Jan. 25, 2021

A cure for FIP. With Dr Dave Collins.

A cure for FIP. With Dr Dave Collins.
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Season 1

You know that virus that the entire world hates at the moment? Yes - the C-word. Well, us vets have hated it for a long time, because it’s been killing our feline patients relentlessly in it’s mutated form of Feline Infectious Peritonitis long before the rest of the world ever heard the name 'corona'. Well, that might be about to change... 

In this episode, we share some highlights of a recording we recently released on the Vet Vault Clinical small animal medicine podcast with our resident medicine specialist, Dr Dave Collins. Join in to find out all the details about some new treatments that are showing very high cure rates for FIP. It's simply too important not to share. We hope you find it as enlightening as we did, and please remember to share it with your colleagues so we can get the word out there. 

Dr Dave also gave us access to some detailed notes on everything we know about Remdesivir, one of the drugs we talk about, including a comprehensive treatment protocol. If you want to get your hands on these go to www.thevetvault.com and subscribe to our mailing list, and we'll send them to you. 

In the full episode, we also cover the ins and outs of diagnosing FIP, which you'll know can be a challenge in itself. Go and check it out at vvn.supercast.tech. 

It's been a death sentence until very recently, but and even drought a few minutes ago, couldn't believe that we do use the word cure in the same sentence as FIP, but it's very much on the horizon.Hello.
And welcome back.We thought we'd give you a little sneak preview of some of the best bits from an episode that we released recently on the vet V, clinical small animal medicine broadcast the information that dr.Dave Collins, our resident medicine specialist at the The vet V shares here is way too good to keep to ourselves and it's also too good to keep to yourself.
So please share this important message with your friends in practice, dr.Dave has given us access to a comprehensive Guide to Everything.We know about Rim disappear, including a step-by-step treatment protocol.If you want to get your hands on these documents go and subscribe to our mailing list at the vet world.com and we will send them to you in the full episode.
Dave also goes over his favorite tips on how to actually diagnose, if IP, which I'm sure, you know, Can be an elusive packet to pin down.If you want to get the full episode go and check it out.At Vivian, the super cast tick that's V in forward voltage.
Network, enjoy, and go and save some kitties.Hi, I'm Hubert.This is Gerardo.Hi.I'm Dave Collins small animal medicine specialist who works in the north of Sydney.And you are listening to the bit Bob medical podcast.Welcome back in.
Buddy, to another clinical episode with dr.Dave Collins, and we are going to talk about a topic that Capital very recently is one of my worst cases in GP land and an emergency not getting bad FIP feline infectious peritonitis.
Dave, you guys see lots of these end up as you as a specialist thing.Yeah.So do yeah, we still say a few of the poor little kitties that have been in the family long enough to develop, A lot of affection with all the family and yet developed the trailer at FIP and I guess, probably more commonly.
I see the cats with a fever of Unknown Origin, that you don't have a few severe Phi P, they're a bit more of an antique mirror and a bit more of a diagnostic dilemma, and a challenge and may need a bunch of tests and imaging and whatnot.But yeah, we do see a few, and I think we're talking before that it's it's been a death sentence until very recently, but and even drought a few minutes.
To go couldn't believe that we do use the word cure in the same sentence as FIP but it's very much on the horizon because coronavirus is well it's a very dirty word at the moment but it's everywhere in the kitten cat world to the dreaded mutation of fop is something that we need to work up extensively sometimes and now have a few more treatment options.
So what are the Hallmarks for you to say?Yeah this is a case of FIB in the non-obvious, the nine weight from what are the boxes that need to be picked for you?The favor the globulins often icterus Don regenerative anemia and non responsive to antibiotics.
The, they're all ring alarm bells for me, okay?And that's enough you to say, all right?This is what's this is, what's wrong with in trouble?If you've got to be careful, jumping to conclusions with clients, when one of the possible diagnosis is, as devastating as that, but it certainly got to be in the list of differentials to entertain initially.
So now here's the exciting part that is what I really wanted to talk about.So at that stage, normally up until for My Thai curry yet, that's a hard conversation because you're basically telling them right to your cat is going to die.Yeah.What can you do about it?Is it a city traditionally?
