COVID19 in Cats - the Ivermectin treatment

I just thought i'd bring this to your attention in case the authorities ever decide to start freaking out about pets transmitting covid19 . We have seen several cases expressed in the news for companion animals and the culling of mink in the netherlands. But the researchers are still dancing around trying not to alarm anyone. China led the studies with cats in april. Cats are quarantined and swabbed in covid positive households in hongkong. 

Here's the update from Dr Niels C Pedersen on the situation - i think he's got it backwards and we should urgently hose down the companion animal reservoir of coronaviruses. Healthy companion animals make more sense surely than sickly ones even if we aren't eating them! ( i would hate to see a FIP like illness appear in humans! )

Dear Veterinarians, cat owners and public: I am being increasingly questioned about the relationship of GS-441524 and a very promising treatment for Covid-19, Remdesivir.  GS-441524 is the biologically active component of Remdesivir and has been widely used around the world to safely and effectively cure cats of feline infectious peritonitis (FIP) for over 18 months. FIP is a common and highly fatal coronavirus disease of cats. GS-441424 and Remdesivir are almost identical drugs. Remdesivir is the form of GS-441424 that Gilead Sciences has chosen to use in humans for COVID-19 and is now in clinical trials in China, USA and several other countries. Remdesivir is what is known as a prodrug. A prodrug is altered by infected cells to yield the active ingredient, which in this case is basically GS-441524 with the addition of one phosphate group (i.e., GS-5734).  Gilead scientists slightly altered GS-5734 to protect the added phosphate group and allow absorption into cells. This form of GS-441524 is what is known as Remdesivir. Once in the cells, cellular enzymes remove the protection to yield  GS-5734. GS-5734 is further activated by the addition of two more phosphates in the cells to the triphosphate form of GS-441524. This is the molecule that inhibits the production of viral RNA.  We chose to use GS-441524 for treatment of the coronavirus disease FIP because it had identical antiviral properties to Remdesivir and at the time was not under consideration by Gilead Sciences for use in humans. GS-441524 is also much cheaper to make than Remdesivir. Therefore, there was no apparent conflict with using one form for cats and another form for humans.  However, Gilead came to believe that our cat research would interfere with their ability to get Remdesivir approved for humans and refused to grant animal rights for GS-441524.  This refusal, coupled with the desperate need around the world for the treatment of FIP, led to a Chinese black market for GS-441524.  FIP is also a significant problem in pet cats in China, and Chinese cat owners were even more desperate for a treatment for FIP than owners in other countries. The first papers describing GS-441524 treatment of cats with FIP were published in 2018 and 2019 and thousands of cats have been treated since then. In spite of this experience, the medical profession, including researchers, have been seemingly unaware of the use of GS-441524 for a coronavirus disease of cats and its relationship to Remdesivir. Veterinarians also have considerable experience with coronaviruses, coronavirus diseases, and coronavirus vaccines for swine, calves and poultry that has gone unappreciated. Pet ferrets also suffer a severe FIP-like disease caused by their own species of coronavirus.What will happen to supplies of GS-441524 for cats if Remdesivir is proven to be safe and effective as a treatment for Covid-19?  GS-441524 is the first critical step in the production of Remdesivir and it is logical to assume that there will be a competition between cats and humans for it.  On a positive note, world wide approval for Remdesivir may also help change minds against granting animal rights for GS-441524. If approved for human use, Remdesivir, if not GS-441524, would become "legally" available through veterinarians.  However, the safety and efficacy of Remdesivir for FIP has not been established. 

-Niels C. Pedersen, DVM, PhD, School of Veterinary Medicine, UC Davis. via https://www.zenbycat.org/blog/connection-between-fip-and-covid19 

GS - 441524 and Mutian Cure FIP! Happy New Year!

The Holy Grail

I first read about it on a private website. As usual the FDA is a stumbling block so private Asian manufacturers have stepped in to bring the cure within our reach instead of sitting on it while our cats suffer. Please go straight to the websites without further delay if your cat needs treatment. The interesting in depth story can wait. 

Anti viral pro drug GS 441524

 treatment of choice as per Dr Adie. Available from https://www.curefip.com/ 

"Dose: GS-441524 treatment at a dosage of 4 mg/kg SC sid for at least 12 weeks, repeating the course if clinical signs recur. The dose can be safely increased to 5mg/kg Murphy et al., 2018 in severe cases and 10mg/kg in ocular cases.
In the field study, about one third of the cats required subsequent courses of treatment and one cat appeared to have a virus which was resistant to the drug.
Remember that this treatment would be off label and that you should have your client sign your practice's legal disclaimer form. There is no veterinary preparation yet available: one awaits news from Gilead Sciences, CA, USA. Check with your own regulatory body for advice about the legality of its use in your own country.
Side effects: the treatment stings on administration and injection site reactions occurred in 16 of 26 cats treated. (Injection site reactions are worrisome in cats, because they can lead to fibrosarcoma formation.) However, no other toxic side effects have been reported so far, in fact, Dr Pedersen stated that it was "remarkably safe". (Pedersen et al, 2019)
GS-441524 not working in your patient?
In my experience, the main reason for this is that the cat is not, in fact, suffering from FIP: 40% of the cats referred to me - usually from referral practices - have had some disease other than FIP." - Dr Adie

Mutian X 

https://www.mutianstore.com/blogs/mutian-warriors has live chat which will provide targeted advice free for your cat

"
Mutian X is available as tablets / capsules or injections. Their CEO informs me that it has FDA approval.Their website is www.mutian.us.Mutian X pills are effective at stopping FCoV shedding: the dose for clearing FCoV infection is 4mg/kg for four days.I am only aware of a couple of cats with FIP who are being treated using Mutian X: watch this space for updates. Liver support using S-adenosyl-L-methionine is essential for longer term use with this compound." Dr  Adie

Happy new year indeed!

Dr Adie's website is http://www.catvirus.com/treatment.htm

Seeing clearly - Dr Ray Peat on Stress

The transparency of life

Information for humans by Dr Ray Peat who taught physiology to medical students for many years. He follows a bioenergetic way of thinking about health and disease processes.

Diseases that produce tissue overgrowth associated with inflammation--granulomas--have been treated with iodides, and although the iodide doesn’t necessarily kill the germ, it does help to break down and remove the granuloma.

