FIP Georgia > treatment info > FAQs
FIP itself is not contagious. The basic feline coronavirus (FCoV, or FECV, for "feline enteric coronavirus") is highly contagious, but nearly all cats living in group settings have already been exposed to FCoV, and it generally causes only mild symptoms. The virus develops into FIP only when it mutates within the cat's body into a form that can infect the white blood cells. The reasons why that happens in some cats and not others are still poorly understood, but there does seem to be a genetic component. For that reason, other cats from the same litter as an FIP kitty are more likely to develop FIP, but it's not because they "catch" it from the already-infected kitty.
See also Dr. Pedersen's statement on this topic; in brief, he says that although it's theoretically possible for the mutated FIP virus to transfer from one cat to another, they've never seen it occur during their research studies.
Because there is no single test that can definitively rule FIP in or out, we have to look for an overall pattern, combining information from several sources: the kitty's history (age and symptoms), various indirect indicators found in blood tests, and—for wet FIP—analysis of a fluid sample. (See the "Bloodwork and other lab tests" section below, for more details on relevant lab tests.)
When there's uncertainty, we do often begin treating for FIP diagnostically—i.e., begin treating and see how the kitty responds over the first few days to a week. If the symptoms improve, that is itself good evidence that it is FIP, as the meds will have no effect on other conditions, and if they don't improve, that suggests it isn't FIP, and we need to keep looking for some other cause of their symptoms. The FIP meds have minimal side effects, and the cost of a vial or two to get started with is modest, so treating diagnostically is a low-risk way to obtain more information to help determine whether it is FIP.
It often makes sense to begin treating before we're certain that it is FIP (see the comments about "treating diagnostically" in the previous question).
Some vets who are not yet aware of this treatment's effectiveness, and were originally taught that FIP isn't treatable, may be inclined to continue testing over an extended period to rule out all other possible causes before recommending trying the treatment. When FIP wasn't yet treatable, and the only course of action was to euthanize, it made sense to do nothing until everything else was ruled out. After all, you wouldn't want to euthanize a kitty before you were sure it had FIP, and at the time they had nothing else to offer. But now that there is an effective treatment with minimal side effects, it makes more sense to start treatment diagnostically when uncertain, as the risk of delaying treatment if it does turn out to be FIP, and allowing the possible FIP to continue developing while waiting for additional testing to be done, is greater than the risk of beginning treatment if it isn't FIP: in that case, the treatment won't worsen any other conditions, and all that's lost is the cost of a vial or two, as we'll soon see that the treatment isn't having any effect.
We can get started without bloodwork if it isn't yet available, but it is important to get bloodwork within the first week or so of treatment, both to help confirm the diagnosis (and make sure we don't have some problem other than FIP that's going untreated), and to serve as a baseline for the FIP treatment, so we can gauge your kitty's progress during treatment, determine whether the dosage needs to be adjusted, and decide whether your kitty is ready to stop treatment at twelve weeks.
CBC (with information on red and white blood cells) and a chem panel (levels of various proteins in the blood).
The effect of FIP on bloodwork can vary widely, and sometimes the bloodwork of kitties with FIP can even look completely normal (most common with neurological FIP, where the virus can be compartmentalized within the central nervous system, keeping it from affecting blood tests). But there is a set of indicators we do usually see in the bloodwork when FIP is present:
• anemia
• high total WBC
• low lymphocytes
• high neutrophils
• low albumin
• high globulin
• high total protein
• low A/G ratio
In more detail:
FIP kitties are often anemic—usually mildly or moderately so, but sometimes severely. The hematocrit value (HCT), sometimes also called packed cell volume (PCV), is the total volume of the red blood cells, and is a good general indicator of the degree of anemia. Anemia caused by FIP will usually be of the "nonregenerative" kind, meaning that too few red blood cells are being produced. A nonregenerative anemia is recognized by the low number of reticulocytes (immature red blood cells) in the blood.
If anemia is present at the outset, we look for it to resolve during treatment: hematocrit will return to the normal range, and the number of reticulocytes may spike while the red blood cells are being replaced, then settle back down into the normal range.
With FIP, the total white blood cell count (WBC) is usually high, with the distribution of the different kinds of white blood cells skewed such that the percentage that are neutrophils (%NEU) is very high, and the percentage that are lymphocytes (%LYM) is very low. The excess neutrophils mean there's a lot of inflammation, and the lymphocytes, which are necessary for eliminating viruses, are reduced because the supply has been exhausted while trying to fight off the virus..
Over the course of treatment, we want to see the number of neutrophils normalize, and the number of lymphocytes spike as they regain health and proliferate to eliminate the FIP virus, then settle back to typical values when they've won the fight.
Albumin (ALB) and globulin (GLOB) are two proteins found in the blood. Total protein (TP) is the sum of the two, and A/G is the ratio between them (ALB divided by GLOB). With FIP, typically albumin is low and globulin is high (above 5.0)—high enough that total protein is also high (above 8.0), even though albumin is low. And low albumin with high globulin yields a low A/G (typically below 0.7).
By the end of treatment, we'll want to see globulin below 5.0 and A/G at 0.7 or higher.
