1 00:00:05,020 --> 00:00:07,530 Yaiza Gomez Mejias: Hello, and welcome to the March episode of 2 00:00:07,540 --> 00:00:09,510 Chattering with International Cat Care. 3 00:00:10,170 --> 00:00:13,990 I'm Yaiza Gomez Mejias, iCatCare Veterinary Community Coordinator 4 00:00:14,020 --> 00:00:15,300 and host of this month's podcast. 5 00:00:16,610 --> 00:00:19,230 Our clinical spotlight this month is focused on nutritional 6 00:00:19,250 --> 00:00:21,450 management of comorbidities in cats. 7 00:00:21,910 --> 00:00:25,110 I will be speaking with Dr. Cecilia Villaverde about dietary 8 00:00:25,120 --> 00:00:28,049 aspects we need to consider in cats with more than one disease. 9 00:00:28,480 --> 00:00:32,370 But first, I will be interviewing Dr. Rachel Korman about the Australian 10 00:00:32,370 --> 00:00:35,610 and New Zealand College of Veterinary Scientists feline chapter and 11 00:01:14,330 --> 00:01:16,360 the membership exam on medicine of cats. 12 00:01:18,760 --> 00:01:21,349 So thank you for your time today, Rachel. 13 00:01:22,270 --> 00:01:26,170 Could you start telling us what is the feline chapter, which sounds 14 00:01:26,170 --> 00:01:30,189 a little bit like the ministry of cats, and what are its objectives? 15 00:01:31,329 --> 00:01:31,469 Rachel Korman: Yeah. 16 00:01:31,690 --> 00:01:33,890 I love the idea of a ministry of cats. 17 00:01:34,130 --> 00:01:36,790 And I think that's very similar to what we are. 18 00:01:36,790 --> 00:01:41,600 Essentially it's just a group of people who are really passionate 19 00:01:41,630 --> 00:01:46,690 about veterinary education, in particular, feline medicine. 20 00:01:46,690 --> 00:01:51,770 And it's probably one of the last kind of bastions of very specific 21 00:01:51,770 --> 00:01:54,869 feline medicine qualifications. 22 00:01:55,360 --> 00:02:03,000 Really the aims of the chapter are to just further study and research and 23 00:02:03,000 --> 00:02:08,250 education in feline medicine across multiple different platforms and it's 24 00:02:08,810 --> 00:02:16,190 a way of encouraging further study for post graduates and also just giving 25 00:02:16,280 --> 00:02:21,069 people the ability to talk to each other about feline medicine, discuss 26 00:02:21,070 --> 00:02:26,880 research projects and just really try and hold that excitement and love 27 00:02:26,890 --> 00:02:33,810 for feline medicine, and definitely encouraging publications and collaborative 28 00:02:33,810 --> 00:02:36,130 work in the research space as well. 29 00:02:37,009 --> 00:02:40,970 Yaiza Gomez Mejias: And what's the link between the feline chapte r and iCatCare, 30 00:02:42,029 --> 00:02:46,040 the medicine of cats, UK qualification that the feline chapter offers. 31 00:02:46,990 --> 00:02:47,240 Rachel Korman: Yeah. 32 00:02:47,240 --> 00:02:53,460 So I guess the Australian New Zealand examination process has been in 33 00:02:54,059 --> 00:02:56,570 medicine of cats for a very long time. 34 00:02:56,570 --> 00:03:01,720 So I think the first sort of examination in medicine of cats was in 1978 so 35 00:03:01,720 --> 00:03:03,370 it's been around for a very long time. 36 00:03:03,370 --> 00:03:10,790 And I think that International Cat Care recognised that it was a very specific 37 00:03:11,050 --> 00:03:17,260 feline qualification that would really align with the values of International 38 00:03:17,260 --> 00:03:22,200 Cat Care with regards to education and furthering academic excellence 39 00:03:22,220 --> 00:03:24,130 in the space of feline medicine. 40 00:03:24,520 --> 00:03:30,180 So International Cat Care, or ISFM as it was back then, adopted 41 00:03:30,180 --> 00:03:34,200 it as it's officially recognised postgraduate qualification. 42 00:03:35,920 --> 00:03:36,170 Yaiza Gomez Mejias: Brilliant. 43 00:03:36,170 --> 00:03:39,820 And that's a good thing because we haven't got a college for 44 00:03:40,100 --> 00:03:41,650 medicine of cats in Europe. 45 00:03:42,080 --> 00:03:45,630 And the feline medicine specialty doesn't exist everywhere. 