Leprosy and syphilis were among the diseases involving granulomas* that were treated in this way. In the case of tuberculosis, it has been suggested that iodides combine with unsaturated fatty acids which inhibit proteolytic enzymes, and thus allow for the removal of the abnormal tissue.

In experimental animals, iodide clearly delays the appearance of cataracts. (Buchberger, et al., 199l.)
raypeat.com/articles/aging/transparency-cataracts.shtml

Gelatin, stress, longevity

The amino acids cysteine and tryptophan, released in large quantities during stress, have antimetabolic (thyroid-suppressing) and, eventually, toxic effects  

A generous supply of glycine/gelatin, against a balanced background of amino acids, has a great variety of antistress actions. Glycine is recognized as an “inhibitory” neurotransmitter, and promotes natural sleep. Used as a supplement, it has helped to promote recovery from strokes and seizures, and to improve learning and memory. But in every type of cell, it apparently has the same kind of quieting, protective antistress action. The range of injuries produced by an excess of tryptophan and serotonin seems to be prevented or corrected by a generous supply of glycine. Fibrosis, free radical damage, inflammation, cell death from ATP depletion or calcium overload, mitochondrial damage, diabetes, etc., can be prevented or alleviated by glycine.

Some types of cell damage are prevented almost as well by alanine and proline as by glycine, so the use of gelatin, rather than glycine, is preferable, especially when the gelatin is associated with its normal biochemicals. For example, skin is a rich source of steroid hormones, and cartilage contains “Mead acid,” which is itself antiinflammatory

 http://raypeat.com/articles/articles/gelatin.shtml

Tank

Dry FIP

Here's a story i was sent about a Bengal calked Tank who had dry FIP. He was treated with Polyprenyl immunostimulant PI. Best Therapy option back in the days before GS 441524 I guess i never published it as i was waiting to see the outcome.

His blood work indicated liver damage with high globulins, his A/G ratio was 0.5, his ALT and bilirubin were high and he was borderline low I took him to a specialist for an ultrasound, liver biopsy, fine needle aspirate of some excess fluids in his abdomen (the internist said it was more "free floating abdominal fluids then you normally see in a kitten), second blood chemistry panel. The results were liver inflammation, fluids consistent with what you would find in FIP (high protein, high neutrophils, etc.), his A/G ratio had gone down, his liver biopsy rules out copper storage disease, his toxo test came back negative. So for all intents and purposes, there is no other disease that this could be. 
I had already put him on 3 times weekly PI (Feb. 22 after his first vet visit) and then upped it to daily based on a conversation I had with Dr. Sass who said when it's really bad - use it daily. I thought this deserved daily treatment I added Denamarin which supposedly prevents further cell damage to the liver and helps the liver heal itself. Then he also was put on Clindamycin for one month - just in case the toxo test produced a false negative, but given the extremely slow recover - it's fair to say it's not toxo. In toxo upon administration of Clindamycin, the recovery is dramatic.

 March 26

Thought that I'd post an update on Tank. He's been on daily PI for about nine days now. He's been on Denamarin (liver support supplement) for four days and on Clindamycin for nine days as well. He has gained 1/2 lbs in the last five days. He's gone back to grooming himself, eats like a horse and is back to wrecking my house as a "normal" Bengal kitten should. Cautiously optimistic that perhaps his FIP is going into remission. Blood work again in three weeks

Love and loss - when FIP kills your kitten

This was such a hard post to write, i'm teared up again after abandoning the effort previously. A recent post on the FIP fighter's page showing Bella still going strong over 5 year's later made me decide to come back to this blog.

Time heals - I can look back now - and finally forward again.

The fire of FIP transformed and fused our mother son relationship in a way that's beyond that which I have with my two older boys. FIP made us talk about matters, and physically and emotionally shared a space, more appropriate to adults, with no one close to lean on but each other. To our horror we discovered some people including our nearest and dearest, just don't understand your utter emotional distress when it's a pet who is terminally ill - not say a human family member with cancer. Especially when its a cat not a dog. The vets even tried to profit from the situation beyond what is ethically appropriate for services rendered!

After FIP took Mishka not only were our hearts broken but the fear and guilt that set in was appalling. I cannot explain why exactly only that it had something to do with entirely optional nature of pet adoption. In that time my teenage son has really grown up - he's moved out of home and made the decision to aquire another cat whom he chose after 'interviewing' several kittens. He wanted an older cat - but not too old, as we know FIP more likely before the immune system is matured. He wanted a moggie from a nice family home. As we know inbreeding is a risk factor for FIP, and show cat breeders or shelter cats are more likely to have issues with corona virus due to crowding. He wanted of course a cat with a nice temperament, and last but not least - hypoallergenic. Soft long but easy to care for coat would be a clue to that, also we had a suspicion that black and white cats in the moggie population are more likely to be hypoallergenic. So here at last is my son's new kitten Missy.  

Vale Mishka, Ave Missy -Long may she purr!

Pharoah tries stemcells for FIP and the cure for FIP is found!

One success story at a time

With FIP there is no point being conservative except for the sake of the cat's comfort. So it was no surprise to hear that yet another innovative therapy is being tried - adipose stemcell therapy for dry FIP. The cat is called Pharoah and his vet is Ed Pattison of City Vets, Exeter UK https://www.facebook.com/cityvets/photos/a.128542133823284.22418.128403317170499/957763074234515/

But how interesting is this - the vet who pioneered the use of adipose stemcells for arthritis in dogs in australia, Simon Craig, was the same chap who cured Dusty of wet FIP - see survivor's page

and how dull and unsexy is this - Hip arthritis in dogs by the way you can simply prevent with adequate vitamin C and a proper diet.
http://oneradionetwork.com/health/dr-r-geoffrey-broderick-world-renowned-veterinarian/

Dr Belfield has the word on vitamin c in animals and was kind enough to answer my emails when Mishka was diagnosed. he did try it for FIP of course and it was the one thing he had no success with after it was established :( That's what we are up against.
I have NO DOUBT this is the same with FIP - we can prevent it  simply - no rocket stemcell science required and finally someone in authority is brave enough to say it 

"The best treatment for FIP is not to get it in the first place: if you are going to buy a pedigree kitten, make sure your Vet sends a blood sample to the University of Glasgow Veterinary Diagnostic Services to get a certificate saying that the kitten tested negative for feline coronavirus (FCoV) antibodies: we need to put consumer pressure on bad breeders and reward good ones." Dr Dianne Addie rocks! http://www.theexeterdaily.co.uk/news/local-news/exeter-vets-pioneer-stem-cell-treatment

- see prevention page

• stop inbreeding 
• stop crowding 
• stop malnourishment of starvation and stop feeding COOKED CRAP & KIBBLE to cats - they weren't designed to eat cereal; they are not birds.

