Hello and welcome to the December episode of Chattering with ISFM.
I'm Nathalie Dowgray, head of ISFM and host of this month's podcast.
Our clinical spotlight this month is focused on genetic testing,
practical do's and don'ts for cats.
Kelly St.
Denis will be speaking with Leslie Lyons about the practicalities of
breeding cats free of health issues.
But first, Yaiza Gomez Meijas will be discussing client
communication with Tamsin Durston.
Could you tell us what positive psychology consists of?
Positive psychology is about adding value to our lives, to the lives of the
animals that we care about, and we try to help with our daily work through giving
meaning, fulfilment and quality of life.
So it's about really thinking about how can I give this life more meaning?
How can I create the conditions in which lives can thrive.
And that means that we need to really understand what wellbeing means
for our human species and all the different animal species we care about
it's not enough to be physically well, the physiological approach
would be, I want this animal to have optimum physical fitness.
I want them to be in the best condition they can be.
But actually the positive psychology approach would say, and I want them to
feel really good all the time, because you can be in peak physical condition
and be having a really bad time.
And that's what positive psychology does.
We want people and animals to flourish, live lives that they are happy in
and that they can really enjoy, despite all the stresses of the world.
Vets need to help caregivers change their behaviour to help their pets.
Behaviour change is a term we are hearing more in the sector these
days, but can you give us an overview of this human behaviour change?
It is an emerging science.
As a clinical animal behaviourist, veterinary nurse and a dog training
instructor, what I'm trying to do is influence my clients, animal carers, to
change their behaviour, to bring about a sense of wellbeing in the animal.
With veterinary clients, we want them to comply, follow treatment
regimes, keep their appointments.
I might be asking a client to make some real life routine changes
that they might not be capable of.
If you could make these changes to your life, that would have a
dramatic impact on your animal's experience and physical health but
how do we get people to do things?
You can't tell somebody 'Just do this' because none of us do what we're told.
Behavioural change science is really about understanding those influences
on human behaviour and thinking about where, as a veterinary profession,
we have leverage in the way an individual and a society behaves.
How do we exert our influence?
How do we bring about behaviour change that's lasting?
Some of it involves changing the environment to make the
behaviour you want more likely.
How do I set the conditions to bring about the behaviour I want?
How do I make that behaviour reinforcing?
The threat of punishment doesn't really work.
In the animal world, we don't use punishment.
I don't recommend positive punishment, it creates disconnect,
that's not positive psychology.
That's feeling frightened and anxious all the time.
How do we make behaving the way we want feel good for them.
It is difficult because every single person and every
single animal is so unique.
They have their own motivations.
It's about thinking we won't be able to influence everybody, but how do we
connect with most people to bring about the behaviour we want and then hope
that other people will then see that behaviour is successful and follow it.
It's so interesting.
Motivational interviewing is one of the tools we can use.
What is motivational interviewing?
Motivational interviewing is a form of positive psychology, it's a consulting
style, developed in a very practical way for healthcare professionals by
two psychologists who are experts in behaviour change and psychological
behaviour change, Milner and Rolnick.
And this came about at the beginning of 2002.
It's a type of consulting where rather than actually trying to tell somebody
what to do, you draw it out of them.
You empower them to realise they can
be the architect of their own change, people need to emotionally buy into
making change for their animal or themselves, if they are emotionally
connected, they're more likely to do it.
It's about being non judgmental and seeing the client as an equal partner.
It's challenging to think of the client as an equal partner in their animal's care.
But motivational interviewing really thinks about the client's own argument
for change, and drawing out their reasons, and their reasons may differ from ours.
I want the client to do certain things because it will make the animal feel
better, but the client, their reason for doing it may be completely different.
To really engage with motivation it's about establishing rapport where they
feel they can actually share with you.
In veterinary practice, in my experience some clients won't open up to certain
conditions, but will come out and talk to the receptionist, or they'll talk
to a different person in the practice because they come out and go, I didn't
want to say to the vet, but actually my dog's growling at the grandkids,
what can I do?
And they perhaps haven't wanted to say to the vet or nurse
because they feel embarrassed.
Might be judged.
They feel this is my animal.
I should know what to do.
Asking another person for help makes you vulnerable.
The concept of motivational interviewing is about understanding the client's
perspective, being respectful of their needs and wishes, setting
the situation so they feel they can open up, really listening to their
language, thinking about where they are at this point in their life with
their relationship with their animal.
How willing to change are they and by change I mean to follow our treatment
plan, because that will involve changes even if it is just three times a day
now you're going to be giving this medicine, it affects their daily routine.
They might not physically have the capability, how often do we hand out
medicine and we don't check with people?
Are you okay opening the bottle of this?
Do you have someone to help you?
It might be somebody with arthritis who struggles to open medicine bottles,
but they don't want to say, and unless we try to draw out what might be
barriers to following our treatment regime, we perhaps set them up to fail.
Let's say it could be a diabetic cat, rather than saying to the
client, I want you to inject the cat, to look at litter trays, etc.
Actually, talking to the client and saying, what do you know about diabetes?
It's saying to the client, have you heard of this condition,?
Do you know anyone who's experienced this?
What's your feeling about it?
