HELP FOR FIP® TREATMENT SUPPORT HANDBOOK

HELP FOR FIP® FIP TREATMENT SUPPORT HANDBOOK FIP CURE AWARENESS · SUPPORT · EDUCATION

by Debra Roberts

Table of Contents 3

About Help for FIP® and the Advisory Team

4

What is GS441524? Why Isn't It Available From My Vet?

5

FIP Diagnostic Checklist

9

Veterinary Needs List

10

Using the Help for FIP® Treatment Tracking Web App

11

Is FIP Contagious?

12

FIP Treatment Protocol

13

FIP Treatment Process

14

FIP Treatment Timeline

15

Normal and Abnormal Expectations

17

Injection Tutorial and Supplies

20

GS-441524 Options and Oral Formulations

23

Supportive Care

25

Interactions, Other Treatments, and Feeding for FIP

28

Understanding Your Cat’s Bloodwork

32

Drug-Resistance, Relapses, and Entering Observation

35 Dr. Pedersen’s Summary 41 Other Frequently Asked Questions 44

Help for FIP® Articles, Tools, Copyright, and References

The Help for FIP® Mission During the treatment journey, FIP cat owners and their vets can navigate the fear and uncertainty of FIP and attain a successful treatment and cure for their cats. This book is a guide that compiles and summarizes everything you need to know and understand about FIP research and treatment options.

You, the owner, treat your cat and make every decision with the Help for FIP® experienced team who help you find safe, tested treatment from a current or past treating FIP cat owner and assist you in avoiding the many internet scams and untested products. FIP is timesensitive, and delays affect the cat's response time to the treatment. We work together quickly to ensure your cat has the best chance of survival. Our highly efficient team has a free treatment-tracking web application at Help for FIP® (https://helpforfip.com). We also have a private Facebook community where you can share your success and ask questions of other FIP cat owners and experienced mentors.

Please collaborate with your veterinarian for supportive care to ensure the most successful treatment, and never take on the treatment process alone. We can also help you find a supportive vet for FIP treatment in your area. Euthanization should be an absolute last resort. Treatment with GS-441524 can work in even the most critical conditions.

We'd like to emphasize that owners work with their veterinarian whenever possible and select one knowledgeable about FIP and the realities of the current situation with GS441524 availability and home treatment. Veterinarians' most important role is to help ensure that the diagnosis of FIP is accurate and to identify any other complicating health problems.

Advisors are online Monday through Saturday EST, 9 am to 6 pm, to answer your questions and after hours for new cases. We appreciate your patience as we respond to many messages daily. Our regular jobs and families keep us busy, but your cat is our priority. We know firsthand what it means to save the lives of our precious cats and the frustration of waiting or finding the proper help or relying on outdated and inaccurate information on the internet.

For fast help with a FIP-diagnosed cat, please visit https://www.helpforfip.com.

You can also message us using WhatsApp at 614-622-2340 or helpforfip@gmail.com.

Your data and privacy is always protected and secure.

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What is GS441524 & Why Isn't It Available From My Vet? GS-441524 is a nucleoside analogue antiviral drug that Gilead Sciences developed. It is the primary plasma metabolite of the antiviral prodrug Remdesivir, developed for human use.

Remdesivir and GS-441524 were both effective in vitro against feline coronavirus strains that cause FIP. Remdesivir was never tested in cats, although it's used in other countries.

GS-441524 is an effective treatment for FIP and is widely used despite no official FDA approval due to Gilead's refusal to license this drug for veterinary use.

The lack of an available, prescribable cure is NOT the fault of the FDA, as many people report. Therefore, it's unfair to scrutinize parents who seek out the off-market FIP treatment —often at their veterinarian's recommendation even though they can't legally provide it. The ethical nature of their oath drives many veterinarians to advise their clients to find it. Cat owners desperately want to save their beloved family pet and have no choice but to find it themselves.

Gilead Sciences holds the patent, aka "the key" to curing tens of thousands of cats globally.

However, they chose not to proceed with FDA approval to make it legally available to prescribing veterinarians after the successful UC Davis 2017 drug trial. Here's their reasoning: Gilead Sciences is known for its antiviral drugs for treating HIV/AIDS, hepatitis B and C, influenza, and COVID-19. Gilead refuses to license the drug for animal use, fearing its similarity to Remdesivir (originally developed to treat Ebola) would interfere with the FDA approval process.

Chinese companies and others worldwide started manufacturing the GS compound to sell via various avenues. **A word of caution: Not all GS are created equal. The Help For FIP® advisors can help guide owners to the safest GS available. Be cautious of the first attractive websites in a Google search or the unsolicited texts or emails from persuasive scammers. A link to multiple brands' laboratory testing results is available upon request. These results may include purity, concentration, consistency, and pH (acidity) testing.

While the media zeroes in on the cost of this life-saving treatment, they neglect to report on this affordability and safety. Compared to 2019, the price of GS to the treating cat owner has drastically reduced, making it affordable to most owners. Never assume that what you're reading on the internet is the current data. In other words, please don't give up on treating your cat because you think the cost is what you see.

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FIP Diagnostic Checklist

Page 5

Diagnostic Checklist Continued

Page 6

Diagnostic Checklist Continued

Page 7

Diagnostic Checklist Continued

Disclaimer and Credits The information provided in this checklist was obtained from Dr. Niels Pedersen, Dr. Glenn Olah, and Dr. Patricia Shea. It was compiled and written by Debra Roberts, a GS441524 UC Davis trial participant with her cat Luna, in April 2017 and following her cure in 2018.

The above checklist is accurate and true to the best of my knowledge. It is not intended to substitute for diagnosis, prognosis, treatment, prescription, or formal and individualized advice from a veterinary professional. Cats exhibiting signs and symptoms of distress should be seen by a veterinarian immediately.

This document is the property of Debra Roberts and may not be altered, changed, or used in any publications without consent. This checklist is a tool to aid owners and veterinarians in the proper diagnosis of Feline Infectious Peritonitis (FIP) and to educate cat owners on testing and terminology. I certify that I am not a veterinary professional.

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Veterinary Needs List Due to the unavailability of an FDA-approved treatment, veterinarians can't legally treat your cat with GS441524. Many need to be made aware of safe, off-market treatments for FIP. Your vet can direct you to Help For FIP® and provide all supportive care. That care includes diagnostics, supplemental medications, fluid support, treatment for secondary infections, and emergent/stabilizing care such as blood transfusions and feeding tubes.

Treatment advisors are NOT "ordering" these items but relaying the recommendations per the current research data.

PLEASE BE SURE TO DISCUSS WITH YOUR VET THE USE OF THE FOLLOWING ITEMS...

◻ Cerenia or ondansetron for nausea and appetite stimulant ◻ Mirataz for an appetite stimulant ◻ Prednisolone (steroid) to stabilize/help with appetite (long-lasting steroids such as depomedrol) are NOT recommended)

Ask your vet about a Prednisolone" anti-inflammatory dosing" prescription of 2 mg/kg for the first one to two weeks, decreasing to 1 mg/kg, then weaning. NEVER abruptly stop Prednisolone and ask your vet for their recommended weaning protocol.

The goal is to wean from the Prednisolone by the third week of treatment. Using it longer may interfere with GS's ability to work effectively.

Please work directly with your veterinarian to taper correctly and inform your advisory team that you've weaned.

◻ Subcutaneous fluids to give at home for dehydration (videos under "Supportive Care.)" ◻ B12 injections: 0.25 ml weekly to reduce inflammation and help with anemia and diarrhea. ◻ Gabapentin to sedate and ease the pain and anxiety of injections are given two to three hours before the injection. Please ask your vet for dosing recommendations and compounding for a chicken flavor.

◻ Schedule any future bloodwork. Check with your advisors to determine the frequency and timing. The labs needed are a CBC and Chem17 (aka "senior panel") and vary according to the specific GS manufacturer's relapse policy coverage.

◻ Schedule spay or neuter surgeries for the tenth week of treatment, or extend your cat's

treatment by two weeks and alter at 12 weeks. Altering surgery is a stressor, and heat cycles and spraying are, too. Researchers don't recommend surgery during the observation period.

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Using the Help for FIP® Treatment Tracking Web App Help for FIP® has a free web-based application to help track your cat's dosing.

Cat's Name

Once you submit your cat's "health and status intake," advisors will "Set the Treatment" by entering your chosen GS brand and the dose specific to your cat's type of FIP (Wet, Neuro, Ocular, Pleural, Dry, or combo).

Using your cat's starting weight, the beginning dose will be calculated, which never decreases and only increases as your cat gains weight. .

Each Monday, you'll weigh your cat and enter the updated weight in pounds/ounces or kilograms (preferred). The web app automatically converts the weight to kilograms for proper dosing.

Your dose may or may not change depending on whether the cat gained enough to "tip the scale" to the next level at every .25kg.

Dosing never goes backward, even if your cat loses weight.

www.helpforfip.com Page 10

Is FIP Contagious?

Is FIP Contagious in Multi-Cat Environments? The short answer is "No." The long answer is...

While contact transmission hasn't been observed in experimental settings, researchers know that FIPV exists in the feces of some cats with FIP. Horizontal transmission is theoretically possible and may explain why cats in the same environment develop FIP. Dr. Pedersen doesn't believe exposing a cured FIP cat to a coronavirus-positive cat will cause a relapse in the cured FIP cat, but that, too, is theoretically possible. In summary, separating a FIP cat from its housemates is more stressful than allowing them to live as they're accustomed to, with cat-to-cat transmission of FIPV rare.

