1 00:00:05,240 --> 00:00:07,100 Yaiza Gomez-Mejias: Hello and welcome to the February episode 2 00:00:07,100 --> 00:00:08,140 of Chattering With iCatCare. 3 00:00:08,690 --> 00:00:11,680 I'm Yaiza Gomez Mejias, Veterinary Community Coordinator and 4 00:00:11,680 --> 00:00:12,780 host of this month's podcast. 5 00:00:13,940 --> 00:00:17,729 Our clinical spotlight this month is focused on the new consensus guidelines 6 00:00:17,740 --> 00:00:21,450 on the diagnosis and management of lower urinary tract disease in cats. 7 00:00:22,230 --> 00:00:25,849 I will be speaking with two authors, Sam Taylor and Rachel Korman, about 8 00:00:25,970 --> 00:00:28,460 the new perspectives discussed in these practice guidelines. 9 00:00:29,179 --> 00:00:32,829 But first, Sarah Ellis will be interviewing Noema Gajdos about the 10 00:00:33,410 --> 00:00:37,100 iCatCare award she received this year at the European Veterinary Congress of 11 00:00:37,530 --> 00:00:38,819 Behavioural Medicine and Animal Welfare. 12 00:00:42,250 --> 00:00:44,750 Sarah Ellis: So the International Cat Care Welfare Research 13 00:00:44,750 --> 00:00:47,889 Award, we conceived it last year. 14 00:00:48,090 --> 00:00:51,800 And it's designed to recognise and celebrate individuals who have 15 00:00:51,800 --> 00:00:55,430 a dedicated piece of research to improving domestic cat welfare. 16 00:00:55,810 --> 00:00:57,420 And of course, when we consider 17 00:00:57,420 --> 00:01:01,870 welfare at iCatCare, we're thinking about both the physical health and the 18 00:01:01,870 --> 00:01:06,260 mental wellbeing of the animal and the interplay between those two things. 19 00:01:06,420 --> 00:01:10,130 Now, the research that we were willing to award could come from any discipline 20 00:01:10,150 --> 00:01:13,890 within animal welfare, including Behavioural medicine, ethics, and law. 21 00:01:13,950 --> 00:01:17,510 And the award aimed to encourage researchers from a variety of 22 00:01:17,510 --> 00:01:21,650 disciplines to conduct cat welfare research and to disseminate such 23 00:01:21,660 --> 00:01:25,410 research in ways that make meaningful, positive differences to cat welfare. 24 00:01:25,460 --> 00:01:29,949 And we used a team of experts to judge the abstracts blindly. 25 00:01:30,000 --> 00:01:34,290 And they were from International Cat Care staff, from our Feline Wellbeing 26 00:01:34,300 --> 00:01:38,580 panel, which we have as a group of experts, and even one of our trustees. 27 00:01:38,940 --> 00:01:44,179 And we judged those abstracts and it was unanimous that your 28 00:01:44,270 --> 00:01:45,710 abstract came out as a winner. 29 00:01:45,799 --> 00:01:50,200 And the title of that was Screening for Association Between Mental and 30 00:01:50,200 --> 00:01:54,820 Physical Health Condition of Feline Patients During Veterinary Consultation 31 00:01:55,090 --> 00:01:57,510 Using the Home Feline Stress Score. 32 00:01:57,570 --> 00:02:01,970 Again, huge congratulations, but I'd be really interested to hear what inspired 33 00:02:01,970 --> 00:02:03,640 you to do that piece of research. 34 00:02:04,080 --> 00:02:08,239 Noema Gajdos Kmeco: The first spark was the work presented at ISFM Congress 35 00:02:08,239 --> 00:02:13,040 in 2022, in Rhodes, it was the poster, presented by Magdalena Glebocka, 36 00:02:13,110 --> 00:02:16,769 and it was a three stage Delphi study with caregivers, but also feline 37 00:02:16,770 --> 00:02:21,150 behaviour or feline medicine expert, and the result of this Delphi study 38 00:02:21,179 --> 00:02:23,140 was the home feline stress score. 39 00:02:23,140 --> 00:02:26,790 So you have 10 items you answer yes or no, which was designed to be used by 40 00:02:26,790 --> 00:02:31,019 caregivers in its five item version, but also, by vets in 10 item version. 41 00:02:31,060 --> 00:02:34,459 And this abstract was awarded by the two committees present. 42 00:02:34,750 --> 00:02:38,390 And I was really excited about the work myself and having 43 00:02:38,420 --> 00:02:39,739 their like poster myself. 44 00:02:39,750 --> 00:02:44,210 I had this chance to speak actually with Magdalena about this work and 45 00:02:44,220 --> 00:02:48,080 the potential uses, and they really designed it to be used by the vets 46 00:02:48,110 --> 00:02:49,540 in general veterinary practice. 47 00:02:49,990 --> 00:02:53,740 And shortly after that, I had a very enthusiastic student at that time. 48 00:02:53,800 --> 00:02:56,889 She was the UK nurse studying for the doctor of veterinary 49 00:02:56,920 --> 00:02:58,630 medicine degree at our university. 