ER VET

BIO:

FIP advocate and admin with FIP Warriors 5.0, founder of FIP Oasis— a specialized data tracking software for cats being treated for FIP.

Transcript:

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Announcer: This is Pet Life Radio.

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Announcer: Let's talk pets.

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Dr. Justine Lee: Welcome to ER Vet on Pet Life Radio.

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Dr. Justine Lee: I'm your host, Dr.

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Dr. Justine Lee: Justine Lee, and I'm an emergency critical care veterinary specialist and toxicologist.

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Dr. Justine Lee: Thanks for joining us.

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Dr. Justine Lee: Today, I'm really excited to talk to you about something that I used to hate as a topic, as a vet, and that's feline infectious peritonitis.

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Dr. Justine Lee: And we're gonna be speaking with Adelaide Boak in just a few minutes.

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Dr. Justine Lee: We'll be right back after these messages.

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Dr. Justine Lee: Welcome back to ER Vet on Pet Life Radio.

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Dr. Justine Lee: Today, I'm really excited to talk about FIP.

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Dr. Justine Lee: So for all you cat owners out there, you're gonna wanna tune in.

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Dr. Justine Lee: Welcome to the show, Adelaide Boak.

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Dr. Justine Lee: Adelaide, thank you so much for joining us today.

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Adelaide Boak: Thank you so much for having me today.

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Dr. Justine Lee: All right, just so our audience knows who you are, give us a little bit of background about who you are, what you do and what you're doing now.

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Adelaide Boak: So I went to school at the University of Texas in Austin.

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Adelaide Boak: I actually majored in nutrition, but while I was in school, I got really involved with fostering and in 2019, I got involved in the FIP, B-Line infectious peritonitis scene.

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Adelaide Boak: I graduated in 2020 and decided to pivot and went into becoming a veterinary technician and did volunteering with CATS and FIP on the side.

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Adelaide Boak: This year in August, I actually quit my job in the clinic to focus my efforts on FIP advocacy, consultation, and I do a lot of data tracking and research full-time.

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Dr. Justine Lee: Wonderful, well, really appreciate your dedication to FIP.

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Dr. Justine Lee: Now, for those of you guys who don't know what FIP is, I'm assuming you've never had an exposure or a cat that was sick with FIP, which is a good thing.

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Dr. Justine Lee: When it comes to FIP, we've done previous episodes a long time ago, episode 87 on feline infectious peritonitis.

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Dr. Justine Lee: And the reason why this topic is so, so important is because it used to be a death sentence.

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Dr. Justine Lee: I more recently in episode 175 talked with Dr.

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Dr. Justine Lee: Vicki Thayer, who's a diplomat of the American Board of Veterinary Practice.

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Dr. Justine Lee: And we talked extensively about FIP, but a lot has changed in the past few years when it comes to FIP.

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Dr. Justine Lee: So I'm excited to talk to you about it today.

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Dr. Justine Lee: Now, could you let us know a little bit more information about FIP for all our listeners out there?

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Dr. Justine Lee: What is it and what is dry versus wet?

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Dr. Justine Lee: And what are the treatment modalities that used to be out there and how do you diagnose it?

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Dr. Justine Lee: What do you do about it?

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Adelaide Boak: So I am not a veterinarian, but FIP is a fatal disease.

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Adelaide Boak: It only affects cats, typically young cats, but it can happen at any age.

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Adelaide Boak: It's a mutation of a common virus in cats actually called Feline Enteric Coronavirus.

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Adelaide Boak: It affects somewhere between 0.3 to 1.4% of cats who have been infected with this virus.

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Adelaide Boak: And you can find information about how common it is on SOCFIP, which is Dr.

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Adelaide Boak: Petersen's website from UC Davis.

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Adelaide Boak: The two main forms of FIP, wet FIP and dry FIP.

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Adelaide Boak: Wet FIP always has some kind of a fluid accumulation.

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Adelaide Boak: So they may have it in their abdomen or it may collect around their lungs.

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Adelaide Boak: It can also be in other locations, but those are the two main spots that the fluid builds.

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Adelaide Boak: And then in dry FIP, that can involve things like granulomas and large lymph nodes, but it's generally a very sick cat that's not responding to other kinds of treatments, or they can develop lesions in their brain or eyes where their eyes might change color or turn red or cloudy.

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Adelaide Boak: The treatment modalities for FIP in the past have included supportive care and a few different antiviral therapies without success.

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Adelaide Boak: Until about 2017, a medication called GS-441524 was used in a trial to treat over 20 cats with most of them achieving remission or cure.

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Dr. Justine Lee: All right, so thank you so much for bringing it up.

