Chattering with iCatCare

In the March episode of Chattering with International Cat Care, host Yaiza Gómez-Mejías explores the nutritional management of comorbidities in cats and the specialisation of feline medicine.

Yaiza interviews Dr Rachel Korman about the Australian and New Zealand College of Veterinary Scientists’ feline chapter and its recognised postgraduate qualification. Dr Korman discusses the chapter’s objectives, examination format, preparation strategies, and global reach.

The episode also features Dr Cecilia Villaverde, who examines the challenges and strategies involved in dietary management for cats with multiple health conditions. She emphasises the importance of a thorough nutritional assessment and the complexities of balancing dietary needs in these cases.

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For iCatCare Veterinary Members, full recordings of each episode of the podcast are available for you to listen to at portal.icatcare.org. To become an iCatCare Veterinary Member, or find out more about our Cat Friendly schemes, visit icatcare.org
Host:

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

Speakers:

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

Cecilia Villaverde, BVSc, PhD, DECVCN, DACVIM (Nutrition), Diplomate (Nutrition) of the ACVIM (Board-Certified Veterinary Nutritionist®), Diplomate ECVCN (EBVS® European Specialist in Veterinary and Comparative Nutrition)

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.

Yaiza Gomez Mejias: Hello, and
welcome to the March episode of

Chattering with International Cat Care.

I'm Yaiza Gomez Mejias, iCatCare
Veterinary Community Coordinator

and host of this month's podcast.

Our clinical spotlight this
month is focused on nutritional

management of comorbidities in cats.

I will be speaking with Dr.
Cecilia Villaverde about dietary

aspects we need to consider in
cats with more than one disease.

But first, I will be interviewing Dr.
Rachel Korman about the Australian

and New Zealand College of Veterinary
Scientists feline chapter and

the membership exam on medicine of cats.

So thank you for your time today, Rachel.

Could you start telling us what is
the feline chapter, which sounds

a little bit like the ministry of
cats, and what are its objectives?

Rachel Korman: Yeah.

I love the idea of a ministry of cats.

And I think that's very
similar to what we are.

Essentially it's just a group of
people who are really passionate

about veterinary education, in
particular, feline medicine.

And it's probably one of the last
kind of bastions of very specific

feline medicine qualifications.

Really the aims of the chapter are to
just further study and research and

education in feline medicine across
multiple different platforms and it's

a way of encouraging further study for
post graduates and also just giving

people the ability to talk to each
other about feline medicine, discuss

research projects and just really
try and hold that excitement and love

for feline medicine, and definitely
encouraging publications and collaborative

work in the research space as well.

Yaiza Gomez Mejias: And what's the link
between the feline chapte r and iCatCare,

the medicine of cats, UK qualification
that the feline chapter offers.

Rachel Korman: Yeah.

So I guess the Australian New Zealand
examination process has been in

medicine of cats for a very long time.

So I think the first sort of examination
in medicine of cats was in 1978 so

it's been around for a very long time.

And I think that International Cat Care
recognised that it was a very specific

feline qualification that would really
align with the values of International

Cat Care with regards to education
and furthering academic excellence

in the space of feline medicine.

So International Cat Care, or
ISFM as it was back then, adopted

it as it's officially recognised
postgraduate qualification.

Yaiza Gomez Mejias: Brilliant.

And that's a good thing because
we haven't got a college for

medicine of cats in Europe.

And the feline medicine specialty
doesn't exist everywhere.

Rachel Korman: We're a rare breed now.

And so I think that, obviously there's
qualifications in multiple areas,

in companion animal or small animal
medicine, but we certainly recognise

that feline medicine itself is a highly
specialised and focused field and

it's certainly something that I feel
really passionate about maintaining

that as a specialty in itself.

Yaiza Gomez Mejias: What does
the examination consist of?

Rachel Korman: So essentially
there are two written papers.

The first paper is primarily
based on pathophysiology.

How diseases occur, the physiology
behind the diseases and more of

that pure science if you like.

But again, remembering that this
is a practical exam as well.

