FIP and FeLV: treatment against the odds

In the January episode of 'Chattering with International Cat Care,' host Yaiza Gomez-Mejias interviews Emma LaVigne about her award-winning research on the treatment of feline infectious peritonitis (FIP) with GS and the effects of co-infection with feline leukemia virus (FELV). Emma shares her personal journey and motivation for the study, as well as the methods and results showing equivalent survival rates. 

The episode also revisits a discussion with Tamsin Durston on the stages of motivational interviewing, emphasizing pre-contemplation, contemplation, preparation, action, and maintenance, and how veterinarians can support clients throughout these stages.

For further reading material please visit:

Human Behaviour Change for Life

View The Transcript Here

If you're interested in reading Emmas full abstract, please contact [e-mail] 

For ISFM members, full recordings of each episode of the podcast is available for you to listen to at portal.icatcare.org. To become an ISFM member, or find out more about our Cat Friendly schemes, visit icatcare.org


Host: 

Yaiza Gomez-Mejias, LdaVet MANZCVS (Medicine of Cats) CertAP (SAM-F) Acr AVEPA, Veterinary Community Co-ordinator.

Speakers:

Tamsin Durston, RVN, CAB, MSc Psych, Veterinary Nurse, Clinical Animal Behaviourist and Human Behaviour Change Practitioner

Emma LaVigne, DVM, Small Animal Internal Medicine Resident at University of Florida & 2024 winner of Best Feline Abstract at the ISCAID Symposium

Creators and Guests

Host

Yaiza Gomez-Mejias

Veterinary Community Co-ordinator @ International Cat Care

What is Chattering with iCatCare?

Welcome to Chattering With iCatCare, the official monthly podcast of International Cat Care, hosted by Yaiza Gomez-Mejias (Veterinary Community Co-ordinator). Each month, we chatter about cats and cat-friendly practices with industry experts and contributors to The Journal of Feline Medicine and Surgery. Each episode contains highlights from our longer discussions and interviews, which are accessible to iCatCare members at portal.icatcare.org. If you would like access to our full episodes, would like to become an iCatCare Veterinary Society Member, or find out more about our Cat-Friendly schemes, visit icatcare.org.

Yaiza Gomez-Mejias: Hello and
welcome to the January episode

of Chattering with iCatCare.

I'm Yaiza Gomez Mejias, Veterinary
Community Coordinator at International

iCatCare and host of this month's podcast.

Today, I will continue the conversation
I started in December with Tamsin

Durston about motivational interviewing.

But first, I will interview Emma LaVigne
about her award winning abstract on the

response to feline infectious peritonitis
treatment with GS and the effect of co

infectiozn with feline leukaemia virus.

So thank you very much for
joining us today, Emma.

Emma LaVigne: Great.

Yeah.

Thanks so much for having me.

Yaiza Gomez-Mejias: You've just received
an award from the ISCAID Conference this

year for your abstract on the response
to FIP treatment with GS and the effect

of co infection with feline leukaemia.

So, what motivated your
interest in this topic?

Emma LaVigne: So actually, I feel
like with a lot of people interested

in FIP, it comes from a personal
experience with the disease itself.

And so when I was in private practice,
my grandmother adopted a couple of

kittens from a newspaper article, and
one of them started coming down with

an illness that we suspected to be FIP.

And so I had not even heard of the
new treatment at this point in time.

This was probably back in like, 2020.

So it was a little bit newer.

And so we explored the option.

We got in touch with the online
Facebook FIP warriors group and

started the treatment for her.

And it was just, really amazing how
quickly she responded to the treatment.

So I feel like from then on out,
I was just so interested in the

disease and the new treatment.

It was just like an unprecedented
thing in veterinary medicine.

And then unfortunately her litter mate
also came down with FIP and he did not

make it unfortunately, but she did.

And she's still thriving and
acting like a happy normal cat.

And so I feel like that really
spurred my desire to do an

internal medicine residency.

So FIP has been a really strong
interest of mine for a while and

I knew coming into the residency,
that's what I wanted to research.

Yaiza Gomez-Mejias: That's brilliant.

Oh, well, happy for the cat that survived.

And what was the aim of
this study in particular?