46 00:03:45,719 --> 00:03:47,840 Rachel Korman: We're a rare breed now. 47 00:03:47,910 --> 00:03:53,709 And so I think that, obviously there's qualifications in multiple areas, 48 00:03:53,709 --> 00:03:58,250 in companion animal or small animal medicine, but we certainly recognise 49 00:03:58,320 --> 00:04:03,730 that feline medicine itself is a highly specialised and focused field and 50 00:04:03,730 --> 00:04:07,140 it's certainly something that I feel really passionate about maintaining 51 00:04:07,460 --> 00:04:09,640 that as a specialty in itself. 52 00:04:11,039 --> 00:04:13,219 Yaiza Gomez Mejias: What does the examination consist of? 53 00:04:14,900 --> 00:04:18,470 Rachel Korman: So essentially there are two written papers. 54 00:04:18,610 --> 00:04:21,490 The first paper is primarily based on pathophysiology. 55 00:04:22,570 --> 00:04:27,800 How diseases occur, the physiology behind the diseases and more of 56 00:04:27,809 --> 00:04:30,019 that pure science if you like. 57 00:04:30,020 --> 00:04:33,830 But again, remembering that this is a practical exam as well. 58 00:04:34,010 --> 00:04:38,810 They should be things that you're seeing fairly regularly in a busy 59 00:04:38,810 --> 00:04:42,789 practice, but certainly paper one is all about pathophysiology 60 00:04:43,889 --> 00:04:46,450 of diseases and understanding. 61 00:04:46,779 --> 00:04:52,250 It runs for about sort of two hours and then the second paper is 62 00:04:52,250 --> 00:04:57,670 another written paper, but paper two is more clinically based. 63 00:04:57,690 --> 00:05:03,050 So diagnosis of diseases and clinical signs of diseases and 64 00:05:03,059 --> 00:05:07,280 treatment, and it's a little bit more practical in its approach. 65 00:05:07,540 --> 00:05:13,060 And then finally, there's a 45 minute oral examination where you might be 66 00:05:13,060 --> 00:05:16,500 shown a series of images from a case. 67 00:05:16,510 --> 00:05:18,280 So you might need to interpret 68 00:05:18,349 --> 00:05:24,189 clinical pathology data and basic x ray images, or radiographic 69 00:05:24,190 --> 00:05:28,039 images or ultrasound images and then work through cases. 70 00:05:28,040 --> 00:05:31,430 And we're certainly, we're not looking for the ultimate diagnosis, 71 00:05:31,430 --> 00:05:37,550 we're looking for an appropriate, practical, broad approach to the case. 72 00:05:37,580 --> 00:05:40,869 And so it's certainly an awful lot of work and it does take 73 00:05:40,869 --> 00:05:43,609 people a lot of time to prepare. 74 00:05:43,870 --> 00:05:48,469 But you'll certainly come out of the process as a much better clinician 75 00:05:48,480 --> 00:05:50,050 with a much better understanding. 76 00:05:50,410 --> 00:05:51,120 Yaiza Gomez Mejias: I agree. 77 00:05:51,300 --> 00:05:52,479 It helped me a lot. 78 00:05:52,740 --> 00:05:55,570 Any personal recommendations on how to approach the study 79 00:05:55,610 --> 00:05:57,359 timeline and the content 80 00:05:57,509 --> 00:05:59,419 Rachel Korman: I think everyone probably has a very different 81 00:05:59,420 --> 00:06:03,140 approach and I can say what's, worked for me and what I've seen work 82 00:06:03,140 --> 00:06:04,730 for other people coming through. 83 00:06:05,140 --> 00:06:11,979 I basically just got a textbook it wasn't Susan Little back then, I think it was, 84 00:06:11,990 --> 00:06:18,199 Scherding was the author back in, in my time, but I basically took the chapter 85 00:06:18,209 --> 00:06:23,090 headings and so it was essentially systems, so it was neurology and urinary 86 00:06:23,090 --> 00:06:29,740 and, and so I then just broke that down into physiology and then diseases and 87 00:06:29,809 --> 00:06:31,729 broke it down a little bit that way. 88 00:06:31,730 --> 00:06:39,200 And I then, once I had that formulated, I put that against a timeframe. 89 00:06:39,200 --> 00:06:44,430 So for example, I wanted to make sure that I had all of my clinical 90 00:06:44,430 --> 00:06:48,809 notes and everything written a couple of months out from the exams. 91 00:06:49,070 --> 00:06:53,379 And so once I'd made that decision, I then figured out how much time 92 00:06:53,379 --> 00:06:55,350 I had to spend on each section. 93 00:06:55,640 --> 00:06:57,960 And I stuck to that pretty rigidly. 