The latest in CKD research and a spotlight on Feline Stress Management during Air Travel

Show Notes

This month we begin by chatting with Dr. Jessica Quimby about her latest research on kidney disease in cats. We're also featuring the first of our JFMS Clinical Spotlight Interviews with Dr. Katrin Jahn talking about air travel and cats.

Jessica and our host Nathalie Dowgray, Head of ISFM, discuss which additional medications you can use to support chronic renal cats with their appetite when suffering with nausea and Jessica talks about her latest study to assess how different medications may affect the blood pressure of our clients.

Nathalie then sits down with Dr. Katrin Jahn to talk about her JFMS clinical spotlight article on feline stress management during air travel.

For further reading material please visit:
https://journals.sagepub.com/doi/epub/10.1177/1098612X221077017
https://journals.sagepub.com/doi/epdf/10.1177/1098612X221145521

Tune in next month for more interviews recorded at ISFM in Rhodes, and next month's clinical spotlight interview.

For ISFM members, the full recording of this discussion is available for you to listen to at portal.icatcare.org. To become an ISFM member, or find out more about our Cat Friendly schemes, visit icatcare.org

Host:
Nathalie Dowgray, BVSc, MANZCVS, PgDip, MRCVS, PhD, Head of ISFM, International Society of Feline Medicine, International Cat Care, Tisbury, Wiltshire, UK

Speakers:
Dr Jessica Quimby, DVM, PhD, DACVIM, Associate Professor of small animal internal medicine at the Ohio State University, Winner of The International Renal Interest Society Award and the AVMF/Winn Feline Foundation Research Award.

Dr Katrin Jahn, CertVA, MANZCVS (Vet Beh), MRCVS, Veterinarian, Veterinary Behaviourist and Resident in Veterinary Behaviour Medicine (ECAWBM & ACVB)

For ISFM members, the full recording of this discussion is available for you to listen to at portal.icatcare.org. To become an ISFM member, or find out more about our Cat Friendly schemes, visit icatcare.org

Creators & Guests

Host

Nathalie Dowgray

What is Chattering With ISFM?

Welcome to Chattering With ISFM, the official monthly podcast of the International Society of Feline Medicine, hosted by Nathalie Dowgray (Head of ISFM). 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 ISFM members at portal.icatcare.org. If you would like access to our full episodes, would like to become an ISFM member, or find out more about our Cat-Friendly schemes, visit icatcare.org.

Nathalie Dowgray: Hello, welcome
to the first episode of

Chattering with ISFM for 2023.
I'm Nathalie Dowgray, head of

ISFM and the host and
interviewer for this month's

podcast. This month we're
starting off with a discussion

that I had with Dr. Jessica
Quimby at our Rhodes Congress

last year. I was talking with
her about some of her latest

research on kidney disease.
We're also featuring the first

of our JFMS Clinical Spotlight
Interviews with Dr. Katrin Jahn

talking about air travel and
cats. We hope you really enjoy

this episode.
When you're managing your

chronic renal cats, what other
additional medications do you

recommend adding in to support
them with their appetite,

especially when some of them
have things like nausea going on

as well?

Jessica Quimby: I do think it's
for the individual cat, of

course nothing is just you know,
we just say across the board

everybody needs this, every cat
will be different in terms of

where it's at with its body
condition score, its muscle mass

and its caloric intake. We
definitely take a look at, is

appetite normal or not? We might
use mirtazapine or capromorelin

to try to help with appetite. We
also are looking at nausea. So

it might be in hospital or at
home. The anti nausea

medications like ondansetron,
dolasetron, cerenia can be used

long term, we very frequently do
that to try to help control

vomiting associated with CKD.
Especially, I don't want them to

lose any more fluids. So anytime
vomiting is happening, we often

use multiple of those
medications together to try to

help out with the total package
for those patients and really

try to get as much caloric
intake as possible

Nathalie Dowgray: Brilliant.
You're really trying to keep

maintaining weight and hydration.

