Veterinary Ethics and a Spotlight on the Feline Skin Biome

Show Notes

This month Dr. Karen Hiestand sits down with Dr. Nathalie Dowgray to talk about ethics in veterinary medicine. We're also featuring our monthly JFMS clinical spotlight interview in which Dr Kelly St Denis discusses the feline skin microbiome with Dr. Alison Diesel.


To begin our episode, Nathalie is joined by Veterinary and Animal Ethics Lecturer and
Researcher Dr Karen Heistand. They discuss the intricacies of balancing personal ethical views with those of caregivers or colleagues. Karen shares how she manages difficult ethical decisions and how we can improve things in practice.


Kelly St Denis then sits down with Dr. Alison Diesel to discuss her JFMS clinical spotlight article The feline skin microbiome: interrelationship between health and disease as well as a wider discussion on Skin disease and dermatology.

For further reading material please visit:
https://journals.sagepub.com/doi/10.1177/1098612X231180231

Host:

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

Speakers:

Dr Karen Heistand, BVSc, BSc, MSc, MA, MRCVS, Lecturer and Researcher in Animal and Veterinary Ethics

Dr 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

Dr Alison Diesel, DVM, DACVD, Veterinary Dermatologist and JFMS Spotlight Author

For ISFM members, the full recording of this discussion 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

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 and
welcome to the July 2023 episode

of chattering with ISFM. I'm
Nathalie Dowgray here, Head of

ISFM and the host of this
month's podcast. First up this

month we're in conversation with
Dr. Karen Hiestand. And we're

going to be talking about
veterinary ethics. We're also

featuring our monthly JFMS
clinical spotlight interview.

And this month, Dr. Kelly St
Denis is going to be talking to

Dr. Alison Diesel about the
feline skin microbiome. We hope

you enjoy this episode.
So how do we as veterinarians

make our ethical decisions?
There's a lot of factors that

are out of our control, both the
fun things about working with

cats, but also, there's a lot of
owner factors that implicate,

quite strongly sometimes, on the
clinical decision making that

we're making, which may in turn,
compromise our ethics sometimes.

Karen Hiestand: Usually. I
actually think that that

medicine for the entire vet team
is one of the most ethically

challenging roles that anyone
can have, it's far more

ethically challenging the
medical doctors and at the

essence, that's because we don't
have central tenant to what we

do. Doctors do. They're meant to
keep people alive and cause no

harm. And everyone agrees on
that, people don't agree about

animals. Everyone has different
opinions about animals in

general, they have different
opinions about different

species, they have different
opinions about different

individuals of a species in a
different context, that pet cat

matters more than that stray
cat. So everyone has a different

view as to what matters morally
when it comes to animals, which

makes our job to treat them
incredibly difficult. Because we

have to navigate all of those
different opinions all the time.

You as part of the veterinary
team will have your view about

the moral worth of individual
animals that you're seeing, but

the person bringing them to you,
who in our context owns them, is

going to have their own
individual view of the moral

worth of that individual. And
those two opinions may not gel

at all. So you might find
yourself at very opposing ends

of where you place the moral
value of the animal on the

table. And that can be
incredibly challenging to

navigate. When you are trying to
go one way they might be trying

to go another and it means we
can be incredibly compromised.

There's a huge literature on
something called moral distress.

And moral distress is when you
know what you should do.

According to your morals, you
can't do it, because you're not

the decision maker. So human
nurses experience this hugely.

And there's been a really good
bunch of research done looking

at mental health impacts of
that. Now, I would argue that

pretty much everyone in the
veterinary team is in that

situation, nurses even more so
because you're not necessarily

the decision maker. And you're
often doing things that you may

not agree with. But vets are to
because of property law, because

of ownership, we don't always
get to make decisions, owners

are the legal ones who can make
a decision and we can't legally

overrule them. And if you take
that a step further, this is

getting quite intense. But we
can be the instruments of harm

or what we consider to be harms.
And when our guiding principle

or our ethics is telling us
we're here to help an animal and

then we are what we might
consider hurting it. That can be

incredibly destructive to us.
The concept of ethics rounds in

vet practices can actually help
vets in practice, especially

with this moral distress.
Hindsight is a wonderful thing.

Yeah, and being able to sit down
in a structured way to talk

through not the clinical aspects
of the case, because we can all

go on about that forever. It's
the ethical aspects of the case.

It's how it made us feel okay,
and what we thought about it,

and being able to openly talk
about that with colleagues is

hugely important. We all have
these cases, we need to be able

to talk about these with
colleagues, I grant you, it's

more difficult when you're not
in a practice with them. But

that tells me then that within
that framework of doing these

kind of home euthanasias, that's
a framework that we need to set

that up then, there needs to be
a way to open the dialogue. But

within practice, I think it
could be hugely beneficial to

discuss these cases after the
fact. And I know that you found

this in shelter care, when we
went too far with a case.

Everyone gets attached, and you
just end up doing too much.

Those are really good cases to
discuss, to sit around and talk

about after the fact and learn
from them. So you can make those

decisions as you talked about
beforehand, before you go down

that road.

