Friday, December 14, 2012

My experience with Feline Infectious Peritonitis (FIP)


FIP is a deadly disease that affects cats [1]. The disease is labeled as the worst disease that a cat can have. The disease is caused by a virus (FIPV) which invades the white blood cells.

The cure in most other diseases caused by viruses consists in stimulating the immune system to fight the virus. Stimulating the immune system in FIP is a bad idea because the virus enters in the white blood cells and turns them against the body of the cat generating a huge inflammation of internal organs.

One of my cats - named Miki - has been recently diagnosed with this disease. I'm keeping here a record of things are happening while Miki is fighting with this disease.

Miki is an 7 years old female.

On July 19, 2012 she gave birth to 2 offspring which have died in few minutes after were born. Miki was still screaming, but we have not realized that is something wrong with her. She was still screaming 24 hours after ... we thought that maybe she is looking for her offspring. On July 20 she left home. In the evening of that day we could not find her. We finally realized that she was not able to deliver all her offspring and she has left home to die in an unknown place. Usually cats don't die at their home. They leave home and search for a quiet place where they can die peacefully.

On July 21 Miki has returned home with a huge infection with worms in her back-side. We run to the vet which confirmed that there is another dead offspring inside her and she must be operated. Temperature was 41.5 Celsius.

The vet operated her, removed everything inside, and the cat was starting to recover. She has got 4 shots with antibiotics in 4 consecutive days. Everything was looking normal.

After 8 days since the surgery, the cat has started to have fever - between 39,2-39,8. We have given again shots with antibiotics (amoxicilin-based : betamox - for 10 consecutive days. No answer ... the fever was still there. The cat was looking fine, eating, playing etc ... so we have not given her more shots anymore.

After few days her abdomen has started to grow. We have not payed too much attention to that because the cat was eating a lot of food. I have asked few friend and all told me that is normal for a cat to gain weight after it was neutered.

In 3 weeks Miki has developed in big abdomen. I went to our local vet and told us that there is something wrong with the abdomen ... and that we should go for an ultrasound. It was Wednesday.

Thursday I've been busy and I could not travel with Miki to another vet.

On Friday we went to another vet in another city and he looked at her with the ultrasound and told us that she has a lot of liquid and that here liver is big.

He tried to take some blood samples, but he could not do that ... the cat was fighting ... so he decided that the cat has cirrhosis and we must give her liver-protection medicine (like Liv52). He also gave her furosemid for removing the water out of body. Friday Miki had 4,3 kg.

We gave her furosemid (0.5 ml/day) - with no help. Until Monday her abdomen became huge ! She was breathing more difficult than usually.

On Monday (6 weeks and 2 days after the initial surgery) we went to another vet in another city and this vet took blood samples and also made her a puncture to try to see what is inside the cat. An incolor liquid filled with something looking like a pus has started to flow in the syringe. Protein content was high. Also the neutrophils.

The vet has suspected that something went wrong with the initial surgery and decided to open her again to see what is the problem inside. When he open her, he saw a lot of fibrosis covering her internal organs, but he discovered nothing strange with the initial operation.

In few hours after the operation, Miki has woken up.

In the second day she was weighting 3,7 kg. It means that it was more than 600g of liquid inside.

The vet has suspected that it was some kind of infection that affected her abdomen. Maybe a simple peritonitis. He started giving her antibiotics - cefotax [2] - a 3rd generation antibiotics.

The liquid inside her abdomen was still accumulating. After one week the abdomen has grown again to a significant size. The vet has drained her again and took some blood samples from which he performed biochemistry looking for something wrong with her liver or kidney. But the analysis were in normal.

Another doctor came up with the idea of FIP.

We stopped giving her cefotax. After one day the temperature has increased to 39.5. After another day the temperature was 40.3.

Several days later we start to give her an antiviral drug (isoprinosine). Second day the temperature was back to normal. It seems that isoprinosine is doing a good job.

We made some FIP test (from feces and blood) but all were negative.

Not having too many options ... we started to give her Virbagen Omega (daily shots for 1 week).

Also I have left the hospital and I went back home to keep the stress as low as possible for Miki.

Her condition has improved. Less fluid built up ... temperature between 38 and 39.

I went to another doctor which discovered a problem to the heart which could cause the heart failure and liquid in the abdomen. I have chosen to ignore this option because the heart problems cannot lead to high temperature.

But, this doctor had performed some serious blood tests and this time we have discovered that albumin over globulin ratio was 0.5. For excluding FIP, this ratio must be over 0.8. To be 100% that your cat has FIP, this ratio should be less than 0.4. So, I was more closer to 0.4 than from 0.8! Another indication that FIP was there.