Gus - pentoxifylline success part 1

Gus is the kitten of a pregnant shelter cat who was kept by hs mother's foster carer Nicole after she rehomed his mom and siblings. He was a more mature cat, and physically strong when he started getting sick. He never got very dehydrated or stopped eating so he stood a much better chance when Nicole went in to bat for him with Prednisone and Pentoxyfilline. These anti inflamatory drugs are easy to get and relatively cheap. pentoxifylline was an early choice for treating wet FIP that didn't pass trials - we still tried it, as have others on the facebook group.

Gus was a big cat- at 2 yrs old, he was 13 lbs! At one point, I sensed something wasn't right with him. He seemed lethargic (wouldn't interact with new kittens, in the past we had called him "Uncle Gus" because he always took the foster kittens under his wing, grooming and playing with them). He also felt bony along his spine- and his belly was bloated. I will admit, I wasn't too concerned at first. I thought worst case scenario, maybe he had gotten worms from one of the foster kittens he loved to groom. After a few weeks when he was still wasn't being his usual self, I took him to the vet.

October 26, 2103 The day my world crumbled.

I went in expecting a Dx of Giardia or a tapeworm... relatively easy fixes. Instead, I was told Gus had wet FIP. The vet actually withdrew fluid on the spot from his belly and showed it to me - thick, yellow, protein filled fluid. And he weighed 10.5 lbs. Still hate myself for not noticing the huge weight loss.All his lab values were abnormal , and he had a fever to boot. 

Initial lab work

I cried ( that is an understatement) in the exam room for about half an hour before i was gently escorted out.The only hope the dr. could offer me was palliative prednisone to improve appetite and the kind offer to come to my house to do the euthanasia when the time came.

I immediately started him on pred, and frantically searched for a second opinion/treatment options. A friend of mine worked for a local vet, and she told him my story. I reached out to him, and after a lengthy phone consultation he mentioned a drug called Pentoxifylene. He said it might help prolong his life. It's a drug normally prescribed for humans, for autoimmune disorders. A pharmacy in Arizona (Diamodback Drugs http://www.diamondbackdrugs.com/contact-us/) compounds it into animal dosages. I brought Gus to see him in the hopes that he would disagree with the original Dx. He broke my heart when he said all signs pointed to wet FIP and he couldn't go against my primary vet's Dx. BUT - he suggested the Pentoxifylene, saying it could potentially help prolong his life.

After 9 months on prednisone and pentoxifyllene Gus visited this vet again. His A/G ratio which had been very low, was back up and the other values that had been abnormal were all good.

New lab work

All lab values were normal, and the ultrasound showed NO fluid in his abdomen. His old chart had a WBC of 30,000 and very abnormal liver/kidney functions. And a fever. His WBC is now 9,000, within normal limits. He is also back to his playful mischievous self, a very happy cat. The difference between the two was amazing. The vet said if he did not know Gus's history he would say he was a perfectly healthy cat.

I am grateful for every day I have with him, and I don't mean to offer false hope. I know FIP is a terminal illness. All I know is that he is seemingly happy healthy and no longer shows any signs of the disease. Part of me hopes he was misdiagnosed, but another part of me hopes that maybe he did (does?) have this dreadful disease and there is in fact, hope. I am slowly weaning him off the meds while monitoring him constantly for any signs of a relapse. My heart goes out to everyone who is dealing or has dealt with this terrible disease. I'm fully aware Gus may be (probably is) living on borrowed time. I just feel like I need to share this in the hopes that it can help another.

 Gus part 2 http://onecatlife.blogspot.com/2015/05/gus-pentoxyfylline-success-part-2.html

Gus - Pentoxyfylline success part 2

Continued from part 1 http://onecatlife.blogspot.com.au/2015/01/gus-pentoxifylline-for-fip.html
Gus's foster carer Nicole kindly answered my questions in detail - texting on a phone! That's dedication for you.

Diet- no special diet. Gus always ate just Purina dry indoor formula. Once he got his Dx, he was spoiled rotten and I added canned friskies plus whatever protein I happened to be having for dinner- shrimp, ham, turkey, ect. Whatever he wanted. He was never put on an antibiotic that I can recall. When Dr. Ciance of Allenwood veterinarian hospital (in Allenwood NJ 732-528-7444) Dx'd  him she put him on 2 ml of pred a day to stimulate appetite and make him feel better. She also prescribed doxy ( doxycycline? a  broad spectrum antibiotic ) in pill form but I couldn't get him to take it, and her opinion was to not force it on him, let him enjoy his remaining time. We may have tried liquid, I can't recall. But he was never on antibiotics for an extended period of time.

Uncle Gus

Then I took him to Dr. Falk (Ocean County Veterinarian Hospital Lakewood NJ ). He was so kind and compassionate, even recommended a support group for me. He looked at the initial bloodwork and agreed that it looked like FIP. (see Gus's labs in previous post) He suggested adding pentox in addition to the pred. So, he was on 2ml of pred and 1 ml of pentox daily. This went on for about 5 months, the whole time Gus very slowly lost his belly bloat, gained muscle tone, and became more energetic. The two meds combined cost about $90/m from Diamondback, including shipping. (60 ml bottle of chicken flavored prednisolone and a 30 ml bottle of chicken flavored Pentoxifylene.) Always got the meds in about 3-4 days flat rate mail but I do believe they offer offer expedited shipping as well. They were great and very easy to deal with.

Gus tolerated the pred well, he did NOT tolerate the pentox. I would say on average he would vomit 7/10 times after I gave it to him. Broke my heart. I tried mixing 1ml of pred with 1/2 ml of pentox 2x daily, that was a little better but he would still throw it up occasionally. I played around with the timing and what seemed to work best was giving it to him about an hour after he ate. 

( Note: when we tried Mishka on pentox we follwed the advice to use a cream - she had no upset other than she didn't exactly like cream smeared on her ears ) Please note how careful they were about not taking Gus off any meds until he was definitely better on bloodwork and they wean slowly.