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Dr. Justine Lee: You know, I've had the unfortunate experience of having to explain and diagnose FIP before, and it is really, really complicated, and again, I do really encourage you to listen to that older episode on FIP that I recorded with Dr.

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Dr. Justine Lee: Vicky Thayer because we did talk about some of the complications of testing for FIP, and unfortunately, the FIP test is complex.

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Dr. Justine Lee: And the main reason why is because a negative test is actually the most helpful answer that you get.

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Dr. Justine Lee: So if your cat happens to have symptoms of FIP, your vet does a blood test, and the test is positive, there are a lot of causes for a false positive or other reasons.

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Dr. Justine Lee: So if I get a negative on the FIP test, that actually helps me more, because when I get that, it means I'm able to rule out that coronavirus.

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Dr. Justine Lee: The frustrating thing with a positive FIP test is it just means your cat is positive for some type of coronavirus, right?

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Dr. Justine Lee: It's not specific for FIP necessarily.

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Dr. Justine Lee: Now, you brought up the clinical signs, you brought up some of the tests that we'll do.

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Dr. Justine Lee: But again, the difference between dry and wet FIP typically are that, again, one is effusive, which makes the body sort of leak fluid.

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Dr. Justine Lee: And so the classic clinical signs I'll see with FIP are what we call in the veterinary world, what we call ADR, ain't doing right.

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Dr. Justine Lee: So the cat is hiding, the cat is dehydrated, doesn't want to eat, maybe vomiting a little, has a fever, just isn't acting like their normal self.

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Dr. Justine Lee: And depending on what our physical examination finds, is sometimes again, it may be that change in the color of the iris where it almost looks fuzzy, and that's what we call a uveitis or inflammation of the uvea in the eye.

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Dr. Justine Lee: Sometimes it's really vague symptoms, like not eating and vomiting.

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Dr. Justine Lee: And that's because FIP can affect different parts of the intestinal tract.

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Dr. Justine Lee: Sometimes if it's that wet or effusive FIP, it can result in huge fluid accumulation within the abdomen.

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Dr. Justine Lee: So you'll notice that your cat's belly may be getting bigger and bigger.

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Dr. Justine Lee: And I should step back and say with FIP, classically when I see it, it's usually younger cats.

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Dr. Justine Lee: So cats, you know, two years old, that even if they were indoor, were adopted or purchased.

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Dr. Justine Lee: Oftentimes we see this more in purebred cats, at catteries.

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Dr. Justine Lee: So it can be a really debilitating, frustrating disease.

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Dr. Justine Lee: But that said, some of the newest treatments out there are now improving the outcome.

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Dr. Justine Lee: Again, this used to be a death sentence, and so much of that has changed.

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Dr. Justine Lee: That said, when it comes to the treatment for FIP, why is it that most veterinarians in the United States and other parts of the world can't actually prescribe the treatment for FIP?

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Adelaide Boak: So, yes, the reason why we can't use GS-441524 in a veterinary environment is because it's actually not approved for any FDA use.

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Adelaide Boak: It is currently held under the patent with Gilead, and they are currently researching human drugs for the treatment of COVID-19, which includes a related drug to GS-441524 called Remdesivir.

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Adelaide Boak: It currently has conditional approval for the treatment of COVID-19, but until it has full FDA approval, it cannot be used off-label in the veterinary world.

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Dr. Justine Lee: All right, so knowing that and knowing how difficult it is, where do you recommend that people go to get up-to-date information and knowledge or even the latest updates and research on FIP?

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Adelaide Boak: The places that I recommend getting excellent information about FIP are going to be socfip.org.

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Adelaide Boak: That's sockfip.org.

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Adelaide Boak: It stands for Saving Our Cats and Kittens from FIP.

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Adelaide Boak: It's an informative website created by Dr.

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Adelaide Boak: Peterson as well as other veterinarians from UC Davis and other associates.

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Adelaide Boak: Dr.

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Adelaide Boak: Peterson is regarded as the leading expert on FIP, so it's my belief that this is the best resource for current information because he is an award-winning Ph.D.

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Adelaide Boak: veterinarian.

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Adelaide Boak: He devoted his life to research and has spent more than 50 years in research and earned many awards for his contributions to feline medicine and feline retroviral research.

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Dr. Justine Lee: All right.

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Dr. Justine Lee: Thank you so much.

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Dr. Justine Lee: I will also advocate for Cornell Feline Health Center that has a lot of great information on anything feline.

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Dr. Justine Lee: So when in doubt, you definitely want to check that out.

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Dr. Justine Lee: I always say when in doubt, EDU websites are very, very credible for a lot of the research that's up there.

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Dr. Justine Lee: And again, it's frustrating because FIP was always considered non-treatable, right?

