Tutorial

The follow is a treatment tutorial for FIP in my own words developed from my own experience over two years. I strongly encourage you to also read the GS Treatment Summary by Dr. Niels Pedersen at UC Davis who led the development of this cure for FIP

If you just found out your cat has FIP you are probably overwhelmed with all the available information here and elsewhere. On this page, I try to make it as easy as possible and explain step by step what you need to do to treat your cat. In one sentence, you will need to give your cat a dose of GS (injection or pills) every day for 84 days. You will need bottles of GS (or pills), syringes, and needles. Below is the detailed step by step tutorial. However, I recommend you also read the treatment summaries written by Dr. Pedersen. If you cat has regular wet or dry FIP then read this article. If you cat has Neuro or Ocular forms of FIP, then also read this article. be sure to fully explore sockfip.org. It is best source for information about FIP.

Step 1: Prednisolone: I am not a vet but if you can’t find a quick source of GS to get started, talk to your vet about prescribing Presnisolone (Pred). Pred, in many cases, can slow down the FIP progression and improve his/her appetite. It will buy you some time while you get GS and other supplies on hand. Then taper off after about a week.

Step 2 Find GS near nearby:.. Time is of the essence when dealing with FIP. Wet FIP, in particular, can progress very quickly (fatal in days or weeks). Use the Facebook groups to network and try to find GS already in your city. In most cases one bottle of GS will hold you until you can order more GS.

Step 3 Order More GS: Again, use the Facebook groups to find a reputable source of good quality (Tier 1) GS. The bottle estimator on the calculator page can help estimate the number of bottles but it is still only an estimate. Due to the uncertainties with suppliers, shipping, and Customs, I suggest you get more than enough to finish. If you end up with some unused GS, then you can help someone new get started. Some sources will buy back extra at the end of treatment.

Step 4: Order (or obtain) the required medical supplies: syringes, needles, sharps container, and alcohol wipes (see links below). Depending on where you live, you may or may not be able to simply go out and buy hypodermic needles. You may be able to get what you need from your vet. I have found that Amazon sells syringes but not needles unless you have a business account and some sort of Healthcare license (California). I have bought from two websites. There are no doubt many more websites. You are going to want Luer Lock style syringes (NOT Luer Slip). Don’t ask me how I know this. Most people are using 1ml syringe for smaller cats or 3ml size for larger cats. Even with smaller cats, some are finding the 3ml size can get the dose in quicker but the measurement resolution won’t be as accurate for small doses. However, injecting fast may not be such a good idea as it tends to hurt the cats more (IHMO). A common practice is to use two needles: one to fill the syringe and one to do the actual injection. The needle gets dulled a little when you pierce the bottle so you want a fresh one when you go to inject. I used 20g by 1 inch to fill and 22g by 1 inch to inject. Needles and syringes are relatively inexpensive so feel free to experiment and see what works best for you and your cat. You will have to do this shot 84 times so anything that makes it easier will be a big plus. You definitely don’t want to use a needle that is too short, like 1/2″. Your initial thought is going to be “gee, I don’t want to stick a needle in my cat too deeply.” However, if the needle is too short, the GS will leak out and burn the skin. 1 inch length worked ok for me and many others.

Sources for Syringes and Needles

There are many places online that sell syringes and needles. Depending on where you live, you may be able to buy both on Amazon. In California, I can buy syringes on Amazon but not needles. I have been successful recently with these two places. Save Rite Medical and Shop Med Vet.

Here are some specific product links from Save Rite:

3ml Luer Lok Syringes

20G x1″ Needles

22G x 1″ Needles

Here are some links for Shop Med Vet. Note: this website does not do a great job showing if items are out of stock. I suggest calling and making sure what you order is in stock and if not, substitute a different brand.

3ml Luer Lok Syringes

20G x1″ Needles

22G x 1″ Needles

Other supplies: You should also get some alcohol wipes and a sharps container but these you can get on Amazon. The wipes are for wiping the top of the bottle but I also use them to wipe any drops of GS off the needle. This will help reduce stinging when you pierce and also help reduce skin burning from the acidic FIP Treatment .