Jessica Quimby: Yeah, I would I
would back it up even more

globally, though, to think about
all of the other things that go

wrong with kidney disease that
would affect appetite, like

dehydration or anaemia or
hypokalemia. If I'm wanting to

help out with appetite,
addressing those things as well,

I think is really important.

Nathalie Dowgray: In terms of
these chronic kidney cats, and

often they do end up being on a
variety of medications. Do you

have sort of general rules about
how you approach potentially the

need, as we mentioned earlier,
to reduce medication sometimes,

especially when they're renally
excreted? Do you have any sort

of rules of thumb that people
can apply to reducing

medications in their CKD cats?

Jessica Quimby: That's a great
question. It's, on the

veterinary side, we're a bit
compromised, I think, because we

have almost no data for cats, or
dogs for that matter, on how to

reduce the dose and medications
or change the dose. So that's

part of what some of my work has
looked at is, well how is the

pharmacokinetics of this drug
different in kidney disease, and

so for instance, again, going
back to the two medications we

mentioned earlier, mirtazapine
and gabapentin, with mirtazapine

we learned that yes, the half
life is longer in kidney

disease. In the normal cat you
could give that medication, the

low dose, daily, but then you
would actually have to give it

less frequently orally, you'd go
to every other day. Now of the

transdermals that doesn't seem
to matter as much. So with

Mirataz, honestly, it's very
common that they get it daily

and we don't see that
accumulation. We don't see the

side effects because they don't
get as much of a serum

concentration buildup as they do
with the oral. In Gabapentin,

again, in you know, we've
learned there that it is 100%

renally excreted as I mentioned,
and so sometimes that dose

reduction is 50 to 75%. We do
have some later stage chronic

kidney disease cats that are
stressed and they do need it,

but they might even, they might
get 15 milligrammes whereas the

normal cat is getting 100
milligrammes, I mean, it's a

huge difference. But that drug,
they're not able to get it out

of the body as quickly. And so
without that, then you know,

they go home, and they can be
quite sedated, and we don't want

that to happen. And then now
we're, we're noticing in the

kidney disease cats that might
actually have a bit of an effect

on blood pressure as well,
especially when the dose is too

high. We're just now launching a
study that's funded by the

EveryCat Health Foundation,
again, as our similar studies

were, to look at the blood
pressure effect, because there's

two papers in normal cats that
show that it's actually not

affecting it. So that's a bit of
a concern, because anecdotally,

I've seen shuttle cats that have
gotten more than they should,

and they're quite sedate. And
when we've measured blood

pressure in that moment, it can
actually be quite low, like even

under 100.

Nathalie Dowgray: Oh, gosh, and
that's going to be a concern

again with your renal cats.

Jessica Quimby: Yeah, exactly.
So not what you would want for

your kidneys. So I'm hoping that
this new study will help give us

information to be able to
interpret that a little bit

better.

Nathalie Dowgray: Oh, we're
going to look forward to

watching out for that.
And now over to Dr. Katrin Jahn

to talk to her about her JFMS
clinical spotlight article on

feline stress management during
air travel.

For someone like me who's had
very, very little experience

with organising air travel, what
would be your sort of top tips?

What would you recommend?

Katrin Jahn: That's a great
question. So I think there are a

couple of key things, I think,
obviously, the more time you

have to prepare these trips, the
better. It just gives everybody

a chance to really think about
what might be the challenges and

how can we best prepare for
them. It also gives some time to

familiarise the cat to the
travel carrier, I think that's

such an important piece, the
more comfortable the cat feels

in the carrier, potentially, the
less stressful the journeys

going to be. So that time factor
is a critical piece. That's not

always possible, though. So
sometimes we do need to, you

know, plan these, these journeys
on the fly, so to speak, I would

say trying to choose as direct a
route as possible would be

important. So we don't have much
data in cats. But we do have

data on some other species, such
as horses, that show that the

most stressful times of the
flight were takeoff, landing,

loading on, loading off,
onboarding, off boarding, you

know, those sort of transit
periods. So having a direct

route with potentially only one
takeoff, and one landing may be

very beneficial. And working
with a really good pet shipping

agent to help with those
logistical pieces of the puzzle.