Two weeks later we went to the hospital again for another set of Virbagen Omega. Her fluid was removed again, but this time was a small quantity (like 200 grams).

One week later the cat was not in good shape. She started to eat less ...

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18.10.2012 - Miki has fever (39.5 - measured with 3 different thermometers). I don't know the reason. Maybe is because she stayed outside all night and the temperatures outside are around 4-5 Celsius.

19.10.2012 - Temperature has dropped again to 38,7. It was measured with 2 different thermometers. I will travel in another city for a ultrasound and draining operations.

My assumption is that Virbac recommended protocol for FIP (0-14-60 days) is wrong. FIP protocol for administrating Virbagen Omega must be "every other day until remission" as recommended by the Japan researchers.

20.10.2012 - Last evening I went to another city for ultrasound. The liquid was not enough to justify a drainage. It means that Virbagen still does its job. However, the cat again has a some big abdomen (probably because she ate too much - however in the last few days she has not ate so much). Temperature in  the evening was 39,5 - 1 degree higher than in the morning ! This could also be because I have traveled 3 hours by car to reach the other city.

The European distributor for LTCI has answered again indicating the way I should do the payment. I'll pay on Monday because during weekend I suppose that nobody is working there.

22.10.2012 - high fever (39.9). It has been given an antiinflamatory + antibiotics + multivitamins.
Payed for LTCI and it was shipped in the afternoon. The liver is larger than 3 days ago.

23.10.2012 - temperature has dropped to 38.7

24.10.2012 - LTCI has arrived.

25.10.2012 - high temperature again (39,9). I have given the first shot of LTCI + B12 + Vit. C. After 1 hour the temperature has dropped to 39.2 (measured with an infrared non-contact thermometer on a blood vesel from tummy). I dont know what is the reason for such significant drop! There is another site which claims fast recovery after the first shot [4].

15.12.2012... I have not kept anymore a record of the things that happened here ... but
Two more LTCI shots have been administered ...at 2 days distance. The condition of the cat has became worse every day. Temperature has started to increase over 40 degrees. On November 1st she was unable to keep her balance anymore.I think that she had great pain. She was crying all the time. I could not stand next to her. The eyeball had a huge size - like she was unable to see anything around. It is possible that she became blind. At midnight I have decided to euthanize her. I have call my local doctor, but he was sleeping so I went to another city. Miki has died during the trip at 1:25 AM (in the morning of November 2nd).

Conclusions

Some conclusions must be drawn after this experience.

1. The cats should be feed mostly with raw food (meat). I have given too much Whiskas to Miki and her immunity has dropped over the years. This is the second cat which I have lost due to some viruses and  both of them were eating mainly cat food.

2. FIP is a terrible disease. It was beyond my imagination that something like that is possible. After 3 months of doing almost nothing but searching for cures for FIP I have been unable to save Miki.

3. Virbagen Omega must be administered continuously [3]. The current protocol 0-14-60 is not enough. I'm not very convinced that Virbagen can cure FIP, but at least it is not doing harm. Japaneses researchers have been able to cure 4 cats (out of 12) with Virbagen and predinsolone.

4. Antiviral drugs (like isoprinosine) can help a lot.

5. LTCI is a questionable drug. I would not use it again unless some serious studies are performed. Currently there are no published studies on it. Why?! If a drug is so good that it cures FIP how there are NO studies published in serious journals ?! You can find a lot of miraculous "studies" on some blogs and in some other obscures internet sites ... but nothing in specialized journals. Very strange ! I advice against LTCI unless some papers about its effects are published. Don't let some internet pages to fool you (like the wikipedia page on FIP [5] - which was written by some TCyte employee)!



[1]. FIP, http://en.wikipedia.org/wiki/Feline_infectious_peritonitis, accessed on 19.10.2012

[2]. cefotax, http://www.eipico.com.eg/PRODUCT.ASP?id1=4&id2=2%20&id4=2, accessed on 19.10.2012

[3]. Ishida T. et al. (2002) – Recombinant feline interferon therapy of feline infectious peritonitis; Proceedings of the 2nd International FCoV/ FIP Symposium, Glasgow, UK, August 2002: 17

[4]. fast recovery after the first shot, http://www.examiner.com/article/miracle-girl-fip-couldn-t-kill-me

[5]. LTCI on wikipedia. http://en.wikipedia.org/wiki/Lymphocyte_T-Cell_Immunomodulator