Murphy - misdiagnosis of wet FIP

Mischievous Murphy from Germany is a kitten successfully treated for bacterial peritonitis which was initially mis-diagnosed as FIP in April 2013 when he was 8 months old. Fortunately Jennifer did not give up. She found a second opinion from another vet, who although she could not rule out FIP even though his abdominal fluid tested negative for coronavirus, committed to save him and went for treating the treatable in the face of uncertainty. Murphy was given Suanatem (Metronidazole and Spiramycin) and recovered quickly.

This continues the series on misdiagnosis. Please make sure you check out Dr Addies's diagnostic algorithm's for FIP on treatment page before losing hope. And donate to FIP research which is working towards a fast and reliable diagnostic tool. In australia this is University of Sydney with Jaqui Norris.

Dorothy - Somewhere over the rainbow

Today I got the news that Marcelo's cat Dorothy has also lost her 8 month fight with wet FIP.  Marcelo is in Brazil, not a native english speaker so it was hard to piece together her story. From what I gather Dorothy had a litter of kittens and developed wet FIP of the abdomen last year around the same time as Mishka. The effusion resolved on corticosteroids and human interferon by late october 2012 when Marcelo wrote to the facebook group for advice:

"Hello everyone, news on Dorothy condition. She is still doing fine, playing and eating, but she is not gaining any weight, is there anything I can give her as a supplement to food? Thanks for any help you can share."

Members reccomended Nutrical and a change from her kibble diet to something like Hill's a/d. John Robbie's mum reccomended colostrum powder (which I then started to give to Mishka who was not a fan of Nutrical as JR has been doing fantastic on PI) 

 "I've used Colostrum powder mixed wither with some water (force feed if they won't drink it) or added to wet food. I have used it on John Robie since he's eating well, but I used to give it to my FIV+ cat when he started declining as well as to unhealthy rescue dogs and cats. It really helps with weight gain and overall health and builds a healthy immune system."

Dorothy was given Nutrical twice daily. On November 22 it seems she was also started on PI and the steroids were weaned. In december 2012 she was on 1.0 ml Interferon and reduced from 2 ml to 1.5 ml of PI. but Marcelo did not say  how often she was taking these. In January the dose was further reduced to 1ml of PI and still 1ml of Interferon. In february after Mishka died Dorothy was still alive and very well. "Dory is better than ever, she is still on PI and Interferon, also on Nutri-cal. She seems to be in normal health now."  

Alas she suddenly crashed - like Mishka. Perhaps this is the best that PI can do for wet FIP, perhaps it's better to just leave it out and use the steroids early with interferon.

"My friends, yesterday was a very sad day for me and my wife, Dory health was downhill since last week, it was fast and cruel, so we had to put her to sleep. It seem that even miracle cats ends like this with this terrible disease."
Goodbye Dorothy dear ... if anyone deserves to wake up in heaven FIP cats do.

"Someday I'll wish upon a star And wake up where the clouds are far behind me."

 

Leap of Faith

"Healing takes courage, and we all have courage, even if we have to dig a little to find it." - Tori Amos

I wrote this just before Mishka died on Feb 1st but I've decided to post it unchanged. Update: a few edits and see the comment from Dusty's mum below!
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Dusty is the reason we are treating Mishka. Dusty survived wet FIP of the lungs in part thanks to injections of feline interferon and oral prednisone in 2007. I first wrote about him in a post about Hope http://onecatlife.blogspot.com/2012/10/hope-is-black-swan.html

Virbac sent me the case history and amazingly here was a cat I could believe in because I knew the vet practice in Sydney (I think my mum even took our old cat there on occasion. Chloe was a stray my brother took in who lived to be 17 on a commercial diet without ever getting regular vaccinations btw)  so I phoned the vet, Simon Craig who verified the cat was still kicking and had made it off the interferon. Based on Dusty's outcome we did the math and decided we could afford the treatment on the basis of expecting a dead cat or a cure in a little over two weeks - but there you have it, each case is unique and Mishka has not progressed as well - but she's not dead either, so the budget is completely blown by five months worth of extra drugs. We have apparently converted an acute illness into a chronic one - as allopathic medicine does so well.

Possibly due to her more advanced disease ( she has abdominal FIP as well) her own genetic challenges (she is a Birman, Dusty is a Scottish Fold) or that two week delay or not using the steroids first up. Dr Addie does mention in her wet fip case study, which I only recently read, that the wet FIP response to FOI is higher for cats with FIP of the lungs, and doesn't seem to work as well on abdominal FIP.

My suspicion is this is because abdominal FIP can be cryptic for longer in that area without causing distress. Mishka had abdominal fluid for a few weeks to a month perhaps before we knew she was sick.

