My work with FIP “terminal cases” (which is when they are diagnosed) started relatively recently, my first success being in early 2003. I’ll present the principles I use which I developed in my work with this illness, but first here’s a little background, to explain the situation to those not already “in the know” about what FIP is really about, as understanding the disease is key to repertorizing a matching remedy. I hope too that what I learned may be useful to others not only in handling FIP but with other comparable disease situations.
According to the Journal of Veterinary Medicine 2007 Nov-Dec issue, “There is no therapy with proven efficacy to treat cats with feline infectious peritonitis (FIP).” In this issue, page 1193, a German study presented is the latest (failed) attempt to repeat the only known claimed success, in Japan in late 2003, when four older cats in a group of 12 cats with FIP, were said to have survived the disease by use of prednisone and interferon.
The Japanese study was not formal, had no controls or protocols and follow-up was indirect; the four survivor cats were not seen but owners claimed they were still alive. The German study had 37 cats from various owners in a placebo controlled double-blind trial, but not one FIP-infected cat (treated or control) survived more than 2 months after diagnosis, whether using prednisone, interferon or a combination. Hence the disease is still considered universally fatal to cats. The standard procedure for a veterinarian diagnosing FIP, is to suppress the immune system with high dose steroid (prednisone) and to give antibiotics “to control secondary infection”, but even though this is a chronic disease, death can occur in just days, especially with the most common effusive form of FIP in kittens, called simply “wet FIP”.
It will help to briefly outline what this illness is about, as the name is a misnomer and understanding it is essential to appropriate homeopathy. Then I’ll discuss what experience has taught me with more than 400 cases since Jan 2003. Included are before and after photos to illustrate progress. It is my hope to encourage other homeopaths not to give up on cats with this illness even though, currently, successes are very hard-won.
Feline Infectious Peritonitis comes in three forms, none infectious, and none peritonitis, and none of this is well understood by the majority of vets either! The misnomer name harks from before 1998 when the true nature of the disease first became known. They got the “Feline” part right – and thankfully this horrid illness does not occur in any other species currently.
FIP is a unique disease in that it is triggered when a commonly present gut corona virus in cats (FeCoV for “feline corona virus”) is forced by external stresses in the presence of an imbalanced immune system, to undergo mutation to a much more dangerous virus (FIPV for “feline infectious peritonitis virus”), which in turn tricks the immune system into attacking and killing the cat, this way:
* the cat’s macrophages, which should normally engulf and overcome any virus invader, are instead used as incubators for virus replication – and
* the antibodies produced that should normally be used against the virus, are instead used to attack and destroy the cat.
That’s the disease in a nut shell, it is a chronic disease by its autoimmune type but can kill very much faster than most autoimmune diseases. It also presents with a huge variety of symptoms and thus deserves deeper understanding to help with remedy selection issues, and with nutrition issues – both equally important in FIP handling as well as FIP prevention.
So I’ll expand on that brief definition with suggestions on prevention or management of illness at each step. I am concentrating here on “wet FIP” as this is the trickiest to deal with, and the fastest killer of the three types.
VIRUS INVOLVEMENT IN FIP:
The commonly present gut virus which is involved in supplying material to mutate into the FIP virus (FIPV) in cats, is a feline enteric corona virus (FeCoV) found in almost all cats. FeCoV usually is not a health problem, though if present in high enough numbers in the gut, it can cause gastroenteritis symptoms and can become a potential stress factor for the cat. This virus can be transmitted from cat to cat, but since it is ubiquitous anyway, that is not an issue contrary to common allopathic belief.
However – if you add enough stress factors, you will see mutation of FeCoV to the FIP virus and that is an altogether different issue to deal with, though the FIP virus is not transmitted cat to cat – each cat has to mutate their own FIP virus to get the disease, and that requires many factors to be present. It’s relevant here as FIP is easy to prevent and it behooves the homeopath to make sure anyone presenting a cat with FIP at least knows how to prevent this devastating disease.
