The good and bad in a different species...

Neither part A or B of this post are horse related. BUT... the first part felt too important not to share and the second is important to my personal animal life, so it's going on here. 

The good first... 

I attended a conference on Friday and Saturday that focused on feline infectious peritonitis (FIP) in cats. FIP is an "uncommon presentation of a common disease". FIP is a disease caused by mutation of the feline enteric corona virus within an individual cat. The seroprevalence of feline enteric corona virus is between 26-78% of cats. Typically when cats are infected, they may have no signs or may develop a fever, diarrhea, or lymphadenopathy. Regardless, most recover and never look back. However, in some cats the immune system does not respond properly, and they develop FIP. FIP comes in a "wet" form or a "dry" form. The wet form is characterized by development of abdominal effusion or pleural effusion with a thick, sticky yellow fluid. The dry form is trickier to diagnose and is characterized by granulomas forming on various organs, even sometimes within the central nervous system and eyes. FIP is the number one cause of neurologic signs in young cats.  

Prior to 2016, FIP was uniformly fatal. Yep, 100% fatality rate, most within days to weeks of diagnosis. To make that even worse, it is a disease that tends to affect younger cats, most under the age of 5, some as young as a few months. 

Then in 2016, UC Davis published a study with an anti-viral drug GC376 showing a 30% survival rate. This drug was less effective against the neurologic and ophthalmic forms. But still, going from 0%, this was huge. Even better though, clinical trials of GC376 were followed by clinical trials of GS-441524 that showed a survival rate of 96% if those who died or were euthanized within the first two weeks were excluded. Even with including those cats, the survival rate was 81%. 

Feline enteric corona virus has been around forever (discovered in 1963, but who knows how long it has existed), but in 2019... yeah... so there was all of a sudden a huge interest in things that might treat corona viruses. GS-441524 is the pro-drug of remdesivir, one of the anti-virals used in treatment of Covid-19. The patent-holder of GS-441524, Gilead Sciences, has withheld animal rights to GS-441524. And remdesivir has a limited distribution according to the US government. So veterinarians cannot write prescriptions for remdesivir. 

But trials have proceeded in Australia and the UK showing similar stunning success rates for a disease that was once considered a death sentence. And... people are resourceful everywhere, and here in the US, so there are facebook groups such as FIP Warriors 5.0 that will help people with cats diagnosed with FIP find treatment. Veterinarians CANNOT purchase or touch these "black-market" drugs. But they can direct people where to connect with other people whose cats have been diagnosed with FIP. And they can help monitor treatment and monitor the resolution of bloodwork abnormalities. They can also share tidbits like make sure the cat is weighed frequently so that ANY medications can be dosed appropriately. 

And the patent for GC376 was acquired by Anivive, they have been developing the medication and should be bringing it to market within the next few years! Then there will be a totally above-board treatment for FIP in the US. 

Anyways, this is just super, super exciting, and I know a few people who read have feline friends as well, so I thought it might be potentially useful to share this. 

The bad... 

Pico has stage 2 chronic kidney disease. She's only 6.5 years old, so she's young for that diagnosis. And far too young for a diagnosis that has a median survival time of 1156 days. I'm coming to terms with it; it is a very treatable disease. But not a curable one. For whatever reason she's had multiple renal infarcts and even a central nervous system infarct once (weird, rapidly resolving neuro signs), but alllllll of her coagulation testing comes back normal. All I can do is treat the kidney disease and hope that she stops infarcting her kidneys. We may end up putting her on plavix, but we're waiting until we recheck her abdominal ultrasound in 6 months. Because there's not great evidence it would help, and true to cat form, medicating her is just a joy for everyone involved.

Supervising bathroom door replacement

She is clinically felling much better though. And after a short hunger strike, she has accepted her new kidney diet. My husband promises to be the voice of reason when it comes to making the hard end of life decision. But she's a pretty vocal and active cat, so I don't think I'll have too hard of a time deciding that one either; it is what I owe her for being such a wonderful companion.