Chattering With ISFM

This month Yaiza Gomez-Meijas is joined by Cecilia Villaverde to discuss feline nutrition. We are then joined by Kelly St Denis who interviews some of the authors of the 2024 ISFM and AAFP consensus guidelines on the long-term use of NSAIDs in cats.

Our first conversation between Yaiza and Cecilia features a discussion on feline nutrition, specifically protein requirements in cat diets. The conversation highlights the importance of animal tissue in a cat's diet due to essential nutrients and compares raw, homemade, and commercial food options.

Our next conversation delves into the 2024 ISFM and AAFP consensus guidelines on the long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) in cats, highlighting considerations for chronic pain management and monitoring. Kelly St Denis is joined by Sam Taylor, Paulo Steagall, and Duncan Lascelles. The guidelines address identifying chronic pain, the use of NSAIDs in cats with comorbidities, and the importance of caregiver involvement in monitoring for side effects and signs of pain relief effectiveness.

For further reading material please visit:

https://wsava.org/wp-content/uploads/2020/01/Frequently-Asked-Questions-and-Myths.pdf

https://wsava.org/committees/global-nutrition-committee/

https://journals.sagepub.com/doi/epub/10.1177/1098612X241241951

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

Host:
Nathalie Dowgray, BVSc, MANZCVS, PgDip, MRCVS, PhD, Head of ISFM, International Society of Feline Medicine, International Cat Care, Tisbury, Wiltshire, UK

Speakers:
Yaiza Gomez-Mejias, LdaVet MANZCVS (Medicine of Cats) CertAP (SAM-F) Acr AVEPA, ISFM Community Coordinator and Small Animal Clinician

Cecilia Villaverde, BVSc, PhD, DECVCN, DACVIM (Nutrition), Diplomate (Nutrition) of the ACVIM (Board-Certified Veterinary Nutritionist®), Diplomate ECVCN (EBVS® European Specialist in Veterinary and Comparative Nutrition)

Kelly St Denis, MSc, DVM, DABVP (Feline), 2022 ISFM/AAFP Cat Friendly Veterinary Environment Guidelines Co-Chair, St Denis Veterinary Professional Corporation, Powassan, Ontario, Canada

Samantha Taylor, BVetMed(Hons), CertSAM, DipECVIM-CA, MANCVS, FRCVS , ISFM Academy Lead and Specialist Veterinary Advisor to ISFM, European Veterinary Specialist in Internal Medicine and RCVS Recognised Specialist in Feline Medicine

Duncan Lascelles, BVSc, BSc, CertVA, PhD, DipECVS, DSAS(Soft Tissue), DipACVS, FRCVS, Professor in Small Animal Surgery and Pain Management, Director of the Comparative Pain Research and Education Centre (CPREC) and the Translational Research in Pain [TRiP] Program

Paulo Steagall, MV, MS, PhD, DipACVAA, Associate professor of Veterinary Anesthesiology and Pain Management, Member of the World Small Animal Veterinary Association (WSAVA) Global Pain Council, the WSAVA Dental Guidelines Committee and Chair of the WSAVA Therapeutic Guidelines Group

Creators & Guests

Host
Nathalie Dowgray

What is Chattering With ISFM?

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

Nathalie Dowgray: Hello, welcome to the
April episode of Chattering with ISFM.

I'm Nathalie Dowgray, Head of ISFM
and host of this month's podcast.

First up this month, iCatCare's own
Yaiza Gomez Mejias is speaking with

Cecilia Villaverde on feline nutrition.

In particular, how much protein
should there be in a cat's diet?

And we're also featuring our monthly
JFMS Clinical Spotlight interview.

This month we're celebrating the
release of the new 2024 ISFM and

AAFP consensus guidelines on the
long-term use of nonsteroidals in cats.

Kelly St Denis is speaking with doctors
Sam Taylor, Paulo Steagall and Duncan

Lascelles on these useful new guidelines.

Yaiza Gomez Mejias: So hello
Ceci, welcome to the ISFM podcast

and thank you for being here.

So we know the cats are strict carnivores
but what does this exactly mean?

Cecilia Villaverde: When people hear
that cats are carnivores, they think

they should only eat meat, right?

That's definitely not what
being a carnivore means.

It means that they at least part of
their diet must come from animal tissue.

The reason cats are strict carnivores is
there's a variety of nutrients that are

either more abundant or more bioavailable
in animal tissue compared to plant tissue.

Cats need retinol.

They cannot use beta carotene and retinol
is more abundant in animal tissue.

Arachidonic acid is another example.

There's a fatty acid that's
much more abundant in animal

tissue compared to plants.

So a lot of these things is what makes
the cat a strict carnivore because they

need those nutrients in those amounts
and in those chemical forms to be used.

Cats compared to an omnivore like the dog,
they require twice as much protein than

they need, and definitely the diet that
they have evolved eating that's prey-based

meets all of those things, right?

Yaiza Gomez Mejias: How
reaching the protein target?

Would you say it's easier to reach the
protein target with the raw or home cooked

food than with the commercial diets?

And is there a difference
between canned and dry food?