It wasn't until her lungs really filled up that we rushed to the vet. Perhaps she was also dehydrated somewhat and thirstier than usual. Here she is the night before, mucking about and looking ok:

She may have been sick for much longer as the earliest signs are so hard to detect as abnormal, if indeed they were - she started being more sleepy (thought that was natural as a cat growing older and not being a kitten any longer), more cuddly and purry - well she got to know us and that's a nice thing, she was very hungry and insisted on 4 am snacks - well she's a growing cat. She got so chubby she was stuck in her cat door - that was cute (ok my son had at that stage twigged something was up. "mum Mishka is not a cat anymore" ? "Definition of a cat - fits anywhere the head fits" ??!!! )

Definition of a cat - fits anywhere the head fits

 Mishka's Leap of Faith

 
and so we followed the example of Dusty. I feel like a cartoon character that's headed over the cliff - can't stop running to look down now or gravity will reassert itself. Hoping to make it to the other side on pure momentum. Courage kitty - leap!

Die another day - Toby and 0029

"I'm checking out. Thanks for the Kiss of Life." ~ James Bond (Die Another Day)

oh heck - just as the rest of her seems to be rallying kitty has a 'funny lump' under the skin which is possibly getting bigger. The vet is ignoring it strenuously and I'm not thinking straight - perhaps I should have jumped on it last week and investigated while she was under for the drain. The thing neither of us want to face is the prospect of a malignancy.

Seems she is simply dying more slowly, as our vet puts it - or living to die from something else like Toby - who was an uneutered Tom cat from Woodstock Ontario Canada. Toby lived the bachelor lifestyle, out partying every night and returning home in the daylight hours for food. When he got wet FIP he survived due to the ministrations of his owner, homeopathy and a change of diet (he stopped Taste of the Wild dry food and the pokeweed prescribed by a naturopath amongst other things); Toby fast tracked from having a FIP belly drained in August 2011 to normal function, including the partying, by September a few weeks later. He had places to be and cats to see - ladies to romance, guys to fight I guess and in April 2012 walked off into the night, sporting a swollen leg from an encounter of the 007 kind, never to be seen since by his human, Monika.

There was similar kitty, known only to me as "29" who was one of the original cats on the Polyprenyl Immunostimulant study. 0029 had dry FIP with neurological symptoms, who during treatment got well enough to get back to the killing business but met his match in a coyote. "when he was sick he was hanging around the house, once he started feeling better, it was hunting again, it was bringing little presents to the owners on a regular basis." ~  Dr Legendre WINN Feline Symposium transcript

But of course I am the eternal optomist. Unlikely things happen such as Miko the red burmese being reunited at the grand old age of 17 with his family in Essex, UK after a staggering ten years AWOL thanks to his microchip. Who knows, Toby is merely MIA he may reappear into Monika's life somewhere down the road.

from humortrain

Madiera

“Some people don't really know enough to make a pronouncement of doom” ― Norman Cousins, Anatomy Of An Illness

Madiera is a year old kitty who had spontaneous resolution of ascites. She was diagnosed with wet fip end of march 2012 around 12 weeks of age.

It is lovely to read about a genuine recovery that demonstrates the bodies natural healing compared to healing that is often termed 'spontaneous' but where the patient has worked jolly hard at repelling the problem. I am reminded of Remarkable recoveries - a speech by Ian Gawler - he recovered from osteogenic sarcoma and his story kickstarted a holistic cancer cure movement in Australia. i think i read in Ian Gawler's biography "the dragon's blessing" something like spontaneous remission - there was nothing spontaneous about it!

She lives with Nicole Griffin-MacKenzie who sent this picture in to the FIP fighters Facebook group (our correspondance copied with permission)

August 19 2012

This is a pic from now, 5 months later and the fluid is still completely gone. ( she loves showers ) we are very blessed. Just wanted to share because I feel there is hope

NICOLE: She's not on anything just takes pedialyte 3x a day for her stools to stay normal. The first time she was tested by the veterinarian it was with a sample from the fluid in her abdomen, then dr Legendre requested a second test to be done ( due to the fluid disappearing ) and again the tests pointed to FIP , we were going to do the PI and that's why we were speaking to Dr. L but he stated to let it be if she is doing so well
Still doing great ( knock on wood) October 8 2012

• 

  NICOLE: We got her in February, at 8 weeks so she will be a year next month. We didn't change her diet at all. We stuck with the same kitten food that she was on. The only thing we changed was giving her pedialyte. When we thought she had weeks to live I we were giving her a tablespoon of vanilla ice cream at night but that changed as soon as we noticed her abdomen going down. She was urinating a lot during this time ... Which I'm sure has nothing to do with it

  November 27, 2012
• ME: wow what brand vanilla icecream! who knows you may have stumbled onto THE CURE. i'm only half kidding. the urine was the fluid going out. what breed is she? there is 'spontaneous resolution' ie her immune system kicked in on its own; thymus gland is still there i think at 8 weeks, it is not so active in older cats. when did she get sick?