Food to control the FeCoV stress:
FeCoV spreads between cats and kittens via litter, grooming, contact, etc., so is quite ubiquitous. In groups of cats where it is symptomatic at all, it can be readily brought under control with diet. In addition to a 34% or more animal protein diet, cats need a colony of appropriate bifidus gut bacteria (not acidophilus) to make for them what we humans get from fruit and vegetables (which cats cannot digest and should not be fed). The bifidus in turn, need up to a teaspoon a day each of pure rice bran and plain cooked pumpkin as fuel, and no herbs or preservatives to kill the bacteria, and they will then ensure the high protein diet is used to make butyrate, acetate and propionate for a healthy gut that supports healthy organs. The bifidus will also out-compete any excess of FeCoV present. This good nutritional base controls FeCoV and improves general health but does not help the potential for FIP mutation triggered by other factors. FeCoV can be induced to mutate into the FIP virus even when present in very small quantities. It only takes one. Hence prevention of FIP requires a balanced immune system in addition to appropriate nutrition.
Prevention of Feline Infectious Peritonitis
External Stresses damage the immune system, a prerequisite to FIP. I’ve put prevention up front as it helps with understanding of the disease and hence with management of it, as one must remove maintaining causes.
This catch-all phrase “external stresses” applies to anything the cat’s body or mind perceives as stressful. This includes:
* chemical stresses such as drugs, vaccinations, insecticides, toxins in most commercial cat foods.
* emotional stresses such as weaning before 3 months old, change of home, constantly being chased by another cat, being frightened by air travel or vet procedures or un-gentle introduction to a houseful of bigger cats or dogs.
* nutritional stresses such as food less than 34% animal protein from good meat, fish, egg and liver, incomplete foods, foods containing feline toxins such as alfalfa, garlic, yucca, rosemary and other herbs.
* physical stresses such as being left out in severe weather, being caged, undergoing surgery, being expected to digest fruit or vegetables, getting a sudden change in diet, or having difficulty finding frequent protein meals. (Cats break down body protein between meals if they do not have several high protein meals a day)
* any other severe stress I may not have listed.
An analysis of over 400 cases of FIP that I have seen since early 2003, shows that the typical cat with FIP is a kitten who has had three or more listed stressors, often a lot more than three, within a short time, usually a month – or an older cat who has had long-term stressors (perhaps nutritional, perhaps being bullied) with a more recent trigger (perhaps a vaccination or inappropriate drugs such as antibiotics for a suspected viral illness.)
The typical shelter kitten for example, has been early weaned, changed home to the shelter, caged, given poor food, vaccinated, given drugs for the vaccine reactions (assumed to be upper respiratory infections), given anesthetic, spayed, “dewormed”, injected with a microchip, and re-homed again to a new owner who likely also changes the diet, takes the kitten to a vet, and gets more multivalent vaccinations and “a clean bill of health” or more antibiotics – often all within a few days, and invariably within less than a month. Kittens from a breeder are often no better off in terms of serious stresses during a short period.
If there are enough stresses, the FeCoV WILL mutate to FIP virus in the kitten or cat.
Without these (usually allopathy-induced) stresses, any number of FeCoV will NOT mutate to FIP and there will be no FIP.
So management of these stresses is a sure-fire way to prevent FIP.
FIP INCUBATION TIME
From these stresses to FIP, it is a 7 to 15 day period to the first phase symptoms of fever, weight loss and leucopenia (not currently recognized by vets as FIP) and invariably assumed to be an “upper respiratory virus” for which antibiotics are usually and inappropriately prescribed. After this, the cat seems to recover as the fever goes, the leucopenia goes and the weight usually returns. However it all reverts and comes back worse than before. It takes an average of 36 days (but can stretch out three months or so) from the stresses to diagnosed effusive form of FIP, called “wet FIP” …. and it takes considerably longer for “dry FIP” or “neurological FIP” to be diagnosed. Each form can affect cats at any age, but “wet FIP” usually affects young kittens – often in groups – due to the typical vaccination stresses, spaying and home changes they all endure.
Thus vets currently fail to spot early FIP at all and indeed have no test for it, and also currently fail to associate it with the prior stress triggers. (Dr Diane Addie is an allopathic vet with more than 16 yrs research in FIP and she is the exception who does recognize the stress triggers.) FIP is thus only diagnosed as of this writing, when the animal is essentially terminal. This is the stage at which the vet advises euthanasia, offers steroid and antibiotic suppression, and the client comes to a homeopath seeking a better prognosis.
Until it is diagnosed at the early fever stage, FIP cases will all be terminal and difficult for the homeopath to work with, and many cases will be lost due to the lack of time and the speed of the illness combined.