95% of cats have been or will be exposed to (and test positive for) the feline coronavirus (FCoV). A small percentage with FCoV will mutate and develop FIP. FCoV is transmitted through the fecal-oral route and is common for cats to become exposed in multi-cat households, shelters, feral colonies, or catteries. Most cats that contract FCoV won't develop FIP. The virus must undergo a mutation within the cat to cause FIP. The virus lives in the digestive tract and is shed in the feces. Cats can shed the virus continuously or intermittently for four to six months and even up to one year or more continuously or intermittently. Recurrent infections are also common. FCoV is spread through litter and carried on bodies and clothing. Virus-contaminated material is easily transferred to the paws and fur of susceptible cats and ingested during grooming.

Younger cats are at a greater risk of developing FIP. The most common mode of transmission of FCoV is believed to occur when infected queens pass the virus to their kittens at five to eight weeks of age. Cats in shelters and catteries are more susceptible to the development of FIP. The same applies to purebred, male, and geriatric cats for unclear reasons.

Stress depresses immunity and increases the likelihood of a FIPV mutation. Stressors include overcrowding, weaning, spaying/neutering, infections, a new household, new cats coming into a home, shipping cats, and the stress of pregnancy and lactation.

It's essential to use good hygiene practices, staunch litterbox maintenance, minimize stress in the household, and manage existing infections to reduce FCoV transmission and potential FIP mutation. Avoid stress and overcrowding. The coronavirus is easily killed with bleach and other disinfectants.

If you've lost a cat to FIP, remove cat-related items that can't be washed or disinfected, such as scratching posts or soft toys. Clean and disinfect everything in the environment. Time will take care of the rest because viruses of this type are not long-lived in the environment. A few months are recommended, which is standard for most infectious diseases.

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FIP Treatment Protocol GS-441524 is an experimental, unapproved anti-viral (nucleoside analog) that cured cats with FIP in field trials by Dr. Niels Pedersen and his team at UC Davis in 2017.

The guideline for treatment is an 84-day course given daily at the same time (+/- one hour).

Some cats may need to extend beyond 84 days if the labs or health status don't support ending the treatment.

GS441524 has, on average, a 90% overall cure rate. There is an 84-day observation period to follow the 12-week treatment. Most cats are deemed cured after 24 weeks, while a small percentage (<.5%) will relapse and require an extension or additional round(s) of treatment at higher dosages.

You may start treatment immediately without confirmation or an official diagnosis if symptoms, clinical findings, and lab values are suspicious of FIP or if your cat is rapidly declining. Time is of the essence, regardless.

GS441524 is often an effective diagnostic tool and less costly than a battery of diagnostics and specialists when a cat is in critical condition and presents with signs and blood markers indicative of FIP (page 28) If your cat has FIP, it'll likely respond to the GS quickly. If they don't respond after a few weeks of regular treatment, it's likely NOT FIP. Giving GS441524 will not harm the cat and, in most cases, will save its life.

If our cat is unstable at the start of treatment, your advisors will recommend dosing twice daily (BID) until the cat stabilizes, usually three to seven days. If warranted, you may administer a dose every twelve hours for three to five days (or longer) to expedite your cat's response to treatment. Once your cat is stable, every 24-hour dosing begins.

Your advisors help you navigate the treatment by reviewing the monthly blood panels (CBC and Chemistry17) performed by your vet and weekly check-ins to manage symptoms, weight, dosage, and other concerns. Your vet is always your first contact for things outside the advisor's scope.

Blood draws are advised at the diagnostic baseline and periodically during treatment as deemed necessary.

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FIP Treatment Process The Drug Trial: Read the research and current status of FIP treatment at www.SockFIP.org.

The antibody test is a significant lab result to understand. The one phrase we hear most often during FIP discussions from cat owners is, "My vet said the FIP test is negative." First of all, there is no singular test for FIP in a live cat--this is a well-documented fact. Whether positive or negative, the FCoV/FECV PCR test is NOT clinically relevant alone. If the PCR result is negative, FIPV can still be high on the differential list as a diagnosis. If the titer > 1:3200, the FIPV mutation is suspicious, and further testing is advised. If > 1:6400 and the other lab values, health history, and physical exam are consistent with an FIPV diagnosis, the positive PCR is clinically relevant and warrants immediate treatment.

Diagnostic tests such as A/G ratio (<0.4) and Real-time PCR on effusions will be more sensitive and specific than those done on blood or serum.

Work with your vet and treatment advisors to get started: When available, your advisors will connect with another parent in your area to help get your initial doses. From there, you'll order more treatment directly from a safe and reputable supplier.

Injection help and recommended supplies: Visit www.helpforfip.com for helpful videos and suggested supplies (easily found on Amazon.com) for your 12-week treatment.

Blood Work Tracking Log: Use the blood log on our website and the end of this book to track, save, and share your cat's ongoing blood work for a side-by-side comparison to view your cat's progress. It's easier for you and your team to understand any value changes when viewing the results together in one place. (You may also use the form provided on page 45 to enter your values manually).

Weight Updates: You should weigh your cat every Monday pre-meal to calculate dosage changes, which is imperative for a successful outcome. Please weigh your cat in kilograms if possible. Please understand that 3 lbs, 2 oz, and 3.2 lbs are not the same weight.

Labwork: Please schedule your cat's blood draws according to your advisor's recommendations, which are generally based on your cat's progress and the relapse and extension coverage offered by the GS manufacturer.

Follow and "Like"

👍🏽 the Help for FIP® Page on Facebook for current FIP news and information updates.

Please don't give up on your cat. Euthanasia is an absolute last resort. This treatment can work even in the most critical of cases.

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FIP Treatment Timeline Not all cats recover at the same rate, so please don't be discouraged by others' posts or comments about their cat's progress. The sicker the cat at the start of treatment, the longer it may take to see improvement. If your cat has a secondary condition or is older, this also affects the response time. Cats with the wet form of FIP often respond faster to treatment but decline more quickly without treatment.

The fever should improve in 12-24 hours and up to several days. A normal temperature for cats is between 100.5°F and 102.5°F (38.1°C and 39.2°C) The cat's appetite should gradually return to normal over one to two weeks but expect daily ups and downs.

General appearances, such as coat sheen, grooming, brighter eyes, stance, playfulness, and alertness, should begin to improve during the first week.

Effusive/Wet FIP fluid should reabsorb in 7-10 days and can take up to three weeks. If the fluid persists longer with no measurable improvement, other diagnoses, such as parasites, lymphoma, masses, or other inflammatory conditions, should become suspect.

Ocular and neurological symptoms may take longer to resolve, requiring patience, close observation of symptoms, and, sometimes, increased dosing.

Overall, notable improvement should be evident within 2-4 weeks and, often, within a few days.

WHY 12 WEEKS? Twelve weeks is the earliest mark for which researchers recorded minimal relapses.

Researchers attempted shorter durations, but more cases had to undergo two, if not three, treatment courses. While the cats often respond fast (a small percentage required doses as high as 30mg/kg and even a second anti-viral added), the virus took 12 weeks to eradicate.

Please only stop treatment by notifying your treatment advisors and your vet. Don't let all the hard work and investment in saving your cat go to waste. The goal is to avoid relapses and achieve a long-term cure the first time. You can read more about this in Dr. Pedersen's summary on page 34.

Stopping the treatment too soon or failing to weigh your cat at least weekly almost always leads to underdosing. Underdosing increases the risk of relapse, the need for treatment extension, and GS-441524 resistance.

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Normal and Abnormal Expectations Down Days: Expect your cat to tire occasionally during the first month as symptoms wax and wane. Their body must fight a deadly virus, so expect good and bad days.

Cold-like symptoms, e.g., runny eyes, sneezing, and congestion, are expected during the first 30 days. Your cat is immuno-compromised by FIPV, so secondary infections are common and often require an antibiotic if symptoms persist over a few days.

Diarrhea is expected with wet FIP, especially as the fluid reabsorbs and means the GS is working. You can add plain, pureed pumpkin (NOT pie filling) to food to firm up the stool; however, it can also worsen diarrhea. The recommended amount is 1 to 2 tsp, up to twice daily. Start low to see the effect and increase if needed. Some pet food manufacturers offer packets of pumpkin puree for pets.

Lesions or sores are almost guaranteed during treatment and are not cause for alarm. Cover your cat with an infant t-shirt, onesie, or a surgical suit if they scratch or over-groom the area. You can also spray with Vetericyn Spray or use neo predef powder (prescription) or colloidal silver to help heal and prevent infection. Some owners are using light therapy with positive results. Please ask your vet to assess the sores if they worsen or appear infected.

Itchy skin or minor hair loss is less common but happens. It helps to keep the cat's nails trimmed, and if the itching becomes excessive, Zyrtec can be given under the guidance of your vet. Please ask them for proper dosing.

If your cat is on Prednisolone, it's normal for them to seem depressed or lethargic for a few days after the dosage tapering.

Rapid or labored breathing. The average respiratory rate for cats is 15-30 breaths per minute. If > 40, observe closely; if > 60, proceed to the E.R. vet hospital. Pleural or abdominal fluids may need to be removed to the extent that breathing is restored. Openmouth breathing is a critical sign regardless of respiratory rate.

Dehydration: Watch this video (https://shorturl.at/bcGYZ) to check for dehydration. If breathing seems rapid, count a full breath (inhale/exhale) for 15 seconds and multiply by four to get the number of breaths per minute. Rates greater than 60 breaths per minute, increased effort, or open-mouth breathing may indicate an emergency. Please report to your vet as soon as possible.