He isn't on any meds at all now, hasn't been since October 2014. When Dr Falk did new bloodwork and declared him either misdiagnosed or "cured", we decided to ween him off all meds. I stopped the pentox almost immediately since he hated it so much- did every other day for about a week and that was it. I went much slower with the pred, as u know u can't just stop it cold turkey. I slowly decreased his dose over a month, down to 1ml, then did 1ml every other day for about 2 weeks, then 1/2 ml every other day for about a week, and that was it.

the Fab4 including Gus

I Have fostered about 75-100 kittens over close to 3 years... as far as I know none of them have ever been Dx'd with either form of FIP. I did have 2 pass away from dehydration and Giardia (they passed away 2 days after I had them, they were in very bad shape when I took them in). Every other cat/kitten has been a success story as far as I know. I have 3 other cats and none of them have ever had any major ailments -unless u count my 12 yr old Oscar just having 5 teeth pulled Poor guy.

Yes, I stopped fostering. I actually had 12 wk old brother and sister kittens in my house when Gus was diagnosed, I immediately had the rescue take them back (a friend's mother has since adopted them both)!

Gus is strictly and indoor cat. I live on a busy street. I fostered his pregnant mother and he has been with me every day since birth. My mother kept his mother and his sister, and I keep in touch with the woman who adopted his brother and other sister. As far as I know none of them have had any major health issues to date.

John Robie - farewell to a FIP fighter Aug 10 2014

Here is the maverick John Robbie who stole Lisa Cone's heart. Cat owners will appreciate how much he meant to her. He was unique in every way. His unconventional FIP story gave us all hope but he has finally run out of lives and has gone into the next world now. I tip my hat to Lisa who did the very best for her cat. John Robbie's chronicle is sprinkled around this blog - just use the tag cloud to look him up.
(On a therapy note I still don't really understand why Dr Addie is so adamant about promoting arginine and stopping JR's lysine which he had been taking since birth to treat another virus that damages nerves (lysine blocks arginine uptake which herpes needs to replicate - it keeps the lid on herpes in humans as well. ) It's a food, a simple protein that is more easily damaged by cooking than arginine with which it shares a balance that on a natural raw cat diet would not be upset in favour of arginine.)

from FIP fighters facebook posts:

(4/7/14)He is still holding his own. He is on MASSIVE amounts of drugs including full dosage of Pred and 6ml of PI daily. But he seems (knock on wood) to be stabilizing again. I won't feel good about it until I have a good 6 weeks of stable. Then maybe we will talk about decreasing meds. He is one expensive little cat at the moment. (And he looks quite pudgy in this picture when he is usually so pointy!) We are nearing 2 years 

(Aug 10 2014 )We are saying goodbye to John Robie in about 1/2 hour. He has been an amazing fighter for almost 2 1/2 years. His FIP has moved into his spine and back legs. He is peeing on himself and can't really walk. I don't want to see him get any worse. Good bye my love. You are the best cat ever. 

Tomten - Where do you go when your cat has stumped all the vets?

A: a cat specialist - case solved by Dr Plotnick! http://manhattancats.com/
The first blog post on I wrote on his case was the Winter Tomten "Yuletide " the midpoint of winter - the cosmic balance between life and death". I feel like we are poised on such a tipping point - and i cant help thinking being in the southern hemisphere the december solstice signals the descent." If you want to follow his story in graphic detail use the labels to find the other posts but now for the news i should have updated months ago! Tomten was originally thought to have FIP around the same time as Mishka. He had already started feline interferon so I drew a lot of strength from the kindness of Cassie answering my emails 2 years ago. For Cassie the drug was a really really big ask as it is hard to import to the USA as well as super expensive. 

"He who asks a question is a fool for five minutes; he who does not ask a question remains a fool forever." - Chinese proverb

 So glad her persitence paid off: June 2014 Cassie posted -

Finally a possible explanation for Tomten's illness. Ok I have truly crossed over to crazy cat lady. While making Tomten's next appointment for his Cardio check up I began feeling frustrated that he still has no diagnosis. So I broke down and submitted an e-mail to Cat Fancy magazine's ask the doctor. I felt a bit silly but figured what could it hurt? 

My 7 year old Devon Rex has stumped all the vets he has seen. 2 years ago he stopped eating, started throwing up and was hiding. An emergency trip to the local ER showed that he hadgranulomatous tumor in his intestines. An aspiration of the tumor ruled out lymphoma and based on his blood work he was diagnosed with dry FIP. He was put on feline interferon and methyl prednisone and sent home to die. Only a “miracle” happened and he appeared to get better over the course of two months. Three months after diagnoses scans showed that his tumors had disappeared through his lymph nodes remained swollen and abnormal. 12 months after the first tumor appeared he stopped eating again. Scans showed 3 new granulomatous tumors one of which was in danger of perforating his bowel. At this point his vet moved him to an excellent large regional vet hospital. They consensus was that he didn’t have FIP (based on his longevity). Since he was no longer responding to the feline interferon the thought was to do surgery to remove the tumors. All 3 tumors where removed in a double bowel resection and subsequent gram staining of the tissue was negative for FIP. He appeared to recover for a bit and then went into a tail spin hiding and not eating. He was placed back on the methyl prednisone and within a week was recovering once again. 3 months later he developed an ear polyp and infection and lost his balance. A month of antibiotics and dedicated ear cleaning and he recovered much of his balance but his counter surfing days where behind him. When he was being evaluated to remove the ear polyps it was discovered that his heart had become greatly enlarged and he was in heart failure. We made the decision to leave the ear polyps and focus on managing his failing heart.

Tomten has been lucky to have better care than many human beings and we are very grateful to his vet teams, who have given him an additional two years of life. The vets have all been unanimous that what ever is causing his health problems is an unknown and perhaps is some sort of an autoimmune disease? While we have tried to make peace with the fact that we will probably never know what is wrong with him its hard not to wonder if we took him somewhere else would someone know what is causing his condition? And could we do anything to stop it other than to treat each symptom as it comes up.

