1 00:00:05,600 --> 00:00:08,469 Yaiza Gomez-Mejias: Hello and welcome to the January episode 2 00:00:08,480 --> 00:00:09,640 of Chattering with iCatCare. 3 00:00:10,580 --> 00:00:14,600 I'm Yaiza Gomez Mejias, Veterinary Community Coordinator at International 4 00:00:15,660 --> 00:00:17,109 iCatCare and host of this month's podcast. 5 00:00:18,109 --> 00:00:21,314 Today, I will continue the conversation I started in December with Tamsin 6 00:00:21,320 --> 00:00:24,050 Durston about motivational interviewing. 7 00:00:24,450 --> 00:00:28,430 But first, I will interview Emma LaVigne about her award winning abstract on the 8 00:00:28,430 --> 00:00:33,290 response to feline infectious peritonitis treatment with GS and the effect of co 9 00:00:33,290 --> 00:00:35,509 infectiozn with feline leukaemia virus. 10 00:00:38,389 --> 00:00:41,800 So thank you very much for joining us today, Emma. 11 00:00:42,170 --> 00:00:42,450 Emma LaVigne: Great. 12 00:00:42,460 --> 00:00:42,650 Yeah. 13 00:00:42,650 --> 00:00:44,020 Thanks so much for having me. 14 00:00:44,059 --> 00:00:47,800 Yaiza Gomez-Mejias: You've just received an award from the ISCAID Conference this 15 00:00:47,800 --> 00:00:53,080 year for your abstract on the response to FIP treatment with GS and the effect 16 00:00:53,080 --> 00:00:55,500 of co infection with feline leukaemia. 17 00:00:55,960 --> 00:00:59,650 So, what motivated your interest in this topic? 18 00:00:59,670 --> 00:01:02,140 Emma LaVigne: So actually, I feel like with a lot of people interested 19 00:01:02,140 --> 00:01:06,049 in FIP, it comes from a personal experience with the disease itself. 20 00:01:06,050 --> 00:01:11,280 And so when I was in private practice, my grandmother adopted a couple of 21 00:01:11,289 --> 00:01:15,980 kittens from a newspaper article, and one of them started coming down with 22 00:01:16,460 --> 00:01:18,950 an illness that we suspected to be FIP. 23 00:01:19,340 --> 00:01:23,030 And so I had not even heard of the new treatment at this point in time. 24 00:01:23,030 --> 00:01:25,899 This was probably back in like, 2020. 25 00:01:25,900 --> 00:01:27,000 So it was a little bit newer. 26 00:01:27,650 --> 00:01:30,339 And so we explored the option. 27 00:01:30,340 --> 00:01:34,869 We got in touch with the online Facebook FIP warriors group and 28 00:01:34,870 --> 00:01:36,310 started the treatment for her. 29 00:01:36,330 --> 00:01:41,470 And it was just, really amazing how quickly she responded to the treatment. 30 00:01:41,480 --> 00:01:44,649 So I feel like from then on out, I was just so interested in the 31 00:01:44,650 --> 00:01:46,049 disease and the new treatment. 32 00:01:46,059 --> 00:01:49,420 It was just like an unprecedented thing in veterinary medicine. 33 00:01:50,100 --> 00:01:55,539 And then unfortunately her litter mate also came down with FIP and he did not 34 00:01:55,550 --> 00:01:57,630 make it unfortunately, but she did. 35 00:01:57,630 --> 00:02:01,999 And she's still thriving and acting like a happy normal cat. 36 00:02:02,030 --> 00:02:05,710 And so I feel like that really spurred my desire to do an 37 00:02:05,710 --> 00:02:07,430 internal medicine residency. 38 00:02:07,430 --> 00:02:10,550 So FIP has been a really strong interest of mine for a while and 39 00:02:10,550 --> 00:02:13,590 I knew coming into the residency, that's what I wanted to research. 40 00:02:14,720 --> 00:02:15,670 Yaiza Gomez-Mejias: That's brilliant. 41 00:02:15,880 --> 00:02:18,159 Oh, well, happy for the cat that survived. 42 00:02:18,509 --> 00:02:20,919 And what was the aim of this study in particular? 