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Dr. Justine Lee: It was really just symptomatic supportive care, which is a fancy way of saying, we're trying to minimize some of the symptoms.

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Dr. Justine Lee: We're trying to hydrate them with fluid therapy.

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Dr. Justine Lee: We're trying to drain that fluid off their belly if they have wet FIP.

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Dr. Justine Lee: Maybe it was giving blood transfusions.

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Dr. Justine Lee: Maybe it was treating with topical steroids on their eyes if they had uveitis.

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Dr. Justine Lee: Maybe it was treating with oral steroids to help decrease some of the inflammation in the body.

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Dr. Justine Lee: So really, up to GS441524, there weren't a lot of treatment options.

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Dr. Justine Lee: So it is really frustrating just because vets can't truly prescribe it, but I will say that's one of the good things about COVID-19 in that it helped us be able to get more information about the treatment of FIP or cats.

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Dr. Justine Lee: Now, how has the public perception for the treatment of FIP changed in the last six years?

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Adelaide Boak: The public perception has changed a lot over time with treatment for FIP.

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Adelaide Boak: It's gone from, as you described, or the way I describe it a little differently, the boogeyman of cat diseases.

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Adelaide Boak: It's this dreaded disease that if your cat got it, there was nothing you could do about it.

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Adelaide Boak: But now it's become a treatable disease that cat owners can feel empowered to tackle and beat.

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Adelaide Boak: FIP treatment is at the cutting edge of feline medicine development, and more and more vets and pet owners are learning every day that it's treatable thanks to advocacy from organizations like SOCFIP, Everyday Cat Health, and the nonprofit Zen by Cat.

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Adelaide Boak: Especially Zen by Cat, they're a nonprofit organization that they raise awareness and they also raise funds for the research that has led to the cures that we've been able to discover.

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Adelaide Boak: Actually, the owner of Zen by Cat, Peter Cohen, he has one of the first cats that was ever treated for FIP in the flagship treatment study in 2017 that was published in 2018 where they treated 26 cats for 12 weeks and showed successful cure.

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Adelaide Boak: Today, despite barriers to treatment due to legality and scope of practice, many vets are supportive of cat parents who pursue treatment for FIP in the capacity that they legally can.

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Dr. Justine Lee: Wonderful, great information.

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Dr. Justine Lee: We'll be right back with this really important information right after these messages.

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Dr. Justine Lee: Welcome back to Er Vet on Pet Life Radio.

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Dr. Justine Lee: We've been speaking with Adelaide, and we've been talking about feline infectious peritonitis.

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Dr. Justine Lee: Again, we've had a couple of episodes previously on FIP, so you definitely want to check those out.

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Dr. Justine Lee: But when it comes to FIP, or feline infectious peritonitis, remember it's that viral disease, feline coronavirus.

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Dr. Justine Lee: Again, we typically see it in younger cats, typically less than really seven months to one and a half years of age.

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Dr. Justine Lee: And again, we often think that it's transmitted when an infected queen passes on to their kittens.

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Dr. Justine Lee: So sometimes we can see this in shelters or catteries, mostly in purebred cats.

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Dr. Justine Lee: And so again, can be really frustrating because FIP used to be considered a death sentence.

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Dr. Justine Lee: Earlier, we talked about wet versus dry FIP and how it can be really difficult to diagnose because of testing.

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Dr. Justine Lee: And again, the clinical signs are really, really vague from fluid accumulation to that pot-bellied appearance to difficulty breathing to really, really vague clinical signs such as discoloration or abnormal looking eyes to things like diarrhea, to not eating.

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Dr. Justine Lee: So again, the clinical signs can be really, really frustrating.

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Dr. Justine Lee: Earlier, we also talked about how testing for FIP is hard because there's no definitive test to diagnose FIP.

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Dr. Justine Lee: And most of the time when we're doing it, we're looking at antibody levels or what we call titers, and they can't always tell and distinguish between feline coronavirus and feline infectious peritonitis.

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Dr. Justine Lee: So again, a negative test means a lot more to me than a positive test.

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Dr. Justine Lee: We talked about whether or not it can be treated.

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Dr. Justine Lee: And up to this point, it's really been symptomatic supportive care.

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Dr. Justine Lee: And I'm hoping that the FDA will one day approve these drugs that we know are out there in the world for FIP, but as of right now in the United States, veterinarians can't actually prescribe it.

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Dr. Justine Lee: So I did want to ask a couple of last few questions when it comes to FIP.

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Dr. Justine Lee: What's coming up next in support for parents for FIP?

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Dr. Justine Lee: And is there anything new in research or treatment that's coming down the pipe?

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Adelaide Boak: Yes, absolutely.

