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.