In cases of wet FIP, the effusion (accumulated fluid) can be sampled and examined. FIP effusion has a characteristic color and consistency: it's usually a clear fluid, tinted yellow (sometimes pink if a blood vessel was nicked while taking the sample), with a "sticky" or "stringy" consistency. Cytology analysis of the sampled fluid will usually find a low cell count and high protein content. A PCR test can also be run on the fluid, to detect the presence of FIP virus. (Note that a PCR test performed on effusion does have about a 30% false negative rate—i.e., the test will come back negative about 30% of the time when the cat actually does have FIP. A positive result, however, is reliable.)
With dry FIP, there's of course no fluid to examine. Abdominal ultrasound can sometimes detect FIP-related lesions (granulomas) on the internal organs. For further confirmation, IHC staining can be performed on a tissue sample from a lesion—IHC staining is a reliable test for FIP. Sometimes in suspected dry cases, a PCR test is run on a blood sample, but we don't recommend doing that, as the concentration of FIP virus in blood is almost always too low for PCR to detect it.
This test—sometimes also referred to as a "coronavirus titer" or an "FIP ELISA" test—detects the presence of antibodies to the feline coronavirus, but is unable to distinguish between antibodies formed in response to the unmutated, harmless form of the coronavirus, and antibodies formed in response to the mutated form of the virus that causes FIP. In other words, a positive result (i.e., a high titer score) would mean the kitty had been exposed at some point to feline coronavirus—as have nearly all cats living in group settings with other cats—but not that the kitty has FIP. And likewise, kitties that do have FIP can have a negative result (a low titer score) on that test. We do not recommend running this test, and wish labs would stop claiming it's an "FIP" test.
Clean the fur with dish soap and warm water, and rinse with water. If you can estimate how much liquid leaked out, and it was more than a drop or two, do another injection to replace what was lost. If you have no idea how much leaked out, do another injection of half the usual amount.
Leakage happens in two ways: the tip of the needle may poke through the far end of the tent or one of its sides, causing the entire injection to land outside the skin, or some amount of the injected liquid may leak back out the injection hole sometime after the needle is withdrawn. In either case, a large tent is your friend, giving you a bigger target for the tip of the needle, and also more room for the injected liquid to disperse in without coming back out the injection site. When forming the tent, you can pull up quite firmly—more so than you might think—without causing discomfort.
To ensure the tip of the needle is within the tent, after inserting the needle and before depressing the plunger, you can wiggle the syringe slightly, to check whether the tip of the needle is moving freely. If you've poked through the far end of the tent, the tip will be stuck in the skin; if it moves freely, then you're in the subcutaneous space.
To minimize the likelihood of leakage back out the injection site, in addition to forming a large tent, you can continue holding up the tent for a while after withdrawing the needle, giving the hole more time to close and the liquid more time to disperse; you can also encourage the hole to close by gently squeezing the skin at the injection site while holding up the tent.
It could just be the liquid from a recent injection that wasn't quite deep enough; such "bubbles" are common, and probably mean you injected into the skin rather than the subcutaneous tissue. If so, the liquid will absorb on its own over the next day or two. (Sometimes the bubbles migrate downward due to gravity, so don't be alarmed if it has moved when you next see it.) It could be that your needle wasn't inserted all the way, or that you entered at too shallow an angle. Try to enter the skin at about 15-20° to the body.
You may have inserted at too steep an angle, reaching beyond the subcutaneous tissue and poking into the muscle. That will hurt more, but it does no damage, and the pain will pass within a day or so. Try to enter the skin at about 15-20° to the body.
If it's only a few drops of blood, your needle probably just nicked a blood vessel on the way through the skin. It's fine.
It's not advised. Lidocaine is unlikely to help much, as the pain is not in the skin, but a reaction in the subcutaneous tissue to the acidity of the GS solution. Also, should the tip of the needle pick up lidocaine from the surface and pass through a small blood vessel, it would introduce the lidocaine into the bloodstream, which can be dangerous.
Before making a decision, please discuss with your vet the risks and benefits of vaccinations for your kitty. There is no one-size-fits-all answer, as many factors affect your cat’s risk of contracting diseases: where you live, whether you have a single- or multi-cat home, whether you foster, whether your cat is strictly indoor, what vaccinations your cat has already had, your cat's other health issues, etc.
Here is one possible set of guidelines, based on advice from FIP Warriors® consulting vet Dr. Susan Pascarella Kliewer:
There is some disagreement among different researchers about the effects of lysine. Some have argued that it helps the body combat the herpes virus because the virus needs arginine in order to reproduce, and lysine binds with arginine, reducing the amount available to the virus. Most studies have been unable to document any effectiveness of lysine against herpes virus in actual cats (one study did seem to show effectiveness against herpes virus in a culture dish). But arginine is also needed by many processes within the cat's own metabolism. Among those who treat FIP, there's concern that reducing the amount of available arginine diminishes the effectiveness of the cat's immune system.
Here are some sources of additional information, from least to most technical:
There are lots of ways to help! Being an all-volunteer group, we always need more people to contribute their time: you could, for example, learn to moderate the Facebook groups, or hold extra meds to help new parents in your area get started.
And if you have spare cash, there are various funds to help parents afford their meds and vet bills, or to sponsor research on FIP and better treatments: please consider supporting the Warriors treatment fund or Dr. Pedersen’s research center.
FIP Georgia > treatment info > FAQs