1 00:00:05,380 --> 00:00:08,810 Nathalie Dowgray: Hello, welcome to the April episode of Chattering with ISFM. 2 00:00:09,469 --> 00:00:13,469 I'm Nathalie Dowgray, Head of ISFM and host of this month's podcast. 3 00:00:14,399 --> 00:00:18,900 First up this month, iCatCare's own Yaiza Gomez Mejias is speaking with 4 00:00:18,900 --> 00:00:21,590 Cecilia Villaverde on feline nutrition. 5 00:00:22,240 --> 00:00:25,449 In particular, how much protein should there be in a cat's diet? 6 00:00:26,400 --> 00:00:30,009 And we're also featuring our monthly JFMS Clinical Spotlight interview. 7 00:00:30,665 --> 00:00:35,725 This month we're celebrating the release of the new 2024 ISFM and 8 00:00:35,725 --> 00:00:41,115 AAFP consensus guidelines on the long-term use of nonsteroidals in cats. 9 00:00:42,214 --> 00:00:46,855 Kelly St Denis is speaking with doctors Sam Taylor, Paulo Steagall and Duncan 10 00:00:46,855 --> 00:00:49,504 Lascelles on these useful new guidelines. 11 00:00:50,285 --> 00:00:58,664 Yaiza Gomez Mejias: So hello Ceci, welcome to the ISFM podcast 12 00:00:58,664 --> 00:01:00,135 and thank you for being here. 13 00:01:00,365 --> 00:01:06,534 So we know the cats are strict carnivores but what does this exactly mean? 14 00:01:06,625 --> 00:01:08,975 Cecilia Villaverde: When people hear that cats are carnivores, they think 15 00:01:08,985 --> 00:01:10,884 they should only eat meat, right? 16 00:01:10,885 --> 00:01:13,265 That's definitely not what being a carnivore means. 17 00:01:13,374 --> 00:01:18,110 It means that they at least part of their diet must come from animal tissue. 18 00:01:18,170 --> 00:01:23,000 The reason cats are strict carnivores is there's a variety of nutrients that are 19 00:01:23,130 --> 00:01:27,850 either more abundant or more bioavailable in animal tissue compared to plant tissue. 20 00:01:27,899 --> 00:01:29,089 Cats need retinol. 21 00:01:29,109 --> 00:01:33,880 They cannot use beta carotene and retinol is more abundant in animal tissue. 22 00:01:34,160 --> 00:01:36,440 Arachidonic acid is another example. 23 00:01:36,460 --> 00:01:39,270 There's a fatty acid that's much more abundant in animal 24 00:01:39,270 --> 00:01:40,509 tissue compared to plants. 25 00:01:40,520 --> 00:01:45,455 So a lot of these things is what makes the cat a strict carnivore because they 26 00:01:45,455 --> 00:01:50,785 need those nutrients in those amounts and in those chemical forms to be used. 27 00:01:51,164 --> 00:01:56,685 Cats compared to an omnivore like the dog, they require twice as much protein than 28 00:01:56,685 --> 00:02:01,374 they need, and definitely the diet that they have evolved eating that's prey-based 29 00:02:01,395 --> 00:02:02,854 meets all of those things, right? 30 00:02:02,854 --> 00:02:06,155 Yaiza Gomez Mejias: How reaching the protein target? 31 00:02:06,485 --> 00:02:12,485 Would you say it's easier to reach the protein target with the raw or home cooked 32 00:02:12,495 --> 00:02:15,105 food than with the commercial diets? 33 00:02:15,145 --> 00:02:18,585 And is there a difference between canned and dry food? 34 00:02:18,645 --> 00:02:19,185 Cecilia Villaverde: For sure. 35 00:02:19,255 --> 00:02:22,434 And I think sometimes the confusion is confusing the ingredient 36 00:02:22,455 --> 00:02:23,525 with the nutrient, right? 37 00:02:23,564 --> 00:02:28,365 And we'll be talking about cats and being carnivores and meat usually associated 38 00:02:28,365 --> 00:02:34,100 to protein, so sometimes it's, Oh, okay, if we're feeding a diet that's maybe raw 39 00:02:34,109 --> 00:02:38,299 or homemade, that potentially we could make it with more meat, for example. 