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Findings & Progressions The eyes with Ocular FIP can present in multiple ways, and not uniformly. The eyes can be foggy, filmy, bloody, patchy, or present with unilateral pupil sizes.

Example of Jaundice

Before

Improving

Before

After

Before Resolution of Abdominal Effusion

Before

After After

Skin sores may also present in other areas aside from injection sites

Before

Improving

Examples Ocular FIP Page 16

After

Injection Tutorial and Supplies The injection is subcutaneous ONLY, not into the muscle. Please watch Dr. Pedersen and Debra's videos on the next page, giving injections to Smokey and Luna.

For leaks and misses: Estimate what was lost and repeat the injection--you can't overdose with GS. Repeat the entire dose if you suspect you lost more than half.

Buffering and Diluting the GS solution: From Dr. Niels Pedersen: "Buffering and diluting GS is an old debate, with many opinions, and one must understand chemistry. Diluting injectable GS with saline or B12 solution won't change the pH, as they have no buffering properties. The only thing accomplished is diluting the GS. You'll still give the same amount, only in a bigger volume. If the pain is due to the GS and not the pH, diluting may help relieve the pain--but if the pain is from the pH, diluting will not make much difference. (In other words, don't do it.)

Supplies needed for giving injections: 3cc/ml Luer Lock syringes (5ml for larger volumes) BD, Monoject, Nipro, Lifetouch, and Terumo are solid brands for needles and syringes.

20-21-guage 3/4 - 1-inch needles (small bore needles are harder to push the thick/oily GS Alcohol to clean the stopper once the vial has been opened A large towel, cat bag, or the "Cozy Cat Wrap" to secure the cat. A soft E-Collar is helpful for cats who bite.

A treat or favorite food to distract the cat Gabapentin, as your vet prescribes, can help calm a feisty or aggressive cat and reduce pain. It's recommended to give gabapentin two hours before the injection.

A glass jar with a lid or a medical "sharps" container to dispose of needles and syringes.

The proper way to tent skin and the injection angle Page 17

Use the top of the black stopper (not the point if there is one) as your mark, not the bottom. This example is 1.1 ml

Needle bevel opening facing upwards during insertion

Shaving may help with injection accuracy

Luna and the “jiggle distraction method” Find the link to both video tutorials and more https://www.lunasfiplegacy.com/treatmenthelp Page 18

Dr. Pedersen demonstrates injections on Smokey

Injection Instructions Changing the needle after drawing the solution: A fresh, sharp point after drawing up the solution is good but isn't a deal breaker if low on needles and is not a reason to skip or delay an injection. The rationale for changing the needle is that the rubber stopper on the vial is thick and can dull the needle. Dull needles can make it harder to pierce the skin and more traumatic to the cat. If using the same needle to draw as to inject, there's also GS residue on the outer part of the needle, which can attach to the inner skin layers. These droplets may become trapped and irritating. Some cats are more sensitive and prone to injection site sores than others.

Before drawing the solution, injecting the same air volume into the vial as the dose you're giving decreases the vacuum pressure, and injecting the air helps the viscous solution fill the syringe more easily. Ensure the needle is screwed on tightly before drawing and injecting to avoid losing the solution under the application pressure.

Inject your cat at a 30-45-degree angle, with the needle bevel/opening facing upwards, into a tented (pulled up) area of the back skin. Avoid the hind end, legs, and upper neck scruff area. After puncturing the skin, draw back slightly on the plunger and look for a flash of blood. If this happens, you're likely in a blood vessel and should pull back or try another area. Inject into the skin, NOT the muscle, and quickly and firmly push the plunger.

When your cat regains body mass, the skin becomes tighter, with less room in the spaces to inject. Tighter skin is more prone to leakage post-injection. You can help avoid this by inserting the needle up to its hub (3/4-1") and then pinching the area for a few seconds after administration- if your cat will allow it. If the solution leaks onto the cat, promptly wipe it off with water and mild dish soap. Leakage is apparent if the fur appears oily.

Rotate injection site areas daily side to side and front to back--think of a zigzag pattern.

If your cat has long fur, you or your vet may shave strips as shown.

NEVER reuse needles or syringes.

Place used syringes and needles in a glass jar or medical sharps container with a lid and not in the trash or recycle bin. Ask your vet to dispose of them or take them to your local EMS. If you can't give a dose on time, you may give it one hour early or one hour late. A very late dose is better than a missed one; do your best.

Store the injectable and oral forms of GS441524 at room temperature and out of direct light- refrigeration is not necessary or recommended. A cold injection is uncomfortable.

Don't use the GS if the vial contents have a yellowish hue or particulate matter. Most brands have a maximum shelf life of up to 24 months.

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GS-441524 Options GS-441524 is more affordable than ever, and your advisors can help you choose the best option for your budget and degree of illness. Much false data exists on the web regarding the affordability of GS and these falsities are why many owners don’t seek treatment.

At Help for FIP®, we suggest a range of safe options (and not limited to the ones listed below) that reflect only the highest test results for purity, concentration, and their history of effectiveness. Your advisors can help you choose the best for your budget and your cat's condition. Product costs are set by the manufacturers using the following criteria: 1. The relapse/extended treatment guarantee coverages. If a relapse occurs within 84 days or less from the start of observation, you'll pay either $0 or 50% of the cost to retreat at a higher dose and with either oral or injectable formulations. Treatment extensions are covered at 50%, regardless of the brand.

2. The purity of the raw materials used in the solution or pills.

3. The vial volume and concentration (in mg per ml).

These are some of the safest, most well-tested, and most widely used options, in our opinion: CAPELLA is a widely used GS brand with an excellent track record. Capella carries a 100% relapse coverage and a 50% extension benefit. Capella is also available in tablet form in varying concentrations.

RAINBOW provides for a smaller injection volume because it has a higher concentration of GS at 20mg/ml. Rainbow is a good choice for larger cats or those with the neurological form of FIP who require a larger baseline dose. Rainbow carries 100% relapse coverage and 50% extension benefit, the same as Capella.

KARMA is excellent for an alert, active cat eating and drinking well—in other words, "stable" at the start of treatment. Karma is the "one size fits all" brand. At 18mg/ml, it falls between Capella and Rainbow concentrations. Karma is a cost-effective option with a 50% relapse guarantee coverage and a 50% extension benefit. It is also available in tablet form.

Ask your advisors about other options if you prefer something more cost-effective and want to forego the relapse and extension coverages. Only purchase a few weeks of treatment first to ensure the best fit for your cat. We encourage everyone to keep extra treatment on hand to help others get started, which is how the FIP treatment community operates.

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Oral GS Formulations Pills or capsules are an option if your cat is free from gastrointestinal (GI) issues such as vomiting, soft stools, diarrhea, or inappetence--and once your cat is in stable condition.

Injections are more reliable because, in most cases, the cat receives the entire dose delivery.

Pills rely on the G.I. system for absorption, and because FIP causes inflammation of the intestinal tract, full absorption of oral medications isn't always possible. If the cat vomits, doesn't eat, or has diarrhea, there's a risk that the GI system won't absorb the pills, resulting in the equivalence of missed doses. Some cats are initially critical, unable to swallow or eat, and might even require a feeding tube. The best start for your cat is with injections; your advisory team can help you overcome injection concerns.

Pills or capsules are recommended only after your cat has shown significant improvement from the effects of the FIP. Injections can be intimidating; some owners are needle-phobic or need extra help administering them. Your treatment advisors and community can help you overcome injection anxiety and gain confidence to give successful injections. The Help For FIP® Facebook support group contains owners sharing tips and tricks.

Another consideration is that oral formulations can be significantly more expensive than injections, especially for larger cats and cats with Ocular and Neurological FIP. When giving your cat oral GS, they must fast for one hour before AND after administration.

Water during fasting is fine. Tablets and capsules can't be crushed or opened to mix into food. For proper delivery and absorption, they must be given whole, or tablets may be split if adjusted for dosage. **Pills can only be crushed if administered down a feeding tube.

You may coat each pill or capsule with a soft treat like “Churu.” You may take a small chicken cube (partially boiled and slightly pink), cut an "X" in it, and tuck the pill inside. Cats will generally eat it whole. Please see the videos below for further pilling instructions: Video One: (https://rb.gy/nb7pc) Video Two: (https://rb.gy/xyitn) If the cat vomits within one hour of taking the pills, another dose should be given. Thirty minutes should be ample time for the GS to absorb, but the safest timeframe to resume eating is one hour after pilling.

Tablets are available in various sizes and doses, the same as injectables, and according to weight and type of FIP. Ocular and Neurological FIP require twice the dose of Wet or Dry to effectively cross the blood-brain barrier. Pleural FIP falls in between at 1.5 times the Wet/Dry amount.

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100% polyester fleece. The exact color may vary slightly from what is pictured.

Machine washable. A laundry bag is recommended. Made in the USA.

Supportive Care When starting treatment, your cat is likely very ill and may need supportive care. This care can include syringe feeding, a feeding tube, subcutaneous fluids, a blood transfusion, weekly B12 injections, a liver support supplement, and chest or abdominal fluid removal.

Please don't take advice from other parents or online sources, but speak directly to your vet or ask your advisors for guidance on the steps you can take to get this additional support.

Since a cat's response is unpredictable, it's good to have a few things on hand: 1. 50/50 mixture of sugar water and an eye dropper or a syringe 2. Karo syrup or pancake syrup 3. Q-tips 4. Pedialyte from the baby aisle at the store 5. Gerber glass-jar baby food (turkey, ham, beef, or chicken) 6. A heating pad or warm towels from the dryer 7. A rectal thermometer from the drug store, Amazon, etc.

