Chattering with iCatCare

This month Nathalie Dowgray is speaking with Dr Panayiotis Mavrikios about the 2023
FIP outbreak in Cyprus. We also feature our monthly JFMS clinical spotlight interview in which Dr. Kelly St Denis discusses the AAFP/IAAHPC Feline Hospice and Palliative care guidelines with Diane Eigner and Katrina Breitreiter.

To begin our episode, we sit down with an ISFM academy member from Cyprus, Dr
Panayiotis Mavrikios, as he shares what it has been like seeing this volume of FIP cases,
how diagnostics are being selected and what treatment is now available to vets in
Cyprus.

Dr Kelly St Denis is then joined by Dr Diane Eigner and Dr Katrina Breitreiter, the
co-chairs of the 2023 AAFP/IAAHPC Feline Hospice and Palliative Care guidelines. We
learn the definitions of hospice care, palliative care and comfort care.

For further reading material please visit:
https://icatcare.org/fip-outbreak-cyprus/
https://pubmed.ncbi.nlm.nih.gov/37768060/
View The Transcript Here

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

Speakers:
Panayiotis Mavrikios, DVM MRCVS MANZCVS (Feline), ISFM Academy Member and Small Animal Veterinarian

Kelly St Denis, MSc, DVM, DABVP (Feline), 2022 ISFM/AAFP Cat Friendly Veterinary Environment Guidelines Co-Chair, St Denis Veterinary Professional Corporation, Powassan, Ontario, Canada

Diane Eigner, VMD MBA CVPM CHPV, Past President of the American Association of Feline Practitioners and owner and founder of The Cat Doctor.

Katrina Breitreiter, DVM, DABVP (Feline), Austin's only board-certified specialist in feline practice, and member of the American Association of Feline Practitioners (Plus many more!)
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 and Guests

Host
Nathalie Dowgray

What is Chattering with iCatCare?

Welcome to Chattering With iCatCare, the official monthly podcast of International Cat Care, hosted by Yaiza Gomez-Mejias (Veterinary Community Co-ordinator). 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 iCatCare members at portal.icatcare.org. If you would like access to our full episodes, would like to become an iCatCare Veterinary Society Member, or find out more about our Cat-Friendly schemes, visit icatcare.org.

Nathalie Dowgray: Hello,
welcome to the October 2023

episode of Chattering with ISFM.

I'm Nathalie Dowgray, Head of ISFM
and host of this month's podcast.

First up this month, I'm going to be
speaking with Dr Panayiotis Mavrikios

an ISFM Academy member from Cyprus.

And we're going to be discussing
the current situation with the

2023 Cypriot FIP outbreak that's
been making the international news.

We're also featuring our monthly JFMS
Clinical Spotlight interview, and

this month it's going to be the focus
on the new AAFP and IAAHPC Feline

Hospice and Palliative Care Guidelines.

Dr Kelly St.

Denis is going to be speaking with the
two co chairs of these guidelines, Dr

Diane Eigner and Dr Katrina Breitreiter.

We hope you enjoy this episode.

This year there's been a
large FIP outbreak in Cyprus.

I really wanted to start by just sort
of asking you about when it really was

that you and your colleagues started to
realize that there was more of a problem

with FIP than perhaps there normally is.

Panayiotis Mavrikios: Sure.

I would probably say for me was
around end of January, beginning

of February of this year.

Some people say that it probably
has started end of 2022.

I do not have my own clinic, so I run
this mobile service, so I would go to

some clinics I collaborate with, and there
will be literally two cats on the table

having their chests or abdomen drained.

And I thought that doesn't look like
what we've known so far about FIP.

There were people that they,
volunteers that go to parks and feed

cats, that they just said that the
population has been decreasing and

they could see quite a few unwell cats.

As a veterinary association here, there
is a hold record of the reported cases.

Obviously, that's not a true reflection
of what's happening, but there were

three or four cases reported in 2021 and
2022, and apparently only for January

2023, we had 98, so nearly 100 cases.

So I would probably say that the first
signs of epidemic were, were back then.

And the cases, they have been
constantly increasing in numbers

until probably around April this year.

And they stay high.

So we haven't noticed a
difference such as drop.

But I think they're stable now.

They're constantly high,
stable since April.

Nathalie Dowgray: That's
really interesting.

One of the difficulties with FIP as
a disease is that it's often a jigsaw

puzzle in terms of that diagnosis.

Is there much available locally for you or
are you having to send all of your tests

to other parts of the European mainland?

Panayiotis Mavrikios: Yeah, the thing
that we have here is unfortunately,

although we are lucky that we have one
veterinary lab, that was established a

couple of years ago, is still most of
the tests, they're highly sophisticated.

I would say they're just sent off abroad
to be run at external laboratories,

either in the UK or in Germany.

So there isn't anything, locally or
in Greece that we could get close

to either confirmation, or close
to confirmation of, our FIP cases.

And obviously when we're talking
about FIP and when we're talking about

what we're experiencing now with this
epidemic, the sooner you start the

cats on treatment, the better outcome
that you're expecting them to have.

Nathalie Dowgray: I understand now
that you do have some legal options

for your FIP cases in Cyprus.

Panayiotis Mavrikios:
Yeah, that's correct.

We do.

And that's only started happening
for the last month or so.

People here have the option of using
three legal preparations formulations.

The first two we're talking about
injectable Remdesivir and oral GS441524.

That's 50 milligram
tablets for the latter.

These are legally sourced from
UK's specials manufacturer.

That was a long process and I needed
a lot of hard work to be able to

get permission to use, import and
distribute these formulations in Cyprus.

We finally succeeded.

So these are now available.