40 00:02:38,749 --> 00:02:42,209 You could reach your protein goals with any form to be fair. 41 00:02:42,540 --> 00:02:44,619 Like they're not as high as people think. 42 00:02:44,849 --> 00:02:48,589 When you look at, for example, in Europe, the recommendations for minimum 43 00:02:48,589 --> 00:02:53,540 protein come from FEDIAF, and their minimum for cat is about 23 percent 44 00:02:53,540 --> 00:02:58,239 calories, we say, and most diets in the market are 30 percent or above. 45 00:02:58,674 --> 00:03:01,345 Dry diets can meet this, wet diets can meet this. 46 00:03:02,024 --> 00:03:04,265 It's not a problem number wise. 47 00:03:04,305 --> 00:03:07,424 Then the other thing is the quality of the protein, the amino 48 00:03:07,425 --> 00:03:08,635 acid profile of that protein. 49 00:03:08,644 --> 00:03:10,394 And that's going to be affected by processing. 50 00:03:10,515 --> 00:03:14,464 Wet food, the processing to making pet food, it's called retorting, 51 00:03:14,695 --> 00:03:16,154 and that's pretty high temperature. 52 00:03:16,334 --> 00:03:19,964 Formulators need to be very careful that when they make wet food, that 53 00:03:19,964 --> 00:03:21,375 protein quality is maintained. 54 00:03:21,834 --> 00:03:23,535 For dry food, you do extrusion. 55 00:03:24,035 --> 00:03:27,495 It is a slower temperature than retorting, but it can also 56 00:03:27,505 --> 00:03:29,015 affect protein digestibility. 57 00:03:29,435 --> 00:03:31,145 And it all depends on your ingredients. 58 00:03:31,155 --> 00:03:35,924 Some, the fact of cooking it, like when making wet food or dry food can 59 00:03:35,924 --> 00:03:37,484 actually increase the digestibility. 60 00:03:37,974 --> 00:03:40,704 But for some amino acids, it might decrease. 61 00:03:40,894 --> 00:03:45,155 So it's very important that the person who's making the diet knows that and 62 00:03:45,165 --> 00:03:48,155 takes that into account to ensure that the final product is correct. 63 00:03:48,725 --> 00:03:52,745 For homemade diet, potentially the processing is milder. 64 00:03:53,125 --> 00:03:57,635 So you could get a higher digestibility of the protein, which again, in 65 00:03:57,635 --> 00:03:58,905 some cats may be a good idea. 66 00:03:58,915 --> 00:03:59,725 In other cats, 67 00:04:00,515 --> 00:04:01,634 it won't be a problem. 68 00:04:02,364 --> 00:04:05,635 And raw diets, even though they're perceived as less processed, 69 00:04:05,694 --> 00:04:07,735 there is also processing going on. 70 00:04:07,745 --> 00:04:12,285 Like they might be ground, they will be frozen, and all of that can also affect. 71 00:04:12,285 --> 00:04:16,219 So companies that make raw, It's not something I recommend, but if 72 00:04:16,219 --> 00:04:18,950 someone chooses to feed raw, they need to make sure that they choose a 73 00:04:18,950 --> 00:04:22,489 reliable manufacturer that does all that testing because just because 74 00:04:22,490 --> 00:04:26,459 it's not cooked, it doesn't mean that it cannot affect the digestibility 75 00:04:26,640 --> 00:04:28,990 or the quality of that protein. 76 00:04:28,990 --> 00:04:32,959 We have a very interesting study in cats where they fed them like the same 77 00:04:32,990 --> 00:04:37,730 thing, but one was, it was a whole chicken and the other was the same thing, 78 00:04:37,730 --> 00:04:39,630 but ground and made into a hamburger. 79 00:04:40,020 --> 00:04:44,430 And they found that just grounding the chicken increases digestibility 80 00:04:44,460 --> 00:04:48,130 so much, actually, because you have all these feathers and these tendons 81 00:04:48,130 --> 00:04:50,300 that were affecting digestibility. 