Chattering with iCatCare

In the June episode of Chattering With International Cat Care, host Yaiza Gómez-Mejías continues two insightful conversations from earlier this year, revisiting complex topics in feline internal medicine and dermatology through the lens of recent clinical guidelines and case experience.

First, Sam Taylor and Rachel Korman return to discuss further aspects of the 2025 iCatCare consensus guidelines on the diagnosis and management of feline lower urinary tract disease. Building on their previous conversation, they explore how clinical decisions are made in practice and reflect on how guideline recommendations translate into everyday patient care. To hear the first part of this discussion, listen back to our February 2025 episode.

Then, Dr Kelly St. Denis is joined once again by Dr Frane Banovic to complete their discussion on immune-mediated skin diseases in cats, drawing on the second of two JFMS Clinical Spotlight articles. Together, they consider some of the key challenges in recognising and managing these conditions, and share insights into treatment options informed by both evidence and experience. For the first half of this conversation, revisit our April 2025 episode.

For further reading material please visit:

Yaiza Gómez-Mejías, LdaVet MANZCVS (Medicine of Cats) CertAP (SAM-F) Acr AVEPA, Veterinary Community Co-ordinator

Speakers:

Samantha Taylor, BVetMed(Hons), CertSAM, DipECVIM-CA, MANZCVS, FRCVS, Feline Medicine Specialist and ISFM Academy Lead

Rachel Korman, BVSc, MANZCVS (Int Med), FANZCVS (Fel Med), Specialist in Feline Internal Medicine

Kelly St. Denis, MSc, DVM, DABVP (Feline), Co-editor of the Journal of Feline Medicine and Surgery and JFMS Open Reports, St Denis Veterinary Professional Corporation, Powassan, Ontario, Canada

Frane Banovic, DVM, PhD, Diplomate ECVD, Associate Professor of Veterinary Dermatology in the Department for Small Animal Medicine and Surgery at the University of Georgia, College of Veterinary Medicine.

Creators and Guests

Host

Yaiza Gomez-Mejias

Veterinary Community Co-ordinator @ International Cat Care

What is Chattering with iCatCare?

Welcome to Chattering With iCatCare, the official monthly podcast of International Cat Care, hosted by Yaiza Gomez-Mejias (Veterinary Community Co-ordinator). 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 iCatCare members at portal.icatcare.org. If you would like access to our full episodes, would like to become an iCatCare Veterinary Society Member, or find out more about our Cat-Friendly schemes, visit icatcare.org.

Hello and welcome to
Chattering With iCatCare.

I'm Yaiza Gomez-Mejias, iCatCare
Veterinary Community Coordinator

and host of this month's podcast.

This episode will include two second
parts of interviews we started to

share with you in previous episodes.

The topics will be skin and urinary tract.

Dr Kelly St Denis will complete
the conversation she started

in April with Dr Banovic about
immune-mediated skin diseases in cats.

But first you will hear the second part
of the interview I started in February

with Sam Taylor and Rachel Korman on
the new iCatCare consensus guidelines

on lower urinary tract diseases in cats.

So what are your thoughts on
supplementary or complimentary therapies?

It's always important to evaluate
the impact on the individual cat.

We always talk about easy to
give and easy to administer.

For example, plugins have the very
minimal impact on the cats sort of day

to day lifestyle and it may be very
helpful, I think that's worthwhile trying.

The flip side might be dietary
add-ins or capsules and might just

be another thing that sort of causes
a change in the cat's routine.

If it's a cat reliant on routine
and not having anything additional

put into its food, or any additional
medications, that could result in

further anxiety and you have to weigh
up the evidence for the benefit of what

you might be adding into that patient.

I agree.

I think many blocked cats we get
referred will be on some supplement,

glycosaminoglycans supplements, you go
on Amazon and they can buy all of these.

I'm yet to meet a cat in that
acute phase of being blocked

where that's been of benefit.

I always wonder if it's a placebo
for us and the client, but I

agree with Rachel, that's not
what that cat needs at that time.

Change can be stressful for some of
these very susceptible individuals.

You just don't want to
be changing anything.

I've got one cat that has very
recurrent FIC, and he is a very hyper

vigilant anxious cat and his latest
episode of FIC was because a large

leaf blew off a tree and went into
his face and he developed hematuria.

This is how sensitive some cats are.

Giving lots of medications is not ideal.

The other thing I would say about
a diet is that changing diet during

that acute phase is not the time, they
like familiarity during that period.

There is minimal evidence for the
benefit of some nutritional supplements.

It's possible that some individuals
would benefit longer term.

But not in that acute period.

The number one priority, that's got
to be things like analgesics for

what is a very painful condition.

I was referring to the chronic or
recurrent disease where owners, we only

see them occasionally and they look for
a way to sort out the ongoing problem.