43 00:02:21,250 --> 00:02:24,369 Emma LaVigne: So we were looking to compare response to treatment 44 00:02:24,369 --> 00:02:28,130 and survival rate of cats with and without feline leukaemia virus 45 00:02:28,170 --> 00:02:30,910 that underwent treatment for FIP. 46 00:02:31,740 --> 00:02:34,980 Yaiza Gomez-Mejias: And was there any specific interest from any 47 00:02:34,980 --> 00:02:39,169 shelters that you were working with or where did the idea come from? 48 00:02:39,469 --> 00:02:43,840 Emma LaVigne: The idea mostly came from, we had a previous shelter study 49 00:02:43,910 --> 00:02:47,940 that was done at Austin Pets Alive, which is in Austin, Texas in the US. 50 00:02:48,380 --> 00:02:52,650 And they have a large FELV cat adoption program, and they also 51 00:02:52,650 --> 00:02:54,909 treat a lot of cats for FIP. 52 00:02:54,920 --> 00:02:59,900 So they recognised in a study that was done partially by my research mentor, 53 00:02:59,900 --> 00:03:06,579 Dr Levy, and they found out that FIP was a major risk factor for cats with FELV. 54 00:03:06,580 --> 00:03:10,430 It just due to potentially their immunocompromised status or being 55 00:03:10,430 --> 00:03:13,959 in a shelter setting and having that higher risk of contracting FIP. 56 00:03:15,320 --> 00:03:19,080 And so what we wanted to find out was what happens if we treat these 57 00:03:19,120 --> 00:03:24,060 FELV positive cats for FIP and do they respond the same way and do 58 00:03:24,060 --> 00:03:26,049 they live the same amount of time? 59 00:03:26,059 --> 00:03:31,460 Was their immune system any different than a normal cat's response to FIP? 60 00:03:31,770 --> 00:03:36,119 So that's what sparked the study was this previous one done that identified 61 00:03:36,129 --> 00:03:40,630 FIP as the most common cause of death in a lot of these FELV positive cats. 62 00:03:40,900 --> 00:03:42,880 Yaiza Gomez-Mejias: Could you go through the methods you used? 63 00:03:43,100 --> 00:03:43,829 Emma LaVigne: Yeah, sure. 64 00:03:43,870 --> 00:03:50,549 So our study population, we ended up with 170 cats that were followed 65 00:03:50,559 --> 00:03:53,220 up starting in September of 2020. 66 00:03:53,220 --> 00:03:57,790 And we followed them through August of 2023, where they were enrolled 67 00:03:57,800 --> 00:04:01,150 during that period, and then followed up through September of 2024. 68 00:04:02,260 --> 00:04:06,330 And they were diagnosed with FIP by a shelter veterinarian, 69 00:04:06,330 --> 00:04:09,499 mostly based on compatible clinical signs and lab findings. 70 00:04:09,520 --> 00:04:15,189 We didn't have the ability to do extensive, more advanced FIP testing 71 00:04:15,189 --> 00:04:19,299 just due to the nature of the shelter and the cost constraints there. 72 00:04:19,659 --> 00:04:25,740 And then they were diagnosed with FELV or not, based on the IDEXX antigen snap test. 73 00:04:26,139 --> 00:04:32,219 These cats were then treated with various doses of the GS441524. 74 00:04:32,620 --> 00:04:37,760 based on their effusive status, whether they had neuro or ocular signs. 75 00:04:38,110 --> 00:04:39,419 And it was a little bit different. 76 00:04:39,419 --> 00:04:43,229 So when the study started back in 2020, we didn't have a lot 77 00:04:43,230 --> 00:04:45,819 of information about GS dosing. 78 00:04:46,049 --> 00:04:51,270 The doses were based a lot on the shelter veterinarians interpretation at the time. 79 00:04:51,270 --> 00:04:54,199 They actually dose the effusive cats a little bit higher than the dry, 80 00:04:54,209 --> 00:04:58,460 which now we know that maybe that's the opposite, but the neuro ocular 81 00:04:58,530 --> 00:05:00,289 cats also got higher doses of GS. 82 00:05:01,449 --> 00:05:05,239 So then we followed these cats, they received 84 days of treatment and then 83 00:05:05,240 --> 00:05:09,589 84 days of observation and then they had a physical exam, CDC chemistry, 84 00:05:10,020 --> 00:05:14,150 about every four weeks during the treatment period and then every six 85 00:05:14,150 --> 00:05:18,610 weeks during the observation period, approximately, it was all based off 86 00:05:18,610 --> 00:05:23,059 of compliance with the caregivers, and then we followed up with the caregivers 87 00:05:23,059 --> 00:05:27,909 about every three months for a minimum of a year and recorded their dates of 88 00:05:27,939 --> 00:05:32,960 if they had any signs of recurrence of FIP or deaths or euthanasias. 