Dr. Julie Levy returns to share an update on the black market FIP cure from one of the most popular episodes of 2022. In this episode of the Cone of Shame Podcast, Dr. Andy Roark and Dr. Julie Levy discuss recent updates on drug approvals for remdesivir as a treatment for FIP. They explore how clients can save the lives of their FIP-diagnosed cats, what veterinarians can do to monitor success, and which resources are available to help in the battle against FIP. Tune in for essential insights and practical advice on managing this challenging condition.
You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!
LINKS
FIP Warriors: https://fipwarriors.com/
Clinicians Brief Article: https://www.cliniciansbrief.com/article/feline-infectious-peritonitis-treatment-outcomes
Uncharted’s Conflict Management at HiVE: https://unchartedvet.com/conflict-management-training-navc-hive/
Black Market FIP Cure Podcast Original: https://drandyroark.com/cure-for-fip/
Dr. Andy Roark Charming the Angry Client Team Training Course: https://drandyroark.com/charming-the-angry-client/
Dr. Andy Roark Swag: drandyroark.com/shop
All Links: linktr.ee/DrAndyRoark
ABOUT OUR GUEST
Dr. Julie Levy is the Fran Marino Distinguished Professor of Shelter Medicine Education at the University of Florida, where she focuses on the health and welfare of animals in shelters, feline infectious diseases, and humane alternatives for cat population control. She founded Operation Catnip, a nonprofit university-based community cat trap-neuter-return program that has spayed, neutered, and vaccinated more than 80,000 cats in Gainesville since 1998. In 2008, she joined Dr. Cynda Crawford to found Maddie’s Shelter Medicine Program at the College of Veterinary Medicine, an educational and discovery initiative with a global impact on the care of homeless animals. In 2014, she joined Dr. Kate Hurley to launch the Million Cat Challenge, a shelter-based campaign that saved more than 4.5 million cats in shelters across North America. In 2022, she helped launch Maddie’s Million Pet Challenge to create transformative “communities of practice” that deliver access to care through humane, community-centric programming—inside and outside of the shelter—to achieve the right outcome for every pet., Dr. Andy Roark is a practicing veterinarian, international speaker, author, and media personality. He is the founder of the Uncharted Veterinary Conference and DrAndyRoark.com. He has been an award-winning columnist for DVM360 and his popular Facebook page, website, and YouTube show reach millions of people every month.
EPISODE TRANSCRIPT
Dr. Andy Roark: Welcome, everybody, to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am back with one of my veterinary idols, dr. Julie Levy. She means the world to me. I just, she’s so great for cats. She is so great for our profession. I just I, I’m always so happy when I get to talk to her.
She was on about a year, year and a half ago, and she dropped the most popular Cone of Shame episode we’ve ever had. I mean, it was tens of thousands of plays. And it was all about a black market cure for FIP. And it’s been at least a year, year and a half since since we did that. And I want to get her back on and sort of talk about where we are today.
This is a great refresher on treatment of FIP. It’s also an interesting conversation about sort of where we are with access to the drugs and also what veterinarians are able to do and not do. And it turns out there’s a lot of things we’re really not all, we’re really not able to do but how do we support pet owners to get their cats taken care of and save lives?
That’s what we get into a really fun episode guys. Let’s get into this.
Kelsey Beth Carpenter: (singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark: Welcome to the podcast, Dr. Julie Levy. Thank you for being here.
Dr. Julie Levy: Thank you, Andy. It’s so good to see you again.
Dr. Andy Roark: You, as well. So, you, it’s an absolute joy to have you on here for a couple of reasons. The first is you were the guest on the most popular podcast I’ve ever been a part of. We did a Black Market Cure for FIP. It’s been about a year, a year and a half, and it has outperformed anything else that I’ve ever done,
that I’ve ever made. It has been wildly popular. And so I’m, I’m really glad to have you back to talk a bit more about that. But, but on a personal note, you’re someone who I’ve, I’ve admired since my first days in veterinary school. For those who don’t know you, you are, I have to catch my breath the Fran Marino Distinguished Professor Shelter Medicine Education at the University of Florida.
You helped you, you started the shelter medicine program at University of Florida. You are the founder of Operation Catnip at the University of which I just, I cannot overstate how important that was to me. I graduated from veterinary school with so much more confidence in surgery than so many other veterinary school graduates because I got the opportunity to go on the weekends and and do spays and neuters and even just vaccinations.