Dr Plotnick's Reply:

I think the ear polyps and the heart disease are separate issues. Devon Rexes are at increased risk of developing hypertrophic cardiomyopathy, which is the heart disease I suspect he has. As for the intestinal disorder, it sounds like your cat has granulomatous enteritis. This is a mysterious illness. Inflammatory bowel disease is a common disorder in cats. With IBD, most cases are due to infiltration of the intestines with either lymphocytes and plasma cells, or with eosinophils. These are types of inflammatory cells. Every now and then, we see a case that doesn’t fit into this pattern. We see what they call granulomatous inflammation. In these cases, the intestines are infiltrated with lymphocytes, plasma cells, macrophages, neutrophils..a whole mishmash of inflammatory cells. It often affects a discrete region of the intestine, rather than diffusely infiltrating the intestines. (Diffuse infiltration is the more common scenario.) (The disease has sometimes been called “regional enteritis” because it affects a discrete region of the intestine). FIP likes to cause granulomatous inflammation, but not all cases of granulomatous inflammation are due to FIP. When granulomatous inflammation is seen on an intestinal biopsy, the specimen should be stained with a special stain that detects coronavirus in the tissue. If the stain comes back positive, the cat has FIP, and the prognosis is terrible. If the stain comes back negative, it rules out FIP. However, the prognosis for granulomatous inflammation in the intestine is unknown. It’s a mysterious disease that no one has really figured out. Some people try steroids, and they work for some cats, in some cases. Other people suggest surgically removing the affected area. There are no big case studies of cats with this type of enteritis, so we don’t really know what the best treatment is. Unfortunately, I think the best approach is the one you’ve been doing, i.e. treat the symptoms as they come up. With him having heart disease, steroids are not recommended because steroids expand your cat’s blood volume, which can put a strain on the heart. I’m not sure how you would treat another bout of granulomatous enteritis if it were to develop again. Good luck with him. I hope he does well.

Dr. Arnold Plotnick

I've asked Cassie for an update - i know some on the facebook group had reccomended the raw diet as she was investigating IBD - Irritable Bowel Disease.  

PS. I love Dr Plotnick's idea of a cat only vet - cats hate the fuss and stress of a regular clinic full of dogs. Poor Mishka's worst moments were not from FIP so much as the 'system' - I won't spoil this feelgood post with the details of that - contact Dr Plotnick http://manhattancats.com/

Tomten - PCR negative for FIP

oh dear dredged out of my drafts so it's older than this by months but rest easy Tomten seems to still be fine as far as I know. This was written before Dr. Plotnick gave Cassie his helpful email in .

"The News I have been hoping for is finally here..... Dr. Ratti just called me a few minutes ago. UC Davis Vet Hospital just called her. Acting on Dr. Addie's advice she has sent a PCR of his effected tissue to a researcher there. The verdict is this is not FIP!!!!!! (second time in his six years I have heard that and its just as sweet the second time around. First time it was herpes when he was a kitten).

Since we had tested him last year when he first got sick for Lymphoma they have ruled that out. The current hypothesis is he has some foreign bodies embedded in the intestine that has caused the granulomas and with surgery maybe there is still a chance. Because it will be a complicated surgery (two granulomas) and he is weak she wants him at a full service surgery center with access to ultrasound equipment at the operating table and the 24 hour critical care. She will be researching Redbank and Garden State Hospital. Because Tomten is somewhat stable, not getting worse but not getting better she wants us to wait until after the Holiday week so where ever he goes they will have a full staff.

I am elated by the news but terrified for him. He will die without the surgery and with it at least I know he has a chance. He is truly a fighter. In his six years I have been told he is dying 4 to 5 times and he battles back. I hope he has it in him one more time.

The foreign body theory makes some sense to me as he has a bad habit of eating wrapping paper ribbon, rubber kids toys, and straw etc. As much as we try and keep these out of the house they sometimes slip in unnoticed. 3 months ago my son brought home a party favor bag and we didn't realize it was tied with wrapping paper ribbon. He got it ate , got sick and passed it... but I can't help but wonder if he didn't pass all of it. Ditto there have been numerous other incidents over the years so its possible.

Sorry I am rambling on today... A lot of emotion. We have been in Limbo with FIP for so very long." ~ Cassie

I don't know what to say other than Tomten is one sick cat. His fur has not been so shiny and nice apparently for the past month. One has to wonder if the interferon is contributing significantly by holding the herpes at bay or in some other way. I don't suppose you should just withdraw it after all this time - but the latest news on Tomten was he pulled through again and in  Cassie finally got some diagnostic insights and peace of mind from a very  unexpected source read on - where-do-you-go-when-your-cat has stumped all the vets?

Ilana's cat survives with wet FIP

 I don't stop in here now except to bring the good news stories - yes in amongst all the heartbreak there are SURVIVORS!!! and as always much love and caring from people like the tireless Oscar Birman who will hold your hand across the internet on the FIP facebook page where we were told about Illana's cat. They live in France where Dr Addie is now ( you can read about her protocols on treatment page ).

Ilana Dagan My cat had the wet FIP and she takes prednisolone every day and interferon (for human, less expensive).I told my vet about the web site of dr diane addie who wrote about FIP and we found there the right treatment for my cat.She had no more fever,no more fluid in the abdomen and she gained back her weight,it was 8 months ago and she is still very fine! ~ 15/10/14 https://www.facebook.com/groups/fipfighters/798509346862004

I've asked Ilana for more details and a photo and she agreed although I still haven't got these - hopefully these will be sent and we can keep tabs on how her cat fared weaning off the drugs.
Please make sure to read my notes on diagnosis, treatment and the actual survivor case histories, where you will find links to notes about Dr Addie's protocols, and do touchbase with the FIP facebook group for support no matter what the outcome.
Wishing much peace and love to you,
Carolyn

Update Jan 2015 Ilana's cat i think is still ok but I've messaged her again for more info.

The Dragon's Blessing

"the dragon's blessing - this deep understanding that suffering can be transformed and be transformative" ~ Guy Allenby

FIP is all about stress. Cat stress. Human stress - my son and I lost our appetites, stopped eating. I lost my spare tire and gained more under eye bags. Naturally we both got a cold almost immediately. Now I don't believe in God, I don't pray - there were no other adults to support me deeply emotionally; even worse - the vets were out of useful ideas so I was searching the internet until the small hours of the morning. I needed to stay strong for Mishka and for Michael. Plus there was no darn way I was going to let FIP take our health as well. 