Sometimes what helps me is to redirect
the conversation towards the diet, not

for the diet to be changed immediately
in the acute phase, but in the long

term that provides them with a tool
to do something not necessarily

dependent on the veterinary practice.

It makes them gain a little
bit of agency on that side.

I feel like that's where you also have
the ability to redirect into behavioural

and environmental modification.

Often there are simple things
owners can change, making sure

they're aware of the different
pillars of key resources cats need.

Everyone wants a magic pill to fix
the problem, but a lot of times

making sure they have all of those key
resources, that is really gonna be the

thing that helps a lot of the cats.

Talking about pain relief, which is
very important, and Gabapentin is very

popular among feline practitioners.

And in your experience, can it
provide some analgesic effect in,

in, in feline idiopathic cystitis?

Yeah, I think Gabapentin is one of those
drugs we over rely on for analgesia.

I see it used a lot for many sources
of pain and having had conversations

with brilliant anaesthetists, when we
wrote the acute pain guidelines, they

were clear to state that there isn't
a huge amount of evidence for the

analgesic effect of this drug, that
we need to not rely on it for that.

Having said that, I think we all accept
it could be quite useful when you

think of a disease that potentially
has a sort of neuropathic origin.

I do tend to use it.

The other reason it can be useful
is from an anxiolytic point of

view, and cats are in the clinic.

I know we are talking longer term
here, but for blocked cats in the

clinic it can help with tolerance of
urinary catheters and things as well

from that anxiolytic point of view.

So I may be relying on it sometimes for
that as well as an analgesic effect, but I

worry about using it as a sole analgesic.

I wouldn't in a blocked cat or a
cat that had an extremely inflamed

bladder, I think then we need to
think about multimodal analgesia,

but I dunno what Rachels thoughts
are on Gabapentin in urinary cases.

I would agree.

We use it quite a lot in our
blocked cats, but not as an

analgesic, often as an anxiolytic.

We'll also use it preemptively in cats
coming to the clinic for assessments

for potentially other disease processes,
but where they've had a history of

anxiety related urinary tract disease.

We may use it after their visit
for a couple of days to help and

take the edge off their anxiety.

But in that acute phase when cats
are presenting with an obstruction,

we are using opioids traditionally.

Catheters have always been a big topic.

How long to leave and what do you do
with the bladder distention in cats

who present with inability to urinate?

Would you like to talk about catheters
on the most controversial aspects?

Well, it was interesting doing
the guidelines with international

differences because some countries
they routinely use red rubber

catheters and find them cost effective.

I haven't used one in
the UK for a long time.

We tried to illustrate different
types of catheter in our guidelines.

I just wanted to mention that because
I found it really interesting and I

learned something from how the red
rubber catheters are attached to the cat,

we've detailed that in the guidelines,
which is a slightly alternative

approach from what I'm familiar with.

Hopefully people will pick
up some tips and information.

The cat that that sort of recurrent blocks
or doesn't urinate after catheterisation

is a really interesting one.

There are a few aspects to it.

Sometimes we have cats that
have anxiety and there may be

cats stressed in the clinic.

They may be cats that are
used to urinating outside.

When we remove their urinary catheter, we
expect them to produce a perfect urination

in a litter tray so that we all feel
better that they're no longer obstructed.

But it's not entirely realistic.

If you have a cat that is not
familiar with using a litter tray in

a stressful environment of the clinic,
they're not gonna use litter tray.

So sometimes you have to be brave and
discharge these cats to see if they will

urinate within their normal environment.

I would say that's like using your own
toilet versus a toilet in public for them,

they're not going to want to do that.

So that doesn't apply if they're straining
or anything like that and that's where

a retrograde, again, I keep advertising
retrogrades, but it's reassuring because

if you know you haven't got a physical
obstruction, you might feel bolder

in giving them more time to urinate.

There are other reasons for cats not being
able to urinate after an obstruction.

In your clinic, Rachel, do you keep
them in or do you try and get them home?

No, we actively try and get them home
and I would say that it's more common

to remove a urinary catheter and
discharge them almost straight away.

But we're hyper vigilant about making sure
the owners understand the risk factors

and what they need to be monitoring for.

If those owners are picking their cat
up at 7:30 in the morning, dropping

him off and then going to work for
the whole day, that's not a cat we'll

discharge into that environment.

They need to be going home and being
closely monitored for signs of straining

and dysuria, but certainly my own cat,
perfectly normal, never had an episode of

lower urinary tract disease, but if she
goes into the clinic, she's scared of her

own shadow, won't urinate for a long time.

For these cats where we know they're
anxious and stressed, expecting them to do

a large, normal stream urination in front
of an audience is really not gonna happen.