If your cat is struggling (i.e., becomes limp or nonresponsive), start by syringe-feeding the sugar water about three milliliters every three minutes.

If the cat feels cold, wrap it in a blanket and place it on a heating pad or warm towel. Use a Q-tip to put the Kayro or pancake syrup on their gums and under their tongue. Continue this protocol for 15 minutes or until the cat becomes alert and responsive.

Make a cocktail using CLEAR Pedialyte along with the baby food. Add some Karo® Syrup and make a cocktail to syringe-feed if the cat won't eat it alone. The Pedialyte provides electrolytes and hydration along with some energy. The Karo Syrup is for low blood sugar.

Cats love baby food and often can't get enough of it!

If the cat hasn't improved in 15 minutes, a trip to the emergency room is needed to check the blood glucose, administer fluids, and other necessary interventions.

Subcutaneous Fluids Video #1: (https://rb.gy/sg6a4) Subcutaneous Fluids Video #2: (https://rb.gy/bxo60)

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Supportive Care ABDOMINAL FLUID: Do NOT drain abdominal fluid unless your cat's abdomen becomes so full that eating, bowel movements, ambulating, or breathing are affected. Draining all the abdominal fluid is risky and can cause your cat to die in hypovolemic shock.

If the fluid must be drained, it should be no more than 30% of the perceived volume. **Buy a seamstress measuring tape from a fabric store or Amazon and measure the widest part of your cat's abdomen daily to monitor the abdominal effusion progress.

CHEST FLUID: Thoracic fluid must be drained 100% if the cat's breathing is rapid, labored, or in obvious distress.

Your cat may need hospitalization for supportive care such as blood transfusions, subcutaneous or intravenous fluids, a feeding tube, incubation/warming, or oxygen.

If your cat is unstable at the start of treatment or begins to decline (aka "crash"), your team may recommend dosing twice daily until the cat stabilizes. This means you'll administer a dose every twelve hours for three to five days and occasionally longer. Once the cat is stable, every 24-hour dosing resumes.

Tips for Successful Syringe Feeding Don't forcefully push food or liquids into a cat's mouth; do it slowly. If your cat struggles, it's okay to take a break and return to the feeding following a short break for play or cuddles.

A great rule of thumb for syringe feeding is one milliliter every minute.

Always feed your cat on its belly with the head up or sitting. NEVER syringe-feed on its back.

It's important to STOP syringe-feeding if your cat vomits or regurgitates during the feeding.

How to Syringe Feed Your Cat: (https://youtu.be/vD9kcvV4iNY) Page 24

Other Drug Interactions L-lysine should not be given during FIP treatment because it binds arginine over long-term use and works against the immune system.

If you must treat your cat for parasites during FIP treatment, veterinary FIP experts recommend Strongid/Pyrantel, Panacur/Fenbendazole, or Dontral for roundworm and hookworm (also Giardia) and Praziquantel (Bayer)/Droncit or Drontal for tapeworm. You can also use Diatomaceous Earth Food Grade. See their website for more information.

If your cat has never been vaccinated, please ask your veterinarian for risk vs. benefit. If the cat is in a higherrisk environment and is exposed to outdoor cats, sick cats, or if you do rescue work, the benefit may outweigh the vaccine risk. You’ll want to avoid reactions that might be confused with FIP relapse. It's best to wait until after the observation period to resume vaccines.

Antibiotics for secondary conditions are often needed. No adverse reactions with Zithromax, Cephalexin, Amoxicillin, Penicillin, Augmentin, Clavamox, Doxycycline, Clindamycin, or the anti-viral Famciclovir have been seen. The fluoroquinolone class of antibiotics, such as Baytril, Zeniquin, Veraflox, Pradofloxacin, and Orbax, contain fluorine and penetrate the brain/nervous system causing neurologic symptoms.

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Deworming, Flea & Tick Treatment Treatment for Worms: Vets familiar with the research and treatment indicate that Strongid®, Pyrantel®, Panacur®, or Fenbendazole® are the best options for deworming roundworms and hookworms. Praziquantel® or Drontal® (Bayer) may be used for tapeworms.

Flea & Tick Treatment: No scientific evidence shows that any available flea treatment hinders GS treatment. There are, however, two possible areas of concern: 1. First, under normal circumstances, flea treatments can have neurological side effects, which could be confused for neurological FIP symptoms.

2. Secondly, if the blood/brain barrier is inflamed, FIP cats may be at a higher risk of these symptoms.

Ultimately, this comes down to a risk assessment based on your cat's situation. The risk of flea meds causing issues while under treatment may be low, but it isn't zero. On the other hand, fleas threaten cats, ranging from discomfort to anemia to spreading diseases. They can also transmit some diseases to nearby humans, for example, Bartonella. Ticks are also a health concern for cats and their owners in some areas.

Generally, you can prevent or eliminate fleas without flea medications by manually treating the environment and removing fleas from your cat. Vacuum daily (floors, closets, bedding, anything the cats come in contact with) and wash all bedding. You can flea-comb your cat daily to remove fleas. You can apply a mixture of water and apple cider vinegar (2:1) on a cloth and wipe it onto your cat daily. You can also use FOOD GRADE Diatomaceous Earth® if you take your cat outdoors on a harness or if they have an outdoor "catio" or enclosure.

Whether or not to use flea medications should be a decision made with input from your vet.

Factors such as your cat's current medical state, whether or not your cat goes outdoors, the prevalence of fleas/ticks in your area, and whether or not it's practical for you to prevent fleas from coming into contact with your cat should weigh into the decision.

Statement from Dr. Pedersen: "There is no scientific evidence that any available flea treatment has a negative effect on GS-441524 treatment. However, I am against using systemic insecticides to control fleas on a cat. They work on the fact that the insecticide is less toxic for the cat than for the fleas that feed on it. Their sole use for flea control is an admission of defeat akin to the military tactic of calling in the artillery on your position when the enemy overruns it".

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Feeding Your FIP Cat Cats need 25 to 35 calories a day per pound. This would equate to 192 to 280 calories a day for an eight-pound cat. A lack of nutrition can lead to hepatic lipidosis, which can be fatal.

Cats with FIP usually first develop nonspecific signs of disease, such as loss of appetite, weight loss, depression, and fever. Inappetence is often one of the first symptoms to appear in FIP cats. As with humans, cats who are ill won't want to eat. Unlike people, cats who go days without food may develop fatty liver, becoming a potentially deadly concern.

If your cat has diarrhea, you can switch to dry cat food for a few days until the diarrhea stops. If your cat is not eating well, you can try manual feeding by liquefying the food in a blender and using a syringe to feed. It usually takes 2-14 days for a cat that stops eating to start wanting to eat again.

Cats with FIP need much nourishment during treatment. The best foods to feed a cat with FIP are freshly cooked Fish, chicken, and beef. You should avoid feeding your cat a raw diet because it could pose additional risks to immunocompromised FIP cats.

Boiled chicken is an excellent source of lean protein that is easily digested and provides essential nutrients.

Steamed Fish is an excellent protein source rich in Omega-3 fatty acids to help reduce inflammation and support your cat's immune system. Choose Fish with a strong smell, such as salmon, to stimulate your cat's appetite.

Dry food of high quality is a convenient option but is often packed with fillers, grains, and ingredients not native to an obligate carnivore's diet. While it's OK to treat your cat to dry food as calories are vital, it shouldn't be their ONLY food or their primary diet.

Wet Canned Food is beneficial for cats with FIP and in health, as it can help keep them hydrated and provide essential nutrients in an easily digestible form. Please look for varieties with intense flavors and aromas to encourage your cat to eat.

Gerber glass-jar baby food (turkey, beef, or chicken) Goat's milk may be given. Unlike cow's milk, which should NEVER be given to cats, goat's milk is digestible and contains vitamins and nutrients for the much-needed calories and hydration.

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Understanding Your Cat’s Bloodwork No singular lab test exists to confirm FIP. However, it's easier to establish an FIP diagnosis when the cat's symptoms are paired with specific markers in its blood results.

If treatment is started and it's determined your cat doesn't have FIP, there's no harm done by the GS. It's better to be proactive than wait until it's too late. The series of results below are from an actual case. The primary markers are apparent, but not all cats present with prevalent findings as it's dependent on the type of FIP and the stage of the disease. You can see the progressive improvements. This cat did not suffer from anemia or jaundice.

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Understanding Your Cat's Bloodwork by: Debra Roberts

Once a blood draw is analyzed, most owners need help understanding the results. Your cat's bloodwork allows your veterinarian to evaluate many system functions.

Bloodwork is an essential component in the diagnosis of diseases. Like any diagnostic tool, cat blood tests are more effective as part of a diagnostic plan, which may include other tests. Elevated BUN and creatinine levels can indicate a kidney problem. However, they can also indicate mild dehydration, leading to bloodwork and warranting further testing.

What if my cat's lab work remains abnormal? Sometimes, cats must be off all medications for the labs to normalize. Dr. Pedersen says, "Treat the cat, not the labs. I tend not to overreact to low or high normal values, or even mild elevations of single values, and rely much more on the outward signs of health: Weight gain, activity levels, appetite, and quality of coat and flesh are more important than any minor deviation in blood values."

Let's explain each component's meaning. The values in blue are the key indicators used to diagnose and monitor specific types of FIP. White Blood Count (WBC) measures the body's immune cells. Increases or decreases indicate certain diseases or infections.