94 00:06:58,170 --> 00:07:03,400 And it's so easy to go down rabbit holes of finite detail, but I think that's 95 00:07:03,400 --> 00:07:08,330 when people can get caught out too, is that you end up spending so much time 96 00:07:08,330 --> 00:07:12,470 on one tiny little aspect of it that you lose sight of the bigger picture. 97 00:07:12,470 --> 00:07:17,830 And so having a bit of a clear timeline just makes you a bit more accountable for 98 00:07:18,130 --> 00:07:20,170 what you have to get finished and when. 99 00:07:20,220 --> 00:07:24,160 And look, I guess one last thing that I probably should have mentioned right back 100 00:07:24,160 --> 00:07:28,560 at the start, but when you asked me to have a chat about the exams and it made me 101 00:07:28,560 --> 00:07:33,570 go back and actually pull out some of the data about how many members we have and 102 00:07:33,570 --> 00:07:39,820 how many people have sat and it actually really amazed me just the variety of 103 00:07:39,950 --> 00:07:42,799 places that the members have come from. 104 00:07:42,799 --> 00:07:47,710 And so all in all, we've got close to 300 people worldwide who've sat and 105 00:07:47,710 --> 00:07:50,170 passed the feline membership exams. 106 00:07:50,520 --> 00:07:55,760 About 150 or 148 of those are in Australia, but we've got people from 107 00:07:55,780 --> 00:08:02,079 Austria, Canada, Czech Republic, Finland, France, Germany, Hong Kong, Hungary, 108 00:08:02,120 --> 00:08:07,119 Ireland, Israel, Malta, The Netherlands, New Zealand, Norway, Portugal, 109 00:08:07,129 --> 00:08:14,690 Singapore, South Africa, Spain, Sweden, Taiwan, UK is 65, USA and West Indies. 110 00:08:15,130 --> 00:08:20,490 I actually had no idea that there were so many members scattered around the world. 111 00:08:20,490 --> 00:08:23,990 So it's something I'm super proud of, actually, that the membership 112 00:08:24,420 --> 00:08:26,250 process is so far reaching. 113 00:08:26,250 --> 00:08:30,010 And so I really would encourage anyone that has the love of cats and that 114 00:08:30,010 --> 00:08:33,970 really wants to expand their knowledge to take the next step, because I 115 00:08:35,299 --> 00:08:39,399 see and hear a lot of people talking about it on various different forums. 116 00:08:39,400 --> 00:08:43,020 And I think a lot of people maybe don't necessarily have the courage to do 117 00:08:43,020 --> 00:08:47,680 it, but anyone that's gotten through a veterinary degree absolutely has the 118 00:08:47,680 --> 00:08:49,660 ability to get through these exams. 119 00:08:49,660 --> 00:08:52,190 And it may not necessarily happen first time. 120 00:08:52,500 --> 00:08:56,279 But even if it doesn't, all the work that you're doing for these things, 121 00:08:56,540 --> 00:09:00,339 it just really only ever makes you the better clinician and more 122 00:09:00,350 --> 00:09:02,670 knowledgeable and better at what you do. 123 00:09:02,700 --> 00:09:05,240 So if you're thinking about doing it, just do it. 124 00:09:05,490 --> 00:09:06,900 It'll be a good decision. 125 00:09:08,349 --> 00:09:10,850 Yaiza Gomez Mejias: And now I will be interviewing Cecilia about 126 00:09:10,860 --> 00:09:15,479 her JFMS article on Nutritional Management of Comorbidities in Cats. 127 00:09:17,000 --> 00:09:20,339 So with the growing number of veterinary dietary options, recommending a 128 00:09:20,340 --> 00:09:24,239 specific diet can be difficult, especially when cats may suffer 129 00:09:24,240 --> 00:09:25,900 different diseases simultaneously. 130 00:09:26,500 --> 00:09:29,630 This is a challenge we often experience in small animal practice. 131 00:09:30,130 --> 00:09:33,810 And up to now there were no specific resources to help us, but Cecilia has 132 00:09:33,810 --> 00:09:38,630 recently published this nutritional approach guide and the article explores 133 00:09:38,710 --> 00:09:41,910 the nutritional management of cats with multiple health conditions. 134 00:09:42,600 --> 00:09:45,999 She details a step by step process to assess nutritional needs and 135 00:09:46,000 --> 00:09:47,980 selects compatible dietary strategies. 