That the practicing and the doing it. And so it’s a wonderful service. You guys have, I think spayed and neutered over 80,000 cats…
Dr. Julie Levy: That’s right.
Dr. Andy Roark: In and around Gainesville. It’s incredible. And, and it was so much hands on education and training for me. It just, it meant so much for my confidence and just, it was. It was something I always just really appreciated.
I just wanted to say that to you. How, what an impact it had for me personally. So thank, thank you for that.
Dr. Julie Levy: Thank you for saying that, Andy. And, and they still to this day are running Operation Catnip, spaying and neutering now about 9, 000 cats a year. And most of those are done by our veterinary students. So the UF students really have an opportunity for outstanding surgical experience.
Dr. Andy Roark: It was, it was a huge deal for me personally. And so I just, I love that you guys are still doing that. I wanted to, to have you back on just because of the reasons I said at the beginning. You came back into my orbit when I was talking to a veterinary student who was like, yeah, there’s this cure for FIP and you’re supposed to send pet owners to this Facebook group.
And that’s where I was like, that’s not right. And I talked to you and it totally was right. I was like, oh my goodness. And so we’ve gotten, I’ve gotten so many questions about this sort of episode and things like that. So I wanted to sort of circle back around. Let’s, let’s touch again on so treatment for FIP and kind of where we are and then I want to get into the legality of this and then finally into the role of the veterinary professional in helping make this care possible.
So if you don’t mind, give me, give me a high level overview of where are we with treatment of feline infectious peritonitis.
Dr. Julie Levy: Well, first off, who of us ever thought we could say cure and FIP in the same sentence? And I’m as shocked as anybody, and I’m always very skeptical of miracle cures that come along. We see them all the time. They never pan out. This one really did. Professor of mine at UC Davis Dr. Niels Peterson discovered antiviral drugs that cure FIP in most cats that are treated.
And it turns out that one of those drugs is Revdesivir, which later became the primary drug used for COVID, and then its related compound, which is known by an abbreviation called GS. Now, those drugs are bound up they’re not approved by FDA. In this country, well, Remdesivir now is approved for use in people, which means it’s also approved for use in animals.
And then GS, which is more popular and more affordable, is not approved in the U. S. and it is bound up by the intellectual property laws by patents. So when word got out that this, these compounds, especially GS, were available and were, effective in cats, cat owners themselves were the ones that really went out and found out where they could get it out of desperation, because like all of us, we’ve diagnosed FIP and very sadly told people that basically they could watch their kitten die.
And so these folks found out that they could go to Chinese. Chemical companies and they could order chemical grade G.S. and that was shipped illegally to the U. S. And little batches of unlabeled vials. And people started injecting it into their cats and, and saving their cats.
So these cat owners found out that they’re, they could effectively treat cats and they started a group called FIP Warriors. And this is a Facebook group that anybody can go on and give information about their cat. They would ask for the medical records and the lab work.
And then they would give advice on how to treat the cat and where to get the drug. And this was all very kind of confusing and undercover for a while when it first came out. And then now there’s multiple papers that are published in the scientific literature about how to treat cats and how people are getting these drugs still not approved in the U. S. But still very effective and tens of thousands of cats have been treated internationally with about an 80 percent survival rate, a parent cure for these, these kitties that have what was used to be a fatal disease. And so now it’s very well organized. They have a lot of information and yet it’s an unapproved drug.
So veterinarians want to know, kind of, where they can play. In this, they don’t want to certainly should not order the drug themselves, prescribe the drug, or dispense the drug. And so the role that we found that most veterinarians are kind of comfortable with is making a diagnosis, teaching owners how to give injections and give pills.
And running lab work and giving supportive care, but then referring them to the Facebook page, which is the surprising thing that we never thought we would do as veterinarians is saying, go to FIP warriors, and they will give you an action plan for your cat. And then they will tell that person where they can meet someone to get some drug.
And this is the really shady part. Usually it’s like the other parts are shady at all, but this part’s like the most shady part, which is they usually say, you know, let’s meet at a closed gas station and somebody will meet you and give you unmarked files and you will get the money and you should go and check that in your cat.
And everybody I talk to and refer to the Facebook warriors page says, that’s exactly what happened. We met in an alley at night and they gave me drugs. And now my cat is alive.