The symptoms are very variable due to the variation in susceptibility of different organs in different individuals, and I strongly suggest lab tests be used to determine what organs are affected, to assist in remedy selection. The trigger list above (which is by no means exhaustive, but gives an idea what to look for) is also extremely variable and potentially relevant in finding the simillimum.
IMBALANCED IMMUNE SYSTEM – A FIP PREREQUISITE
Cats who get FIP, per my experience, ALL have an imbalanced immune system, skewed in a specific direction, towards excess Th-2 helper cell expression and away from Th-1 helper cell expression. They should be in balance. Those who understand this can skip to the next paragraph. I’ll offer a brief explanation, with minimum terminology here, including relevance to FIP disease management:
The immune system has a complex interacting system of chemicals called “cytokines” which determine what kind of immune defenses to produce if there is a problem to be handled. Th-1 cytokines include things like interleukins and tumor necrosis factors, primarily used in chronic disease and in engulfing invaders where they enter and the Th-1 “base camp” for production is the thymus. They make sure for example, that enough defensive cells via cytokine “Tumor Necrosis Factor alpha” are produced to overcome cancer cells, or that via cytokine “interleukin-2” enough macrophages are made to engulf invading viruses (think pac-man activity). This is the aspect of the immune system – the cellular defense and chronic disease defense system – the “Th-1” side of things – that needs to be in good health to overcome the FIP virus – or to prevent it from being a possible disease. Sadly vets usually give prednisone which skews the system even more away from Th-1 necessary activity.
If there are too few Th-1 cytokines to do the job they need to do, called a “Th-2-skewed” immune system, then cytokines like interferon with go-between capabilities, “tell” the immune system that the Th-1 first defense system is overwhelmed (when in fact it is only inactive due to damage), and the Th-2 system will go into overdrive for a major war to try to compensate for the huge battle it expects. But since there is not an overwhelming number of invaders or viruses in a skewed system – it’s just too damaged to make the Th-1 cytokines or macrophages to deal with invaders – the immune system misreads the problem and will end up making too many antibodies. It does this via Th-2 cytokine messages to the bone marrow where antibodies are made. FIP and other chronic diseases that involve too many antibodies or that involve auto-antibodies (antibodies against self as in FIP, also HIV and the feline version FIV) all have this feature of a Th-2-skewed immune system. Allergies and cancer for example, can also occur only in a Th-2 skewed system.
HOW AN IMMUNE SYSTEM BECOMES TH-2 SKEWED
Don’t skip this part – it applies to anyone who does not want a chronic disease!
If we can prevent Th-2 skewed immune systems, we have done the major aspect and most important part of preventing all Th-2 skewed diseases, FIP being one of them. In addition, if we can restore balance to a skewed system, which I believe the successful homeopathic simillimum will achieve, we go a long way towards restoring overall health.
So what is it that skews the system and can we avoid it to prevent chronic disease including FIP?
The first answer to this is that anything that damages the Thymus gland, causes Th-2 skewing as it reduces this major organ responsible for Th-1 cytokine management and production. The spleen is also involved but the thymus is the major aspect and is routinely severely damaged by modern medicine. Animal research shows for example that a single injection of prednisone can remove 90% of thymus function, and that vaccination of a pregnant animal damages not only her thymus but that of all her unborn offspring in the womb.
Research shows that all vaccines damage the thymus. In cats, so many vaccines are used, and they are started well before immune system maturity at three months, that there is often no thymus left to detect. A vet who has done multiple feline necropsies once told me “There is no thymus to speak of in adult cats, it atrophies after kittenhood.” No it does not atrophy, that assumption is due to the massive vaccination damage that is so universal in cats.
Unvaccinated healthy cats have a normal thymus and good chronic disease resistance. Vaccinated cats have little or no chronic disease resistance, and every “annual vaccine” reduces the resistance further.