Nathalie Dowgray: Yeah, it's a
lot easier to have those

decision making tools in place
before there's an animal in

front of you.
If you want to hear more from

Karen, ISFM veterinary members
can access her lectures and our

virtual Congress from 2022, and
also 2023, in the event section

of our portal. And now we're
going over to Kelly St Denis

who's talking with Dr. Alison
Diesel on her JFMS clinical

spotlight article, the feline
skin microbiome,

interrelationship between health
and disease. Don't forget that

JFMS is an open access journal
now and the link to read the

full article is in the show
notes.

Alison Diesel: There's nothing
out there on allergies and cats.

That's exactly why I want to do
something like that.

Kelly St Denis: And are you
finding, just out of curiosity,

if you're starting to see more
cats coming to secondary

referral practice than you used
to?

Alison Diesel: Yeah, for sure.
Definitely does seem that owners

are bringing their cats in as
well, recognising the fact that

there is skin disease in cats.
And so it's nice to actually see

this species starting to come
into the clinics a bit more too.

One of the biggest frustrations
right in feline dermatology is

that everything really looks the
same and you sit there and it's

like am I dealing with fleas or
am I dealing with something

other than fleas. Is it
allergies? It is non allergy?

Working with that is just a lot
of fun.

Kelly St Denis: Yeah, that's
really good. I'm starting to see

more skin cases in my practice,
too. So it's been interesting

learning about all of this
stuff. I think back when I was

in vet college and reading the
article, traditionally, our

understanding of the
microorganisms that live on the

feline skin have been related to
culture, live organisms that can

successfully be cultured. The
article will discuss this more

advanced technique, so the next
generation sequencing. So I

wondered if you could tell us a
little bit more about that and

what the benefits are compared
to what we've used in the past.

Alison Diesel: So the benefits
of the next generation

sequencing is that it really
does give us a hugely clear

picture about what actually is
living on our skin, as opposed

to being limited to things that
will grow out on a culture

plate, the next generation
sequencing really picks up on

everything on the DNA level. So
it's basically able to detect

all the different organisms, not
just ones that are going out, as

opposed to the historical
studies, that you'd maybe pick

up a handful of organisms that
are part of whatever disease

process or just the quote,
unquote, normal skin flora of

dogs, cats, people, etc. The
next generation sequencing

really takes it a huge step
further, where it's identifying,

like at times hundreds and 1000s
of organisms from between

bacteria, fungal organisms,
viruses, that are all part of

the normal cutaneous microbiome.
So we're just learning a lot

more, and finding the massive
diversity of these organisms

that really live on the skin.

Kelly St Denis: Yeah, it's
almost mind boggling. And then

on top of that, in the article,
you talk about the microbiome,

but also the metabolome. That's
another aspect of it, because

it's not just about the
microbiome is it, you're trying

to look at other things.

Alison Diesel: Yes, exactly.
Right now, the next generation

sequencing really focuses
primarily on what are the

organisms that are there. These
newer studies coming out are

even looking at it from the
standpoint of okay, what are the

organisms? But then also, what
are they producing? What are

their metabolites? What are the
proteins that are there as well?

Because it's not just about the
bugs, it's about the, what are

they doing? And how are they
interacting with the cutaneous

environment. And I think the
impact on grooming in this

species is might be at least a
big reason for why we're seeing

some of those differences,
especially if we're talking

about states of health and
disease. If we're seeing a shift

in the microbiome, how does that
relate to the grooming practices

of the cat? Are we seeing it
because they're, as an example,

an itchy cat? And so we're
seeing a lot more grooming where

they're now translating the
normal microbiome into something

else? Are we seeing more oral
cavity Flora coming in? That's

taking over the cutaneous aspect
of things, and or vice verse, is

the cutaneous microbiome now
infiltrating the oral cavity and

the GI tract, I think we're
gonna see a lot of interrelated

conditions here. And already in
human medicine, they talk about

the impact of the gut microbiome
on the health of the skin, I

think, especially if you're
talking about a species where

grooming is part of their just
normal behaviour, the changes

and the impacts that we might
see as part of that, and in

different states of health and
diseases is, I think, going to

be really interesting.

Kelly St Denis: Reflecting off
the GI stuff that we know, what

is your sense about how
antibiotics are going to be

possibly negatively impacting
the skin microbiome? And how to

practitioners balance that with,
well, I think the cat might have

a bacterial pyoderma, which is
more difficult to diagnose in a

cat than a dog.

Alison Diesel: I think that's
one of those things where it's

weighing the risk versus the
benefit. And if we're

benefiting, or is it you're
treating an active infection? I

think we're going to have to
take that into a well, the cat

needs antibiotics at this time,
but now downstream to your point

of how long does it take to get
back. And not only the

microbiome standpoint, but the
metabolism part of things. So

that's something that in talking
with the folks that are doing

the GI research that can be
impacted for an extended period

of time, I think this is an area
that warrants a lot of

consideration. This is an area
that especially from the ability

to use, I guess more biological
agents, as opposed to just

straight up antibiotics as an
example. So things that might

not necessarily fully negative
impact overall, but might help

to take out the more problematic
pathogenic organisms that we're

looking at it, can we do better
at targeting our therapeutics

from either a topical standpoint
or a going into the whole realm

of prebiotic/probiotic
standpoint? And is that

something that we can tap into
as far as being able to build a

bit more balance? Yeah.

Nathalie Dowgray: Thank you for
listening. If you're an ISFM

member, please don't forget you
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