We've got a few cats in treatment
on those preparations already.

And we're hoping that they will
become more popular as we go.

The second pathway, those can only
be sourced from the pharmaceutical

company that is a distributor.

And that pharmaceutical
company can only sell to vets.

The second option that would come
to the third drug that's available,

that's a Molnupiravir preparation,
it's 200 milligram capsules that

were labelled for human use.

They've been sourced from
the human hospitals here.

That, again, was a long process that
the veterinarians here tried since

the beginning of when they noticed the
epidemic and they , thank God, that

led it to positive outcome as well.

I've heard we are the first country that
we've got three authorized medications

to use for treatment of FIP in cats.

So that's really good, but I've
experienced firsthand how difficult it

was to go through that process and all the
documentation that was needed time after

time, just to persuade authorities that
they were, uh, those medications were very

much needed, especially with the epidemic.

But it's such a devastating disease and
what I have really tried to, if there

is any glimpse of hope in the whole
thing, and if there's any positive

little things to look into this epidemic
is, we know is a treatable disease.

The more we are open about it, the more
we share our experiences, the more we...

We talk about these things, I think the
more we can be able to help those cats, I

hope it doesn't happen to another country,
but we all know that it's possible and

so I think if the next country that
these or another infectious disease

hits in terms of cats, if there is a,
you know, a preparation, then obviously

we, there will be a better outcome.

Nathalie Dowgray: And now
it's over to Dr Kelly St.

Denis, and she's going to be
speaking with Dr Diane Eigner

and Dr Katrina Breitreiter.

They're the co chairs on the
2023 AAFP, IAAHPC Feline Hospice

and Palliative Care Guidelines.

Kelly St Denis: Congratulations to
both of you on this publication.

It is a fantastic guideline
and we're looking forward

to sharing it with everyone.

What is this hospice and palliative
care and end of life care?

Where do they fit into what we do?

And what sort of definitions
would you give them?

And are they different?

Diane Eigner: I think when I think
of either one the first thing that

comes to mind now is comfort care,
a term that is everyday language,

but really speaks to what our job
is in terms of for the patient.

One of the terms is the care unit.

We have our clinicians hat on and
we're communicating with our owners.

Those owners, you want to be major
participants in the decision making that's

going on regarding their very sick cat.

And that care unit can even be expanded to
other family members, anybody who's really

going to be involved in the decision
making about the care of that pet.

So you want to consider the patient's
perspective, of course, as much

as we can understand the cat.

Um, but we then want to really remember
that we're treating the owners as well.

Our first responsibility is
to the comfort of our patient.

Ethically, we have to focus on that,
but we can't separate the owner

from the way we're communicating
and handling these cases.

Hospice care, hospice is really
utilized, the term is utilized

when you've got a patient when
there were no other therapeutic

options available to that patient.

And the diagnosis is terminal.

They're seriously ill, and that one
is especially focused on comfort here.

I think what will be nice
about these guidelines is,

it'll remind us that sometimes when
we unfortunately have to share a poor

prognosis or diagnosis with an owner,
we may not think holistically about

how to provide that comfort care.

And I think these guidelines
will help make that much more

accessible to the reader.

And I think we'll be better able to
meet the needs of those patients.

And of course, their owners.

Katrina Breitreiter: And when I think
of palliative care, I really have

come to think of it as how can I make
this cat, their life, as great as it

possibly can be given the circumstances
that they're in, the medical

condition that they're dealing with.

And then another thing that we talk a
lot about in the guidelines is budgets

of care because not every client can
afford financially to do everything

that we might want to do, but then,
two, emotionally and physically, and

not every client is capable of giving
subcutaneous fluids at home, or maybe

there is some strong emotional ties
around the cancer diagnosis because of

past experiences or, or things like that.

And so those are all, I think, factors
that have to come into mind whenever

we're making a specific game plan
for an individual patient, because

we, we have to be mindful in the
hospice setting of, of what the, the

caregiver is able to do for that cat.

I was heavily involved in the writing
of the comfort care section, which

talks about how do we meet these cats
needs both physically and emotionally.

So, you know, their environmental needs,
giving a cat who maybe has mobility

restrictions access to places where
they like to be, you know, how do we

enable them to still get into the sunny
window or to the top of the cat tower?

Because those are the places the cat
wants to be, but there may be some

physical limitation to how to get there.

How do we make feeding more
comfortable for the cat?

Not just what we're feeding, but how
and where, and same with litter boxes

and scratching posts and all of those
vital resources throughout the home.

When you've got a hospice feline patient,
modifications are likely going to be

needed in that home environment in
order to still meet their environmental

Diane Eigner: We don't want to lose
focus on many of the ways that we

need to try as much as we can to
ensure emotional feline health.

And so we've brought in information about
that and applied it into this environment

with hospice and palliative care patients.

Nathalie Dowgray: Thank you for listening.

If you're an ISFM member, don't forget
you can access the full version of

this podcast and all of the other
ISFM member benefits, including

congress recordings, monthly webinars,
the clinical club, the discussion

forum, and much, much more at portal.

icatcare.

org.

If you're looking for more free CPD, we
have two open access webinars in November.

The first is from ISFM.

We have our quarterly Cat
Friendly Clinic webinar.

And this month, it's going
to be with Dr Sarah Caney.

She's speaking on Feline Wellness
Programs and that's going

live on the 7th of November.

And then, from Elanco on the 14th of
November, we have Manage Weight Loss,

Control Anemia: the Key Factors in
Feline CKD Management and that's with Dr.

Audrey Cook.

We'll be back again next month.

If you don't want to miss out, do make
sure you have signed up to Chattering with

ISFM on your preferred podcast platform.