Step 6. Watch some videos on how to give cats a subcutaneous shot. Here are two that I found useful. Also, perhaps you know a local vet tech or your own vet can show you how.

This first video is direct from Dr. Pedersen. Pay very close attention near the beginning where he shows the direction of the needle going into the tent. We see people posting all the time about having “through and throughs”. This is because they insert the needle across the tent rather than into the tent and the needle comes out the other side of the pinch.

The second is just one of several I found on YouTube and thought it was the best of the ones I watched. I am sure there are others so feel free to search.

This video shows the entire process of giving a GS shot: from filling the needle, to wrapping the cat to hold him still, to doing the actual injection.

Step 7 Calculate your dose: The injection dose rate depends on your cats FIP type and is based on weight. The standard dose is 5mg/kg of weight. If your cat has Ocular FIP (reddish brown eyes) then the dose rate is 8mg/kg of weight. If you cat has Neuro FIP (Neurological symptoms indicating virus was reached the brain) then the dose rate is 10mg/kg. My Calculator page can figure the dose for your cat’s weight and FIP type. Try it yourself and/or ask me to help.

Step 8 Daily shots: Continue with one shot a day for 84 days. Weigh your cat about once a week and adjust dose upward as he/she gains weight. Do not adjust downward if your cat loses apparent weight from wet FIP fluid re-absorption.

Step 9 Re-testing CBC and Chemistry: You will need to get CBC and Chemistry blood tests periodically during and after treatment. I recommend this schedule in most cases: after week 6 (day 42), at the start of week 12 (day 77), 6 weeks after Day 84, and finally, 12 weeks after day 84.

Step 10 Observation Period: After 84 days of treatment you will enter an 84 day observation period. Relapses can occur and they most often seem to occur within the first week of the observation period. According to the UC Davis protocol, cats that remain FIP symptom free for the full 84 day observation period are considered fully cured.

Step 11 Good luck. I know this is probably overwhelming but take it one step and one day at time. There is a good chance you can cure your cat of this horrible disease.

Questions, commonly encountered problems and solutions

Is the cure 100%? No, or course not but the odds are pretty good. The UC Davis Study started with 30 cats. 4 died early in the treatment period (84 days). It is presumed they were just too damaged from the FIP. Of the 26 that finished 84 injections, 4 had relapses and were retreated. One relapsed a second time and was retreated again. All of those cats were cured of FIP. Cure is defined as normal 12 weeks after the 84 day treatment period. The original UC Davis dose rate was 2 mg/kg. They treated their relapses at 4 mg/kg (twice as much). The current common practice is to treat with at least 5 mg/kg because they determined in China that gave the lowest relapse rate. Bottom line is that if you get started before your cat gets too critical, your odds are very good.

Are there side effects? Yes. The main one is that it appears that GS causes skin sores after a few weeks of treatment. In the Davis study, 16 of 26 cats developed some degree of skin sores. There is info below about how to deal with them. There is a good chance your cat will experience skin sores at some point in the treatment. Some of us have seen mild sneezing after starting treatment. It typically goes a way after a few weeks.

How should I store my GS? GS should always be kept covered from direct light. Storfe unpoened bottom in your refrigerator but leave your open “working bottle” at room temperature but covered.

How long does it take for the GS to work? This question is best answered by the visual timeline graphic

Treatment tips and tricks

Giving GS injections for 84 days is no picnic. You will likely run into issues including holding your cat still and the appearance of skin lesions. So here are some tips.

Two person job: Don’t try to do the injection by yourself. Plan to have one person hold the cat while a second person does the injection.

Holding your cat still: There are two main approaches: Chemical and physical restraint.

Chemical: People are using both Gabapentin and CBD. Gabapentin is more of a sure thing and if you have a cooperative Vet, they can prescribe it for you. Some people are having luck with CBD but for others it doesn’t seem to help much. If you are interested in CBD, there are a lot of products showing up. Our local pet stores are now carrying them. I web-order from Procana. They have various products including a Vet Formula in either a dropper or softgel form.

