Hello and welcome to 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 fundoscopy.
I will be speaking with Dr Natalia Giannakopoulou and Dr Ben Blacklock about
the review article, Fundoscopy in Cats, A Practical Guide and Common Findings,
which they have recently published in the Journal of Feline Medicine and Surgery.
But first, I will be interviewing Dr Petra Cerna and Professor Daniel
Gunn-Moore about last year's JFMS article.
Feline Dystocia and Kitten Mortality up to 12 weeks in Pedigree Cats.
Thank you very much, Petra and Danielle, for your time today and
thank you for writing this article together with the other co-authors.
Could you talk about the main types of, you said dystocia.
You said dystocia.
How is it pronounced?
I think it depends whether you are Latin based or Greek.
How do you say it Petra?
I say dystocia, but I might be wrong.
Me too, me too.
I think dystocia is Latin and dystocia is Greek, right?
Yeah.
I think that's the difference.
Okay.
That's so revealing.
I always got confused with this since I came to England.
Anyway.
What are the main types of, dystocia or dystocia in cats and how are they managed?
You've got the maternal and the fetal type of dystocia, and we can all decide
that any pronunciation is the right one.
So the maternal ones, the what we see most, particularly with the, much more the
oriental cats, and this is just generally is where you've got the, the myometrium
just gives up pushing or never started.
So you can get primary.
You try an inertia where it never pushes or sometimes it pushes for a wee
bit and then it goes, no, I couldn't possibly, this is all just too tiring.
Or as we say, the cats are just too posh to push.
And I did, there was a breeder with the first questionnaire and she filled
it out and she said she was very proud of three generations with Siamese
and she said, yes, none of my girls are able to give birth naturally.
And she said they're all just too posh to push.
And it was the fact that she'd got three generations of them.
And you just think, was there not a concept that maybe, that breeding
from cats that can't give birth naturally might not be the ideal thing?
So you've got maternal, which I'll particularly say if a uterine
inertia, primary or secondary, it can be that the cat is unwell
or older, would be other reasons.
And then you've got the maternal fetal mismatch.
So where the kitten is too big, that tends to be when you've got a small number of
kittens in the litter, particularly we see this in Persians classically, only one
or two kittens and they can get chunky.
And of course the thing about a Persian cat, it's got a big head with no nose
and the mum cat has got a little pelvis, and so the, the kitten comes up to the
internal cervix, and because he's got no nose, it can't push into the cervix,
which is what they need to do to open the inside of the cervix so they can get out.
So their little faces pushed down the ways, or they get diverted laterally.
And so you then can get them presenting with the back of the head or a shoulder or
they're just too big and they get halfway into the cervix and then they're stuck.
So this fetal, maternal fetal mismatch, were all one kitten,
very big, is not uncommon.
They would be the major ones.
Petra, what ones would you add?
I think these are probably the major ones.
There, of course, I think it's a big difference and that's how I as a breeder
decided, when I spay my females and not breed from them anymore, was actually
if the kitten has given birth to couple of kittens and then maybe the third
one in the litter was stuck, or too big, we needed a C-section for that.
I was willing to try one more litter with that queen because she already
delivered multiple kittens on her own, and it was just, if it's a fetal
dystocia, I think there is a little bit more space for potentially trying
to mate the female one more time.
But every time I had a uterine dystocia where inertia, where they
had no contractions or the mom just couldn't push the kittens.
The birth canal was too narrow and no single kitten was actually born alive.
That's where I usually combine my spay with the C-section at the
same time because I just don't think it's fair to put the cats
through that experience again.
And it's, it was also very stressful for me, but I just don't think it
is fair for the Queen to having to go through that experience again.
So that's how I usually make the call.
And your studies about reproduction of in pedigree cats, what
changes have you observed?
One of the biggest difference that we had noticed that in the previous
studies that Danielle has been part of, the Persians and exotics seem to
have higher dystocia rates than these days, which was very surprising for us
especially because Persians and exotics have been quite rapidly changing in
type and they are now some of them quite severely brachycephalic cats, and
there's a lot of discussion about that.