  November 28, 2012 at 12:09pm
   
• ME: i better explain my self about the vanilla icecream - if you read the anatomy of an illness as perceived by the patient by norman cousins and see what he did. i have been searching for the equivalent of funny things for a cat. icecream may be the thing.

  November 28, 2012 at 12:11pm
   
• 

  NICOLE: I think it was hood Boston vanilla bean

  November 28, 2012 at 1:03pm
  
  Madiera was still well and taking her 3xdaily pedialyte when Nicole sent me copies of the tests in December 2012.

• 

  open in a new window and use the zoom function of your browser

  otherwise download from here - Madiera's blood tests

  
  

and here is Madiera all grown up in Jan 2013 - a sleek young lady

UPDATE MAY 2015 - Madiera is still a happy healthy cat!

Alfie

FIP is notoriously hard to diagnose if it is dry form - but even the wet form does have a differential.

Dear all,
Today we had to say goodbye to our 11 week old baby Alfie. 3 days ago he started to get sick; his appetite was gone, he was lethargic, I could feel his spine and ribs while his tummy felt "healthy" as if he just had eaten.

All these symptoms worried me, so I went with him to the vet the day after. They took blood samples to send to the lab. The abdominal puncture fluid was clear, colourless and not stringy.

The following day we got back the results from the lab and they were not consistent with fip. Today, we took him to a clinic for an ultrasound, a Rivalta test and an analysis of the puncture fluid. The Rivalta test was very clearly negative and through the ultrasound we learned Alfie had a congenital disorder; his pericardium contained not only his heart but also a big part of his liver... This is not a inherited disease but "just" something in the embryonic development that went wrong :(

Without surgery there was no chance for Alfie, so we didn't have a choice but to give him this chance and left him there for surgery later today. Unfortunately Alfie was already too weak or maybe just too young too cope with the anaesthetics and died even before the surgery could start. Obviously we are very sad about this...

For three days I lived with the sadness, stress and insecurity that a lot of you have been through too when you discover your kitten might have fip. I have been in contact with some of you and I searched the internet for information about fip and differential diagnosis while at the same time I was afraid to believe it could be anything else but the much dreaded fip... It's for this reason that I want to share Alfie's story. If you think your kitten might have (the beginning of) wet fip, insist on all the tests at once. Blood and puncture fluid analysis, Rivalta test and ultrasound of abdomen and thorax, because my Alfie is proof that this can give some of the symptoms presented by fip.

PS On the picture you can see Alfie in better days... We miss him so much :(

from Cattery SmittenKitten

Dr Pedersen's comments on expensive diagnostic tests

"Okay, I'm not going to do many graphic pictures, but I do not understand why veterinarians have so much trouble diagnosing it like me, okay. I do not understand it because there are just the two forms. There is the wet form and the dry form and sometimes there is a little intermediate as they can switch from one to another and you can catch them in that transition stage, but people seem to have a hard time making this diagnosis, and like Al said, if you have a young cat from a shelter cattery that has a distended abdomen and has this yellowish, mucinous fluid that contains the right kind of inflammatory cells, high protein… gee, what else is this? What else can we call it? And the problem that we have is that because the diagnosis of FIP as I said, once they become clinically apparent, they’re going to die, okay, and I tell you right now, they’re going to die. There is no treatment. Okay… that I know of, that has been successful to reverse this thing. Okay, so basically because it’s a fatal disease, people especially veterinarians, and especially owners and especially pathologists; do not want to tell you that this is a fatal disease. They say, just as Al says. You get tired of seeing a path report that describes, there's a clinical history just like FIP, lesions that cannot be anything but FIP and then they say, characteristic of FIP, typical FIP. What does that mean? You tell me, does it have FIP? Just tell me.

