Chattering with iCatCare

In the February episode of Chattering With International Cat Care, host Yaiza Gómez-Mejías discusses the new consensus guidelines on the diagnosis and management of feline lower urinary tract disease in cats with authors Sam Taylor and Rachel Korman. They discuss the challenges and nuances of developing these guidelines and emphasize the importance of comprehensive history-taking for accurate diagnosis.

Additionally, Sarah Ellis interviews Noema Gajdoš Kmecová, the winner of the International Cat Care Welfare Research Award, about her study on the Home Feline Stress Score (HFSS). Gajdoš explains how her research, inspired by a previous study, highlights the connection between physical and mental health in cats, advocating for a holistic approach to feline veterinary care.

For further reading material please visit:

2025 iCatCare consensus guidelines on the diagnosis and management of lower urinary tract diseases in cats.

Development of the home feline stress score as a tool for assessing owner perception of stress in their cats at home (Pg 6 / e440) - This study inspired Noema and explores how owners can evaluate stress in their cats

View The Transcript Here

For iCatCare Veterinary Members, full recordings of each episode of the podcast are available for you to listen to at portal.icatcare.org. To become an iCatCare Veterinary Member, or find out more about our Cat Friendly schemes, visit icatcare.org

Host: 

Yaiza Gómez-Mejías, LdaVet MANZCVS (Medicine of Cats) CertAP (SAM-F) Acr AVEPA, Veterinary Community Co-ordinator


Speakers:

Samantha Taylor, BVetMed(Hons), CertSAM, DipECVIM-CA, MANZCVS, FRCVS, Feline Medicine Specialist and ISFM Academy Lead

Rachel Korman, ​​BVSc, MANZCVS (Int Med), FANZCVS (Fel Med), Specialist in Feline Internal Medicine 

Sarah Ellis,BSc, PGDip, PhD,Head of Cat Wellbeing and Behaviour at International Cat Care, independent feline welfare educator, writer and consultant.

Noema Gajdoš Kmecová, MVDr., PhD, Researcher at University of Veterinary Medicine and Pharmacy in Košice

Creators and Guests

Host
Yaiza Gomez-Mejias
Veterinary Community Co-ordinator @ International Cat Care

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.

Yaiza Gomez-Mejias: Hello and
welcome to the February episode

of Chattering With iCatCare.

I'm Yaiza Gomez Mejias, Veterinary
Community Coordinator and

host of this month's podcast.

Our clinical spotlight this month is
focused on the new consensus guidelines

on the diagnosis and management of
lower urinary tract disease in cats.

I will be speaking with two authors,
Sam Taylor and Rachel Korman, about

the new perspectives discussed
in these practice guidelines.

But first, Sarah Ellis will be
interviewing Noema Gajdos about the

iCatCare award she received this year
at the European Veterinary Congress of

Behavioural Medicine and Animal Welfare.

Sarah Ellis: So the International
Cat Care Welfare Research

Award, we conceived it last year.

And it's designed to recognise
and celebrate individuals who have

a dedicated piece of research to
improving domestic cat welfare.

And of course, when we consider

welfare at iCatCare, we're thinking
about both the physical health and the

mental wellbeing of the animal and the
interplay between those two things.

Now, the research that we were willing
to award could come from any discipline

within animal welfare, including
Behavioural medicine, ethics, and law.

And the award aimed to encourage
researchers from a variety of

disciplines to conduct cat welfare
research and to disseminate such

research in ways that make meaningful,
positive differences to cat welfare.

And we used a team of experts
to judge the abstracts blindly.

And they were from International Cat
Care staff, from our Feline Wellbeing

panel, which we have as a group of
experts, and even one of our trustees.

And we judged those abstracts
and it was unanimous that your

abstract came out as a winner.

And the title of that was Screening
for Association Between Mental and

Physical Health Condition of Feline
Patients During Veterinary Consultation

Using the Home Feline Stress Score.