Dr. Andy Roark: They gave me some Chinese pharmaceuticals and I paid in cash. And that’s what happens. And I just, I can’t believe we’re a part of this interaction in any way, shape or form. It’s, it’s amazing to me. Have it doesn’t sound like there’s been really any sort of progress made in increasing access or availability since you and I talked a year, year and a half ago. Is that true?
Dr. Julie Levy: It’s on a practical basis. That’s true. Legally. Remdesivir became fully approved for use in people, which then allows veterinarians to use it off label in cats. However, it’s not been available through veterinary distributors. Some folks have been able to get it from human hospitals. So a veterinarian can call up their human hospital and see if they will share some Remdesivir.
for a veterinary patient. We do that for all kinds of other drugs that we need occasionally that aren’t stocked by, by veterinary pharmacies. So, that is something that veterinarians can do and that would be totally legal. It’s just been a challenge to get access to the drug. Also, it’s several times more expensive. So we’re talking Many thousands of dollars rather than a few thousand dollars to treat a cat.
Dr. Andy Roark: Talk, talk to me a little bit about, so it’s, it’s really been fascinating. So there was an article in Clinician’s Brief that came out and they were talking about remdesivir and they were, they were quoting doses of, you know, 10 per kg. And so, but it was, it’s all this really weird. The language around all of this is really strange, and so shout out to Clinician’s Brief for sort of covering this and talking about it, which I appreciate, but it’s all still kind of strange.
Can you talk to me a little bit about the number jumbles that are out there? So it seems to me, when we look at remdesivir, we start to talk about the GS. There’s GS441524, which seems to be the, the go to treatment. But then if you get in there and people start, I don’t know if they’re throwing out on slang, but there’s somebody’s like talking about GS441 is that different?
Is that the same? And then there’s GC376, which is another thing. And so can you help me at least make some sense of this so that I. I don’t feel, I guess either foolish when I talk about it or when a, when a pet owner comes back with a very logical question of I’m seeing these other things, I have some bearing of even what that sort of means. Can you help me get my feet under me here?
Dr. Julie Levy: Absolutely, it is confusing. So remdesivir is the licensed drug. There is a pro drug of remdesivir called GS 441 blah blah blah and that is actually more effective we think than remdesivir is for FIP. And so GS and GS441 and GS, the long 441, are all the same thing. It’s just abbreviated as GS. That’s the most common drug that people are getting, not licensed.
Now GC is different. That is a drug that Dr. Peterson at UCD also discovered works against FIP. And that one is being moved through the FDA approval process by a drug company. That is developing it, and so eventually, maybe within a year or two, that drug will be legally available to veterinarians in the U.S.
Dr. Andy Roark: Okay, so that, that does, that does help me.
Dr. Andy Roark: Hey guys, I just have to jump in with incredible news. I will be traveling with the Uncharted Veterinary Conference team. That includes Stephanie Goss and Maria Pirita we are going to Minneapolis for the NAVC HiVE conference that is there. This is on June 15th and 16th guys. We are doing a one day Uncharted conflict management training program.
That’s right and it is included with the cost of HiVE. All you have to do is register for the HiVE conference that’s $99 for two days, one day, you can spend it with us, bring your team, send multiple people from your practice, put them together. We’ll put them at round tables. We will have them working together, talking about conflict management.
We’re going to take them through a whole day. This is not a series of lectures. It’s not, they’re going to go to one and they’re going to do something else. Nope. Check the box register for the Uncharted event at HiVE. And you will spend the day with us. And I guess you’re never going to see an Uncharted event that is a day long.
That is $99. Again, like this is the best price you will ever see on conflict management. So anyway, if you are anywhere near Minneapolis, June 15th and 16th, Come to the HiVE event it’s $99 and you get a day with Uncharted. If you register for it and the other day, you can use it HiVE and get their amazing CE for technicians and managers. Anyway I’ll put links in the show notes.
You should learn more. I’m serious. If you were within hours of HiVE, there was never going to be a chance for you to sign up multiple team members come together. And do conflict management training as a group. This is a phenomenal opportunity, please don’t miss it. If you’re able to make it, it’s going to be great.
Let’s get back into this episode. We’ve talked a little bit about, about what the veterinarian’s role is. It seems like it’s pretty darn hands off. There’s, there’s just not, there’s just not a lot to do here. We, you know, when I’m, when I’m checking blood work, things like that, Julie can you give me any guidance on kind of what I’m looking for here as opposed to just saying, here, take this blood work back to a Facebook like feels terrible.
Dr. Julie Levy: That feels weird.