They should be things that you're
seeing fairly regularly in a busy

practice, but certainly paper
one is all about pathophysiology

of diseases and understanding.

It runs for about sort of two
hours and then the second paper is

another written paper, but paper
two is more clinically based.

So diagnosis of diseases and
clinical signs of diseases and

treatment, and it's a little bit
more practical in its approach.

And then finally, there's a 45 minute
oral examination where you might be

shown a series of images from a case.

So you might need to interpret

clinical pathology data and basic
x ray images, or radiographic

images or ultrasound images
and then work through cases.

And we're certainly, we're not
looking for the ultimate diagnosis,

we're looking for an appropriate,
practical, broad approach to the case.

And so it's certainly an awful
lot of work and it does take

people a lot of time to prepare.

But you'll certainly come out of the
process as a much better clinician

with a much better understanding.

Yaiza Gomez Mejias: I agree.

It helped me a lot.

Any personal recommendations
on how to approach the study

timeline and the content

Rachel Korman: I think everyone
probably has a very different

approach and I can say what's,
worked for me and what I've seen work

for other people coming through.

I basically just got a textbook it wasn't
Susan Little back then, I think it was,

Scherding was the author back in, in my
time, but I basically took the chapter

headings and so it was essentially
systems, so it was neurology and urinary

and, and so I then just broke that down
into physiology and then diseases and

broke it down a little bit that way.

And I then, once I had that formulated,
I put that against a timeframe.

So for example, I wanted to make
sure that I had all of my clinical

notes and everything written a
couple of months out from the exams.

And so once I'd made that decision,
I then figured out how much time

I had to spend on each section.

And I stuck to that pretty rigidly.

And it's so easy to go down rabbit holes
of finite detail, but I think that's

when people can get caught out too, is
that you end up spending so much time

on one tiny little aspect of it that
you lose sight of the bigger picture.

And so having a bit of a clear timeline
just makes you a bit more accountable for

what you have to get finished and when.

And look, I guess one last thing that I
probably should have mentioned right back

at the start, but when you asked me to
have a chat about the exams and it made me

go back and actually pull out some of the
data about how many members we have and

how many people have sat and it actually
really amazed me just the variety of

places that the members have come from.

And so all in all, we've got close to
300 people worldwide who've sat and

passed the feline membership exams.

About 150 or 148 of those are in
Australia, but we've got people from

Austria, Canada, Czech Republic, Finland,
France, Germany, Hong Kong, Hungary,

Ireland, Israel, Malta, The Netherlands,
New Zealand, Norway, Portugal,

Singapore, South Africa, Spain, Sweden,
Taiwan, UK is 65, USA and West Indies.

I actually had no idea that there were so
many members scattered around the world.

So it's something I'm super proud
of, actually, that the membership

process is so far reaching.

And so I really would encourage anyone
that has the love of cats and that

really wants to expand their knowledge
to take the next step, because I

see and hear a lot of people talking
about it on various different forums.

And I think a lot of people maybe don't
necessarily have the courage to do

it, but anyone that's gotten through
a veterinary degree absolutely has the

ability to get through these exams.

And it may not necessarily
happen first time.

But even if it doesn't, all the work
that you're doing for these things,

it just really only ever makes
you the better clinician and more

knowledgeable and better at what you do.

So if you're thinking
about doing it, just do it.

It'll be a good decision.

Yaiza Gomez Mejias: And now I
will be interviewing Cecilia about

her JFMS article on Nutritional
Management of Comorbidities in Cats.

So with the growing number of veterinary
dietary options, recommending a

specific diet can be difficult,
especially when cats may suffer

different diseases simultaneously.

This is a challenge we often
experience in small animal practice.

And up to now there were no specific
resources to help us, but Cecilia has

recently published this nutritional
approach guide and the article explores

the nutritional management of cats
with multiple health conditions.

She details a step by step process
to assess nutritional needs and

selects compatible dietary strategies.

And she also uses case studies
to illustrate the practical

application of her suggestions.

I really liked the way you
combined the existing scientific

evidence with a holistic approach.