82 00:04:50,350 --> 00:04:55,749 So, I would say you can meet your protein goals with any dietary form. 83 00:04:55,749 --> 00:04:59,349 You just want to make sure you choose a manufacturer that's actually 84 00:04:59,349 --> 00:05:03,309 testing that the protein is there in the right amounts and with the 85 00:05:03,309 --> 00:05:04,830 good quality that it should have. 86 00:05:05,960 --> 00:05:09,749 Usually wet diets can be higher in protein than dry on average. 87 00:05:10,020 --> 00:05:13,969 Not necessarily true because for dry food, you need some starch to make it. 88 00:05:14,350 --> 00:05:17,230 There's a lot of overlap and the fact that it's higher in protein, is 89 00:05:17,230 --> 00:05:21,719 not necessarily beneficial for the health of any cat in most cases. 90 00:05:21,790 --> 00:05:25,200 Yaiza Gomez Mejias: You need a smaller volume of wet food to 91 00:05:25,210 --> 00:05:28,030 feed the same amount of protein? 92 00:05:28,500 --> 00:05:31,940 Cecilia Villaverde: Not necessarily no, because wet food, you 93 00:05:31,940 --> 00:05:33,490 have a lot of moisture, right? 94 00:05:33,870 --> 00:05:38,539 Every time I do a feeding plan for a cat, there's three things I want answered, like 95 00:05:38,539 --> 00:05:40,380 what do I feed, how much and how, right? 96 00:05:40,789 --> 00:05:45,340 So if we focus on what and how much, the what is the diet, there's a lot of things 97 00:05:45,349 --> 00:05:46,640 that are going to affect that choice. 98 00:05:47,280 --> 00:05:50,039 And, for example, between dry and wet, that's also going to be 99 00:05:50,039 --> 00:05:55,159 depending on client and patient preferences, the budget, any health 100 00:05:55,210 --> 00:05:58,569 issues that we might want to push more water into that cat, et cetera. 101 00:05:58,590 --> 00:06:02,330 But the how much is determined by the calories or the 102 00:06:02,330 --> 00:06:03,630 energy that this cat needs. 103 00:06:03,960 --> 00:06:09,210 So think about dry food only has 10 percent moisture, wet food has about 104 00:06:09,300 --> 00:06:13,080 70, ballpark, this is going to vary depending on the product, but I need to 105 00:06:13,080 --> 00:06:18,710 feed four times more to meet energy needs from a wet food than for a dry food. 106 00:06:19,250 --> 00:06:22,240 So that's why I say dry food sometimes can be your friend. 107 00:06:22,490 --> 00:06:25,609 If you have a cat that doesn't have a lot of appetite and waxing 108 00:06:25,610 --> 00:06:29,260 and waning and thin, having dry food that you can leave out. 109 00:06:29,689 --> 00:06:32,570 And then when the cat is hungry, something's going to be there. 110 00:06:32,820 --> 00:06:34,950 More calories can be super helpful. 111 00:06:35,120 --> 00:06:38,810 So both dry and wet have their pros, have their cons, 112 00:06:39,275 --> 00:06:42,805 but you're always going to need to eat much more of the wet than the dry to 113 00:06:42,805 --> 00:06:46,185 meet your calorie and your nutrient needs just because of that moisture. 114 00:06:46,844 --> 00:06:47,385 Yaiza Gomez Mejias: Brilliant. 115 00:06:47,435 --> 00:06:49,365 This has been so helpful. 116 00:06:49,385 --> 00:06:52,884 I think this will facilitate my conversations with my clients. 117 00:06:52,955 --> 00:06:54,025 Thank you so much for your time. 118 00:06:55,415 --> 00:06:58,545 Nathalie Dowgray: And now it's over to Kelly St Denis and she's going to be 119 00:06:58,545 --> 00:07:05,025 speaking with authors on our 2024 ISFM and AAFP consensus guidelines and the 120 00:07:05,025 --> 00:07:08,984 long term use of of NSAIDs in cats. 121 00:07:09,594 --> 00:07:13,615 She's going to be joined by Sam Taylor, Paulo Steagall and Duncan Lascelles. 