Again, huge congratulations, but I'd be
really interested to hear what inspired

you to do that piece of research.

Noema Gajdos Kmeco: The first spark
was the work presented at ISFM Congress

in 2022, in Rhodes, it was the poster,
presented by Magdalena Glebocka,

and it was a three stage Delphi study
with caregivers, but also feline

behaviour or feline medicine expert,
and the result of this Delphi study

was the home feline stress score.

So you have 10 items you answer yes or
no, which was designed to be used by

caregivers in its five item version,
but also, by vets in 10 item version.

And this abstract was awarded
by the two committees present.

And I was really excited about
the work myself and having

their like poster myself.

I had this chance to speak actually
with Magdalena about this work and

the potential uses, and they really
designed it to be used by the vets

in general veterinary practice.

And shortly after that, I had a very
enthusiastic student at that time.

She was the UK nurse studying
for the doctor of veterinary

medicine degree at our university.

And she wanted to do the study, which
would be like focused on cats because she

was studying towards specialisation in a
feline medicine and emergency medicine.

So she was really like
hands on practical person.

And she came to me, if I had some like
topics, which she could look into.

So I had this idea that it would be nice
to test this 10 item home feline stress

score in a general veterinary practice
and first opinion practice environment.

And actually to use it to see if there
is a difference in a stress score

between the healthy cat population
and sick cat population, which are

coming to the first opinion practice.

So she liked the idea and we started
this small study with the aim to

find out something which actually
she herself could be able to use

once she finishes her veterinary
degree in practice, but also myself.

Sarah Ellis: That's great.

And, one of the things that we loved
about your research is that clinical

application that actually, you say maybe
it's a small or a straightforward study,

but actually some of those studies can
have really big, real world application,

and that's what's really important,
and big things come from small seeds.

As judges, we did not know at all at
the time, and found out subsequently

from yourself, was that your
research was inspired by another

researcher, which, as you said,
you met at one of our congresses.

And that really highlighted to me the
importance of everybody being brave

enough to get their research out there,
regardless of how big or how small they

think their research is, whether it's
a student project or a large grant,

to be brave and get it out there and
to chat to each other, because that's

where those sparks happen, isn't it?

And lo and behold, there's this
whole network now that's come and

I'm sure you will stay in touch and
it's fantastic that you've used the

score that she developed further.

So can you tell us a little bit more about
the results that you got from that study?

Noema Gajdos Kmeco: Yeah.

So we just did the one page survey,
a few questions about the cat owner,

a few questions about the cat.

So age, breed, sex, if
the cat is neutered.

And then we asked these 10 questions so,

Sarah Ellis: Hi, Sorry to
interrupt you Noema, were they

asked as a paper questionnaire?

Noema Gajdos Kmeco: Yeah.

Yeah.

The whole idea was to make
it as real life as possible.

So as part of the interview, during
the examination or in the waiting

room, Natalie and I interviewed
UK caregivers and also Slovak

caregivers, approximately half to
half, with this paper based interview,

asking these few simple questions.

It was aimed to be very quick, so
very concise, up to five minutes.

We learned about these 10
possible stress indicators.

Within the HFSS, we asked if the cat is
spending more time sitting or hiding in

unusual places, whether it is increasingly
seeking attention, whether it's being

scared more easily, if the neuter cat is
doing the urines spraying, if the cat is

urinating indoors, and then there are five
extra questions, which we were entitled

to ask as the veterinary professionals.

If the cat has been treated for societies,
if it's hissing more at other people

or cats, if it's attacking other cats
or people more than before, if it's

grooming to the point of the hair loss
and if it's being blocked or prevented by

other cats from access to key resources,
more now in comparison with some past.

So we asked these questions and we
analysed data on 50 cats, so 27 of them

were healthy, 23 were unhealthy, so almost
equal number of cats in these groups.