If things change at all, in terms of treatment, what do you guys do for treatment?And yeah, previously, my whole career it's been a benefit for 25 years and it's been a death sentence, the whole time and has been since you guys trained as well.
Trusting that long after me, you know, we're talking about things like interferons for a while there.They're talking about Polly perennial immunostimulant, which had some kind of if you Results, the interferon and I think the initial cases were probably definitively FIP so the successors were a bit dubious for this hour.
For the number going to interfere on even talked about in the old days, things like thalidomide, you know, the the caused all the birth defects, many years ago, that was actually used to switch the immune response to a cell mediated or th1 response because the strong cell mediated response.
It's actually can eliminate FRP.It's the type to reaction with the antigen antibody that causes the effusive form.So that's sort of genetically determined their response to the virus and I guess it's also, why covid in humans has such massively different impacts.
It's the response of the immune system.So strong cell mediated response is actually desirable to eliminate infection.They thought for living my utmost, which that but in my time, I've sort of tried so many.Fear on and otherwise, I've said, try prednisolone for a little while and see how we go at my settle down some inflammation.
Things like pentoxifylline for vasculitis much help, but it's basically been preparing owners for euthanasia and having that quality of life discussion, but, you know, fortunately, on the horizon, there's a lot of research being done on antiviral compounds.
There's a few novel Concepts like even itraconazole the antifungals got some antiviral effects.There's Larium any Surfers motor power in the tropics might have had delirium to try and fight malaria but it does drive you cuckoo the day week that he take it.
So I think they've even banned people taking that it's called mefloquine.It's a bit like the hydroxychloroquine that's been in the press a little bit about covid, but that has been found to have some antiviral effects for not just fop, but can they see virus as well.So there's some research on going or coming up at the University of Sydney for But I think what?
It's all boiling down to is in a company called Gilead in the US.That's got some great nucleus, tide analogs, which are antiviral compounds, that inhibit RNA replication and been found well one of them REM desert fear which has also been in the press a bit about covid.
It was originally developed for Ebola and found to be ineffective but it's probably going to be a very effective drug if we ever get our hands on it for cats and there's A very similar compound called GS4 for 125 for, which is not a very sexy name.
So we'll have to get the marketing department on to that one.But it's like I'm reborn from so related to C-3PO and that's had some very promising results.So for both The Fugitive and reform Neil Peterson from the University of Davis has published a lot of papers on that with some very promising results, including 19 paper, 31 cats and 26, survivors are so incredible.
And then there's a follow-up paper of, for neurological cases, which three out of four survive, they need a much higher dose, some of them do relapse, but all of these were previously death sentence for survival times.We looking at, I think, I think we'd only had like two years since the, since the cases.
So we haven't heard of looked at long-term survival, right?So, I guess, that'll follow, but all very promising.Do is sort of in a touchy area here.The company hasn't registered it for fit and reuse at all, anywhere in the world.So we're not really allowed to dispense it.
People are obtaining, it and anecdotally has been about an 80% success rate in cats in Australia.So so anyone interested can Google it or go under the FIP Warriors Facebook page and find out some information about it and Once we can get ahold of these compounds or Rim disappear, then you know pull the Left Right.
P cats have got a much better fighting chance.So we have a we have a drug that could get if I be yeah.Absolutely.But we're going to use it.Yeah.Let's the heartbreaking thing at the moment.Also, reportedly incredibly expensive.So macaque is that many say could you jump online pharmacy and be a little bit of knowledge and we're talking many thousands of dollars for a Treatment.
So so I don't know what's going to happen, because it's illegal because it's so.So what's happened?I read this article that they've shared and it's you can get it from China, the people who Black Market producing it, and it can be legally order it from one of these places.