Cecilia Villaverde: For sure.

And I think sometimes the confusion
is confusing the ingredient

with the nutrient, right?

And we'll be talking about cats and being
carnivores and meat usually associated

to protein, so sometimes it's, Oh, okay,
if we're feeding a diet that's maybe raw

or homemade, that potentially we could
make it with more meat, for example.

You could reach your protein
goals with any form to be fair.

Like they're not as high as people think.

When you look at, for example, in
Europe, the recommendations for minimum

protein come from FEDIAF, and their
minimum for cat is about 23 percent

calories, we say, and most diets in
the market are 30 percent or above.

Dry diets can meet this,
wet diets can meet this.

It's not a problem number wise.

Then the other thing is the
quality of the protein, the amino

acid profile of that protein.

And that's going to be
affected by processing.

Wet food, the processing to making
pet food, it's called retorting,

and that's pretty high temperature.

Formulators need to be very careful
that when they make wet food, that

protein quality is maintained.

For dry food, you do extrusion.

It is a slower temperature
than retorting, but it can also

affect protein digestibility.

And it all depends on your ingredients.

Some, the fact of cooking it, like
when making wet food or dry food can

actually increase the digestibility.

But for some amino
acids, it might decrease.

So it's very important that the person
who's making the diet knows that and

takes that into account to ensure
that the final product is correct.

For homemade diet, potentially
the processing is milder.

So you could get a higher digestibility
of the protein, which again, in

some cats may be a good idea.

In other cats,

it won't be a problem.

And raw diets, even though they're
perceived as less processed,

there is also processing going on.

Like they might be ground, they will be
frozen, and all of that can also affect.

So companies that make raw, It's
not something I recommend, but if

someone chooses to feed raw, they
need to make sure that they choose a

reliable manufacturer that does all
that testing because just because

it's not cooked, it doesn't mean that
it cannot affect the digestibility

or the quality of that protein.

We have a very interesting study in
cats where they fed them like the same

thing, but one was, it was a whole
chicken and the other was the same thing,

but ground and made into a hamburger.

And they found that just grounding
the chicken increases digestibility

so much, actually, because you have
all these feathers and these tendons

that were affecting digestibility.

So, I would say you can meet your
protein goals with any dietary form.

You just want to make sure you
choose a manufacturer that's actually

testing that the protein is there
in the right amounts and with the

good quality that it should have.

Usually wet diets can be higher
in protein than dry on average.

Not necessarily true because for dry
food, you need some starch to make it.

There's a lot of overlap and the
fact that it's higher in protein, is

not necessarily beneficial for the
health of any cat in most cases.

Yaiza Gomez Mejias: You need a
smaller volume of wet food to

feed the same amount of protein?

Cecilia Villaverde: Not necessarily
no, because wet food, you

have a lot of moisture, right?

Every time I do a feeding plan for a cat,
there's three things I want answered, like

what do I feed, how much and how, right?

So if we focus on what and how much, the
what is the diet, there's a lot of things

that are going to affect that choice.

And, for example, between dry
and wet, that's also going to be

depending on client and patient
preferences, the budget, any health

issues that we might want to push
more water into that cat, et cetera.

But the how much is determined
by the calories or the

energy that this cat needs.

So think about dry food only has 10
percent moisture, wet food has about

70, ballpark, this is going to vary
depending on the product, but I need to

feed four times more to meet energy needs
from a wet food than for a dry food.

So that's why I say dry food
sometimes can be your friend.

If you have a cat that doesn't
have a lot of appetite and waxing

and waning and thin, having dry
food that you can leave out.

And then when the cat is hungry,
something's going to be there.

More calories can be super helpful.

So both dry and wet have
their pros, have their cons,

but you're always going to need to eat
much more of the wet than the dry to

meet your calorie and your nutrient
needs just because of that moisture.

Yaiza Gomez Mejias: Brilliant.

This has been so helpful.

I think this will facilitate my
conversations with my clients.

Thank you so much for your time.

Nathalie Dowgray: And now it's over to
Kelly St Denis and she's going to be

speaking with authors on our 2024 ISFM
and AAFP consensus guidelines and the

long term use of of NSAIDs in cats.

She's going to be joined by Sam Taylor,
Paulo Steagall and Duncan Lascelles.

Kelly St Dennis: Dr Lascelles, if you
could just talk a little bit about these

guidelines and how we identify chronic
pain in cats, what are some of the

things that we are going to look for?

Is it specific conditions,
specific clinical signs?

Duncan Lascelles: I think a major
update in terms of these guidelines

is the new information on the
identification of persistent,

longstanding, maladaptive chronic pain,
depending on the term you want to use.

And I think you can see the shift from
rather generic descriptions of behaviours

that may or may not be altered, to now
some more specifics around behaviours

to look for, behaviours to watch for.

We've got emphasis on caregivers.

We've got emphasis on the behavioural
aspects of identification of pain.

We've got emphasis on cat behaviour.

There's beautiful sections on what normal
cat behaviour is, what cat needs are.

And I think for me, all of these areas
start to talk to the biopsychosocial

model of pain, the biology of
pain, and how to manage that.