For the statistics enthusiasts, we used
rock curve and regression models, so

the rock curve, or this, the key finding
was that we found this association

between this physical health, and
which we call it as real binary thing.

So came out as healthy from the basic
physical examination or not healthy.

So usually this where cats come in
with a problem, healthy cats were

coming for checkups and vaccinations.

And we found this association
between this physical health, this

binary state, and the mental health
represented by this stress score.

However, this association
was quite weak, so it was the

significance, the p value was 0.49.

So it was really on the
borderline with randomness.

But there was an association and
so it really seemed that the sick

cats tended to have higher stress
score and we could suspect that cats

scoring high on HFSS to be sick.

So hence there is another confirmation
how the health does not only have the

physical aspect, but also mental as well.

But there were also cats which scored
relatively high on the stress score, but

came out from the clinical examination
clinically healthy and vice versa.

So what this result can tell us is
that no such tool we develop is about

proof and probably, that wasn't really
the point of developing this tool.

But and it also tells us that we
shouldn't be, if you're a vet,

relying on caregiver's report is
not, it's not a hundred percent thing.

And the caregiver's report is,
might also not be a hundred percent

accurate, but often, because
of very understandable reasons.

And on the other hand, we also as
vets need to be honest with ourselves.

The basic clinical examination may
not reveal some of the physical

problems, especially chronic ones with
a good example for osteoarthritis.

We are just learning just now how cats
can mimic these signs of the chronic

pain, for example, and we might not
reveal this during the examination

because we only see the cat in this
unnatural stressful environment

and it behaves very differently.

And these two things, these, like
how caregiver is able to observe the

cat, how they can report on these 10
questions and also how accurate is

our basic clinical examination when
we are using just our like basic

things we do as initial examination.

These things could have been
responsible for the weaker relationship

and would like to learn more if we
will collect the, the more data.

. Yaiza Gomez-Mejias: And now I will
be interviewing Sam Taylor and Rachel

Korman about the JFMS guidelines
on diagnosis and treatment of lower

urinary tract disease in cats.

Did you find it challenging to
coordinate the work in these guidelines?

Sam Taylor: The challenges are,
we've wanted to write these

guidelines for some years actually.

And the hesitation has been, there's
quite conflicting literature on certain

areas of urinary tract disease in cats.

And there are some areas that
are quite poorly studied.

And so we weren't quite brave
enough before to launch into it.

And then we thought, actually, although
there are those controversies, that

shouldn't put us off writing a guideline
because people still need to deal with

these cases, which are extremely common
in both primary care and referral.

So we decided to be brave and face
some of those controversies, look at

the literature and acknowledge that
there are areas that are understudied,

but to get that consensus from people
who see a lot of cases, like Rachel,

from different countries around the
world and from experts like Professor

Buffington, who spent their whole life
studying FIC and bring them all together

and produce something that hopefully
is really practical for people to use.

And I'm really glad we did.

And I hope we've navigated some of
those challenges effectively, but I

think there's a real need out there to
support people in managing these cases.

So yes, challenging, but
hopefully we've managed it.

Yaiza Gomez-Mejias: And why has
the terminology in this area of

medicine changed so much over the

years?

Rachel Korman: It's similar with many
other different sort of processes where

different groups have similar names for
similar presentations and I think it

just takes a combined focus group to
sit down and really try and make sure

that everybody's on the same page and
understanding sort of the specific aspects

that we're talking about for each group.

So I think that's where sort of the
consensus part of it really comes

into it is just to try and bring
all of the different aspects of it

under one umbrella so that we can
try and get better comparisons.

Sam Taylor: Yeah, I think it helps if you
can have some clarity in this, because

then when you talk about it or you
study it, everyone knows what you mean.

And it was important to me in
these guidelines that we did really

talk about the fact that flitted
or FLUTD is not a diagnosis.

I found that quite frustrating and I
hear people say the cat's got FLUTD.

And that's not really very helpful, is it?

A cat's got FLUTD.

What does that mean?