89 00:05:33,610 --> 00:05:39,319 And then we did some statistical analyses that compared the two groups 90 00:05:39,339 --> 00:05:42,679 to see if there was a difference in survival and we found that it was 91 00:05:42,679 --> 00:05:47,650 actually an equivalent survival of 74 percent through the observation period. 92 00:05:47,829 --> 00:05:53,289 And then once we reached that one year follow up, the FELV positive 93 00:05:53,299 --> 00:05:58,849 cats started to succumb to the natural progression of the disease. 94 00:05:59,799 --> 00:06:02,030 Yaiza Gomez-Mejias: And now we will listen to the second part 95 00:06:02,049 --> 00:06:05,709 of our conversation with Tamsin about motivational interviewing. 96 00:06:06,860 --> 00:06:10,970 It helped me a lot to listen to you talking about these stages, it made 97 00:06:10,970 --> 00:06:15,120 me realise that not all the owners are in the same stage, depending 98 00:06:15,120 --> 00:06:17,729 on what's going on with the cats and what they expected to hear. 99 00:06:18,100 --> 00:06:21,109 Could you repeat the four names of the different stages? 100 00:06:21,380 --> 00:06:23,860 Tamsin Durston: The first is pre contemplation, where you're 101 00:06:23,860 --> 00:06:26,609 not even considering it, and there can be reasons for that. 102 00:06:26,630 --> 00:06:30,849 That can be because you might have tried before and it didn't 103 00:06:30,849 --> 00:06:31,436 work, so you're like, ah. 104 00:06:31,436 --> 00:06:34,169 You've shut down to even the thought of making a change. 105 00:06:34,520 --> 00:06:38,280 Or you're not consciously aware of it, it has no value for you. 106 00:06:38,319 --> 00:06:40,919 Actually, you're enjoying the way you're living your life. 107 00:06:41,589 --> 00:06:42,689 Why would you change? 108 00:06:42,740 --> 00:06:44,640 You might say to me, you should get to the gym. 109 00:06:44,640 --> 00:06:46,099 And I might be like, why? 110 00:06:46,579 --> 00:06:50,620 The next stage is contemplation, where you might have heard something and 111 00:06:50,620 --> 00:06:55,850 you are aware that your belief or your attitude to something could be challenged. 112 00:06:56,289 --> 00:06:58,400 Something has sparked a bit of curiosity. 113 00:06:59,280 --> 00:07:03,100 This doesn't necessarily mean you're going to start to change, but it just 114 00:07:03,100 --> 00:07:07,579 means you, you're now aware, you're aware that there's a different way. 115 00:07:07,610 --> 00:07:11,419 You might think, Oh, and you might not take it in at the vets, but you 116 00:07:11,419 --> 00:07:15,299 might go home and think, might talk to my friends, have you heard of this? 117 00:07:15,679 --> 00:07:19,689 Or you go on online and you find out all sorts of stuff, scary stuff. 118 00:07:19,959 --> 00:07:25,559 In this contemplation stage you're aware there's a possible new thing to discover. 119 00:07:26,309 --> 00:07:29,229 Then you move into the preparation stage where you're actually 120 00:07:29,279 --> 00:07:31,219 preparing psychologically. 121 00:07:31,839 --> 00:07:34,179 And it's not just about psychological, it's about your 122 00:07:34,199 --> 00:07:35,890 physical capability as well. 123 00:07:35,890 --> 00:07:37,609 It's about your environment. 124 00:07:37,850 --> 00:07:40,990 You're wanting to see a difference, wanting to make a change. 125 00:07:41,720 --> 00:07:46,909 And you're motivated now to actually think, can I put measures in place? 