In my opinion and experience there is no such thing as a needed vaccine, and without them we had no FIP – it’s a new feline disease. Homeoprophylaxis is far superior in maintaining and building health and resistance to both acute and chronic illnesses. As Hahnemann explains in the Organon, a remedy given to healthy individuals, increases their robustness and health. In the case of FIP, the remedy I recommend most highly for FIP prophylaxis is FIP/FIV/FeLV 30C which is a remedy made from organisms for all three autoimmune viral diseases in cats. (FIV is the feline version of HIV, and FeLV is Feline Leukaemia.) This remedy from a combination starter substance, is a single remedy with wider “similar symptom activity” than could be obtained using a single strain of a single virus as the starter substance for remedy making. In my view, this wider symptom coverage is one reason for the effectiveness to date, of this remedy in preventing FIP and the other two illnesses). To date I have very rarely been approached to address FIP cases at the very early stages, and had no way to prove it was FIP, except that the precursors were all there and the FIP/FIV/FeLV 30C remedy restored health in days. With an advanced FIP case, there is no point using this remedy except as future prophylaxis. It needs a simillimum, supplements, nutrition and a lot of nursing, to rebuild health.
THREEE FORMS OF FIP
Each type of FIP has different symptoms and will point you to very different remedies. There is no genus epidemicus for FIP. This is very important. Even the FIP in different regions may be a different virus clade with different presenting symptoms, different virulence or a different order of attack of organs. Then too, each constitutional type of cat, will have different strengths and organ susceptibilities and the FIP illness takes advantage of such susceptibilities.
I find that if one can determine the life-long constitutional type of the cat – in addition to the simillimum main remedy for the total disease condition seen – this constitutional-type remedy can be given to the cat as an additional “crutch” to support the cat during this illness. The intention of this is to bolster its constitutionally susceptible organs, and to give it a little extra edge in resisting the FIP damage, while the simillimum works to restore health. It’s like a crutch for a broken leg, it may heal nothing directly, but it prevents some damage, and emotionally strengthens the will of the cat, so as to assist the healing process directed by a carefully matched simillimum remedy.
HOMEOPATHY FOR EACH TYPE OF FIP
“Effusive FIP” also called “wet FIP”:
This is the FIP version most likely to be seen in kittens, who are the most frequent victims of this illness. The homeopath has no time to lose as the kitten can die within days of diagnosis despite the fact this is really a chronic disease. While cases vary widely, a typical kitten presents with a drooping huge fluid-filled abdomen, a concave (drooping) back, dragging tail, unkempt “staring” coat, backbone sticking up and with evident muscle wasting despite the “fat” abdomen, either losing muscle despite a ravenous appetite, or soon after that, with zero appetite, and is really near starvation. There is often recurrent or persistent very high fever. Clinically, tests will show clear, sticky, yellow, high-globulin-content effusive fluid in the abdomen and/or thorax (where it restricts lungs and breathing), and very high blood globulin and low albumin, and may give you a picture of what organs have been damaged enough already to be near or at failure.
Many homeopaths have written that they have tried Apis in effusive FIP because of the abdominal swelling and high fever, but it has not helped because the source of the fluid is leaking blood vessels after auto-antibody attack, and so the real issue is “loss of animal fluids” and starvation in presence of recurrent high fever, as opposed to “hot inflammatory swelling” as would suit Apis. It is very important to understand the nature of the illness and know the specifics of the case to select the best remedy. Remedies I have found effective vary widely – for example Cinchona officinalis, Lycopodium clavatum, Baryta carb and many others – and I cannot stress enough the importance of individual repertorizing for each case. Do it well and carefully as the disease is unforgiving time-wise, and you are likely to get one quick shot at it. Use all the information you can gather so you do not end up feeling like you have a distant dartboard and one dart with which to hit the bullseye.
In older cats an even wider range of remedies has been needed than in kittens with effusive FIP, and I do not find that surprising, considering the triggers in older cats are less predictable, as are organ health issues, hence there is less commonality than in kittens who are mostly (but not always) ill due to a common set of triggers as discussed above.
SUPPRESSED SECOND DISEASE
Effusive FIP also often follows another acute disease and takes over and suppresses the acute disease. Look out for this as you can lose a case that is coming right if you are not ready to handle the underlying disease as soon as it emerges in the weakened cat once you overcome the FIP. This is something the homeopath needs to be acutely aware of – and sometimes taking a good history will be an indicator of this. In this situation, FIP presents as the only illness (as indeed Hahnemann also described in the Organon when one dissimilar illness is stronger than another), and the homeopath may work hard to build back health against FIP, only to find that within mere hours of seeing positive results, the suppressed disease emerges at its most virulent. The homeopath can easily lose a case despite beating FIP, if they are not ready for this event. (There is no time to order remedies after this happens; make sure they are handy).