136 00:09:48,520 --> 00:09:51,350 And she also uses case studies to illustrate the practical 137 00:09:51,350 --> 00:09:53,029 application of her suggestions. 138 00:09:54,020 --> 00:09:57,100 I really liked the way you combined the existing scientific 139 00:09:57,100 --> 00:09:58,830 evidence with a holistic approach. 140 00:09:59,140 --> 00:10:01,260 What are nutrient sensitive diseases? 141 00:10:01,310 --> 00:10:04,180 And why is nutritional management important for them? 142 00:10:05,230 --> 00:10:06,709 Cecilia Villaverde: Thank you for liking the paper. 143 00:10:06,950 --> 00:10:09,470 I would like to thank my coauthor Marta Hervera as well. 144 00:10:09,820 --> 00:10:13,510 This was really tricky to write as it's such a wide topic, right? 145 00:10:14,060 --> 00:10:19,160 Nutrient sensitive diseases are those diseases where dietary therapy is part 146 00:10:19,350 --> 00:10:21,380 of the overall management of the case. 147 00:10:21,719 --> 00:10:25,660 So in this case, you would be using diet as some sort of medication 148 00:10:25,660 --> 00:10:27,199 or part of the therapy, right? 149 00:10:27,219 --> 00:10:31,189 So the role of diet in nutrient sensitive diseases varies. 150 00:10:31,189 --> 00:10:34,710 It can be central like for chronic kidney disease or it can 151 00:10:34,770 --> 00:10:36,390 have more of a supportive role. 152 00:10:37,130 --> 00:10:41,020 It's not that it's not important to consider diet in none nutrient sensitive, 153 00:10:41,080 --> 00:10:43,610 but the diet itself is less critical. 154 00:10:43,610 --> 00:10:47,279 If I have a cat with Cushing's disease, I just want the diet to be 155 00:10:47,279 --> 00:10:50,360 complete and balanced and fed it enough amounts, but I don't have to give 156 00:10:50,380 --> 00:10:52,420 specific nutrient modifications, right? 157 00:10:52,980 --> 00:10:55,410 So when we talk about nutrient sensitive diseases, we're talking 158 00:10:55,410 --> 00:10:58,040 about those where we make some changes. 159 00:10:58,090 --> 00:11:01,459 We use a diet with specific modifications that can help either 160 00:11:01,469 --> 00:11:03,729 with quality of life or survival. 161 00:11:04,340 --> 00:11:07,190 Yaiza Gomez Mejias: And why is nutritional assessment so crucial 162 00:11:07,200 --> 00:11:08,850 for cats with comorbidities? 163 00:11:09,860 --> 00:11:13,370 Cecilia Villaverde: It's particularly critical when we have a cat with multiple 164 00:11:13,370 --> 00:11:15,360 conditions because they are all different. 165 00:11:15,820 --> 00:11:19,270 Cats with comorbidities, every cat is its own universe, right? 166 00:11:19,759 --> 00:11:23,709 And all diseases, even though we call them one name, will present differently, 167 00:11:23,719 --> 00:11:27,020 with different clinical signs, with different laboratory abnormalities. 168 00:11:27,030 --> 00:11:29,560 So we need to identify all of those things. 169 00:11:29,870 --> 00:11:33,519 Of course, during your workup, but also in your nutritional assessment, you're 170 00:11:33,550 --> 00:11:37,380 going to identify which systems are more affected, what are the risks for 171 00:11:37,420 --> 00:11:39,770 malnutrition individual for each case? 172 00:11:40,090 --> 00:11:42,010 Is my body condition score good? 173 00:11:42,020 --> 00:11:45,329 Do I have time to play around and try different diets? 174 00:11:45,330 --> 00:11:48,080 Or am I more in a rush if it's a very thin animal? 175 00:11:48,650 --> 00:11:52,289 So do your nutritional assessment, your advanced nutritional assessment, 176 00:11:52,290 --> 00:11:56,660 and you can have more information on that on the WSAVA Global Nutrition 177 00:11:56,660 --> 00:11:59,239 Committee website to get some tools. 178 00:11:59,240 --> 00:12:01,719 I think they are also cited in the article as well. 179 00:12:02,540 --> 00:12:05,030 Yaiza Gomez Mejias: Yes, they are, yeah, and I find them really helpful. 180 00:12:05,160 --> 00:12:08,380 In the article you mentioned how valuable the physical examination 181 00:12:08,660 --> 00:12:10,220 and a good history taking is. 182 00:12:10,220 --> 00:12:15,279 Can you name a few risk factors we may identify once we chat with the owners 183 00:12:15,280 --> 00:12:19,920 and examine the cat that may indicate a need for nutritional adjustments? 