Yaiza Gomez-Mejias: Hello and welcome to the January episode
of Chattering with iCatCare.
I'm Yaiza Gomez Mejias, Veterinary Community Coordinator at International
iCatCare and host of this month's podcast.
Today, I will continue the conversation I started in December with Tamsin
Durston about motivational interviewing.
But first, I will interview Emma LaVigne about her award winning abstract on the
response to feline infectious peritonitis treatment with GS and the effect of co
infectiozn with feline leukaemia virus.
So thank you very much for joining us today, Emma.
Emma LaVigne: Great.
Yeah.
Thanks so much for having me.
Yaiza Gomez-Mejias: You've just received an award from the ISCAID Conference this
year for your abstract on the response to FIP treatment with GS and the effect
of co infection with feline leukaemia.
So, what motivated your interest in this topic?
Emma LaVigne: So actually, I feel like with a lot of people interested
in FIP, it comes from a personal experience with the disease itself.
And so when I was in private practice, my grandmother adopted a couple of
kittens from a newspaper article, and one of them started coming down with
an illness that we suspected to be FIP.
And so I had not even heard of the new treatment at this point in time.
This was probably back in like, 2020.
So it was a little bit newer.
And so we explored the option.
We got in touch with the online Facebook FIP warriors group and
started the treatment for her.
And it was just, really amazing how quickly she responded to the treatment.
So I feel like from then on out, I was just so interested in the
disease and the new treatment.
It was just like an unprecedented thing in veterinary medicine.
And then unfortunately her litter mate also came down with FIP and he did not
make it unfortunately, but she did.
And she's still thriving and acting like a happy normal cat.
And so I feel like that really spurred my desire to do an
internal medicine residency.
So FIP has been a really strong interest of mine for a while and
I knew coming into the residency, that's what I wanted to research.
Yaiza Gomez-Mejias: That's brilliant.
Oh, well, happy for the cat that survived.
And what was the aim of this study in particular?
Emma LaVigne: So we were looking to compare response to treatment
and survival rate of cats with and without feline leukaemia virus
that underwent treatment for FIP.
Yaiza Gomez-Mejias: And was there any specific interest from any
shelters that you were working with or where did the idea come from?
Emma LaVigne: The idea mostly came from, we had a previous shelter study
that was done at Austin Pets Alive, which is in Austin, Texas in the US.
And they have a large FELV cat adoption program, and they also
treat a lot of cats for FIP.
So they recognised in a study that was done partially by my research mentor,
Dr Levy, and they found out that FIP was a major risk factor for cats with FELV.
It just due to potentially their immunocompromised status or being
in a shelter setting and having that higher risk of contracting FIP.
And so what we wanted to find out was what happens if we treat these
FELV positive cats for FIP and do they respond the same way and do
they live the same amount of time?
Was their immune system any different than a normal cat's response to FIP?
So that's what sparked the study was this previous one done that identified
FIP as the most common cause of death in a lot of these FELV positive cats.
Yaiza Gomez-Mejias: Could you go through the methods you used?
Emma LaVigne: Yeah, sure.
So our study population, we ended up with 170 cats that were followed
up starting in September of 2020.
And we followed them through August of 2023, where they were enrolled
during that period, and then followed up through September of 2024.
And they were diagnosed with FIP by a shelter veterinarian,
mostly based on compatible clinical signs and lab findings.
We didn't have the ability to do extensive, more advanced FIP testing
just due to the nature of the shelter and the cost constraints there.
And then they were diagnosed with FELV or not, based on the IDEXX antigen snap test.
These cats were then treated with various doses of the GS441524.
based on their effusive status, whether they had neuro or ocular signs.
And it was a little bit different.
So when the study started back in 2020, we didn't have a lot
of information about GS dosing.
The doses were based a lot on the shelter veterinarians interpretation at the time.
They actually dose the effusive cats a little bit higher than the dry,
which now we know that maybe that's the opposite, but the neuro ocular
cats also got higher doses of GS.
So then we followed these cats, they received 84 days of treatment and then
84 days of observation and then they had a physical exam, CDC chemistry,
about every four weeks during the treatment period and then every six
weeks during the observation period, approximately, it was all based off
of compliance with the caregivers, and then we followed up with the caregivers
about every three months for a minimum of a year and recorded their dates of
if they had any signs of recurrence of FIP or deaths or euthanasias.
And then we did some statistical analyses that compared the two groups
to see if there was a difference in survival and we found that it was
actually an equivalent survival of 74 percent through the observation period.
And then once we reached that one year follow up, the FELV positive
cats started to succumb to the natural progression of the disease.
Yaiza Gomez-Mejias: And now we will listen to the second part
of our conversation with Tamsin about motivational interviewing.
It helped me a lot to listen to you talking about these stages, it made
me realise that not all the owners are in the same stage, depending
on what's going on with the cats and what they expected to hear.
Could you repeat the four names of the different stages?
