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Nathalie Dowgray: Hello,
welcome to the October 2023

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episode of Chattering with ISFM.

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

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

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an ISFM Academy member from Cyprus.

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

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

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

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

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Hospice and Palliative Care Guidelines.

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Dr Kelly St.

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

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Diane Eigner and Dr Katrina Breitreiter.

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We hope you enjoy this episode.

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

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

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

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with FIP than perhaps there normally is.

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Panayiotis Mavrikios: Sure.

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

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of February of this year.

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

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

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

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having their chests or abdomen drained.

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

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

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

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they could see quite a few unwell cats.

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

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

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

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2023, we had 98, so nearly 100 cases.

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

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And the cases, they have been
constantly increasing in numbers

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until probably around April this year.

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And they stay high.

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

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But I think they're stable now.

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They're constantly high,
stable since April.

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Nathalie Dowgray: That's
really interesting.

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

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puzzle in terms of that diagnosis.

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

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to other parts of the European mainland?

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

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

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

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

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either in the UK or in Germany.

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

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

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

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

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

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

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for your FIP cases in Cyprus.

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Panayiotis Mavrikios:
Yeah, that's correct.

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We do.

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

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

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

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That's 50 milligram
tablets for the latter.

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These are legally sourced from
UK's specials manufacturer.

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

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

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We finally succeeded.

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So these are now available.

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

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

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

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company that is a distributor.

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And that pharmaceutical
company can only sell to vets.

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

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

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were  labelled for human use.

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They've been sourced from
the human hospitals here.

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

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

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led it to positive outcome as well.

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

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to use for treatment of FIP in cats.

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

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

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

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much needed, especially with the epidemic.

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

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

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

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

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

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

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

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

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we, there will be a better outcome.

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

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

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and Dr Katrina Breitreiter.

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

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and Palliative Care Guidelines.

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

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It is a fantastic guideline
and we're looking forward

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to sharing it with everyone.

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

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Where do they fit into what we do?

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And what sort of definitions
would you give them?

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And are they different?

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

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

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

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One of the terms is the care unit.

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

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

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going on regarding their very sick cat.

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

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

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

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as we can understand the cat.

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

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Our first responsibility is
to the comfort of our patient.

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

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

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

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

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options available to that patient.

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And the diagnosis is terminal.

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

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I think what will be nice
about these guidelines is,

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

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

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how to provide that comfort care.

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And I think these guidelines
will help make that much more

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accessible to the reader.

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

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And of course, their owners.

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

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

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

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condition that they're dealing with.

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

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

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

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

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

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past experiences or, or things like that.

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

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

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

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caregiver is able to do for that cat.

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

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

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

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

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

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

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physical limitation to how to get there.

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How do we make feeding more
comfortable for the cat?

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

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

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

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

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

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

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

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with hospice and palliative care patients.

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Nathalie Dowgray: Thank you for listening.

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

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

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

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forum, and much, much more at portal.

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icatcare.

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org.

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

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The first is from ISFM.

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We have our quarterly Cat
Friendly Clinic webinar.

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

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

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live on the 7th of November.

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

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

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Audrey Cook.

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We'll be back again next month.

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If you don't want to miss out, do make
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