126 00:07:46,909 --> 00:07:50,480 Can I change something to make the difference that I want? 127 00:07:50,549 --> 00:07:51,679 You're making plans. 128 00:07:51,990 --> 00:07:55,650 And this is where it's really important in this stage that we help clients. 129 00:07:55,650 --> 00:08:00,709 If they're saying, okay, tell me more, or what could I do to 130 00:08:00,709 --> 00:08:02,510 help my cat have a better life? 131 00:08:03,139 --> 00:08:06,199 Then we can say, let's think about all the obstacles and barriers 132 00:08:07,250 --> 00:08:08,799 and, how can we overcome these? 133 00:08:08,829 --> 00:08:10,809 Let's anticipate what might go wrong. 134 00:08:11,289 --> 00:08:16,543 I'm a big fan of if then plans, if this happens, then I will do this. 135 00:08:16,760 --> 00:08:19,549 If we think about how we will respond to all the 136 00:08:21,939 --> 00:08:23,260 different ifs, then we're ready if they do happen. 137 00:08:23,929 --> 00:08:28,510 I, I always think it's better to have a plan and not need it, then need a plan and 138 00:08:28,510 --> 00:08:31,010 not have it, because planning takes time. 139 00:08:31,720 --> 00:08:35,479 And when you're in this preparation phase, making a plan, which is what 140 00:08:35,480 --> 00:08:38,780 we do with the client in our consult room, we're helping them make a plan. 141 00:08:39,020 --> 00:08:43,110 We want to make a plan that's realistic for them, but that's also 142 00:08:43,110 --> 00:08:46,699 reinforcing so that they see the benefit of it and keep doing it. 143 00:08:47,310 --> 00:08:51,090 The next phase is the action phase where they start making changes. 144 00:08:52,080 --> 00:08:56,150 It's psychologically challenging because they're now facing life 145 00:08:56,700 --> 00:08:58,130 doing something differently. 146 00:08:58,209 --> 00:09:00,474 I've never done this before with the cat. 147 00:09:01,010 --> 00:09:02,370 I've never examined them every day. 148 00:09:02,460 --> 00:09:03,530 I've never had to do this. 149 00:09:03,820 --> 00:09:06,260 I've never checked their mouth, the vet thinks I should do. 150 00:09:06,810 --> 00:09:10,579 And it's difficult for them to, to building this habit to their life. 151 00:09:11,090 --> 00:09:15,140 So it's really clear we need to consider their motivation here. 152 00:09:15,140 --> 00:09:19,069 And we want in this stage where people are starting to take action, 153 00:09:19,069 --> 00:09:22,210 and this might be that they come back to their second checkup and 154 00:09:22,210 --> 00:09:23,840 we're saying, okay, how is it going? 155 00:09:24,260 --> 00:09:26,040 Have you been able to give the medicine? 156 00:09:26,389 --> 00:09:30,510 Have you been following the ISFM how to tablet my cat advice? 157 00:09:30,900 --> 00:09:31,980 How is it going? 158 00:09:32,000 --> 00:09:36,660 I know this is difficult for you, but it is brilliant to see you're trying. 159 00:09:37,160 --> 00:09:41,030 You are making a difference by even trying to give this medicine. 160 00:09:41,260 --> 00:09:43,849 I know it's difficult to give medicine to a cat. 161 00:09:44,340 --> 00:09:47,129 That's why I get the nurse to come and do it in the clinic, but it's 162 00:09:48,000 --> 00:09:51,559 brilliant to see what you're doing, but, you know, what else can we do? 163 00:09:51,559 --> 00:09:55,219 What happens if your cat runs away as soon as you see them? 164 00:09:55,279 --> 00:09:56,839 How do you cope with that? 165 00:09:57,060 --> 00:10:01,140 We, we can talk to our clients about the way they talk to themselves, that 166 00:10:01,170 --> 00:10:04,579 they can write down the pros and cons to what they're doing and see they're 167 00:10:04,580 --> 00:10:07,130 making a difference and get support. 