But then, they, obviously it's illegal.So they still argue for, it doesn't come from the bottle of tigers or something like that.No.So thankfully every combat Product, I believe so, yeah, I think one day we'll be able to get hold of it, you know, whether the price of the affordable remains to be seen.
So, the, if I B, vaccines, I know, there is one out there that feeling coronavirus.Vaccean, ineffective.No point.Yeah, no point.They just cannot universally protect against mutated coronavirus and give effective immunity.And they're also does seem to be a problem with the length of immunity as well.
So not just, is it not?Against the right thing that the duration of protectiveness is grossly inadequate to for so nothing.You can do to protect your patients against that and for the time being still not a hell of a lot, you could do for treatment but keep an ear to the ground because hope.
Yeah.Hopes on the horizon, that's really exciting.So we wrapped up that episode there, but since recording this about six months ago, things have happened in the world of FIP treatment.So we've recorded this little addendum with the most up-to-date what's happening right now?
What you can do, you definitely want to hear what Dave has to say about if I pee right now, please enjoy.I want to start with, with just asking, have you had any cases or any more stories or anybody?
You know, let's treat it.If I'd be with these new drugs and any more info on how they go tragically, I haven't had my own case manage, but after said anecdotal reports and they've all been very favorable, you know, a nurse that's had a cat that's done very well.
And I think Gerardo was involved in a case as well.So, but yeah, personally, I haven't sure.I know you.You know somebody who is The daycare is that, right?Yeah.Yeah.It was helping them.Try to determine the diagnosis of their pet.
It was a cat, had a big effusion with high globulins, didn't sound cardiac and things and suspected was FIP.They later confirmed that the next day, but then, my original discussion, was that look at there's no treatment there is a treatment, we can't get in Australia and there's in this incredibly resourceful and Percy.
Distant friend of mine track down treatment and management within like one day just got online.And these people are very proactive in assisting in helping especially Facebook groups and then it was I don't know exactly how much it cost but it was several thousand dollars of management care.
But if you Embark my take on this is that if you embark on it it's daily injections and her cat was a really, really nice.At the start and after daily injections, she started to come across things.
Like the cat was starting to get quite needle shy and we put the cat on on daily Gabapentin for pain relief and bit of sedation and yeah, that helped a little bit and then tried like Emma creams and things like that.
So the daily injections you can get through it, but you have to be prepared for that.Yeah, yeah, yeah, absolutely.I think the efficacy if you can get It in.And that's obviously the problem with a lot of cats that need chronic therapy.They can turn into vicious Killers after a while.But yeah, various strategies such as Gabapentin or buprenorphine for Sedation, sometimes even putting an IV catheter in every five days for given intravenously.
So that's another option as well.But there's certainly been some exciting developments in the availability of treatment for cats.Okay, last time we talked about, you know, trying to get hold of some of the the protease.Give it a GS4 for 1524 and viral Facebook group because vets weren't legally allowed to prescribe it or obtain it, which is problematic.
So, people were resorting to importing from China mostly, which was sort of black market and you don't know what about the efficacy or anything of the product.So it was certainly, suboptimal availability, but ironically, the Stars, Cove to or what's it?
Bloody called Mighty covid covid.It's just put away to a dark side of my brain.I don't accept.Yeah.So covid-19 or SARS Cove to is meant massive, renewed interest in obviously vaccinations and therapy for Coronavirus, and that's helped our little cats.
So, so the company that makes well, both that protease inhibitor.The similar one from Desert View, which you may have heard about which is GS5 734, which is pretty much the same as the other product for protease inhibitor.
So we can import it into Australia and we can prescribe it and obtain it Vibe over.And we know exactly what we're getting it's licensed and you know with guaranteed well, efficacy or availability.Anyway, so we've got a legal source of it and we can manage The FIP cats and usually pretty successfully.
And, and if you say, we, that's specifically Australia, we know, we've got access to it through that one company.You know, it is anywhere else.I haven't.So, I should have looked into UK and South Africa, and whatnot.But haven't, as yet selfishly.