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Adelaide Boak: There are so many developments that have happened just in the time period that I have been involved in helping cats with FIP.

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Adelaide Boak: There's more information available.

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Adelaide Boak: There's more support than there ever had been before.

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Adelaide Boak: There are numerous support Facebook groups where cat owners can speak to each other and get support on what is going on and advice.

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Adelaide Boak: And there's also specialized websites and resources that exist to get information and make sure that it's reputable information.

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Adelaide Boak: What's coming next in research is most exciting.

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Adelaide Boak: The research is ongoing for better treatments to have available and learn more about cats who are treated for FIP.

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Adelaide Boak: Currently, there's a research trial that is open for enrollment through the Colorado State University using Malnupiravir as the antiviral therapy.

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Adelaide Boak: Malnupiravir is actually already being used in Europe with great success for the treatment of FIP.

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Adelaide Boak: The trial is called Evaluation of New FIP Immunotherapy for Cats Being Treated with Antiviral Therapy.

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Adelaide Boak: It's being led by Dr.

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Adelaide Boak: Patrick Cherna at CSU.

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Adelaide Boak: So I'd highly recommend checking that out if anyone is facing FIP and wants to help with furthering research as well as helping their cat.

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Adelaide Boak: Currently, I am collecting a large amount of data on cats who are treated with GS through a specialized tracking website that I created, information like the cat's weight over time, blood work values over time, any comorbid conditions that they have, as well as side effects reported with the medication, and much, much more.

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Adelaide Boak: I hope to have this information published, as currently we have ongoing data collection for about 1,400 cats since May of 2023, and that number grows every day.

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Adelaide Boak: I'm so excited for how much more we are going to know about the outcomes of these cats in the next two to five years, and developments into alternative antivirals that will hopefully readily get FDA approval and become available to our veterinarians to prescribe and treat these cats.

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Dr. Justine Lee: Wonderful, thank you so much.

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Dr. Justine Lee: We just need a very philanthropic feline owner who can help us in this process, because it is a really important battle.

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Dr. Justine Lee: You know, the question that I wanted to leave with that a lot of pet owners will often ask is, how can I protect my cat from getting FIP?

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Dr. Justine Lee: And I will say, while there is one licensed FIP vaccine out there, please know this is one of the vaccines we do not actually advocate for.

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Dr. Justine Lee: It's not recommended by the American Association of Feline Practitioners.

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Dr. Justine Lee: And the main reason why is because it's got questionable efficacy.

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Dr. Justine Lee: And while the vaccine is safe, the benefits don't really outweigh the benefit of giving the vaccine.

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Dr. Justine Lee: It will also make your cat test positive for FIP on the antibody titer because of that.

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Dr. Justine Lee: So again, while there's a vaccine out there, we as veterinary professionals don't actually advocate for it right now.

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Dr. Justine Lee: And unfortunately, there's no great way of protecting your cat from FIP.

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Dr. Justine Lee: If your cat came from a high density cattery or shelter, it is often really hard because when we see cat's house in those situations, that crowded living condition can actually contribute to stress, it can contribute to infectious disease.

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Dr. Justine Lee: And we do know that feline coronavirus is actually really contagious.

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Dr. Justine Lee: But again, it's not thought that the coronavirus that mutates into the malignant FIP is that contagious.

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Dr. Justine Lee: So again, a lot more information is coming down the pipe.

00:18:57.608 --> 00:19:11.608
Dr. Justine Lee: And again, I do hope that this one day gets FDA approved because it is so helpful for us to be able to make sure that our feline patients are healthy and that we do have a treatment option for cats with what used to be a devastating disease, FIP.

00:19:11.828 --> 00:19:13.928
Dr. Justine Lee: Adelaide, thank you so much for joining us today.

00:19:14.008 --> 00:19:15.428
Dr. Justine Lee: Appreciate all that you do.

00:19:15.988 --> 00:19:17.028
Dr. Justine Lee: And thank you again.

00:19:17.048 --> 00:19:18.488
Adelaide Boak: Thank you, it's been wonderful.

00:19:18.888 --> 00:19:21.208
Dr. Justine Lee: Well, that brings us to the end of today's show.

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Dr. Justine Lee: Find me at drjustinelee.com, on Facebook or Instagram at drjustinelee, or email me your questions at drjustin at petliferadio.com.

00:19:29.688 --> 00:19:35.908
Dr. Justine Lee: With that, we're out of time, and we would like to thank Adelaide Boak and Mark Winter, our producer, for making this show possible.

00:19:36.048 --> 00:19:37.268
Dr. Justine Lee: See you at the next episode.

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Announcer: Let's Talk Pets, every week on demand, only on petliferadio.com.