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Nathalie Dowgray: Hello, welcome
to the first episode of

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

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ISFM and the host and
interviewer for this month's

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

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

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

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

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of our JFMS Clinical Spotlight
Interviews with Dr. Katrin Jahn

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

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this episode.
When you're managing your

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chronic renal cats, what other
additional medications do you

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recommend adding in to support
them with their appetite,

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especially when some of them
have things like nausea going on

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as well?

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

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

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

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

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

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appetite normal or not? We might
use mirtazapine or capromorelin

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

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

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medications like ondansetron,
dolasetron, cerenia can be used

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

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

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

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use multiple of those
medications together to try to

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help out with the total package
for those patients and really

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try to get as much caloric
intake as possible

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

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maintaining weight and hydration.

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

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

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wrong with kidney disease that
would affect appetite, like

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

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help out with appetite,
addressing those things as well,

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I think is really important.

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

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

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have sort of general rules about
how you approach potentially the

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

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

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of rules of thumb that people
can apply to reducing

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medications in their CKD cats?

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

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

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

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

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

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pharmacokinetics of this drug
different in kidney disease, and

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

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mentioned earlier, mirtazapine
and gabapentin, with mirtazapine

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

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

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

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

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

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

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

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

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

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

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renally excreted as I mentioned,
and so sometimes that dose

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

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

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

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

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

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

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

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

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

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

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

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EveryCat Health Foundation,
again, as our similar studies

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

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

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

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

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

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

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under 100.

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

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again with your renal cats.

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

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

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information to be able to
interpret that a little bit

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better.

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

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

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to talk to her about her JFMS
clinical spotlight article on

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feline stress management during
air travel.

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

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

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What would you recommend?

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

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

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

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

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

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

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such an important piece, the
more comfortable the cat feels

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in the carrier, potentially, the
less stressful the journeys

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

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

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

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

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

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

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most stressful times of the
flight were takeoff, landing,

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

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

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

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very beneficial. And working
with a really good pet shipping

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agent to help with those
logistical pieces of the puzzle.

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

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pet care industries,
unfortunately. So anybody really

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

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

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

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

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

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

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

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experienced and well
established. And that's, you

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

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can really help with choosing
those direct routes, finding pet

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

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

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requirements are, they'll know
what the travel carrier

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

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just from an organisational
point of view, because the last

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

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

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

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

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that logistical piece in places
is really important from a

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

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

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

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

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

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

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mentioned, but also looking at
all those adjunctive stress

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management methods, whether
that's pheromones or supplements

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

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

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

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

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

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

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

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

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

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

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

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got that post flight period
where the cats are then having

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

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are in the household, that
reintroduction process of the

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

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

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cats that might be involved in
the journey have just gone

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

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

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

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

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

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

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

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

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

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shipper and then work with other
professionals such as vets who

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

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point of view for for the
journey.

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

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

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interview being available on the
ISFM members podcast. To access

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

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

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veterinary member benefits,
including Dr. Quimby's lectures

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

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

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

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

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

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in Rhodes, and next months
clinical spotlight interview.