Physical: We used physical restraint aka “cat wrapping” or making a a Kitty Burrito. Click on that link to see what we have been using. This video shows you how we did our Kitty Burrito wrapping.

Skin Lesions: These are a common side effect from the GS. A majority of the cats in the UC Davis study got them so it is not because there is anything wrong with the GS. The general procedure for dealing with sores is shave the area, treat with antiseptic, and cover with a shirt or recovery suit. If a lesion does pop up you may want to get advice from your Vet. During Buster’s treatment we did have skin lesions appear. Here is what you need to know about dealing with GS-related sores: Shave, treat, cover. Shave to remove the fur from around the sore. The fur increases the chance of infection. We shaved with an Andis electric clipper and a 40 blade. Treat the area several times a day with an antiseptic. The paper from UC Davis mentions using diluted peroxide 2:1 with water: twice as much water as Peroxide. Other have used Vetericyn. Your vet may their own favorite.

Cover the sore with a shirt or recovery suit. We tried a lot of different shirts. Infant shirts from Walmart worked fairly well. We used a lot of the Chlo & Vivi shirts. We also used the Suitical Recovery suits

If you get a bad lesion, you may need to get additional treatment from your Vet including antibiotics. Move the injection site around as much as possible and look everyday for skin sores. Don’t let them get “bad” and the methods mentioned here could be enough.

Syringe deadspace: You will see people saying things like “hey I am not getting the right number of doses per bottle.” There are two causes for this: syringe deadspace (aka head-loss) and bottle residue. Syringe deadspace is the space in the syringe between the black rubber plunger gasket and the end of the syringe and also inside the needle. When you do your injection, the GS in the deadspace is not injected and will be wasted unless you do something about it. It can be on the order of 0.1ml. There are (at least) two methods for using the GS left in the deadspace: 1. using an air bubble to displace the deadspace volume or 2. carry over the deadspace GS to the next injection. See the video below showing how to use either of these two methods.

Bottle Residue: Despite your best efforts to draw 100% of the GS from each bottle, some GS will be left the in bottles. See this video below which shows how to remove the bottle tops and recover all the remaining GS. I found that on average, about 0.13ml was left in each bottle. You can remove this GS “bottle by bottle” or collect a number of “empties” and extract from a bunch at once.

B12 Mixing to reduce sting: I now call this process pH bumping. pH is a measure of acidity level in a solution. pH 7 is Neutral. Lower numbers are acidic and higher numbers are alkaline. GS injection must be acidic. The UC Davis mix had a pH of about 2.1. As of March 2020 the endorsed GS brands have pH’s ranging from 1.5 to about 2.0. The original Shire being used in 2019 had a very low pH of 1.0. People noticed that it seem to burn on injection more than other brands and that was explained by its very low pH. Some vets in group found they could reduce the sting by mixing B12 with the GS. It turns out that the B12 actually didn’t have anything to do with it. The common B12 mixture also contains Sodium Citrate which is an alkaline so when you mix the B12 with GS, the pH is increased (less acidic). This was important when pH 1.0 Shire was in wide use. It is not less important as the brands are now higher pH. However, we show here to do the B12 mixing.

You will need injection grade B12. Vet One brand is the one I ran my tests with. One place to get it is Valley Vet Supply. However, you will need an RX from your Vet to be able to order it. Or perhaps you can get some directly from your Vet. I found that 10-20% B12 gave a decent pH bump to pH 1.0 Shire. To figure your B12 amount, just divide your GS dose by 10 for 10% or 5 for 20%. Simple. So if your GS dose is 2 ml, your B12 amount to mix would be 0.2ml for 10% B12 or .4ml for 20% B12.

Here is my video showing the two-syringe method that I used to mix GS and B12..

For those of you that are more technically minded the ingredients of the B12 are as follows: EACH mL CONTAINS: Cyanocobalamin (Vitamin B-12) 1000mcg with sodium chloride 0.22% w/v, ammonium sulfate 0.1% w/v, citric acid 0.01% w/v, sodium citrate 0.008% w/v, and benzyl alcohol 1.0% v/v (preservative).