And we tried to explain in the guidelines
that actually there are quite a few

different diseases that can cause lower
urinary tract signs, but we shouldn't

just label these cats as having FLUTD.

We still need to investigate them.

We need to see if they've got
urolithiasis, if they've got cystitis.

And so there's a real drive to
move away from some of those terms.

And actually, feline idiopathic
cystitis is not the best term.

The trouble with that term is that
owners don't understand the word

idiopathic and owners associate
the term cystitis with infection.

So it gives you a very problematic
way of explaining a disease to owners.

We don't really need the feline
bit, it's a cat in front of us.

And in human medicine, that is
called bladder pain syndrome,

rather than idiopathic cystitis.

And so we discuss in the guidelines,
should we give that a better name so

the owners understand it's a syndrome
and actually a systemic disorder.

And what we see in the hematuria
and things is just the bladder's

expression of that systemic disease.

And I love the way that

Professor Buffington describes it, that
we should think about this condition

affecting the whole cat and it's just
that the bladder is expressing that

stress so there's work to do and we'll
still need more conversations about this

terminology, but hopefully people can
think about this not being a diagnosis.

That's not an end point, FLUTD,
we've got to do a bit more.

Yaiza Gomez-Mejias: Yeah, there are
so many challenges when it comes

to this type of science, not just
because the problem in some of the

diseases seems multifactorial, but also
because the urinary tract has a very

few ways of express itself as well.

Starting from the beginning, from
the history taking, what's the most

relevant information we should gather
before deciding on the testing and

deciding how proactive we should be
in obtaining an accurate diagnosis?

Rachel Korman: I guess there's a, quite
a few things that I always want to

know right at the very start, the first
is obviously if you're dealing with

a male or a female cat because that
also just helps to highlight a little

bit the urgency, for example, complete
obstruction of the urethra, which is

obviously a lot more common in male cats.

A lot of the history taking that I start
off with is really evaluating whether

the cat is an indoor or outdoor cat,
how many cats are housed together?

Is it a multi cat household
or a single cat household?

And we like to get a lot of information
about litter box access, types of litter

boxes, how many litter boxes, locations
in the house, because a lot of that

gives us risk factors potentially for
some of the Behavioural aspects that

we may want to focus on as part of
our treatment further down the line.

I'm very keen to find out the dietary
aspect of what cats are receiving.

So the history taking component takes
an awful lot of time and it's really

beneficial, I think, to have a pre
written template, just to make sure

that you're not missing any of the
common aspects that you need to cover.

Yaiza Gomez-Mejias: Would you
like to add anything, Sam?

Sam Taylor: Yeah, I think
that's really important.

As Rachel was talking, I was thinking
about how often when I read the history

of cats that are referred, that that
kind of information is not included.

And I'm really boring when I mark
people's case reports for various

things that I just find myself repeating
myself saying, what's the diet?

What's the lifestyle?

Because that's the unique
thing about cats, isn't it?

You can have a cat, like my cat
that goes out and kills moles and

birds and all sorts of things.

And you can have a cat that sleeps
on the sofa all day and they're

obviously going to have quite different
risk factors for lots of things.

So yeah, I really, I like
what Rachel was saying about

getting that complete history.

It's not just this, they're
fed a complete diet.

It's what diet and do
they have access outdoors?

How many litter trays do they have?

And we had a case just this week that
came in for exactly low urinary tract

signs and turned out there were about
five cats in the home and one litter tray.

And if we hadn't asked that
question, we wouldn't have got that

really crucial bit of information.

So yeah, I think that's very important.

Yaiza Gomez-Mejias:
Thank you for listening.

If you're an iCatCare Veterinary Society
member, don't forget that you can access

the full version of the podcast and all
the other member benefits, including

congress recordings, monthly webinars
and clinical clubs, the discussion forum,

and much more at portal.icatcare.org.

We'll be back again next month
with more from the world of

feline medicine and JFMS.