168 00:10:07,130 --> 00:10:10,449 And also tell people they're doing it because there's a whole bit of 169 00:10:10,459 --> 00:10:16,070 science about if we make ourselves accountable, if I, as an animal 170 00:10:16,070 --> 00:10:20,080 owner, I'm trying to give my cat medicine, let's say three times a day. 171 00:10:20,360 --> 00:10:24,409 If I say to someone that I trust, Oh my goodness, I've got to do this. 172 00:10:24,410 --> 00:10:26,500 My cat's on these new medicine, these new pills. 173 00:10:26,500 --> 00:10:28,859 And I have to do it three times a day, but I'm doing it. 174 00:10:28,859 --> 00:10:29,150 I'm committing to it. 175 00:10:29,619 --> 00:10:32,600 We're more likely to do it because we told someone. 176 00:10:34,100 --> 00:10:34,285 That's really important. 177 00:10:34,390 --> 00:10:36,569 The next stage is maintenance. 178 00:10:36,990 --> 00:10:41,399 Yes, when a client has started doing this behaviour, are they going to stick to it? 179 00:10:42,030 --> 00:10:46,370 And actually this maintenance phase, it's not considered maintenance until you've 180 00:10:46,370 --> 00:10:50,710 been doing that behaviour consistently for about six months, depending on the change. 181 00:10:50,750 --> 00:10:55,450 For example, getting insulin injections or hyperthyroidism meds 182 00:10:55,450 --> 00:10:56,920 that are going to be lifelong. 183 00:10:58,099 --> 00:11:00,009 That then has to be your new way of life. 184 00:11:00,259 --> 00:11:04,570 And it will be six months in before you can say, okay, I have changed my behaviour 185 00:11:04,660 --> 00:11:06,249 and now I'm in this maintenance phase. 186 00:11:06,249 --> 00:11:10,630 It can be relapses and recovery periods between maintenance. 187 00:11:10,970 --> 00:11:16,315 You can relapse, recover, go back into maintenance, or you can go back to pre 188 00:11:17,020 --> 00:11:20,770 contemplation where you're like, didn't work, and actually something then triggers 189 00:11:20,770 --> 00:11:22,779 you again to move into contemplation. 190 00:11:22,779 --> 00:11:24,130 Maybe I'll give it another go. 191 00:11:24,130 --> 00:11:25,020 Maybe things are different. 192 00:11:25,070 --> 00:11:30,140 Maybe there's a new treatment out now, I may be able to plan, 193 00:11:30,280 --> 00:11:32,300 move into preparation, act on it. 194 00:11:32,420 --> 00:11:33,610 Now I'll maintain it. 195 00:11:34,030 --> 00:11:35,920 And then you go back through that cycle. 196 00:11:37,219 --> 00:11:39,100 Yaiza Gomez-Mejias: The fact, knowing that it's not a linear 197 00:11:39,100 --> 00:11:45,700 process, so we can go back to a previous stage, I find very helpful. 198 00:11:45,780 --> 00:11:51,110 What you've just said about legitimating the, the caregiver's narrative, sometimes 199 00:11:51,440 --> 00:11:56,079 I think vets can play an important role by supporting those good aspects 200 00:11:56,080 --> 00:11:59,880 of the client's narrative, which we don't necessarily entirely agree with. 201 00:12:00,190 --> 00:12:04,590 But as long as it favours a good outcome in the pet, then I think 202 00:12:04,590 --> 00:12:06,320 it's very helpful to support. 203 00:12:11,719 --> 00:12:12,919 Thank you for listening. 204 00:12:13,270 --> 00:12:17,600 If you're a member, don't forget you can access the full version of the podcast and 205 00:12:17,629 --> 00:12:22,620 all the other member benefits including congress recordings, monthly webinars, 206 00:12:22,620 --> 00:12:28,770 and clinical club, the discussion forum, and much more at portal.icatcare.org. 207 00:12:29,580 --> 00:12:33,930 If you're looking for more free CPD from International Cat Care, We'll 208 00:12:33,940 --> 00:12:37,720 have Nikki Gaut's webinar on cat friendly home visits as part of the 209 00:12:37,720 --> 00:12:43,740 Cat Friendly Clinic webinar program on the 25th of February at 7 pm UK time. 210 00:12:44,760 --> 00:12:48,930 We'll be back again next month with more from the world of feline medicine and the 211 00:12:48,930 --> 00:12:50,800 Journal of Feline Medicine and Surgery.