What are nutrient sensitive diseases?

And why is nutritional
management important for them?

Cecilia Villaverde: Thank
you for liking the paper.

I would like to thank my
coauthor Marta Hervera as well.

This was really tricky to write
as it's such a wide topic, right?

Nutrient sensitive diseases are those
diseases where dietary therapy is part

of the overall management of the case.

So in this case, you would be using
diet as some sort of medication

or part of the therapy, right?

So the role of diet in nutrient
sensitive diseases varies.

It can be central like for
chronic kidney disease or it can

have more of a supportive role.

It's not that it's not important to
consider diet in none nutrient sensitive,

but the diet itself is less critical.

If I have a cat with Cushing's
disease, I just want the diet to be

complete and balanced and fed it enough
amounts, but I don't have to give

specific nutrient modifications, right?

So when we talk about nutrient
sensitive diseases, we're talking

about those where we make some changes.

We use a diet with specific
modifications that can help either

with quality of life or survival.

Yaiza Gomez Mejias: And why is
nutritional assessment so crucial

for cats with comorbidities?

Cecilia Villaverde: It's particularly
critical when we have a cat with multiple

conditions because they are all different.

Cats with comorbidities, every
cat is its own universe, right?

And all diseases, even though we call
them one name, will present differently,

with different clinical signs, with
different laboratory abnormalities.

So we need to identify
all of those things.

Of course, during your workup, but also
in your nutritional assessment, you're

going to identify which systems are
more affected, what are the risks for

malnutrition individual for each case?

Is my body condition score good?

Do I have time to play around
and try different diets?

Or am I more in a rush if
it's a very thin animal?

So do your nutritional assessment,
your advanced nutritional assessment,

and you can have more information on
that on the WSAVA Global Nutrition

Committee website to get some tools.

I think they are also cited
in the article as well.

Yaiza Gomez Mejias: Yes, they are,
yeah, and I find them really helpful.

In the article you mentioned how
valuable the physical examination

and a good history taking is.

Can you name a few risk factors we may
identify once we chat with the owners

and examine the cat that may indicate
a need for nutritional adjustments?

Cecilia Villaverde: Yeah, so for example,
in the physical exam, though your

body condition score and your muscle
condition score would be very important,

they are geared towards estimating body
composition of the cat, both the fat

deposits and also the muscle mass, right?

Definitely abnormal body condition
score and abnormal muscle condition

score will be risk factors.

Not always modifiable by diet.

Like when an animal is underweight
or overweight, definitely

calories play a big role.

When a cat is muscle wasted, diet can
be supportive, but it won't always

solve the problem because the reasons
for muscle wasting are multiple.

It can be due to disease,
to aging, et cetera, but

definitely warrants intervention.

So those would be ones on the physical
exam, of course, the weight, not so

much the weight alone, but the weight
history or the weight evolution,

you can catch any changes in the
wrong direction quickly enough.

And also on the history, I would say doing
a good diet history is very important.

And that's probably really hard because
you need a lot of time to figure

out not only what the cat is eating,
but also how it's eating that food.

Make sure you include treats and any
other items because for a lot of cats

that have multiple diseases, and you have
to balance so many balls, it's important

that you know where you are right now.

And the nutrients of interest are going to
vary depending on your combo of diseases.

But when you have a baseline then it
makes it much easier to choose a diet

because you have goals from that baseline.

Yaiza Gomez Mejias: The advice you've
given is so clear in the article.

It's so cool.

I wish I had this article available
when I was studying nutrition because

it's always consumed so much time.

Cecilia Villaverde: And as you said at
the beginning, there's so many options

out there, and that's a good thing, right?

Having choices is always good, but
it can be paralysing sometimes.

Yaiza Gomez Mejias:
Thank you for listening.

If you're 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're looking for more free CPD

from International Cat Care, in April
we have an open webinar sponsored by

IDEXX where Dr Sarah Sweet will speak
about SDMA and common kidney diagnostic

conundrums in the feline patient.

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

Journal of Feline Medicine and Surgery.

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