The psychological aspects of pain
around behaviour and how to manage

that by addressing that needs

and they talk about the social aspects
because we bring in the caregiver

and support for the caregiver.

Kelly St Dennis: And I do love that.

And that's so much of what we've
started to see in our focus is

in all of our guidelines, in our
literature through the AAFP and ISFM.

And that emotional aspect of pain,
there's such a fantastic section on

pain not just being a sensory experience
but also part of the emotional

complex of fear, anxiety, frustration.

Sam, did you want to tell us
a little bit about how pain is

an emotional experience and how
that's addressed in the guidelines?

Sam Taylor: In the last few years,
I've really tried to understand

that relationship between
anxiety, fear, and pain, and not

being able to pull those apart.

And if you think about it,
it actually makes sense.

To me,

if you have a cat who is fearful,
then their experience of pain

could be different to a cat who
is not fearful, and vice versa.

I know that in human medicine, if
you're in pain, then your other

emotions like fear and anxiety
are going to also be heightened.

And I think for our older cats,
their tolerance of stressful

situations is going to be much
lower if they're in chronic pain.

If you encounter a novel and frightening
situation and you have chronic pain, then

your reaction is going to be different
to if you don't have chronic pain.

So I guess what I mainly learnt
is that it is impossible to

pull those experiences apart.

To me controlling pain is a key part of
improving a cat's experience of life,

really, and that goes hand in hand with
controlling stress, anxiety and fear.

Kelly St Dennis: That's amazing.

A wonderful description.

Thank you.

So when we're talking about NSAIDs
and people are prescribing, say, in

acute pain situations, what are we
going to ask our clinicians to tell

the caregivers to be monitoring for?

When should they stop
using non steroidals?

Or has anything changed with that?

And Paulo, maybe you want
to address that question?

Paulo Steagall: I would start with
the basics and the classic questions.

You want to make sure that the patient
is drinking and eating normally.

The anorexia, it's actually the first
clinical sign that you would see in

most studies leading to adverse effects.

So I would be very concerned to give
an NSAIDs in a patient that is not

eating as one of the first GI signs.

But in terms of in the acute pain
scenario, I think that would be

the first thing in making sure that
there are no comorbidities involved.

And if these comorbidities are involved,
such as CKD, you want to make sure you

know how stable that is and so forth.

So I think the take home message is
to really look at a patient on a case

by case basis before determining what
you're going to do at the end of the day.

I will push for a dose of non steriodals
towards the end of the procedures.

So I think we have to be careful with the
myths and facts about non steroidals and

making sure that we're a bit more black
and white in terms of contraindications.

Is there a contraindication or
not, or is just you're being

fearful of giving that drug?

Kelly St Dennis: In the guidelines,
some hot topics that seem to come up

often when I lecture are interactions
for potential for non-steroidals with,

say, frunevetmab, in terms of any
concerns with interactions, risks of

chronic kidney disease or kidney issues.

What are your thoughts on what
we know about that at this stage?

Duncan Lascelles: I think the one that
comes to the top of the pile all the time

is, can we concurrently use an anti-NGF,
anti-nerve growth factor, monoclonal

antibody and nonsteroidals, and, very
briefly, because of some side effects

seen at a relatively low level in humans,
that combination is still of concern

to us, even though those side effects
have not, to my knowledge, been seen in

cats, and those concerns revolve around
rapidly progressing osteoarthritis.

That's come over from the human
side and has led a lot of people to

be concerned about concurrent use

and, honestly, in the face of a
lack of knowledge about what happens

when they're used concurrently,
my stance would be to avoid the

concurrent use until we know more.

And I think probably short-term
use, a few days, a couple of weeks,

is going to be fine because it
really was the long term use in

humans where those issues were seen.

Paulo Steagall: But this is
quite interesting, Duncan

and Kelly and Sam as well.

But I don't know what's your feedback on
this, but what would be the cases or the

reasons of using both drugs together?

Would it be that, cases that are, you
have severe OA that is refractory to

non-steroidal, what's going on there?

Duncan Lascelles: I think that's
a really good point, Paulo.

Thanks for bringing that up.

Because I think that's
almost a red flag to me.

If you think you need both non-steroidals
and an anti NGF mAb, you probably

need to look at that cat again
and really ask, what is going on?

What is behind the signs
that we are seeing?

Kelly St Dennis: That
was a really great point.

Thank you.

Just want to remind everyone that the
April Journal of Feline Medicine and

Surgery will be seeing the 2024 ISFM and
AAFP consensus guidelines on the longterm

use of NSAIDs and cats landing there.

It is open access, so you can access
that guideline as well as all of

the other JFMS and JFMSOR content.

Thank you again, everyone.

Nathalie Dowgray: Thank you for listening.

If you're an ISFM member, don't forget,
you can access the full version of

the podcast and all the other ISFM
member benefits, including Congress

recordings, monthly webinars, clinical
club, the discussion forum, and much,

much more at portal.icatcare.org.

If you're looking for more CPD from ISFM,
we have a number of open access webinars

going live in May, so do keep an eye on
our social media for more information.

We'll be back again next
month with another episode.

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