Emma LaVigne: So we were looking
to compare response to treatment

and survival rate of cats with
and without feline leukaemia virus

that underwent treatment for FIP.

Yaiza Gomez-Mejias: And was there
any specific interest from any

shelters that you were working with
or where did the idea come from?

Emma LaVigne: The idea mostly came
from, we had a previous shelter study

that was done at Austin Pets Alive,
which is in Austin, Texas in the US.

And they have a large FELV cat
adoption program, and they also

treat a lot of cats for FIP.

So they recognised in a study that was
done partially by my research mentor,

Dr Levy, and they found out that FIP was
a major risk factor for cats with FELV.

It just due to potentially their
immunocompromised status or being

in a shelter setting and having
that higher risk of contracting FIP.

And so what we wanted to find out
was what happens if we treat these

FELV positive cats for FIP and do
they respond the same way and do

they live the same amount of time?

Was their immune system any different
than a normal cat's response to FIP?

So that's what sparked the study was
this previous one done that identified

FIP as the most common cause of death
in a lot of these FELV positive cats.

Yaiza Gomez-Mejias: Could you
go through the methods you used?

Emma LaVigne: Yeah, sure.

So our study population, we ended
up with 170 cats that were followed

up starting in September of 2020.

And we followed them through August
of 2023, where they were enrolled

during that period, and then followed
up through September of 2024.

And they were diagnosed with
FIP by a shelter veterinarian,

mostly based on compatible
clinical signs and lab findings.

We didn't have the ability to do
extensive, more advanced FIP testing

just due to the nature of the shelter
and the cost constraints there.

And then they were diagnosed with FELV or
not, based on the IDEXX antigen snap test.

These cats were then treated with
various doses of the GS441524.

based on their effusive status,
whether they had neuro or ocular signs.

And it was a little bit different.

So when the study started back
in 2020, we didn't have a lot

of information about GS dosing.

The doses were based a lot on the shelter
veterinarians interpretation at the time.

They actually dose the effusive cats
a little bit higher than the dry,

which now we know that maybe that's
the opposite, but the neuro ocular

cats also got higher doses of GS.

So then we followed these cats, they
received 84 days of treatment and then

84 days of observation and then they
had a physical exam, CDC chemistry,

about every four weeks during the
treatment period and then every six

weeks during the observation period,
approximately, it was all based off

of compliance with the caregivers, and
then we followed up with the caregivers

about every three months for a minimum
of a year and recorded their dates of

if they had any signs of recurrence
of FIP or deaths or euthanasias.

And then we did some statistical
analyses that compared the two groups

to see if there was a difference in
survival and we found that it was

actually an equivalent survival of 74
percent through the observation period.

And then once we reached that one
year follow up, the FELV positive

cats started to succumb to the
natural progression of the disease.

Yaiza Gomez-Mejias: And now we
will listen to the second part

of our conversation with Tamsin
about motivational interviewing.

It helped me a lot to listen to you
talking about these stages, it made

me realise that not all the owners
are in the same stage, depending

on what's going on with the cats
and what they expected to hear.

Could you repeat the four
names of the different stages?

Tamsin Durston: The first is
pre contemplation, where you're

not even considering it, and
there can be reasons for that.

That can be because you might
have tried before and it didn't

work, so you're like, ah.

You've shut down to even the
thought of making a change.

Or you're not consciously aware
of it, it has no value for you.

Actually, you're enjoying the
way you're living your life.

Why would you change?

You might say to me, you
should get to the gym.

And I might be like, why?

The next stage is contemplation, where
you might have heard something and

you are aware that your belief or your
attitude to something could be challenged.

Something has sparked a bit of curiosity.

This doesn't necessarily mean you're
going to start to change, but it just

means you, you're now aware, you're
aware that there's a different way.

You might think, Oh, and you might
not take it in at the vets, but you

might go home and think, might talk
to my friends, have you heard of this?

Or you go on online and you find
out all sorts of stuff, scary stuff.

In this contemplation stage you're aware
there's a possible new thing to discover.

Then you move into the preparation
stage where you're actually

preparing psychologically.

And it's not just about
psychological, it's about your

physical capability as well.