For example, a case I had of a tiny kitten called Annie, presented as effusive FIP. The constitutional type of the kitten was Sulphur and her simillimum for the FIP picture was Lycopodium. As these two remedies follow well, they were alternated in her case, with Sulph 200C once a day and more frequent use of Lycopodium 30C then Lycopodium 200C in accordance with symptoms, as needed. Her FIP symptoms were typical for a shelter kitten as described above, and all resolved over a few weeks. The day she started playing games and acting normal, was one of rejoicing till that night she had a hacking cough that racked and rattled her little body violently, and her owners feared she would not survive the night, she was so bad. She had late-stage Bordetella bronchiseptica, (abbrev BB) which is also usually fatal in kittens under 6 months old. The sudden violent change in symptoms was indeed a return of a suppressed weaker disease of BB. She’d had a hacking cough – looking like an unsuccessful attempt to throw up a hairball, and severe lethargy, before she got FIP. Bordetella bronchiseptica 200C was used for the new illness, and it resolved in a week. Since then Annie has become and remained a strong, healthy cat.
DIAGNOSIS OF FIP
The homeopath often needs to spot FIP before a formal diagnosis is made by a vet. It pays to be proactive when the symptoms fit, and to initiate homeopathy as soon as possible, as well as high protein assist feeding. The effusive form includes the feature of fluid collecting in the abdominal and/or thoracic cavity, often misdiagnosed and inappropriately treated as worms or overweight till the cat’s backbone is standing proud and the cat is near death.
The dry form has no such accumulation, but has the general symptoms of muscle wasting and internal organ deterioration, and often uveitis is present in one or both eyes.
The neurological form involves seizures, especially starting with eye seizures (pendulum movement of pupils), a common symptom before diagnosis is made.
The divisions for FIP types are relatively arbitrary. Which form a cat has, depends on the cat’s susceptibility (as indicated by several factors) – and is a matter of what parts of the body are destroyed first, and which parts of the immune system are damaged and how much and in what order. All parts of the cat are attacked in the course of the disease. Also any form can convert to any other form during the course of this illness. This is something else to be ready for – as there will be very little time to respond when it happens, and again availability of a newly matched remedy can be a problem for the client – and for the homeopath who needs to drop everything and repertorize…. timing can be everything in FIP.
So one is basically chasing a moving target of changing symptoms to use in choosing the best current remedy, and the rate of deterioration can be so fast that it is necessary to be very alert and on top of each case and even to try to pre-empt changes if possible. By this I mean, one gets a feeling for what damage is going to happen in a particular cat, and it is beneficial to include that as a rubric even BEFORE the symptom shows up. This can save an otherwise impossibly late stage case, and is worth the risk that the symptom might not develop. The risk in omitting the potential danger is higher than the risk of including a symptom that is not there yet.
In FIP the pre-empting of a symptom is often the cause for rejoicing later when the case resolves. It helps to educate the client in what you are doing and why, and in close observation so they know what to look for. Also use laboratory tests so as to be able to predict which organs are weakest, and in what order they are most likely to be attacked. It may be liver, kidney, pancreas, blood vessels, bone marrow, nerves, muscles, etc, and the remedy selection must coincide. It helps to pre-empt symptoms by using lab results in FIP. For example if you see the lab report shows raised liver enzymes, you know there is liver damage and you need to use a rubric for liver inflammation even though there may be no inappetance, constipation or other liver-related symptoms to see. This is an essential strategy in FIP, as the disease can change much faster than the homeopath can respond if one waits for symptoms.
FIP IS A STARVATION DISEASE
In all cases there is muscle wasting and starvation as an obvious symptom as the body is attacked by its own immune system antibodies. This makes nutrition and appropriate supplements, also key to success in this illness. Muscle wasting needs a high protein diet from animal protein – from real muscle-meat – of prey-size. Prey-size matters as the amino acid ratios of the prey-size protein are closer to those of the cat, and thus there are less digestive left-overs to stress the kidneys. The liver is also damaged in all FIP cases sooner or later, and it helps to feed liver, one way being to use the commercial Hills a/d mixed 50/50 with hot water for palatability and for dehydration prevention. This slurry is also a suitable base for other supplements such as glutamine to slow muscle wasting, and Moducare to help balance Th-1 cytokines, and antioxidant vitamins. It can be assist-fed in small frequent meals. Look for anemia as it is common in FIP, include in repertorizing and Pet-Tinic is the best anemia supplement I know.