So from that spiritual void to calm everyone's panic, ease their pain, and later, to mend a broken heart I reached out for music therapy and meditation. All the wooo hippy junk I wasn't going to bother with when I was younger and life was easy. Certainly not in medical school - I was there to learn about drugs and surgical interventions.

I didn't really believe in the power of the mind until a christmas holiday a few years ago. It just bucketed down, and the family's holiday at Coolum was not the escape to sunny Queensland promised. So while Brisbane flooded and a state of emergence was declared, I retreated to the spa to sauna, sip tea and read Dr. Ian Gawler's biography "the Dragon's Blessing". Studies over the years have increasingly backed up what was at the heart of his healing from 'terminal' sarcoma but much derided at the time and for many years after - meditation. It improves the immune system, critical thinking and memory. With FIP I needed all of these things for each of us FAST without heading for a pill bottle. Music of the right frequency was a shortcut to moving our minds into the zone. There's an abundance of suitable music for free on youtube. It far exceeded my hopes for keeping Mishka comfortable and everyone calm during any therapy. Since she was a highly strung cat and we were all empathically wired in together, one buzz in the wrong direction could wind us all up. We even found one track that reliably sent her and my son to sleep quickly. I have kept adding to the playlist now and then for pleasure. It's unintentionally chronicled a mental healing with the tone of the tracks becoming brighter over time.

 Other resources

Dr. Hedy Kober, a neuroscientist at Yale talks about how she began practising meditation to mend her broken heart.

Other resources I collected along the way are on the support and solace webpage. The most amazing was the facebook community - please also check that out and find what blessings you can as you face FIP.

Pikachu - a wobbly cat

Pikachu does not seem to have FIP although one vet he was taken to made this diagnosis. He was a wobbler (ataxia) because his brain or inner ear ( vestibular system responsible for balance) had damage after a viral illness but is getting better on PI (polyprenyl immunostimmulant) since early Nov 2012 " For the first few months, his ataxia waxed and waned, but now all that remains is a head tilt and the deafness. The head tilt seems to get worse/more exaggerated when he has a UTI or some other issue affecting his general health. He is doing really well now, although it took months to recover, and he still has a few neurological deficits. My only worry is that the virus may reactivate in his system and he won't be able to fight it off again"

"He was first diagnosed in September/October 2012. We took him to an emergency vet because he was ataxic (wobbly) and had nystagmus (shaking eyes). They originally diagnosed him with Idiopathic Vestibular Disease and said it would resolve within two weeks. When he didn't get better, we got a referral to a neurologist who did an MRI, Spinal Tap, FIP titer, toxoplasmosis test, etc., and said it was in his central nervous system and diagnosed dry FIP. After he became ill, we noticed he had lost his hearing completely. We were basically told to say goodbye to him, but you can't give up as long as you have hope. 

The neuro was ready to give up on Pika and really had no interest in PI or Dr. Legendre. I found the information on Dr. Legendre's success with PI and PUSHED the neuro to contact him and write the rx for the PI. Even after he contacted the university, he called me back and told me it was too costly and I should just put Pika down. It was unbelievably frustrating! I'm soo glad I didn't follow his advice. Even if the PI didn't help his situation, it certainly must have boosted his immune system in general and definitely didn't hurt him. " Kathleen Maki Potts

 She sent his results to the FIP fighters for opinions.

 "Pika's A/G ratio is 0.9. Anything above 0.8 almost always rules out FIP. A positive titer for FIP only means exposure to FCoV. It is not predictive of FIP. An extremely high titer, along with other suspicious lab results would make me think different. Also the 7b ELISA was negative. I would definitely explore some of the CNS stuff and it looks like your vet is doing a good job and looking at other things. You can always print out Dr. Addie's flowchart and provide to your vet if they start to explore the possible diagnosis of FIP again. The slightly elevated liver values can just be dehydration or a low grade infection."

Moki is a 'famous' facebook cat who seems to have a similar mystery wobbly problem but which didn't resolve, also initially diagnosed as FIP.

Tigger

"I'm so happy I could bounce!" ~ Tigger

This is a story I got from one of the FIP yahoo groups. It has stayed in the drafts folder of this blog for over a year. I didn't manage to contact Tigger's mum for more details, a picture and so on. Post is copied verbatim as I expect Tigger's mum wants the story out there. So sadly I don't have details of diagnosis, no bloodwork - that's a caveat, it may not be FIP but it's hard to think of what else could have made him so sick for 6 weeks; my notes say wet FIP.  I can see the precipitating immune suppressing causes are pretty common ones. The move was big one as I recall; I think Tigger had to take a plane ride and was received at the other end unwell. He is a little older than usual. Most importantly Tigger's successful treatment has commonalities with other survivors - antibiotics combined with IV fluids and an immune stimulant - in this case interferon ( i think probably it is feline interferon since this cat is in Europe. ) special food (again wish I knew the details!) and intense daily attention.

Hi. I have a rambunctious male 5 year old cat. His name is Tigger. 5 months ago, I moved to Turkey. He had a shot for Luekemia (sp prob wrong) Anyway BAD idea. Don't ever get your cat a shot for this without getting him tested for the corona virus. I'm not sure if I spelled that right either but it's easy enough for you to google.

Anyway, the move and shot sent him into full blown FIP. His eyes were rolling to the back of his head, sky high fever, skin and bones, boy did I thought he was a goner. We started interferon and vitamins, antibiotics and Iv every day for a month and a half. Each day I spent 2-3 hours at the vet. 5 months later, he is alive and fat and happy. Each day I give him 2 vitamins. One in the morning and one at night. And they have garlic in them, yes, garlic.

If you make a serious commitment to keep your cat alive, I believe you have a pretty good shot of beating this with the help of interferon. I also give him food for sensitive systems and NO treats!! TReats do not help any cat. I have a second cat that seems to be fine and probably live to be 20. Tigger is living on borrowed time but I treasure ever extra moment. I also keep their cat box VERY clean. 2ce a day I clean it. My heart goes out to all owners with fip cats. It's heart wrenching, I know.

