be left in place for weeks to months if needed. He can still eat on his own if he wants while the tube is in place.

This would be a case where I would consider treatment with a feline interferon. Interferons can be active against many types of viruses including calicivirus.

There is limited data on their use for feline calicivirus (no large studies that I am aware of), but there are a number of small studies that suggest interferon can help. It's certainly no guarantee but I have seen a few cases that have responded well.

The problem may be sourcing the medication as it will be off-label use in most countries, and may be difficult to find. You may need to see an internal medicine specialist if your vet has not used this treatment before.

A few references on interferons —

• Hennet PR, Camy GAL, McGahie DM, Albouy MV. Comparative efficacy of a recombinant feline interferon omega in refractory cases of calicivirus-positive cats with caudal stomatitis: A randomised, multi-centre, controlled, double-blind study in 39 cats. Journal of Feline Medicine and Surgery. 2011;13(8):577-587. doi:10.1016/j.jfms.2011.05.012

• Hirotaka Matsumoto, Takahiro Teshima, Yoshiyuki Iizuka, Arihito Sakusabe, Daiki Takahashi, Akiteru Amimoto, Hidekazu Koyama. Evaluation of the efficacy of the subcutaneous low recombinant feline interferon-omega administration protocol for feline chronic gingivitis-stomatitis in feline calicivirus-positive cats, Research in Veterinary Science, 2018;121:53-58 doi:10.1016/j.rvsc.2018.10.003.

• Yongxiang Liu, Xiaoxiao Liu, Hongtao Kang, Xiaoliang Hu, Jiasen Liu, Jin Tian, Liandong Qu, "Identification of Feline Interferon Regulatory Factor 1 as an Efficient Antiviral Factor against the Replication of Feline Calicivirus and Other Feline Viruses", BioMed Research International, vol. 2018, Article ID 2739830, 10 pages, 2018. doi:10.1155/2018/2739830

• Anne C. Ballin, Bianka Schulz, Christopher Helps, Carola Sauter-Louis, Ralf S. Mueller, Katrin Hartmann. Limited efficacy of topical recombinant feline interferon-omega for treatment of cats with acute upper respiratory viral disease, The Veterinary Journal, Volume 202, Issue 3, 2014; 202(3), 466-470, doi:10.1016/j.tvjl.2014.09.030.

Answer 3

I'm very sorry for you and your cat. My cat (around 15-16 years old) also has a calicivirus infection, for several years now. He was treated with ARA 3000 ALPHA for 2 years and it helped a lot. The treatment is a bit difficult to put in place, as the patient needs an injection every 3 days during the first 2 or 3 weeks, then it is once a month, but it worked quite well. We then started a new treatment with lasers (no tranquilization needed, my cat understood quite fast that the treatment is good for him). During a year my cat had both ARA and laser once a month. Now he is "only" having laser when he needs (more or less once a month). I also put an aloevera gel (called Buccanima) in his mouth once a day, it seems to help with the pain. I hope this can help, as I'm living in France and I do not know if you can have access to these treatments. Good luck and my best wishes.

Answer 4

In addition to the strong suggestions you've received thus far, I wanted to echo potentially getting a second opinion. I'm curious if your vet has ruled out stomatitis, a chronic autoimmune disorder that can be caused by calcivirus.

I bring this up because I cared for a cat who suffered from chronic upper respiratory infections, but these were actually continuously perpetuated by stomatitis rather than a viral infection. Full dental extractions are usually part of the treatment plan, which it sounds like your cat has already received. Stomatitis that persists even after dental extraction is called refractory stomatitis and there are medicine-based treatment plans for it that seem slightly different than the treatment plan your cat has been on.

I'm not a vet so this is purely anecdotal based off my experience, but it might be worth looking into further.