That tells us where they are and how receptive they might be and you're
seeking permission from the client with motivational interviewing to
talk to them about treatment regimes.
That emphasises their autonomy because we want them to feel powerful.
We want them to feel as if they are making the decision.
Rather than saying, this is what you have to do, we can say would
it be okay if I shared different options for treating your cat?
And then you can tell me, and you can decide what you feel would
work best for your situation, your lifestyle, and your family.
And ultimately, your cat.
And that really, it hands back power to the client to feel as if they are with
you as a partner in helping their animal, which is important because they're more
likely to commit to our treatment plans.
And now, Kelly St.
Denis will be speaking with Lesley Lyons about her JFMS Clinical
Spotlight article, Genetic Testing Practical Do's and Don'ts for Cats.
Welcome Dr Lyons.
Oh, thank you, Kelly.
It's wonderful to join you today.
could you tell us about what a variant is?
A gene is made up of a specific DNA sequence.
Those sequences for any given gene are very well conserved, meaning they're the
same throughout various different animals.
We tend now to use the word DNA variant instead of mutation because
everyone gets the wrong idea with mutation, that mutation is bad.
So changing a base pair or a sequence within the DNA code, that's the
variation that we're talking about.
You've actually changed an adenine for guanine or you can flip a sequence.
There's all kind of different ways you can have variants and variants occur
through mutation and that's a good thing, though, because if we don't have mutation,
we don't develop genetic diversity.
The genetic diversity we have now is due to historical mutations,
some are good, some bad, most are neutral and really don't do anything.
And so it's actually my job to figure out what mutations are good and
bad and which ones are neutral and what we should do with those guys.
Very cool.
Thank you for explaining that.
I noticed we have a feline genome sequence and the online Mendelian
inheritance and animals list.
OMIA.
Yes.
OMIA.
I like that.
That's good.
What can veterinarians do with this list?
What is the O M I A and how would we use it?
I use it all the time.
And so if I'm wondering whether a disease has been documented in a cat,
I can go to PubMed, put in that disease, say domestic cat, and get
everything or I'm more likely to go to OMIA and try the same search
because if it's been documented, it'll bring up all the scientific
publications that describe that disease.
If a genetic mutation has been identified, it will bring up
the genetic information as well.
This should be where you go and not to Dr.
Google, right?
And, you're going to find all the scientific information that you need for a
disease or particularly for a DNA variant.
It's a wonderful resource.
I did have a look at it.
It looks quite amazing.
And for our listeners, like Dr.
Lyons does explain in the clinical spotlight article how
to approach it for our purposes.
Another concept that you discuss in the clinical spotlight article
is that concept of validation.
Whether it's actually resulting in a disease phenotype, for example,
I wonder if you could explain that for us a little bit too?
Yeah, there's two aspects to that.
First off, when we identify a DNA variant, it's usually within
a specific breed or population.
And so, that variant can get into other populations by different methods.
One is by crossbreeding.
So a good example is Persians with polycystic kidney disease.
They have bred to Scottish Folds and Selkirk Rex and other breeds as well.
And so they've moved polycystic kidney disease into those breeds as well.
But sometimes you could have the exact same mutation occur again.
And a good example of that is pyruvate kinase deficiency, where historically
we know that it caused disease in Abyssinians and Somalis, but now we see
it in Bengals, and I think a commercial lab has documented into Maine Coons.
And so you could see that it would go into Bengals because Bengals used
Abyssinians early in their development.
But gee, why a Maine Coon?
How did it get there?
So we're not sure if that's a new mutation or the same mutation and there's been some
type of crossbreeding that we don't know.
And so you always need to, when these mutations show up in other
breeds that are unexpected, you should do a validation process.
Do we find disease associated with that same mutation?
We do know that the genetic background of an individual, meaning other genetic
mutations that an individual has, can sometimes override a disease and cause
something called incomplete penetrance.
You have a mutation that should cause a disease but you don't have the disease.
And we're now starting to understand the mechanisms which
cause incomplete penetrance.
That doesn't mean we shouldn't try to eliminate those variants,
we have to figure out whether they cause disease or not.
If they do, we should be working towards trying to really
eradicate them as much as we can.
Is there value for us if we find a cat with HCM and it's not a Maine
Coon, to send for whole genome sequencing to see if there's a
different mutation causing the disease?
Is value to the research community?
Is there value to the pet caregiver or breeder?
Yeah, absolutely.
First I would order the two tests for ragdolls and Maine coon cats, because
you never know, as we get more data, then we get more or less confidence.
So should you sequence a cat?
If you sequence a cat, you might find the causal variant.
That chance is about 50 50, 60 40, that you would find it from DNA
sequencing, and if you did, now you know that mutation, if it's a breed
cat, probably a lot more important because then you want to make sure
that's not segregating within the breed.
If it's a random bred cat, probably that cat's not going to be breeding.
However, we're always moving forward with, if we know the gene and
mutation, targeted therapies, drug therapies and immunotherapies are
being developed that can be an option.
So DNA sequencing could give you a chance to figure out whether you know the gene
and the mutation and maybe that will lead you to a targeted therapy for the cat.
Thank you for listening.
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We'll be back again next month with more from the world of
feline medicine and JFMS.