And so, the problem is that in any of these kinds of diseases where there is a 100% mortality and believe me, owners are just as guilty because owners will push that risk, and is there a chance that it is this, or it is that, toxoplasmosis is one million, you know, is it the mycosis, one in a million, you know, all of these things, and so, they are always grasping for stuff and they are pushing it, and the more they push you, the more diagnostic tests that you ask for, and the problem is that hardly any of those diagnostic tests are 100% correct. And so, even the PCR test maybe only 80%. Immunohistochemistry might be 70-80% depending on what you do. The blood work is not 100%. They are all just little things that help you make the diagnosis, but there is not a single test that’s simple, short of taking a biopsy or taking some fluid, and doing a specific test by a lab that knows what they are doing, which is another problem, okay, to get a decent result back. And then, you know, then there are still veterinarians refusing to believe that antibody titers are not necessarily diagnostic, so they will continue to do the FIP virus serology on a whole bunch of cats. One cat will die of FIP in the cattery. They will test every cat for $30 or $40 a cat, and then they’ll get the results back and then they will say, “Well, I don’t know what they mean.” So then they’ll call me up. Well, I didn’t order 50 serologies at $50 a piece, you know, and so they wanted a free consult, you know, as far as I never charge for consults, but they want a consultation as to what that test means, well, no veterinarian should ever ask for a test that they do not know how to interpret it.
If the results come back [Applause] if the results come back and they can’t interpret it, why the hell did they ask for it in the first place?"  from WINN feline foundation 2011 FIP symposium

Lessons from Dr. Lipkin

"SARS was contained not because of a drug or vaccine but because we identified people who were infected or at risk, and we isolated them." ~ Prof Ian Lipkin MD

"When DISCOVER features editor Pamela Weintraub interviewed Lipkin last year, his dog, Koprowski was desperately sick. Lipkin had a treatment plan: not an antiviral drug or chemotherapy, but red meat. “It has antibiotics, it has growth hormone, it has everything"
Ian Lipkin is a virus hunter who was instrumental in helping China get control of SARS beginning with easy low tech things like soap and water for handwashing. He treated one of the first cases of AIDS successfully for a while with the new but existing technique of plasmapharesis to remove the antibody complexes that were causing his patients neurological symptoms.

Let's follow Lipkins lead and treat FIP with these things. Raw meat Mishka wont eat so until i can get hold of raw goats milk shes happily eating a kitty powershake - undenatured whey and colostrum powders, a teaspoon of each mixed with a teasoon of water daily, and raw egg yolk - yum!

FIP shares some similarities with SARS they are both corona viruses, and AIDS a disease of marked immune dysfunction.

Here's Mishka - Half the cat she was. She's leaking about 100 mls of fluid and protein a day into her peritoneum from damaged blood vessels - if we opened her belly up we would see little lumps called granulomas everwhere as the body tries unsuccessfully to destroy diseased cells that are nestled in the tissues like splinters. Collateral damage inflames the blood vessels - so far everything we have tried has not stopped this.
I have to wonder if plasmapharesis would have any success - UC Davis uses it for dogs with myesthenia gravis just as it is used in humans with this disease which inspired Lipkins AIDS treatment.

Hope is a Black Swan

"Rara avis in terris nigroque simillima cygno" (a rare bird in the lands, very much like a black swan) ~ Juvenal

The first thing you will likely hear after the diagnosis of FIP is that 'there is no cure'. Utter bunkum - there are cured cats - not a sure thing, not easy and not cheap but just one survivor proves that it is possible. Black swans did exist unbeknownst to Juvenal writing in 1st century Rome. If your cat has wet FIP the cure is Feline Omega Interferon (FOI); if your cat has dry FIP the cure is Polyprenyl Immunostimulant (PI). UPDATE: PI has also possibly cured a kitten with wet FIP. The sooner you start the more likely the cat will do well.

Wet FIP Cases

Miracle 6 week old F6 Savanah http://onecatlife.blogspot.com/2012/11/a-miracle-kitten.html

Dusty 3yo scottish fold - survived wet fip with pleural effusion in 2007. Still alive and well October 2012 and on no meds. Diagnosis confirmed by Jaqui Norris, University of Sydney direct immunoflourescence of pleural aspirate. This is the feline omega interferon (FOI) 'poster case' for the manufacturers Virbac.

Click here for full case history

I talked directly to the vet responsible for Dusty's case - Simon Craig in Sydney Australia; his practice is up the road from where I used to live and I have followed their pioneering work in autologous bonemarrow stemcell treatment for hip arthitis in dogs which we can now use in humans too, thanks to their collaboration with a local doc. Be aware Simon Craig says it is no miracle cure and did not help most of his patients and he has not used it in years.

Dry FIP Case

The Hucaby cats live in Nashville Tennesee. Gringo (white cat in centre photo) was 2 years old and Natasha was 15 when they contracted dry FIP in 2006. Both were successfully treated with PI and Natasha reached the grand old age of 20 in 2010. (Update: at autopsy Natasha was found not to have FIP "Natasha passed last year of natural causes at the age of 21. Dr. Legendre has not included her data on his paper since he doubted that she had FIP (he had no doubts about Gringo). Natasha's necropsy revealed no FIP, as I recall. Dr. Legendre was correct as always." Oct 2012)

Click here to read their story

Polyprenyl Immunostimuant (PI ) survivors - reprinted with permission