However, it seemed actually that the prevalence of them having birth problems
is decreasing compared to previously.
So this was one thing that was very surprising for us, and I think we
were very excited to learn that.
I have to say that the Persians and exotic breeders, they work usually
quite hard to try to minimise the risks because they're already aware
that there are so many problems with that breed as it is because of its
extreme features and brachycephalism.
So a lot of them actually work very hard.
Look at, for example, polycystic kidney disease, right?
We went from crazy high prevalence to extremely low prevalence
just because of genetic testing.
So I think that was one of the things that really has changed
the most from the past, studies.
Yeah.
And just to jump in there, the, the numbers really are amazing.
So when I was doing my residency in say the early 1990s, then it was 40%, 35
to 40% of all Persians and exotic and all of the push face breeds, the, the
more what we would call ultra types.
So we put the color point Persians, whether you call
them himalayans or whatever.
Those 40%, 35 to 40% all over the world had polycystic
kidney disease, which was huge.
And it was such a major thing.
And of course we didn't have the genetic tests then, so we
couldn't test them as newborns.
We had to wait until they were 10 months old and then we could do the ultrasound
to check them, and by that time, people were really bonded with them.
And then you discover that no, they've got polycystic kidney disease.
The good thing was, of course, we could then say, no, don't
breed from the affected cat.
Or if you must, because it's got a particular trait that you really want
to capture, then you need to make sure that they're bred to a non affected cat.
Whereas now it's 2%.
And that shows just how effective the Persian exotic breeders have been.
They have just taken responsibility and gone, okay, we have a problem
with our breed, this we can mend.
And so we've taken it from 40% to 2%.
That is hats off to all those breeders who've had their cat screened,
that came from Persians and exotic cats, by the time they were eight
weeks of age, 25%, one in four.
And so many, it was dystocia that caused them to be stillborn or they
were so brain damaged by the whole birth, birth canal business, that
they didn't suck properly so that they were lost as fading kittens,
but certainly dead by eight weeks.
So to see the turnaround, where did they come in the collection of things, Petra?
Because say, they'd been the first for so long
we went down to about 15% now.
So it has decreased quite a lot and they were nowhere close to the
breeds that were the highest kitten mortality we unfortunately have seen.
I was also wanna mention that my biggest message here is that we need
to start advocating for these cats more because they can't do it themselves.
And that's why we are here.
Danielle and I think this is wonderful and I can't wait for the Feline World Congress
in Edinburgh, one of my favourite cities in the world, and I do hope that, a lot
of people will join us in Edinburgh and come to the Congress because I cannot wait
to actually have, I think three full days
and I'm actually doing lecture after lecture almost.
I hope people won't get bored of me, but I just cannot wait to
just talk about kittens and feline reproduction with a lot of amazing
speakers, and of course, Danielle.
And so I really hope I will see everybody there.
It's gonna be an amazing conference.
So definitely big shout out please, everyone who can get to
Edinburgh, please come and join us.
And I think what makes it really important is there are so few
meetings that talk about kittens.
And it is because, yes, as a a general practitioner, even as a specialist, we
don't get our paws on that many babies.
But we have to give a lot of advice.
And if we don't understand, we can't give the right advice.
So I think it is the perfect opportunity for people to come and
really get some really grounded, experienced advice about what can
and can't be done for these babies, how to do it right by these babies.
I'm particularly looking forward to talking about squitty kitties 'cause
I get to talk about babies with squits and they are fun to manage.
I like those.
So yeah, we've got a whole series of lectures on all sorts of aspects.
So yes to everybody.
Please come and join us in, in Edinburgh.
Thank you so much.
I think, uh, if, if there's a still anyone there who doesn't want to come
to the Congress, they will want to come to the Congress once they listen to you.
Thank you so much for your time today.
And now, Dr Natalia Giannakopoulou and Dr Ben Blacklock will discuss
fundoscopy in cats, some practical tips and common findings.