122 00:07:15,349 --> 00:07:18,340 Kelly St Dennis: Dr Lascelles, if you could just talk a little bit about these 123 00:07:18,340 --> 00:07:22,750 guidelines and how we identify chronic pain in cats, what are some of the 124 00:07:22,760 --> 00:07:24,049 things that we are going to look for? 125 00:07:24,050 --> 00:07:26,830 Is it specific conditions, specific clinical signs? 126 00:07:27,219 --> 00:07:31,279 Duncan Lascelles: I think a major update in terms of these guidelines 127 00:07:31,599 --> 00:07:36,130 is the new information on the identification of persistent, 128 00:07:36,469 --> 00:07:40,690 longstanding, maladaptive chronic pain, depending on the term you want to use. 129 00:07:41,349 --> 00:07:48,100 And I think you can see the shift from rather generic descriptions of behaviours 130 00:07:48,100 --> 00:07:53,450 that may or may not be altered, to now some more specifics around behaviours 131 00:07:53,469 --> 00:07:55,520 to look for, behaviours to watch for. 132 00:07:55,849 --> 00:07:58,250 We've got emphasis on caregivers. 133 00:07:58,550 --> 00:08:03,999 We've got emphasis on the behavioural aspects of identification of pain. 134 00:08:04,000 --> 00:08:06,549 We've got emphasis on cat behaviour. 135 00:08:07,225 --> 00:08:13,215 There's beautiful sections on what normal cat behaviour is, what cat needs are. 136 00:08:13,855 --> 00:08:22,115 And I think for me, all of these areas start to talk to the biopsychosocial 137 00:08:22,245 --> 00:08:26,215 model of pain, the biology of pain, and how to manage that. 138 00:08:26,305 --> 00:08:30,815 The psychological aspects of pain around behaviour and how to manage 139 00:08:30,815 --> 00:08:33,435 that by addressing that needs 140 00:08:33,695 --> 00:08:37,965 and they talk about the social aspects because we bring in the caregiver 141 00:08:37,965 --> 00:08:39,615 and support for the caregiver. 142 00:08:40,230 --> 00:08:41,090 Kelly St Dennis: And I do love that. 143 00:08:41,120 --> 00:08:44,380 And that's so much of what we've started to see in our focus is 144 00:08:44,449 --> 00:08:48,550 in all of our guidelines, in our literature through the AAFP and ISFM. 145 00:08:48,599 --> 00:08:53,119 And that emotional aspect of pain, there's such a fantastic section on 146 00:08:53,460 --> 00:08:57,380 pain not just being a sensory experience but also part of the emotional 147 00:08:57,400 --> 00:08:59,890 complex of fear, anxiety, frustration. 148 00:09:00,400 --> 00:09:03,580 Sam, did you want to tell us a little bit about how pain is 149 00:09:03,580 --> 00:09:06,450 an emotional experience and how that's addressed in the guidelines? 150 00:09:07,155 --> 00:09:10,475 Sam Taylor: In the last few years, I've really tried to understand 151 00:09:10,475 --> 00:09:14,305 that relationship between anxiety, fear, and pain, and not 152 00:09:14,305 --> 00:09:16,095 being able to pull those apart. 153 00:09:16,385 --> 00:09:18,835 And if you think about it, it actually makes sense. 154 00:09:19,224 --> 00:09:19,675 To me, 155 00:09:19,894 --> 00:09:23,925 if you have a cat who is fearful, then their experience of pain 156 00:09:24,244 --> 00:09:28,355 could be different to a cat who is not fearful, and vice versa. 157 00:09:28,425 --> 00:09:32,390 I know that in human medicine, if you're in pain, then your other 158 00:09:32,439 --> 00:09:35,780 emotions like fear and anxiety are going to also be heightened. 159 00:09:35,790 --> 00:09:39,099 And I think for our older cats, their tolerance of stressful 160 00:09:39,099 --> 00:09:41,900 situations is going to be much lower if they're in chronic pain. 161 00:09:42,050 --> 00:09:46,849 If you encounter a novel and frightening situation and you have chronic pain, then 162 00:09:46,849 --> 00:09:50,540 your reaction is going to be different to if you don't have chronic pain. 163 00:09:50,550 --> 00:09:53,739 So I guess what I mainly learnt is that it is impossible to 164 00:09:53,810 --> 00:09:55,500 pull those experiences apart. 