Pet shippers are a non regulated
industry like so many sort of

pet care industries,
unfortunately. So anybody really

can call themselves a pet
shipper, if they've got a little

bit of an idea of you know how
to sort of ship pets. However,

there are a couple of very good
industry organisations, one of

them is IPATA. The other one is
the ATA. And the members that

belong to IPATA, for example, or
the ATA, are really experienced

pet shippers, you know, they
have to go through an onboarding

period to become members. So
trying to find somebody that's

experienced and well
established. And that's, you

know, done this for a while, is
a really good idea, because they

can really help with choosing
those direct routes, finding pet

shippers on the other side that
are going to be able to help

with the arrival side of things.
They'll know what the country

requirements are, they'll know
what the travel carrier

requirements are. So that's a
really important piece, I think,

just from an organisational
point of view, because the last

thing you want is for the cat to
arrive somewhere, not have the

correct paperwork, have a stamp
missing. And then they've either

got to stay in quarantine for a
long time, or God forbid, they

get shipped back to the country
of origin. So, really having

that logistical piece in places
is really important from a

welfare point of view. And then
finally, I think, you know,

speaking to a vet, who has some
experience with air travel, and

there are a few out there, I've
got a number of colleagues in

the UK who do a lot of air
travel and speaking to them

about, you know, how best to
prepare the cat for the journey.

And that could be looking at the
physical health, as we

mentioned, but also looking at
all those adjunctive stress

management methods, whether
that's pheromones or supplements

or anxiolytic medication,
that's, I think, is a really

important piece. And then I'd
say don't forget the either

side, because if you think,
let's say we're dealing with an

actual relocation, so the whole
family is moving house from one

country to another, you've got
that whole period in the old

home, where you're packing up
the home, you're packing up the

boxes, there might be, you know,
packers and movers coming into

the house, we're potentially
removing the cats scent areas,

you know, we're removing their
beds and their scratch posts and

packing them all up. So that pre
flight period can be quite

stressful, then you've got the
flight itself, and then you've

got that post flight period
where the cats are then having

to acclimatised to a new home.
And depending on how many cats

are in the household, that
reintroduction process of the

cats to each other when they get
to the new home. That's another

really important piece because
each of the cats or all of the

cats that might be involved in
the journey have just gone

through quite a stressful event,
they're going to smell quite

different. They're not going to
sort of smell how they would

expect each other to smell. So
when they get reintroduced to

each other at the other end,
there might be an initial sort

of period of hostility and
stress. So making sure we do

reintroductions really safely on
the other side. There are a lot

of things to think about, but
those would be I think the most

important things try and have as
much time as you can, choose the

most direct route that you can,
work with an experienced pet

shipper and then work with other
professionals such as vets who

can help prepare the animal from
a mental, emotional, physical

point of view for for the
journey.

Nathalie Dowgray: Thank you for
listening. If you're an ISFM

veterinary member you can hear
more from Dr. Jahn with her full

interview being available on the
ISFM members podcast. To access

this please visit portal.icat
care.org. As well as the

podcast, you'll also be able to
access all of the other ISFM

veterinary member benefits,
including Dr. Quimby's lectures

from our ISFM Congress's,
monthly webinars, the discussion

forum and much more. And also
don't forget JFMS is now an open

access journal. So if you wish
to read Dr Jahn's clinical

spotlight article, please follow
the link in the show notes.

We'll be back next month with
more interviews recorded at ISFM

in Rhodes, and next months
clinical spotlight interview.