Red Blood Count (RBC) is the number of red blood cells per unit of blood volume. Increases or decreases can indicate dehydration or anemia.

Hemoglobin is the oxygen-carrying pigment of red blood cells. You must interpret increases or decreases in this number with other blood values.

Hematocrit is the most critical value of red blood cells. This value measures the percentage of red blood cells in the blood to detect anemia and dehydration and can help indicate some disease processes.

MCV (Mean cell volume) is the average red blood cell size. This value can help indicate some disease processes when paired with other data.

MCH (Mean cell hemoglobin) is the average amount of hemoglobin per red blood cell. When paired with other data, this value can help indicate some disease processes.

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Bloodwork Continued MCHC (Mean Corpuscular Hemoglobin Concentration) is another value for interpreting cell hemoglobin concentrations.

RDW (Red Blood Cell Distribution Width) elevations can indicate an increased variety in red blood cell sizes.

Platelets measure cells used in blood clotting.

Neutrophils are a type of white blood cell in the immune system. An elevation or decrease in absolute or total neutrophil counts can indicate various processes, including stress, inflammation, infection, or other disease processes.

Lymphocytes are another type of white blood cell in the immune system. An elevation or decrease in absolute or total lymphocyte counts can indicate a variety of processes, including stress, inflammation, infection, or other disease processes.

Monocytes are a less common type of immune system white blood cells that can indicate stress or chronic inflammation.

Eosinophils are white blood cells of the immune system. Elevating absolute or total eosinophils can indicate allergy disorders, parasitism, and skin and intestinal disorders.

Basophils are a less common type of immune system white blood cells. Elevations in these can indicate allergy disorders, parasitism, and neoplastic states.

Albumin (ALB) is a serum protein that helps evaluate hydration, hemorrhage, and intestinal, liver, and kidney disease.

Alkaline phosphatase (ALP) elevation may indicate liver disease, gall bladder disease, pancreatic disease, or active bone growth in a young cat. This test is very significant in cats.

Alanine aminotransferase (ALT) may determine active liver damage but does not indicate the cause.

Aspartate aminotransferase (AST) elevations may indicate liver, heart, or skeletal muscle damage.

Blood Urea Nitrogen (BUN) helps determine kidney function and intestinal disease. Kidney, liver, gastrointestinal, or urethral obstruction, shock, or dehydration can cause an elevation in BUN. Page 30

Bloodwork Continued Calcium (Ca) changes can indicate various diseases. Tumors, hyperparathyroidism, and kidney disease are just some conditions that alter serum calcium.

Chloride (Cl) is an electrolyte lost with symptoms like vomiting. Elevations often indicate dehydration.

Creatinine (CREA) reveals kidney function and helps distinguish between kidney and nonkidney causes of elevated BUN. Gamma Glutamyl transferase (GGT) indicates liver, gall bladder, and bile duct disease.

Globulin (GLOB) is a blood protein that often increases with chronic inflammation.

Glucose (GLU) is a blood sugar. Elevated levels may indicate diabetes mellitus, while low levels can cause collapse, seizures, or coma.

Potassium (K) is an electrolyte typically lost with symptoms such as vomiting, diarrhea, or excessive urination. Increased levels may indicate kidney failure, dehydration, or urethral obstruction. High levels can lead to cardiac arrest.

Sodium (Na) is an electrolyte often lost with symptoms such as vomiting, diarrhea, kidney disease, etc. This test helps indicate hydration status.

Phosphorus (PHOS) abnormalities are often associated with kidney disease, hyperthyroidism, and bleeding disorders.

Total bilirubin (TBIL) elevation may indicate liver or hemolytic disease. This test helps identify bile duct problems and certain types of anemia.

Total protein indicates hydration status and provides additional information about the liver, kidneys, and infectious diseases.

Thyroxine (T4) is a thyroid hormone. High levels indicate hyperthyroidism in cats.

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GS-441524 DRUG RESISTANCE If your cat resists GS-441524 (no longer responding, returning, or worsening symptoms), you needn't give up on achieving a cure.

The first option for resistance is to progressively increase the GS dosage that exceeds the resistance level. This can be accomplished by increasing to a maximum of 20mg/kg.

The second option is to use another antiviral drug with a different resistance mechanism, either by itself or combined with GS-441524.

Molnupiravir (EIDD) undergoes official clinical trials in the U.S. in 2024. In other countries, Molnupiravir is an effective solo treatment for FIP. Because of its lower cost, it is attractive for those with financial hardship or in shelters that treat multiple cats.

Dr. Niels Pedersen states that when using Molnupiravir/EIDD, dose-dependent harmful side effects such as severe bone marrow toxicity and growth plate issues are possible. A minor typical side effect of EIDD is low White Blood Count (WBC). The extreme side effects occur when treating cats with exceedingly high doses and over longer periods.

Dr. Pedersen recommends that EIDD be used only for cats that have developed resistance to GS441524. Based on over four years of treatment of thousands of cats, GS has no longterm toxicities. No such toxicity data exists for long-term EIDD use. If EIDD proves safe over time, EIDD and GS441524 will be considered equivalent treatment options.

Dr. Pedersen states that combining GS-441524 and molnupiravir/EIDD shouldn’t increase either's toxicity. However, combining is pointless for treating resistance, as continuing the GS is wasteful and painful. Combining them for primary treatment won’t increase efficacy over using either alone. The benefit of combining for primary treatment may inhibit the development of resistance to either, making resistance rarer than when a drug is used singly.

A safe and effective dosage for Molnupiravir with FIP wasn’t established by well-controlled, monitored field trials but rather established by independent field trials. Recommended dosing for oral Molnupiravir/EIDD is: Wet or Dry FIP: 5-7 mg/kg every 12 hours Ocular FIP: 8-10 mg/kg every 12 hours Neurological FIP: 10-15 mg/kg every 12 hours **GC-376 is no longer a viable treatment option, even if it becomes legal. If a viral protease inhibitor is used in cats, it’s more likely to be Nirmatrelvir (Paxlovid) or some form of it.

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Why Do Some Cats Relapse?

Relapses can happen for many reasons, but the main reason is that not all of the virus was eradicated during the initial treatment. While we don't know all the answers, here's some information about relapse that may be helpful regarding the individual cat.

Causes for this viral retention are generally because neurological issues can progress slowly and have little or no symptoms, causing a missed Neurological FIP diagnosis. A lower dose may successfully suppress the virus in the brain throughout treatment, producing a neurological relapse once the treatment ends. This is why providing everything we ask for during the initial intake and anytime your cat has a setback during treatment is essential.

It's possible that lesions (in any part of the body) didn't receive enough GS during treatment, and the virus lingered, producing a relapse.

Some cats may develop partial resistance to the GS, requiring a higher dose. While the lower dose suppresses the virus, it likely didn't kill it, thus producing a relapse.

Sometimes, cats are underdosed due to failing to recalculate the dose as their weight changes, significant leakage after injection, or failure to take all their pills. Everyone makes mistakes during treatment; in most cases, following the protocol closely can compensate for these minor lapses.

There's no effective test to tell if the virus was eliminated from the body. However, the clinical picture and bloodwork give your treatment team essential clues. Cats that relapse for the above reasons can sometimes still have an excellent clinical appearance and lab values.

If you treat your cat with a brand that offers relapse and treatment extension coverage, you needn't worry about the cost to retreat, should this be the case: You've used the brand exclusively for at least ten of the twelve-week treatment course at the proper dose and increases. (Please let your advisors know which brands offer coverage.)

You've updated your treatment team with all changes and weighted your cat weekly.

You've increased the dose with each weight gain, if indicated.

You've never lowered the dose with weight loss or for any other reason.

You've provided a clear photo of the cat's eyes, showing both pupils at the start of treatment.

You've provided a video of your cat walking/jumping if they could at the start of treatment.

You've provided all required diagnostic test results from your vet.

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FIP FIPFIP

Entering Observation Completing the entire treatment course and seeing your cat's unbelievable progress over the past 12 weeks is a fascinating time. However, the treatment is still ongoing, only without the GS. Now it's time to see your cat thrive without the daily treatment regimen. Over the course of the next 12 weeks, you'll be cognizant of the following tasks and observations: 1. Avoid exposing your cat to unneeded stress, such as new pets, significant environmental changes, vaccinations, deworming, flea and tick treatment, or surgical procedures unless necessary.

2. Speak with your veterinarian if your cat was never vaccinated or lives in a higher-risk environment (i.e., goes outside, is exposed to cats who go outside, or if you do rescue work.)

3. Please monitor your cat's weight, appetite, and energy during this time. Any changes, including fever, inappetence, lethargy, loss of balance, unequal eyes, and unkept coat, are red flags to be reported to your vet and advisory team. These symptoms don't always indicate a relapse, but you'll need to investigate them with your vet and discuss them with your treatment advisors.

4. Per Dr. Pedersen, bloodwork is only necessary during observation if your cat is a critical or complex case. Could you ask your treatment team about lab work during observation to decide what's best for your cat? While relapses are rare, the cat usually exhibits apparent symptoms before the event is detected in the lab results.

5. Once you've reached the milestone of a cure, please consider donating to FIP research, without which GS would not be available to save cats. Ask your advisors where you can contribute, as various fundraisers are in effect throughout the year to help fund grants at multiple institutions. You can also visit www.sockfip.org to donate directly to the research at UC Davis.