165 00:09:55,560 --> 00:10:02,410 To me controlling pain is a key part of improving a cat's experience of life, 166 00:10:02,430 --> 00:10:06,079 really, and that goes hand in hand with controlling stress, anxiety and fear. 167 00:10:07,235 --> 00:10:08,205 Kelly St Dennis: That's amazing. 168 00:10:08,525 --> 00:10:09,715 A wonderful description. 169 00:10:09,715 --> 00:10:10,095 Thank you. 170 00:10:10,185 --> 00:10:13,505 So when we're talking about NSAIDs and people are prescribing, say, in 171 00:10:13,505 --> 00:10:18,344 acute pain situations, what are we going to ask our clinicians to tell 172 00:10:18,344 --> 00:10:20,214 the caregivers to be monitoring for? 173 00:10:20,214 --> 00:10:22,164 When should they stop using non steroidals? 174 00:10:22,205 --> 00:10:23,844 Or has anything changed with that? 175 00:10:24,214 --> 00:10:26,725 And Paulo, maybe you want to address that question? 176 00:10:27,525 --> 00:10:31,715 Paulo Steagall: I would start with the basics and the classic questions. 177 00:10:31,815 --> 00:10:35,785 You want to make sure that the patient is drinking and eating normally. 178 00:10:36,235 --> 00:10:40,705 The anorexia, it's actually the first clinical sign that you would see in 179 00:10:40,714 --> 00:10:43,404 most studies leading to adverse effects. 180 00:10:43,415 --> 00:10:48,164 So I would be very concerned to give an NSAIDs in a patient that is not 181 00:10:48,224 --> 00:10:50,785 eating as one of the first GI signs. 182 00:10:50,844 --> 00:10:54,535 But in terms of in the acute pain scenario, I think that would be 183 00:10:54,535 --> 00:10:58,704 the first thing in making sure that there are no comorbidities involved. 184 00:10:59,095 --> 00:11:03,525 And if these comorbidities are involved, such as CKD, you want to make sure you 185 00:11:03,525 --> 00:11:05,965 know how stable that is and so forth. 186 00:11:06,455 --> 00:11:11,365 So I think the take home message is to really look at a patient on a case 187 00:11:11,365 --> 00:11:16,034 by case basis before determining what you're going to do at the end of the day. 188 00:11:16,595 --> 00:11:20,355 I will push for a dose of non steriodals towards the end of the procedures. 189 00:11:20,675 --> 00:11:26,220 So I think we have to be careful with the myths and facts about non steroidals and 190 00:11:26,230 --> 00:11:30,410 making sure that we're a bit more black and white in terms of contraindications. 191 00:11:31,570 --> 00:11:34,899 Is there a contraindication or not, or is just you're being 192 00:11:34,920 --> 00:11:36,650 fearful of giving that drug? 193 00:11:37,260 --> 00:11:40,579 Kelly St Dennis: In the guidelines, some hot topics that seem to come up 194 00:11:40,590 --> 00:11:45,120 often when I lecture are interactions for potential for non-steroidals with, 195 00:11:45,270 --> 00:11:51,535 say, frunevetmab, in terms of any concerns with interactions, risks of 196 00:11:51,535 --> 00:11:53,625 chronic kidney disease or kidney issues. 197 00:11:54,105 --> 00:11:56,685 What are your thoughts on what we know about that at this stage? 198 00:11:57,155 --> 00:12:00,864 Duncan Lascelles: I think the one that comes to the top of the pile all the time 199 00:12:00,864 --> 00:12:05,854 is, can we concurrently use an anti-NGF, anti-nerve growth factor, monoclonal 200 00:12:05,854 --> 00:12:12,285 antibody and nonsteroidals, and, very briefly, because of some side effects 201 00:12:12,505 --> 00:12:18,815 seen at a relatively low level in humans, that combination is still of concern 202 00:12:18,815 --> 00:12:23,015 to us, even though those side effects have not, to my knowledge, been seen in 203 00:12:23,015 --> 00:12:28,355 cats, and those concerns revolve around rapidly progressing osteoarthritis. 