Tamsin Durston: The first is pre contemplation, where you're
not even considering it, and there can be reasons for that.
That can be because you might have tried before and it didn't
work, so you're like, ah.
You've shut down to even the thought of making a change.
Or you're not consciously aware of it, it has no value for you.
Actually, you're enjoying the way you're living your life.
Why would you change?
You might say to me, you should get to the gym.
And I might be like, why?
The next stage is contemplation, where you might have heard something and
you are aware that your belief or your attitude to something could be challenged.
Something has sparked a bit of curiosity.
This doesn't necessarily mean you're going to start to change, but it just
means you, you're now aware, you're aware that there's a different way.
You might think, Oh, and you might not take it in at the vets, but you
might go home and think, might talk to my friends, have you heard of this?
Or you go on online and you find out all sorts of stuff, scary stuff.
In this contemplation stage you're aware there's a possible new thing to discover.
Then you move into the preparation stage where you're actually
preparing psychologically.
And it's not just about psychological, it's about your
physical capability as well.
It's about your environment.
You're wanting to see a difference, wanting to make a change.
And you're motivated now to actually think, can I put measures in place?
Can I change something to make the difference that I want?
You're making plans.
And this is where it's really important in this stage that we help clients.
If they're saying, okay, tell me more, or what could I do to
help my cat have a better life?
Then we can say, let's think about all the obstacles and barriers
and, how can we overcome these?
Let's anticipate what might go wrong.
I'm a big fan of if then plans, if this happens, then I will do this.
If we think about how we will respond to all the
different ifs, then we're ready if they do happen.
I, I always think it's better to have a plan and not need it, then need a plan and
not have it, because planning takes time.
And when you're in this preparation phase, making a plan, which is what
we do with the client in our consult room, we're helping them make a plan.
We want to make a plan that's realistic for them, but that's also
reinforcing so that they see the benefit of it and keep doing it.
The next phase is the action phase where they start making changes.
It's psychologically challenging because they're now facing life
doing something differently.
I've never done this before with the cat.
I've never examined them every day.
I've never had to do this.
I've never checked their mouth, the vet thinks I should do.
And it's difficult for them to, to building this habit to their life.
So it's really clear we need to consider their motivation here.
And we want in this stage where people are starting to take action,
and this might be that they come back to their second checkup and
we're saying, okay, how is it going?
Have you been able to give the medicine?
Have you been following the ISFM how to tablet my cat advice?
How is it going?
I know this is difficult for you, but it is brilliant to see you're trying.
You are making a difference by even trying to give this medicine.
I know it's difficult to give medicine to a cat.
That's why I get the nurse to come and do it in the clinic, but it's
brilliant to see what you're doing, but, you know, what else can we do?
What happens if your cat runs away as soon as you see them?
How do you cope with that?
We, we can talk to our clients about the way they talk to themselves, that
they can write down the pros and cons to what they're doing and see they're
making a difference and get support.
And also tell people they're doing it because there's a whole bit of
science about if we make ourselves accountable, if I, as an animal
owner, I'm trying to give my cat medicine, let's say three times a day.
If I say to someone that I trust, Oh my goodness, I've got to do this.
My cat's on these new medicine, these new pills.
And I have to do it three times a day, but I'm doing it.
I'm committing to it.
We're more likely to do it because we told someone.
That's really important.
The next stage is maintenance.
Yes, when a client has started doing this behaviour, are they going to stick to it?
And actually this maintenance phase, it's not considered maintenance until you've
been doing that behaviour consistently for about six months, depending on the change.
For example, getting insulin injections or hyperthyroidism meds
that are going to be lifelong.
That then has to be your new way of life.
And it will be six months in before you can say, okay, I have changed my behaviour
and now I'm in this maintenance phase.
It can be relapses and recovery periods between maintenance.
You can relapse, recover, go back into maintenance, or you can go back to pre
contemplation where you're like, didn't work, and actually something then triggers
you again to move into contemplation.
Maybe I'll give it another go.
Maybe things are different.
Maybe there's a new treatment out now, I may be able to plan,
move into preparation, act on it.
Now I'll maintain it.
And then you go back through that cycle.
Yaiza Gomez-Mejias: The fact, knowing that it's not a linear
process, so we can go back to a previous stage, I find very helpful.
What you've just said about legitimating the, the caregiver's narrative, sometimes
I think vets can play an important role by supporting those good aspects
of the client's narrative, which we don't necessarily entirely agree with.
But as long as it favours a good outcome in the pet, then I think
it's very helpful to support.
Thank you for listening.
If you're a 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 club, the discussion forum, and much more at portal.icatcare.org.
If you're looking for more free CPD from International Cat Care, We'll
have Nikki Gaut's webinar on cat friendly home visits as part of the
Cat Friendly Clinic webinar program on the 25th of February at 7 pm UK time.
We'll be back again next month with more from the world of feline medicine and the
Journal of Feline Medicine and Surgery.