Please update your advisors on your cat's progress during observation and send any observation bloodwork for review upon completion. Your team wants to hear how your cat is doing. We also hope you remain an active supporter and mentor to other FIP cat parents in the Facebook support group. A strong community is needed to carry out the goals we wish to achieve with FIP treatment.

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Summary of GS-441524 Treatment for FIP Niels C. Pedersen, DVM Ph.D., Distinguished Professor Emeritus Center for Companion Animal Health

School of Veterinary Medicine, UC Davis

With permission from Dr. Pedersen, I share this summary, which I've formatted for this book. The information presented here represents Dr. Pedersen's recommendations and preferences for treating FIP cats. --Debra Roberts

TREATMENT EXPECTATIONS Using the same criteria for monitoring treatment described in the Journal of Feline Medicine and Surgery field trial paper, owners should track their cat's temperature, weight, activity, appetite, and clinical signs of the original disease daily or weekly. Blood tests, including a minimum CBC (hemogram) and serum chemistry panel (including serum protein values total protein, albumin, globulin, A:G ratio) at the onset of treatment and every four weeks after that, are helpful. It is always beneficial to update these values in a graph form.

The goal is to have a healthy, alert, and active cat at the end of 12 weeks of treatment and with normal blood test values, especially hematocrit, total protein, globulin, albumin, and A:G ratio. A significant weight gain is also a good sign, as some young or particularly wasted cats can more than double their weight during treatment. Of course, this is an idealized treatment, and one must expect that dosage may need to be adjusted upward if the response is slow or if complications such as ocular or neurological involvement manifest during treatment.

RESPONSE TO TREATMENT Response to treatment may be noticeable within 24-72 hours, and most cats are back to normal or near normal within 2-4 weeks, which is a good sign. The cure rate for FIP with GS441424 is over 80%, with treatment failures due to the misdiagnosis of FIP, inadequate dosage, complicated disease conditions, and drug resistance. Young cats are easier to treat and have a higher cure rate than old cats >7 years of age. Cats with wet or dry FIP not complicated by neurological or ocular disease are easier to cure than cats with neurological FIP. Page 35

TREATMENT DOSING The starting dosage for cats with wet or dry FIP and no ocular or neurological disease signs is 6 mg/kg daily for 12 weeks. The younger and wet cases tend toward the lower end, and the dry cases tend toward the higher end. Cats with ocular lesions and no neurological signs start at 8 mg/kg daily for 12 weeks. Cats with neurological symptoms begin 10 mg/kg daily for 12 weeks. If cats with wet or dry FIP develop ocular or neurological signs at the beginning, they go to the appropriate ocular or neurological dosage. Oral forms of GS are available, but I do not use them and am unfamiliar with the comparable dosages (at the time of this article writing). I do not recommend oral forms when the injectable dosage exceeds 10 mg/kg daily, as oral absorption efficiency decreases at these high dosages.

I strongly recommend adjusting the dosage with weekly weight checks. Weight gain can be tremendous in many of these cats because they are wasted at the start, growing, or both. If there is some weight loss at first of treatment, I stay at the original dosage and do not lower it. Failure to gain enough weight during treatment is considered a bad sign. I only raise a dosage for significant reasons, such as failure or blood tests to improve, slow improvement, poor activity levels, failure of original clinical signs to disappear, or change in disease form to include ocular or neurological signs.

DOSAGE INCREASES Dosage adjustment is where the art comes into play because we must avoid getting stuck on single blood values that are not quite normal and neglect the cat's overall health status. For example, the globulin may still be a bit high, but other critical blood test values and health status are excellent.

If there is a valid reason to increase the dosage, it should always be from +2 to +5 mg/kg daily for a minimum of four weeks. If four weeks extend the 12-week treatment time, we extend the treatment time to accommodate. One should expect a positive response to any increase in the dosage, and a failure to see improvement indicates that the dosage is still not high enough, drug resistance is occurring, the brand of GS is not what it should be, the cat does not have FIP, or other diseases are confusing the treatment.

WHEN TO STOP TREATMENT One of the most difficult decisions is to determine when to stop treatment. Although some cats, often younger ones with wet FIP, can be cured in as little as eight weeks and possibly sooner, the usual treatment time is twelve weeks. Some cats may even require dosage adjustments and even more extended treatment periods. Critical blood values such as hematocrit, total protein, albumin and globulin levels, and absolute lymphocyte counts usually normalize in cats destined for cures at 8- 10 weeks. At this time, there is often an unanticipated increase in activity levels. It is the belief, but not proven, that 8-10 weeks is Page 36

when the cat's immunity to the infection occurs. This situation happens with hepatitis C treatment in people, also a chronic RNA virus infection that often requires up to 12 weeks or more of antiviral drug treatment.

DETERMINING A CURE Unfortunately, no simple test will determine when a cure has occurred, and the fear of relapse often drives owners, treatment advisors, and veterinarians to extend treatments beyond 84 days. Fear of relapses will also cause those people involved in the decision process to be overly cautious about single blood values that are slightly abnormal (e.g., higher globulin or lower A:G ratio) or terminal ultrasound findings suggesting suspiciously enlarged abdominal lymph nodes, small amounts of abdominal fluid, or vague irregularities in organs such as the kidneys, spleen, pancreas, or intestines.

We must remember that a normal range for a blood value covers most animals, but it is a bell-shaped curve, and a few exceptional patients will have values on the margins of these curves. Ultrasonographers must consider the degree of pathology in a FIP-diseased abdomen and how scarring and other residual effects can alter normal appearances in successfully treated cats.

When such questions arise, it is best to look more closely at the total picture, not just one small part. The most important result of treatment is the return to normal health, which has two components – outward signs of health and inward signs of health. Outward signs of health include a return to normal activity levels, appetite, appropriate weight gain and/or growth, and coat quality. The latter is one of the best measures of health for a cat. Inward signs of health manifest a normal return to specific critical values based on periodic complete blood counts (CBC) and serum chemistry profiles.

The most important values in the CBC are the hematocrit and the relative and absolute total white blood cell, neutrophil, and lymphocyte counts. The most important values in the serum chemistry panel (or serum electrophoresis panel) are the levels of total protein, globulin, albumin, and the A:G ratio. Bilirubin is often elevated in cats with effusive FIP and can help monitor the severity and duration of the inflammation. There are many other values in CBC and serum chemistry panels, and it is common for some to be a little higher or lower than expected. It is best to ignore these values unless they are significantly elevated and associated with clinical signs. For instance, BUN and Creatinine increase with high water consumption, excess urination, and abnormalities in the urinalysis. Platelet counts by machine are notoriously low in cats due to trauma from blood collection and platelet clumping and always require verification by manual examination of the blood smears.

When confronted with doubts based on test results, base the decision to stop or extend treatment on the outward manifestations of health more than any singular test result.

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TREATMENT VARIANCES Different FIP treatment groups have created various modifications in the treatment. Some groups will treat with an exceedingly high dosage of GS from the onset rather than escalating the dosage only when indicated or cap off the treatment during the last two weeks or in an added two weeks with a higher dosage of GS in the hope that it may reduce treatment time or the chances of relapse. Some advocate using interferon omega or nonspecific immunostimulants to stimulate the immune system further, and some employ different modifications. No evidence exists that capping the treatment with an extra high dosage will improve cure rates. Likewise, interferon omega and non-specific immunostimulants have no proven beneficial effects on FIP when given as sole treatments or as supplements to GS. The practice of adding another antiviral drug, GC376 viral protease inhibitor, to GS treatment in cats developing GS resistance is also emerging and needs research.

Finally, it is common for owners, treatment groups, and veterinarians to add in many supplements, tonics, or injections (e.g., B12) to bolster blood levels or prevent liver or kidney disease. Such supplements are rarely necessary in cats with pure FIP disease.

RELAPSES Relapses of FIP occur during the 12-week post-treatment observation period, and there is no simple blood test to predict when a cure has happened or if a relapse is possible. Relapses usually involve infections that have escaped to the central nervous system (brain, spine, eyes) during treatment for wet or dry FIP not accompanied by neurological or ocular signs.

The dosage of GS441524 used to treat these forms of FIP is often insufficient to overcome the blood-to-brain or blood-to-eye barriers effectively. The blood-to-brain barrier is even more effective than the blood-to-eye barrier, which explains why eye lesions cure easier than brain and/or spinal infections.

Relapses occurring in the post-treatment period and that involve eyes, brain, or spine are usually retreated for at least eight weeks at a starting daily dosage at least 5 mg/kg higher than the dosage used during the primary treatment (e.g., 10, 12, 15 mg/kg daily). I recommended that oral forms of GS not be used when the dosage exceeds 10 mg/kg daily of the injectable form, as the efficiency of gut absorption diminishes at high oral concentrations. Cats not cured of infection at dosages as high as 15 mg/kg daily will likely develop varying degrees of resistance to GS-441524. Partial resistance may allow for the control of disease signs but not a cure, while total resistance manifests by the severity of clinical symptoms in the face of treatment.

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DRUG RESISTANCE Resistance to GS-441524 can exist during diagnosis, but this is uncommon. Instead, it tends to occur during treatment, is often partial at first, and necessitates a higher dosage to accommodate it. It can become total in some cats. Resistance is the biggest problem in cats with neurological disease, especially those that present with neurological illness or develop brain infections during treatment or relapse after what appears to have been a successful treatment. Many cats with partial drug resistance are treated for their disease signs but will relapse when the treatment stops. There have been cats "treated" for FIP for over a year with no cure, but ultimately, resistance worsens, or the owner runs out of money.