Fundoscopy is such a relevant tool in our routine physical examination, especially
in senior cats and those with eye problems ophthalmoscopes are available
in most practices, but still some vets may need advice to use them correctly.
So what main tips would you recommend for them to gain confidence when
performing a basic ophthalmologic
I think for me, my biggest tip would be, which could sound quite basic,
but to just pick up the ophthalmoscope and use it as much as possible.
And also not to use it only for cases that have eye problems, but also
to examine a lot of normal eyes.
And I think clinicians would benefit in many ways by doing this.
First of all, they would familiarise themselves with the ophthalmoscope better,
and they would learn what different settings do on the ophthalmoscope.
Let's say you have the diopter wheel that you can use to focus
on different parts of the eye.
That can be helpful to know that, but also by examining a lot of normal eyes,
because it's a lot of different variations in what a normal fundus looks like.
You are almost able to build this like mental reference
of what normal looks like.
So then when you're examining an eye with ocular pathology, you're
able to identify that easier.
Technique-wise with your ophthalmoscope it always helps if you have a fully
dilated pupil, because with the direct ophthalmoscope you get this
almost keyhole view of the fundus, your field of view is quite narrow
and the image is quite magnified.
So if the pupil is not fully mydriatic it can be quite challenging to have
a good view, especially because with our patients, they don't tend
to stay still for long enough.
So I would always recommend dilating the pupil before you
start doing this technique.
Great.
And I also, I really liked the part of the article where you
recommend a methodic approach to the different parts of the fundus.
Yeah, definitely.
And this is something that we teach our students at the vet school, and
we normally tell them to follow the systematic approach where you would
try to find the optic nerve yet first and use it as a reference point.
And then I would recommend assessing the retinal blood vessels next, then
splitting the fundus into quadrants and try to examine each quadrant
as efficiently as possible, as to not miss any little subtle lesions.
If these ophthalmoscopes are not routinely used in your practice, just
make sure the batteries are fully charged.
Make sure they're nice and clean.
'cause all the little lenses get dirty.
Make sure you can look through it without, without any major
opacities on all the lenses.
And then when I was in practice, the cats that I used to love practicing
this on was those that'd had triple anaesthetics for routine neutering.
'cause the pupils are widely dilated, they've got a central eye
and you can spend a minute just practicing your ophthalmoscopy
on these anaesthetised kittens.
That's brilliant advice.
I love it.
Thank you.
And besides the ophthalmoscope, is there any other equipment that we
could use or that we should be using?
Definitely there's a lot of different options that you can use for
ophthalmoscopy and they all can give you like a different perspective and
they have their pros and their cons.
Another ophthalmoscope that you can use is the panoptic ophthalmoscope
that basically can attach to the standard ophthalmoscope handle.
With this ophthalmoscope you get, you still get an upright view of the fundus,
but your field of view is wider, so it can be more easy to see more of the fundus
at once, which is helpful for someone who's just beginning and might struggle
with the direct of ophthalmoscope.
I wanted to ask you about the lens.Which lens do you recommend for
vets working in general practice?
So I think if you're a general practitioner, you only
want to invest in one lens.
We tend to recommend The Pan Retinal 2.2 because I feel like that lens is a good
choice because it gives you a wide field of view, but also good magnification.
And in general, the higher the diopter the lens is, the more wide the magnification
you're gonna get, the more wide the field of view is gonna be, but the
less magnification you're gonna get.
So for example, if you're gonna buy a 30 D lens, it's gonna give
you a wide field of view, but less magnification compared to a 20 D lens.
But with the the pan retinal, it's basically between these two lenses,
so you get the both of those worlds.
So I think it would be the one to invest if you're
considering buying only one lens.
Thank you so much for writing this article 'cause it will be
extremely helpful to practitioners.
Thank you for listening.
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We’ll be back again next month with more from the world of feline
medicine and The Journal of Feline Medicine and Surgery [JFMS].