204 00:12:28,495 --> 00:12:33,354 That's come over from the human side and has led a lot of people to 205 00:12:33,354 --> 00:12:35,225 be concerned about concurrent use 206 00:12:35,375 --> 00:12:40,690 and, honestly, in the face of a lack of knowledge about what happens 207 00:12:40,700 --> 00:12:44,990 when they're used concurrently, my stance would be to avoid the 208 00:12:44,990 --> 00:12:46,520 concurrent use until we know more. 209 00:12:46,809 --> 00:12:50,369 And I think probably short-term use, a few days, a couple of weeks, 210 00:12:50,590 --> 00:12:53,379 is going to be fine because it really was the long term use in 211 00:12:53,379 --> 00:12:55,230 humans where those issues were seen. 212 00:12:55,875 --> 00:12:57,895 Paulo Steagall: But this is quite interesting, Duncan 213 00:12:57,945 --> 00:12:59,645 and Kelly and Sam as well. 214 00:12:59,645 --> 00:13:04,975 But I don't know what's your feedback on this, but what would be the cases or the 215 00:13:04,975 --> 00:13:07,795 reasons of using both drugs together? 216 00:13:08,235 --> 00:13:13,435 Would it be that, cases that are, you have severe OA that is refractory to 217 00:13:13,435 --> 00:13:15,575 non-steroidal, what's going on there? 218 00:13:15,585 --> 00:13:17,005 Duncan Lascelles: I think that's a really good point, Paulo. 219 00:13:17,005 --> 00:13:18,015 Thanks for bringing that up. 220 00:13:18,025 --> 00:13:20,615 Because I think that's almost a red flag to me. 221 00:13:20,695 --> 00:13:25,939 If you think you need both non-steroidals and an anti NGF mAb, you probably 222 00:13:25,939 --> 00:13:29,950 need to look at that cat again and really ask, what is going on? 223 00:13:30,190 --> 00:13:33,350 What is behind the signs that we are seeing? 224 00:13:33,530 --> 00:13:34,990 Kelly St Dennis: That was a really great point. 225 00:13:35,009 --> 00:13:35,620 Thank you. 226 00:13:35,879 --> 00:13:39,870 Just want to remind everyone that the April Journal of Feline Medicine and 227 00:13:39,870 --> 00:13:45,710 Surgery will be seeing the 2024 ISFM and AAFP consensus guidelines on the longterm 228 00:13:45,710 --> 00:13:47,850 use of NSAIDs and cats landing there. 229 00:13:47,880 --> 00:13:52,290 It is open access, so you can access that guideline as well as all of 230 00:13:52,299 --> 00:13:55,620 the other JFMS and JFMSOR content. 231 00:13:56,100 --> 00:13:57,230 Thank you again, everyone. 232 00:14:04,260 --> 00:14:05,329 Nathalie Dowgray: Thank you for listening. 233 00:14:05,439 --> 00:14:09,249 If you're an ISFM member, don't forget, you can access the full version of 234 00:14:09,249 --> 00:14:13,659 the podcast and all the other ISFM member benefits, including Congress 235 00:14:13,659 --> 00:14:18,279 recordings, monthly webinars, clinical club, the discussion forum, and much, 236 00:14:18,299 --> 00:14:21,309 much more at portal.icatcare.org. 237 00:14:21,555 --> 00:14:26,215 If you're looking for more CPD from ISFM, we have a number of open access webinars 238 00:14:26,225 --> 00:14:30,405 going live in May, so do keep an eye on our social media for more information. 239 00:14:31,085 --> 00:14:33,195 We'll be back again next month with another episode. 240 00:14:33,714 --> 00:14:36,525 If you don't want to miss out, do make sure you've signed up to Chattering With 241 00:14:36,525 --> 00:14:39,365 ISFM on your preferred podcast platform.