My other thought, a year of case history reviews later, is that I feel vets are not paying enough attention to fluid and salt (electrolyte) managment in FIP cats. Sick inapetant cats are easily dehydrated as they are desert animals designed to get most of their fluids from freshly killed prey. Vets seem to devote all the owner's resources to diagnostic gymnastics while their patient slips away from under their noses. Any reasonably sick human wheeled into an ER would be instantly hooked to an IV while this is worked out.
Also on the home front I doubt this cat was left to waste his remaining energy dragging himself to a litterbox too far, up a flight of stairs to the bedroom or being needlessly stressed by a bath (this is not sarcasm - I do actually know of someone who went to the trouble of getting PI then bathed their FIP cat. Predictably it took a downhill turn from there and is not listed on my survivors log.)

picture by felicia ruiyi - deviantart

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.

Mutant Ninja FIP

"Evolutionary plasticity can be purchased only at the ruthlessly dear price of continuously sacrificing some individuals to death from unfavourable mutations."

~Theodosius Dobzhansky Genetics and the Origin of Species (1937)

Life does not stand still. Evidence of the mutation of Feline crossed Canine coronavirus to produce a virulent form that creates directly cat-cat transmissible FIP disease. Marleen from Facebook FIP fighters group posted this today -

"One of our members contacted Dr. Niels Pedersen from the UC Davic SOCK FIP team and he kindly sent her this lengthy reply (see below). She got his permision to share this with the FIP community.

Q: In a recent article by Wang et al (http://www.veterinaryresearch.org/content/44/1/57) an outbreak of FIP among cats in a Taiwanese shelter was described. This has caused some anxiety among cat owners concerning the potential of cat-to-cat transmission of FIPV. What are your views on this? 

A: I reviewed this paper and believe that this was a case that started with cat-to-cat transmission. However, the virus in this outbreak is what we call type II FIPV, which is a hybrid that occurs between feline and canine coronavirus. The primary strain of coronavirus in most cats is serotype I. Serotype II FIPV are more virulent than type I viruses and there is an old report of possible cat-to-cat transmission with another FIP virus of this serotype. However, this is a very rare occurrence and should not be taken as a universal finding. Cat-to-cat transmission of FIPV is extremely uncommon, even with serotype II virus, and when it occurs the outbreaks are self-limiting because the virus rapidly mutates to a form that does not go cat-to-cat. It is likely that the virus in this outbreak came from a cat or cats that were housed with dogs in another shelter and had not yet had time to fully adapt to cats. 

At this point, we need to define the difference between epizootic (epidemic=human) and enzootic (endemic=human) disease. An epizootic occurs when a new pathogen such as a virus enters a group of susceptible animals for the first time. There is a very rapid spread with a high morbidity (prevalence of diseased individuals) and often a high mortality (death from that disesae). An example would be the appearance of parvo virus enteritis in dogs in the 1970s, an epizootic disease that is now enzootic. Enzootic disease occurs when a pathogen lurks continuously in the environment and only targets individuals that become susceptible. For instance, feline enteric coronavirus is shed by a majority of older cats in a cattery but it is the kittens that take the brunt of disease. Enzootic disease is sporadic in nature and the morbidity and mortality waxes and wanes depending on the presence or absence of disease cofactors. People often mistake epizootic for enzootic disease when several cases occur close together. Epizootics usually get far more attention than enzootics, because they hit like a hammer. Enzootic disease is frequently tolerated, as is the case with feline upper respiratory and intestinal infections and even with FIP. However, the tap-tap-tap of enzootic disease is in the long run far more damaging and causes far more deaths than epizootic disease. 

Q: How can an epizootic of FIP, such as occurred in this Taiwan shelter, be differentiated from the enzootic type disease that causes almost all FIP deaths? Or another way to ask the question in the case of FIP is how can you differentiate cat-to-cat transmission of an FIP virus from the normal pattern of infection, which involves cat-to-cat transmission of the parent feline enteric coronavirus followed by internal mutation of the disease causing FIP virus?

A:  The epizootic of FIP that occurred in Taiwan was easy to characterize, because it could be traced to the introduction of a specific hybrid cat/dog virus that came in with a cat from another environment. This virus then rapidly spread to susceptible cats by contact. The virus that caused the epizootic was also genetically unique from normal enteric coronaviruses that were enzootic to the shelter, confirming that it was indeed a new introduction. As would be expected from an epizootic, the introduced virus changed as it rapidly spread cat-to-cat in the shelter. With subsequent cat passages, the infecting virus started developing mutations in one of the coronavirus-related genes associated with production of a protein called 3c. Coronaviruses that do not produce normal 3c protein will no longer infect enterocytes and are therefore not shed in the feces. This same type of mutation is common to the FIP viruses isolated from cats with enzootic disease. This occurrence of 3c gene mutations was probably the major reason why the Taiwanese outbreak was self-limiting, and not just because a simple quarantine was initiated.

Q: We can all understand that cases of FIP commonly occur in large catteries where FECV is prevalent, and where there is a genetic relationship between affected cats. However, there are also cases where 3-4 genetically unrelated cats in the same household (not a large cattery) develop FIP one after the other during a time period of 6-12 months. Assuming that all of these cats developed FIP due to internal mutation of FECV, this seems a bit strange considering that only a small proportion of cats are supposed to go on and develop FIP after FECV infection. How do you explain this?

A: The morbidity to FIP can range from less than 1% to more than 5-20% in the enzootic form, depending on many factors. In catteries, genetics play an important role, but it is not the sole factor. With random bred cats, non-genetic factors are even more important. We know that the age at exposure to FECV and stressors of many types that occur during primary FECV infection (starting around 9 weeks) are very important. Resistance develops with age and the younger they are exposed the more likely to come down. The problem is that in shelters and catteries the exposure occurs much earlier in life than if cats are running free at a reasonable density. There is no accident that over 70% of FIP cases come from catteries, shelters and kitten/cat foster and rescue organizations. We also know that 20% or more of FECV infections can generate FIP-causing mutants, but yet only a fraction of cats get sick. This means that many cats actually resist the disease. The question then becomes - why do some get the disease when others do not?

Q: Which are the most important stress factors that can influence the development of FIP in young cats?

A: In principle anything that interferes with a kitten’s immune response in that critical period between 9 weeks when they usually first see FECV and 16 weeks or so when their immune system really starts to become mature can potentially tip the balance towards disease. Vaccinations, deworming, early neutering, moving to a new family – all of these things can affect the immune system, plus all of the common kittenhood respiratory and enteric disorders that occur during this period. However, it is impossible to weight the influence of one or another, or any combination. I like to use the term “perfect storm” from the famous movie. You get FIP when enough bad things come together at the wrong time.