Dr. Andy Roark: Got like, yeah, it feels bad. Get, can, can you give me at least some, some buoys, you know, in the passageway that I can kind of mark where I’m going.
Dr. Julie Levy: So, it’s really interesting, because this group is very data driven. So they’ve collected tens of thousands of sets of data, and they’ve followed the cats over time, and notice which ones have relapses or don’t respond. What kinds of FIP need higher doses of drug. So kind of from a baseline, there’s a regular FIP, wet FIP, it’s probably the best one.
So that’s going to start off at about 10 milligrams per kilogram. And then higher doses right from the start for cats that have FeLV or cats that have neurologic or ocular sites because those are a little harder to get drugs into those sites, the CNS and the eyes. So right from the start they get a higher dose.
They also will start right from the start on injectable because that’s going to be more effective and better bioavailability. Then often, they will switch to pills when cats are more stable and they’re recovering because that’s a little less stress on the cat to get the pills rather than the injections, which are pretty stingy.
Now, the blood work that you’re going to follow, there’s a few things that really do usually start out abnormal and then normalize if the cat is responding. The most important one is the albumin to globulin ratio. Most cats with FIP, but not all, will have a very low albumin to globulin ratio. And as they’re responding to treatment, you just see that go back to normal.
Also, they often have a high white blood cell count, high neutrophil count low lymphocyte count, and they’re often anemic as well. And all of those in the responding cats just like track towards normal and they don’t stop treatment until they are solidly normal. So they might recommend extending treatment if the lab values are still abnormal.
Dr. Andy Roark: What, what’s the general, I know this is going to vary with, with the type of FIP and, and the specific kitten, what are we talking about from a timeline here? I mean, I know a lot of the research that was done we’re looking at, you know, six months out and things like that. If I want to try to set some expectations or even just kind of understand what sort of a process the pet owner is getting into, what is it?
What is a reasonable sort of ballpark timeline?
Dr. Julie Levy: So the current therapy is 84 days of daily medication, followed by 84 days of observation. And there’s some blood work that’s been, that is done during the observation period so that you can tell if a cat is falling back and needs to be restarted on medication. What we’ve learned over time is that the vast majority of cats that survive a week are going to live.
And so, and, and even really four days, if they’re still alive within four days of treatment, they often, most of them are going to go on and live. So, if you are on the fence or a client is on the fence about, is it worth it? How will I know if my cat will respond? That very early response is very predictive of how the cats would do.
So I would recommend for most people, like, give it a shot, give it a week, and see how the cat responds. And usually it’s dramatic. Like, it kind of defies logic that these cats can go from death’s door sometimes, unable to stand, unable to eat, and within a couple days, they’re already markedly improved.
Dr. Andy Roark: That’s phenomenal. Thank you so much, Julie, for being here and for talking through this stuff with me. I, I always love it. You are such a wealth of information. I just really appreciate your time. If there are people who want to learn more, are there, are there resources out there that you really recommend, places that you like?
Dr. Julie Levy: I, I, you know, I hate to be the person that says, go to Facebook, but FIP Warriors is an incredible source of information for cat owners to go to. Now there’s also a FIP Warriors for Veterinarians group and I like that one because that is only veterinarians talking to each other and reviewing lab work and and helping each other kind of navigate the guardrails of where they can practice.
So I recommend that one. We also have on our shelter medicine website, we have a whole section on research that we’ve done and clinical trials that are going on and there’s some also some links to websites that are specifically focused on the veterinary aspect of treating this for veterinarians.
Dr. Andy Roark: That sounds great. I’ll put links to all that down in the show notes and get everybody set up. Julie, thank you so much for all you do for cats. Thank you so much for what you do for vet students like myself back in the day. You are just a joy. Guys, thanks for listening to everybody. Take care of yourselves, gang.
Dr. Julie Levy: Thanks, Andy.
And that’s it. That’s what I got guys I hope you enjoyed it. I hope you got something out of it. If you did you share with your friends I I really I want I want to save cat lives and we do that with education. So feel free to pass this episode on to other people and just make sure that everybody’s kind of on the same page.
This is a really weird situation in my opinion, where the veterinarian’s hands are really tied. It’s still, it’s always going to feel really strange to me sending people to a Facebook group to get help, but it’s, it’s a hard pill for me to swallow, but, but I think that that’s where we are right now.
And so anyway make sure you help me spread the word. All right, guys, take care of yourselves. I’ll talk to you later. Bye.