184 00:12:20,170 --> 00:12:23,490 Cecilia Villaverde: Yeah, so for example, in the physical exam, though your 185 00:12:23,490 --> 00:12:27,299 body condition score and your muscle condition score would be very important, 186 00:12:27,750 --> 00:12:32,279 they are geared towards estimating body composition of the cat, both the fat 187 00:12:32,619 --> 00:12:34,920 deposits and also the muscle mass, right? 188 00:12:35,480 --> 00:12:39,089 Definitely abnormal body condition score and abnormal muscle condition 189 00:12:39,090 --> 00:12:40,910 score will be risk factors. 190 00:12:41,340 --> 00:12:43,520 Not always modifiable by diet. 191 00:12:43,540 --> 00:12:46,370 Like when an animal is underweight or overweight, definitely 192 00:12:46,380 --> 00:12:47,550 calories play a big role. 193 00:12:47,980 --> 00:12:52,340 When a cat is muscle wasted, diet can be supportive, but it won't always 194 00:12:52,340 --> 00:12:55,870 solve the problem because the reasons for muscle wasting are multiple. 195 00:12:55,990 --> 00:12:58,990 It can be due to disease, to aging, et cetera, but 196 00:12:59,000 --> 00:13:00,910 definitely warrants intervention. 197 00:13:01,110 --> 00:13:04,859 So those would be ones on the physical exam, of course, the weight, not so 198 00:13:04,860 --> 00:13:08,310 much the weight alone, but the weight history or the weight evolution, 199 00:13:09,009 --> 00:13:13,000 you can catch any changes in the wrong direction quickly enough. 200 00:13:13,540 --> 00:13:18,060 And also on the history, I would say doing a good diet history is very important. 201 00:13:18,360 --> 00:13:22,300 And that's probably really hard because you need a lot of time to figure 202 00:13:22,360 --> 00:13:27,280 out not only what the cat is eating, but also how it's eating that food. 203 00:13:27,599 --> 00:13:32,700 Make sure you include treats and any other items because for a lot of cats 204 00:13:32,700 --> 00:13:36,630 that have multiple diseases, and you have to balance so many balls, it's important 205 00:13:36,720 --> 00:13:38,310 that you know where you are right now. 206 00:13:38,500 --> 00:13:42,590 And the nutrients of interest are going to vary depending on your combo of diseases. 207 00:13:42,599 --> 00:13:46,600 But when you have a baseline then it makes it much easier to choose a diet 208 00:13:46,600 --> 00:13:48,910 because you have goals from that baseline. 209 00:13:49,210 --> 00:13:52,490 Yaiza Gomez Mejias: The advice you've given is so clear in the article. 210 00:13:52,490 --> 00:13:53,370 It's so cool. 211 00:13:53,390 --> 00:13:58,250 I wish I had this article available when I was studying nutrition because 212 00:13:58,639 --> 00:14:00,080 it's always consumed so much time. 213 00:14:00,090 --> 00:14:02,469 Cecilia Villaverde: And as you said at the beginning, there's so many options 214 00:14:02,469 --> 00:14:03,880 out there, and that's a good thing, right? 215 00:14:03,889 --> 00:14:07,560 Having choices is always good, but it can be paralysing sometimes. 216 00:14:13,730 --> 00:14:14,640 Yaiza Gomez Mejias: Thank you for listening. 217 00:14:14,720 --> 00:14:18,189 If you're an iCatCare Veterinary Society Member, don't forget you can access 218 00:14:18,190 --> 00:14:22,059 the full version of the podcast and all the other member benefits including 219 00:14:22,059 --> 00:14:26,440 congress recordings, monthly webinars and clinical clubs, the discussion forum 220 00:14:26,480 --> 00:14:32,370 and much more at portal.icatcare.org If you're looking for more free CPD 221 00:14:32,380 --> 00:14:36,540 from International Cat Care, in April we have an open webinar sponsored by 222 00:14:36,570 --> 00:14:42,799 IDEXX where Dr Sarah Sweet will speak about SDMA and common kidney diagnostic 223 00:14:42,799 --> 00:14:44,660 conundrums in the feline patient. 224 00:14:45,460 --> 00:14:49,400 We'll be back again next month with more from the world of feline medicine and the 225 00:14:49,400 --> 00:14:51,260 Journal of Feline Medicine and Surgery.