I'm just interested in Access for my own patients and I know we're all over it.So I'll I'll check that out and see if I can put something in the show notes if I can find out.Well, we could we could do.Edit the other thing I've joined since I'm Chad I joined the FIP worry is Veterinary Facebook page.
So yes you're on there as well and yeah absolutely yep.So there is a group joined that there's a lot of it to using this or prescribed not prescribing it but helping the clients they did.I see the default answer in B ask questions is always refer them to their Facebook page for clients where they can get the medications.
It doesn't look on the like people are accessing it.It illegally, it anywhere else, but they strike this Sydney, seems reliable ways to get it to few brand names that they seem to be reliable gate.And, and there's also a lot of discussion about treatment and treatment problems.It's actually quite a useful, useful Facebook page.
So go and check that out.Another thing that might be ideally after and I run through the treatment schedule for the rim.There's a view and I've got the notes which I've got permission to put in the show notes as well as some tacos and Porter kind of treatment protocol on there.
Put Richard Malik has put together a protocol and tried on a few patients in Sydney, where they start with going on IV fluids and getting a high dose or 10 mix bikini intravenously over 10 minutes so I load it.Diluted in Saline do that daily for the first few days and then on to a lower dose of five to six weeks because once a day might take two or three months to resolve completely and I guess with cats with ocular or Local involvement.
They are going to need at as for as per the other drug that it seems to be a similar similar dose to to that other nucleoside.It's probably going to be more like 10 weeks, petite.So that's more drug.So this is the, this is the room reserved.
Are we talking about?And as it is, yeah, so, higher dose, ocular and neurological involvement.As I think we discussed in the podcast, and with, if there isn't any ocular or CNS signs too, To kind of monitor that, I guess you sort of looking at globulins and things like that to look for resolution of the disease.
Okay, what else are we missing in Australia?Its legal conduct by over.There's a treatment protocol.Will put it in the notes for you as well.So just quickly replication because you can get it legally.You can mean as a veterinarian, yes, legally treat this.
So it is this can come into your hospital.You're not going to get your license revoked.Yeah, absolutely.Yeah.It's all above board.So fake and and we can legally manage and treat.That's fantastic news.I don't give this is a groundbreaking groundbreaking.
It's lovely to be work at a period with something huge.Like that happens when there's a paradigm shift for something.It's all thanks to covid really?So price, was it, looks like 100 mg vial is about 250 bucks, plus GST and postage, I reckon I just did a quick calculation.
It's still going to be A drug and some Veterinary Care 6 to 10 grand to treat.So it's probably the downside and I fear that it probably won't eliminate the black market.If things are that expensive but at least as veterinarians, you know, we've got a legal option.
I think that's a great thing to have happened.Even if it does cost a little bit extra from the back Market aspect.But at least you got confirmation of the the product and the quality of the product, you know, you're getting there.Well And especially the Telly injections.
I mean, if I, if it was my cat and I had to do that at home without any help even as a Visionary and it would be extremely stressful for me.So you can imagine for a client to have to go through this.It's, it's been absolute hell to do it.Now that you can actually.If it's actually legally allowed to help you, yeah, makes a mess of the recycling, definitely worth the money.
I'd say come in for some help here, for the injections.Okay, we'll wrap it up there.That's excellent.Excellent news.Thanks so much guys.Right.You know, those conversations that you have at conferences, back in the days, when we still had big bed conferences, when people are chatting to the lectures and asking questions and you hear things like this isn't really in the books.
But here's what I think it's in those kinds of conversations that the best nuggets of wisdom appear.The nitty-gritty real life details that you can only get from here is and years of experience.And it's exactly those kinds of conversations that we try to emulate on the vent valve.
The clinical podcast, we don't want lecture Has we want to hear about the challenges?The tips, the stuff UPS there.This is how I do it.Go to VV n dot super cast, dotnet to join in the conversation.

Dr Dave Collins