SIDE EFFECTS GS-441524 treatment is amazingly free of systemic side effects. It can cause minor kidney damage in some cats, but this does not progress to overt renal disease. Systemic drug reactions of the vasculitis type have been seen in a few cats and can be confused with injection site reactions. However, these drug reactions are at non-injection sites and are often self-limiting or respond well to a short-term low dose of steroids. The major sideeffect of GS treatment is pain at the injection sites, which varies from cat to cat and according to the injection prowess of the person doing the treatment (usually the owner).

Injection site sores are a problem for some cats and typically occur when the injection site is not moved around the body (stay away from between the shoulders and do not inject into the muscle and nerve layers below the subcutis). I recommend selecting sites starting an inch behind the shoulder blades, down the back to 1-2 inches before the tailhead, and onethird to one-half of the way down the chest and abdomen.

For sores, clear the injection site sore area of the surrounding hair and gently cleanse four or more times daily with sterile cotton balls soaked in 1:5 dilution of household hydrogen peroxide and water. Sores usually do not require sophisticated treatment and heal within two weeks.

THE FUTURE The hope is that a legal form of GS-441524 will become available. A drug named "Remdesivir®" is the best current hope because Remdesivir is immediately broken down to GS when administered intravenously in humans, mice, primates, and cats. The U.S. FDA has given Remdesivir® full approval, and similar approval will probably follow in other countries.

If so, it can be prescribed by any licensed human physician and, by default, by veterinarians.

However, the use of Remdesivir in the U.S. has still been limited to a specific subset of COVID-19 patients, only under controlled conditions and with continued data collection.

Only when all restrictions are lifted will it be readily available for even human use. We have Page 39

no experience with treating cats with Remdesivir® instead of GS-441524. The dosage of Remdesivir® on a molar basis is theoretically the same as GS-441524. GS-441524 has a molecular weight of 291.3 g/M, while Remdesivir® is 442.3 g/M. Therefore, it would take 442.3/291.3=1.5 mg of Remdesivir® to yield 1 mg of GS-441524.

The diluent for Remdesivir® is significantly different from that used for GS-441524 and designed for IV use in humans. How diluted Remdesivir will behave when injected subcutaneously over 12 or more weeks of daily treatment is unknown. Finally, mild liver and kidney toxicity signs have been seen with Remdesivir® in humans. GS-441524 causes mild and non-progressive renal toxicity in cats but with no apparent liver toxicity. It is uncertain whether the renal toxicity seen in humans given Remdesivir® is due to its active ingredient (i.e., GS-441524) or the chemical additions meant to enhance antiviral activity.

GC376 approval for cats (and humans) is in progress by Anivive® but is still two or more years away. GC376 is a viral protease inhibitor and works downstream from GS-441524, which inhibits the earliest stage of viral RNA replication. Therefore, it is unlikely to have a significant synergistic viral inhibitory effect. It will be much more important in inhibiting drug resistance when combined (such as in combination antiviral therapy for HIV/AIDS).

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Frequent FIP Questions Is there a vaccine for FIP? Only one licensed FIP vaccine is available, but its effectiveness in preventing FIP is questionable. The American Association of Feline Practitioners Feline Vaccine Advisory Panel does not recommend it.

What happens if my cat misses a daily dose of GS-441524?

Missing one dose is not serious because effective blood levels are sustained over 24 hours.

However, missing a dose should be avoided if possible and not become habitual so the cat doesn’t lose those sustained blood levels of the drug.

Is it necessary to administer the dose at the same time each day?

There is some flexibility in dosing as with human medicine’s general rule of thumb: “One hour early or one hour late.” It’s best not to avoid inconsistent dosing, but we also understand that daily life can throw curveballs. Adjust accordingly when this happens, but not habitually.

My GS shipment is running late or didn’t order in time. What should I do?

You can reduce the dosage by half that day rather than skipping a day, but this should not become a routine practice. Please be proactive and don’t wait until the last minute to order.

Alert your advisors and check within your local community to secure a dose or two from a fellow parent.

Is completing 12 weeks necessary even if my cat is “back to normal” now?

There’s no simple test to diagnose FIP, as there’s no test to determine if the virus has been eradicated. The twelve-week treatment period is based on well-documented field trials.

Undoubtedly, some cats aren’t cured even after 12 weeks, and there’s evidence that some are cured sooner. Early cessation of treatment leads to a higher chance of relapse. The best opportunity for a permanent cure and no retreatment is to finish the twelve-week course.

Can I give my cat GS-441524 to eliminate feline coronavirus and keep my cat from developing FIP? Dr. Pedersen vehemently advises against using GS441524 to eliminate FCOV. NOT all FCOV mutates into FIPV; therefore, misuse of antivirals can cause drug resistance in cats.

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Frequent FIP Questions I got my cat as a kitten, and FIP occurred before we could spay or neuter it. When is the best time to have the surgery?

Spay and neuter procedures can be completed during the tenth week of treatment while still covered by the GS treatment. You may also postpone until after the twelve-week observation period. According to Dr. Pedersen's recommendation, surgeries stress the cat's immune system and could cause treatment setbacks. However, the heat cycle may be more stressful on the cat than the procedure, and male cats also begin spraying, which is a behavior that could be difficult to stop once started. If the cat is in good health and the lab results greatly improve by the 10th week, please consult your veterinarian to schedule the procedure accordingly. Many vets book weeks to months out, so don't wait too long to ask for scheduling; otherwise, it will have to happen after the twelve-week observation period when the threat of relapse is most unlikely.

How can breeders help stop the development of FIP in pedigreed catteries?

Breeders can decrease the incidence of FIP by isolating weaned kittens from the queen t to avoid exposure to the FCoV and by not mixing very young kittens with older kittens. Limiting coronavirus exposure until 12-16 weeks of age, when the immune system is better developed, lessens the likelihood of kittens developing FIP. Breeders should avoid matings between cats with close relatives who've died of FIP or who've produced known kittens that developed FIP. Researchers have yet to identify a specific genetic component, and until that happens, breeders must take every precaution to avoid producing more cats who develop FIP. Lastly, follow accepted vaccination protocols and practice good husbandry to limit other infections that weaken the cat's immune system, predisposing kittens to secondary illnesses that can trigger a FIP mutation.

How much money is needed yearly for FIP research, and how can I help?

All money donated to SOCK FIP goes directly into FIP research. $50,000 – 75,000 a year supports a single technician or graduate student, and the more students the CCAH can engage in research, the faster they can reach their goals.

While SOCK FIP funds UC Davis for greater impact, the scientific community is collaborative.

Other groups raise money to study FIP, which is highly respected. Researchers have studied FIP for over 40 years, and while more is known about it, there is still the dilemma of preventing and curing FIP, which is a collaborative, worldwide effort.

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What About the Scammers?

Did you know some FIP Facebook groups take advantage of anxious, frightened cat owners who receive a new FIP diagnosis? They’ve been told by their vets to "look online and on Facebook for FIP groups" and not always name a specific group but one that can "help connect to treatment." This is where to problems begin.

The barriers to owners finding safe groups include some who are pushy and disparage the true research and current protocols. They "sound too good to be true” and often come with a hefty price tag.

One group leader convinces owners NOT to use scientifically proven and trusted GS-441524.

The group owner claims that GS441524 is "made in Chinese garages and that it's "horrible and inhumane to give cats painful injections," which is entirely false.

They convince frightened parents to buy their price-inflated oral product—not GS-441524, but "Espiravir," also known as Molnupiravir or EIDD2801. This human COVID-19 treatment is currently used cautiously worldwide in cases of resistance to GS-441524.

Although Molnupiravir (EIDD2801) can effectively treat FIP, EIDD is recommended at this time only for cats who become resistant to GS-441524. EIDD still needs proper trials and testing and has proven toxic in cats when not correctly used. (Page 32) This dishonest practice and untruths are disrespectful to the research proving the safety and effectiveness of GS in cats and to the price-gouging of cat owners. The fact is, Molnupiravir is very inexpensive, and owners are charged thousands of dollars above the actual cost. It's not only unethical and dishonest, but it puts cats at risk for long-term effects. (Note: Molnupiravir costs $1 per gram on average.)

In many countries, Molnupiravir is controlled and monitored by veterinarians. For some people around the world, that's their only option. However, in the US, Canada, and parts of Europe, GS is the safe, preferred option. The respectable FIP groups refer owners to many affordable options and will do everything possible to ensure that all cats receive safe and effective GS treatment.

The GS suppliers that reputable FIP groups like Help For FIP® recommend are trusted because the products undergo U.S.-based testing for purity and concentration before they are recommended.

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Calculating Your Cat’s Body Condition Score A cat's "ideal weight" depends on its age and, often, its specific breed. Therefore, a scale assessing a cat's fat reserves (layers of fat covering the body) is often used. This is known as a Body Condition Score (BCS) system. Veterinary professionals and owners use this technique to assess the body condition of cats and diagnose overweight or underweight conditions.

In the case of FIP, many vets prefer a body score of 5 or 6 of 9 to be considered ideal. This is because FIP can cause weight loss and muscle wasting in cats, leading to a lower BCS. However, it's important to note that the BCS system is not the only factor to consider when assessing a cat's health. Consider other factors, such as muscle mass and hydration levels. A veterinary professional can evaluate your cat's individual needs and provide tailored advice for their specific situation, so when the time comes to enter the observation period, ask your vet to assign a BCS and give this to your advisory team to assess along with the final blood values and overall assessment.