It's about your environment.

You're wanting to see a difference,
wanting to make a change.

And you're motivated now to actually
think, can I put measures in place?

Can I change something to make
the difference that I want?

You're making plans.

And this is where it's really important
in this stage that we help clients.

If they're saying, okay, tell
me more, or what could I do to

help my cat have a better life?

Then we can say, let's think about
all the obstacles and barriers

and, how can we overcome these?

Let's anticipate what might go wrong.

I'm a big fan of if then plans, if
this happens, then I will do this.

If we think about how we
will respond to all the

different ifs, then we're
ready if they do happen.

I, I always think it's better to have a
plan and not need it, then need a plan and

not have it, because planning takes time.

And when you're in this preparation
phase, making a plan, which is what

we do with the client in our consult
room, we're helping them make a plan.

We want to make a plan that's
realistic for them, but that's also

reinforcing so that they see the
benefit of it and keep doing it.

The next phase is the action phase
where they start making changes.

It's psychologically challenging
because they're now facing life

doing something differently.

I've never done this before with the cat.

I've never examined them every day.

I've never had to do this.

I've never checked their mouth,
the vet thinks I should do.

And it's difficult for them to, to
building this habit to their life.

So it's really clear we need to
consider their motivation here.

And we want in this stage where
people are starting to take action,

and this might be that they come
back to their second checkup and

we're saying, okay, how is it going?

Have you been able to give the medicine?

Have you been following the ISFM
how to tablet my cat advice?

How is it going?

I know this is difficult for you, but
it is brilliant to see you're trying.

You are making a difference by
even trying to give this medicine.

I know it's difficult to
give medicine to a cat.

That's why I get the nurse to come
and do it in the clinic, but it's

brilliant to see what you're doing,
but, you know, what else can we do?

What happens if your cat runs
away as soon as you see them?

How do you cope with that?

We, we can talk to our clients about
the way they talk to themselves, that

they can write down the pros and cons
to what they're doing and see they're

making a difference and get support.

And also tell people they're doing
it because there's a whole bit of

science about if we make ourselves
accountable, if I, as an animal

owner, I'm trying to give my cat
medicine, let's say three times a day.

If I say to someone that I trust,
Oh my goodness, I've got to do this.

My cat's on these new
medicine, these new pills.

And I have to do it three
times a day, but I'm doing it.

I'm committing to it.

We're more likely to do it
because we told someone.

That's really important.

The next stage is maintenance.

Yes, when a client has started doing this
behaviour, are they going to stick to it?

And actually this maintenance phase, it's
not considered maintenance until you've

been doing that behaviour consistently for
about six months, depending on the change.

For example, getting insulin
injections or hyperthyroidism meds

that are going to be lifelong.

That then has to be your new way of life.

And it will be six months in before you
can say, okay, I have changed my behaviour

and now I'm in this maintenance phase.

It can be relapses and recovery
periods between maintenance.

You can relapse, recover, go back into
maintenance, or you can go back to pre

contemplation where you're like, didn't
work, and actually something then triggers

you again to move into contemplation.

Maybe I'll give it another go.

Maybe things are different.

Maybe there's a new treatment
out now, I may be able to plan,

move into preparation, act on it.

Now I'll maintain it.

And then you go back through that cycle.

Yaiza Gomez-Mejias: The fact,
knowing that it's not a linear

process, so we can go back to a
previous stage, I find very helpful.

What you've just said about legitimating
the, the caregiver's narrative, sometimes

I think vets can play an important
role by supporting those good aspects

of the client's narrative, which we
don't necessarily entirely agree with.

But as long as it favours a good
outcome in the pet, then I think

it's very helpful to support.

Thank you for listening.

If you're a member, don't forget you can
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all the other member benefits including
congress recordings, monthly webinars,

and clinical club, the discussion forum,
and much more at portal.icatcare.org.

If you're looking for more free CPD
from International Cat Care, We'll

have Nikki Gaut's webinar on cat
friendly home visits as part of the

Cat Friendly Clinic webinar program on
the 25th of February at 7 pm UK time.

We'll be back again next month with more
from the world of feline medicine and the

Journal of Feline Medicine and Surgery.