The Bottom Line - House your cats in small groups. Do not stress them when they are young. Protect kittens from encountering FeCoV until their immune system is strong and don't inbreed.

Preventing FIP is simple

"God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference."Reinhold Niebuhr

What really really makes me mad about FIP is the complacency in the cat owning community since it is supposedly a coronavirus mutation confined to the unlucky individual cat and furthermore not transmissable to humans; FeCoV (feline coronavirus) is an oral fecal thing and has a very short persistance outside a host therefor theoretically easy to beat. No FeCOV = no FIP. Worse things have been banished with no more exciting weapons than soap, clean water and flushing loos.

"FIP is pretty rare in housecats who are not exposed to other cats, occurring in roughly 1 in 5000 cats in this situation. FIP is fairly common in catteries in which feline coronavirus carriers are present, occurring in about 1 in 20 cats in this situation." 
Read more: Feline Infectious Peritonitis( FIP) and Feline coronavirus (FeCoV) - VetInfo 

What really really scares me about FIP though is the breeding of virulence by letting it cycle multiple times through kitty hosts who are unaturally confined indoors with an abnormal number of other potential hosts, who are to boot, probably immune suppressed through poor diet and inbreeding. "Wu Lien-teh, moreover, suggested that virulence increases in the course of an epidemic. Dongzheng Yu conducted a series of experiments in rats to test this idea. He injected them with a strain of plague from wild rodents; the injected rats were not easily infected and died slowly. Next, he withdrew plague bacteria from those rats and injected it into others, and on and on. Eventually, this serial passage produced a plague strain so lethal that rats injected with only a tiny amount died rapidly, suggesting that the strain's virulence had markedly increased." http://discovermagazine.com/2001/nov/featblack#.UaXtboLC--k

The knee jerk reaction, massive culling, as happened to the civet cats in China during SARS, is probably counterproductive - civets have low immunity anyway, why ruin the genepool further?

 "The last thing we should do is to take it out on the bats, because the evidence suggests that they have carried this coronavirus for thousands, perhaps millions, of years; only recently has it emerged in a big way, and it was human behaviours that made the difference." http://evolution.berkeley.edu/evolibrary/news/060101_batsars

We need to change our behaviours now, because this is the one thing about FIP we can control while still dreaming of some miracle pill - and it's entirely DOABLE http://www.dr-addie.com/Prevention/PreventionS1.htm#How to eliminate FCoV infection from a cattery

Tomten - thoughts on inflammation

"drink the wine drink the wine- music, good friends, I'm not dyin' today" ~ Tori Amos

Tomten has been doing the Lazarus cat dance back from the brink for past eight months. He was heading downhill in late June and a surgery was performed hoping the granulomas were from a foreign body like string. However he crashed after the surgery and was very poorly for several weeks.

"Tomten continues to fight but is growing steadily weaker. He has taken to spending the entire day in a pile of stuffed animals in the kids play room. My husband can get him to eat a little bit. He is becoming wobbly on his feet. My husband is still hopeful and when he eats I am too but in my gut I think he is in his final weeks."

But his vets didn't think he was in pain, didn't toss in the towel and a week later on July 26th he turned the corner with last ditch antibiotics, steroids and high energy paste.

 Cassie wrote - "I am scared to to even post this in case it jinxes us but Tom has had a great two days. Since going on the last ditch antibiotics and back on pregnazone (sic) and the high calorie paste he is feeling so much better. He is eating!! He is hanging out with us and Gizmo instead of hiding in the stuffed animal pile. When he got sick last year we did 3 things. Interferone, prednasone, and a course of antibiotics for the herpes which was bad. Since surgery Tom was off the pregnazone and he had antibiotics on the operating table but none since. Keeping my fingers crossed he is turning a corner but too scared to hope. Is it possible he has 18 lives?"

I wonder if I've been underestimating the support antibiotics can provide an ailing cat - even if it's not the primary illness, knocking down the numbers of bacteria multiplying out of their normal range due to host debilitation, may allow the cat enough space to muster his reserves for the fight. "lipo polysaccharides (LPS ) from many bacterial species will initiate acute inflammatory responses in mammals". Maybe we should have tried harder with Mishka's lump.

So his ultrasounds didn't show any other lumps - he went back to happy and active. And Cassie was back to square one diagnostically.

"He continues to do well since the antibiotics and the return to Pred. I caught him playing kitty smack down with Gizmo last night first time in 3 months. I don't know who was happier Gizmo or me. I think Gizmo was letting him win since he out weighs Tomten 3 to 1 at this point. Tomten couldn't have a more loving brother. Now that I have him back again my thoughts are turning to how do I keep him alive and delay the granulomas from coming back. I started doing some internet research trying to figure out what besides FIP causes granulomas and responds so dramatically to antibiotics and prednisone. I came across Inflammatory Bowel disease (IBD). The literature says its rare but can cause granulomas."

 Some informational links and my thoughts on IBD and inflammation:

• http://feline-nutrition.org/health/feline-inflammatory-bowel-disease-nature-and-treatment - My gut feeling (haha a pun) is that Feline Irritable Bowel its not far off human IBD. What you eat determines the gut microbiome. We have a little human friend who had to have a fecal transplant to get rid of his awful colitis. He is a very sick boy who is now off all his meds! Anyone with Crohn's disease or colitis who wants to get cured contact Dr Borody in Sydney.

• http://www.2ndchance.info/inflambowelcat.htm Although i dont have direct cat experience with IBD per se I noted our other pets have better skin on a proper raw diet, which I imagine reflects the state of the gut as it is basically the same as skin - both are made of epithelial cells. Mishka was the big diet fail - i always thought she'd come a cropper on dry food diet but figured (wrongly) I had time to transition her to a 'better' diet. Wrong again - commercial petfood is just wrong, I had no idea it was all so dreadful until she got ill. Now i know even the tinned food, though 'complete', is still highly inflammatory.

• http://raypeat.com/articles/nutrition/carrageenan.shtml  - carageenan is seaweed - not meant to be eaten by cats but it's the thickener in most commercial petfood. It is known to incite inflammation, in fact it's used experimentally to do just that when you need to make a wound to test a cure on!  I have no idea why they dont use gelatin instead, which is anti inflammatory and being connective tissue supplies all the right things for building connective tissue for both humans and animals http://raypeat.com/articles/articles/gelatin.shtml