And now Dr Kelly St Dennis will speak
with Dr Banovic about the two articles

he co-authored and published in the
Journal of Feline Medicine and Surgery

on Immune-Mediated Skin Diseases in Cats:
Presentation, Diagnosis and Management.

I know we talked a little bit about
plasma cell pododermatitis in the last

episode, but I also wanted to talk
about PNOE, which is proliferative

necrotising otitis externa, which
has been interesting problem that

we don't see very often in cats.

I've had a couple cases in my own career.

That can look like ear mites, a food
allergy response or, at least that's, I've

seen a few cases respond to food changes.

What sets them apart in terms of
the things that we see with PNOE

that we wouldn't see with ear mites?

We're gonna do cytology to diagnose
ear mites, but what are the other

things that we see in PNOE in cats?

Depends where you practice.

Population-wise, majority of patients are
getting some kind of isoxazolines in cats.

Isoxazolines are good medications
that deal with ear mites efficiently.

Suspecting ear mites with isoxazolines
is rare unless the owner is not applying

it and just keeping cubes at home.

The ear mite itself versus this
disease, this disease based on the

images causes unique plaques, generally
erythematous plaques, raised, bumpy,

proliferative lesions, they can
have hyper pigmented crusting on

top, probably scaling with crusting.

The mites tend to be preauricular,
so before the entrance to the ear

canal, although sometimes we see
them in the ear canal as well.

The mites itself, they don't like
to usually cause any proliferative

epidermal lesions, like this entity.

So just looking clinically, you
probably would figure out, but just to

be safe, you can always run cytology.

If you suspect you don't mites and you
don't find them on cytology, doesn't mean

they may not be there, still run your
treatment to be certain it's this disease.

We do not know a lot about
proliferative necrotising otitis.

It's called proliferative because like
I said, they tend to be like raised

elevated lesions and it's necrotising
because there is a lot of cell death of

keratinocytes in these lesions likely
associated with a lymphocytic attack.

The most common reason lymphocytes
would kill epithelial cells, you

would think infectious, so like the
herpes virus, because to kill viruses

you send these cytotoxic T cells.

But all the times that we have ever
seen, we never find any virus, so we

really don't understand the aetiology.

It does happen usually in younger
cats, but can happen in older as well.

But.

Usually tends to respond
to immunomodulation.

I would say it's 50 50 with sometimes
cats going in remission fully, and you can

stop your immunosuppressors, but sometimes
you may still need to do something

that the lesions don't come back.

Again, really unique, unknown to us why
this would happen, but once you see it,

I think it's very unique clinically.

Sure.

Specifically, if you look at the
images we show there, those are the

classic examples of the disease.

Yeah, tacrolimus is the preferred
treatment then for, as a topical?

As a topical, yes.

People will use topical glucocorticoids
depending what access you have.

Tacrolimus is a calcineurin inhibitor,
like cyclosporine, except it's more

potent and it's topical in why we
use it in veterinary dermatology.

What probably usually happens
is that people will use oral,

like oral glucocorticoid.

It's in a topical.

You have to be careful that you apply it
in areas that a cat cannot lick it off.

So preauricular would be a good
area because they cannot do that.

So yeah, we will try to do
tacrolimus, but it's not wrong

to do topical steroids either.

They're just not ideal long-term
for the skin because they can cause

atrophy, commodos, and fragility.

Tacrolimus would be a better
long-term option if you can get that.

Thank you.

That's much appreciated.

I really appreciated the conversations
we've been able to have, like,

Just really highlighting how
practical these articles are.

I love how they're laid out in terms
of each disease, how you have the

pathophysiology signalmeant, how to
diagnose and what are the clinical

features that are hallmark to those
specific diseases, and where to

take your biopsies depending on the
condition that might be suspected.

And so I just wanted to thank you again
for agreeing to write the articles

for us and doing such a great job
and for joining us today as well.

Again, we are talking about the
clinical spotlight articles in

the Journal of Feline Medicine
and Surgery Feline Immune-Mediated

Skin Disorders part two today.

But we also have a part one that
we discussed in our last podcast.

So Dr Banovich, again,
thank you for joining us.

Thank you, Kelly, and
thank your team as well.

We hope these articles contribute a
lot to public knowledge of the diseases

and hopefully people will have a
better understanding of these entities

and how to treat them in the future.

Thank you for listening.

If you are an iCatCare Veterinary Society
member don’t forget you can access the

full version of the podcast and all
the other member benefits including

congress recordings, monthly webinars
and clinical clubs, the discussion forum

and much more at portal.icatcare.org

If you are looking for more Free CPD
from International Cat Care on the

15th of July Prof. Dr Nadine Passlack
will host an open access webinar

on Nutritional strategies in Feline
Urolithiasis, sponsored by Purina

We’ll be back again next month with more
from the world of feline medicine and JFMS

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