A cat body condition scale ranges from 1 to 9, with 1 indicating a cat is severely underweight (emaciated) and 9 showing a severely obese cat. A healthy cat is considered to have an ideal body condition if it scores between 4 and 5. Assessing your cat's body condition score is easy and can be done while petting it.

To calculate a cat's BCS, look at the cat from above and from the side, then look at and feel the cat's: Ribs Spine Pelvis Waist Assess the amount of: Muscle Fat

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1 Too thin Ribs, spine, and pelvic bones are easily visible on shorthaired cats Very narrow waist A small amount of muscle No palpable fat on the rib cage

Severe abdominal tuck

2 Too thin Ribs are easily visible on shorthaired cats Very narrow waist Loss of muscle mass No palpable fat on the rib cage Very pronounced abdominal tuck

3 Too thin Ribs visible on shorthaired cats Obvious waist A very small amount of abdominal fat

Marked abdominal tuck

4 Ideal Ribs are not visible but are easily palpable Obvious waist Minimal amount of abdominal fat

5 Ideal Well proportioned Ribs are not visible but are easily palpable Obvious waist A small amount of abdominal fat Slight abdominal tuck Page 45

6 Above ideal Ribs not visible but palpable

Waist not clearly defined when seen from above

There’s a very slight abdominal tuck

7 Overweight Ribs are difficult to palpate under the fat Waist barely visible No abdominal tuck Rounding of the abdomen with moderate abdominal pad

8 Obese Ribs not palpable under the fat Waist not visible Slight abdominal distension

9 Obese Ribs not palpable under a thick layer of fat Waist absent Obvious abdominal distension Extensive abdominal fat deposits

Graphics and descriptions are the property of Royal Canin and are used with permission.

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Written by: Debra Roberts www.helpforFIP.com Did you know that Diatomaceous Earth (DE) FOOD GRADE, known for treating insect pests, is also a natural alternative to chemical-based flea, parasite, and deworming treatments for your cat?

Diatomaceous earth is a chalky powder of amorphous silica from fossilizing tiny marine organisms and diatoms in freshwater rivers and lakes. DE is known for attacking bugs that have soft bodies. It can be used as a natural insecticide or detox agent for your pet. It's not without some risks, but if used correctly, the benefits outweigh the risks and are far less harmful than vet-prescribed or over-the-counter treatments for parasites, fleas, ticks, and worms. You'll need the food-grade DE used for human consumption, so please purchase with the focus and intention of not buying the pesticide version.

The principle behind DE for flea and parasite control is the microscopic sharpness of the powdered components.

When DE comes in contact with a flea, tick, or other arthropods and worms, the shard-like components scratch and abrade the exoskeleton and damaging it. The absorbent properties of the material then absorb oils and fats from the insect's skin, leading to desiccation or drying and eventual death of the pest.

Benefits of Diatomaceous Earth Eliminates fleas, mites, and ticks Detoxes your pet's body of parasites It helps eliminate intestinal roundworms, hookworms, pinworms, lungworms It helps cleanse the digestive system It provides some trace minerals It helps with skin issues It helps with digestive issues By aiding the digestive system, it helps improve liver function It helps improve overall nutrient absorption Natural source of silica DE can be given orally for deworming.

DE can be applied topically as a flea or tick treatment.

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As a preventative, get an empty spice shaker and add DE. You can lightly dust your pet's fur, paying close attention to avoid the eyes.

Dust the neck area to prevent your pet from licking it off. This is not harmful but will hinder its ability to kill the bugs. A little goes a very long way.

For parasites and worms, administer on an empty stomach over a few weeks to eliminate the cycles for both the adults and to kill any eggs. Once you start, don't break the cycle so all parasites are flushed from the body to avoid toxicity. Please work with your vet to determine the time needed for your pet's specific condition.

Mix DE with water and slowly syringe it into your pet's mouth. Observe your pet for any changes, as giving too much too fast can cause a rapid detox.

Monitor your pet for changes outside of their normal behavior. If your pet becomes constipated, reduce the dosage slightly. Your pet should be able to continue eliminating as normal without any straining or constipation.

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Recommendations as a dewormer and dietary supplement dissolved in water: For small cats and kittens weighing less than seven pounds (3 kilograms): ½ teaspoon For cats weighing 7 to 13 pounds (3 to 6 kilograms): 1 teaspoon For cats weighing more than 13 pounds (>6 kilograms): 1½ teaspoons No specific amounts are available for topical or environmental use.

Avoid directly breathing in the powder.

Don't use it with pregnant or nursing pets.

To order: https://amzn.to/3Dev5ZM

Visit www.helpforFIP.com for more great articles like this.

Disclaimers & Copyright Disclaimers for Help For FIP® by Luna's Legacy LLC If you need more information or have questions about our site's disclaimer, please email us at helpforfip@gmail.com.

All the information in this book and on our websites - https://www.lunasfiplegacy.com and https://www.helpforfip.com is published in good faith and for general information purposes only. Help For FIP® by Luna's Legacy LLC does not make any warranties about the completeness, reliability, and accuracy of this information. Any action you take based on the information you find in this book or the above websites is strictly at your own risk. Help For FIP® by Luna's Legacy LLC will not be liable for any losses and damages concerning using our book or websites.

You can visit other websites from our digital book and website by following hyperlinks to such external sites. While we strive to provide only quality links to useful and ethical websites, we have no control over the content and nature of these sites. These links to other websites do not imply a recommendation for all the content found on these sites. Site owners and content may change without notice and occur before we can remove a link that may have gone bad.

Please also be aware that other sites may have different privacy policies and terms beyond our control when you leave our websites. Please check the Privacy Policies of these sites and their "Terms of Service" before engaging in any business or uploading any information.

Consent By using our book, digital book, or websites, you consent to our disclaimer and agree to its terms.

Update Should we update, amend, or make any changes to this document, those changes will be prominently updated.

Copyright © Help for FIP® 2023 All Rights Reserved All files and information contained here are copyrighted by Help for FIP® by Luna's Legacy LLC. They may not be duplicated, copied, modified, or adapted in any way without our written permission.

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References IDEXX Reference Laboratories. (2015, April). IDEXX Reference Laboratories now offers the Feline Infectious Peritonitis (FIP) Virus RealPCRTM Test to aid in the diagnosis of this devastating feline disease. 1-5.

Julie K. Levy, D. P. (n.d.). Overview of Feline Infectious Peritonitis. Retrieved from Merck Veterinary Manual: http://www.merckvetmanual.com/generalized-conditions/feline infectious-peritonitis/overview-of-feline-infectious-peritonitis Niels C Pedersen, D. P. (2009, January 13). A synopsis of feline infectious peritonitis virus infection. Retrieved from sockfip.org: http://www.sockfip.com/pdf/FIP_Synopsis_Jan13_09.pdf Olah DVM, G. (2018).

Pedersen, N. (2014). An update on feline infectious peritonitis: diagnostics and therapeutics.

The Veterinary Journal, 201, 133-141. Shea DVM, D. P. (2018).

WINN Feline Foundation. (2017, June). Ending FIP, Is There Hope? A Summary of Dr. Niels Pedersen’s Presentation at the Winn Feline Foundation Symposium. Chicago: WINN Feline Foundation.

Pedersen, Niels C, et al. “Efficacy and Safety of the Nucleoside Analog GS-441524 for Treatment of Cats with Naturally Occurring Feline Infectious Peritonitis.” Journal of Feline Medicine and Surgery, U.S. National Library of Medicine, Apr. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6435921/.

Pedersen, Niels. Diluting GS441524 for Administration, 2022. Private email Kitten Lady, https://www.kittenlady.org/fluids. Accessed 4 Sept. 2023.

Dr. Niels Pedersen DVM, p. (n.d.). Summary of GS-441524 treatment for FIP. Retrieved from Center for Companion Animal Health: https://ccah.vetmed.ucdavis.edu/sites/g/files/dgvnsk4586/files/inlinefiles/Summary%20of%20GS-441524%20treatment%20v5.pdf Dr. Niels Pedersen DVM, personal discussions

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Our Savannah cat, Luna, is the first cat from the 2017 GS441524 drug trial with Dr. Niels Pedersen held in 2017.

Luna is seven years old as of January 2024 and 6.5 years cured. I'm proud to support this ground-breaking research that changed veterinary history and the lives of cat owners everywhere. Our involvement with the trial and the confusion and misinformation surrounding the treatment led me to write this handbook to help those opting to selftreat their cats for FIP using the off-market treatment GS441524.

I’m a Registered Nurse, a writer, and owner of five Savannah cats. My husband Jamison created our helpful website and treatment tracking application, www.helpforfip.com.” We aim to help owners understand this ground-breaking yet unconventional mode of saving their cats. FIP is an overwhelming, 100% fatal diagnosis. If you act fast and follow the FIP experts' guidelines and protocol outlined in this book, you have a >90% chance to save your cat, just like Luna and now tens of thousands of cats worldwide.

Debra Roberts Author

I've been an animal lover and rescuer since childhood.

I attended Veterinary Technician school at Stautzenberger College. I operate a non-profit cat rescue, Embrace Rescue, in Cleveland, Ohio, with my dear friend. We rescue special needs and death row cats from other cities and neonates.

I've treated and cured two FIP cats, Dewey 2021 and Finnegan 2022, of Effusive FIP. Both are "foster fail" cats due to their treatment and are still with me and thriving today!

I have one son who also helps with my rescue. I also hold a degree in Art Therapy and love working with many mediums. I draw and paint animals, and I also draw portraits and make mini albums.

An example of my art work

Charity Semczyszyn

My sketched portrait of my survivor, "Finnegan"