50 00:02:58,709 --> 00:03:03,370 And she wanted to do the study, which would be like focused on cats because she 51 00:03:03,460 --> 00:03:07,870 was studying towards specialisation in a feline medicine and emergency medicine. 52 00:03:08,120 --> 00:03:11,320 So she was really like hands on practical person. 53 00:03:11,349 --> 00:03:15,330 And she came to me, if I had some like topics, which she could look into. 54 00:03:15,690 --> 00:03:21,070 So I had this idea that it would be nice to test this 10 item home feline stress 55 00:03:21,070 --> 00:03:25,530 score in a general veterinary practice and first opinion practice environment. 56 00:03:25,580 --> 00:03:28,909 And actually to use it to see if there is a difference in a stress score 57 00:03:28,910 --> 00:03:32,520 between the healthy cat population and sick cat population, which are 58 00:03:32,759 --> 00:03:34,530 coming to the first opinion practice. 59 00:03:34,539 --> 00:03:39,120 So she liked the idea and we started this small study with the aim to 60 00:03:39,140 --> 00:03:43,850 find out something which actually she herself could be able to use 61 00:03:44,050 --> 00:03:48,519 once she finishes her veterinary degree in practice, but also myself. 62 00:03:49,210 --> 00:03:49,710 Sarah Ellis: That's great. 63 00:03:49,719 --> 00:03:52,709 And, one of the things that we loved about your research is that clinical 64 00:03:52,709 --> 00:03:57,360 application that actually, you say maybe it's a small or a straightforward study, 65 00:03:57,400 --> 00:04:02,820 but actually some of those studies can have really big, real world application, 66 00:04:03,099 --> 00:04:06,440 and that's what's really important, and big things come from small seeds. 67 00:04:06,820 --> 00:04:10,370 As judges, we did not know at all at the time, and found out subsequently 68 00:04:10,370 --> 00:04:14,290 from yourself, was that your research was inspired by another 69 00:04:14,290 --> 00:04:16,740 researcher, which, as you said, you met at one of our congresses. 70 00:04:17,940 --> 00:04:22,859 And that really highlighted to me the importance of everybody being brave 71 00:04:22,860 --> 00:04:26,549 enough to get their research out there, regardless of how big or how small they 72 00:04:26,549 --> 00:04:29,729 think their research is, whether it's a student project or a large grant, 73 00:04:30,299 --> 00:04:34,340 to be brave and get it out there and to chat to each other, because that's 74 00:04:34,340 --> 00:04:36,049 where those sparks happen, isn't it? 75 00:04:36,060 --> 00:04:39,830 And lo and behold, there's this whole network now that's come and 76 00:04:39,830 --> 00:04:42,950 I'm sure you will stay in touch and it's fantastic that you've used the 77 00:04:42,950 --> 00:04:44,870 score that she developed further. 78 00:04:45,080 --> 00:04:49,239 So can you tell us a little bit more about the results that you got from that study? 79 00:04:50,290 --> 00:04:50,500 Noema Gajdos Kmeco: Yeah. 80 00:04:50,550 --> 00:04:54,880 So we just did the one page survey, a few questions about the cat owner, 81 00:04:54,880 --> 00:04:56,190 a few questions about the cat. 82 00:04:56,190 --> 00:04:58,770 So age, breed, sex, if the cat is neutered. 83 00:04:58,800 --> 00:05:01,789 And then we asked these 10 questions so, 84 00:05:02,109 --> 00:05:03,640 Sarah Ellis: Hi, Sorry to interrupt you Noema, were they 85 00:05:03,690 --> 00:05:05,270 asked as a paper questionnaire? 86 00:05:05,660 --> 00:05:05,910 Noema Gajdos Kmeco: Yeah. 87 00:05:05,990 --> 00:05:06,170 Yeah. 88 00:05:06,170 --> 00:05:09,590 The whole idea was to make it as real life as possible. 89 00:05:09,890 --> 00:05:13,710 So as part of the interview, during the examination or in the waiting 90 00:05:13,710 --> 00:05:17,500 room, Natalie and I interviewed UK caregivers and also Slovak 91 00:05:17,509 --> 00:05:21,670 caregivers, approximately half to half, with this paper based interview, 92 00:05:21,700 --> 00:05:23,410 asking these few simple questions. 93 00:05:23,430 --> 00:05:27,090 It was aimed to be very quick, so very concise, up to five minutes. 94 00:05:27,220 --> 00:05:30,410 We learned about these 10 possible stress indicators. 95 00:05:30,520 --> 00:05:34,679 Within the HFSS, we asked if the cat is spending more time sitting or hiding in 96 00:05:34,679 --> 00:05:39,109 unusual places, whether it is increasingly seeking attention, whether it's being 97 00:05:39,120 --> 00:05:44,109 scared more easily, if the neuter cat is doing the urines spraying, if the cat is 98 00:05:44,110 --> 00:05:48,359 urinating indoors, and then there are five extra questions, which we were entitled 99 00:05:48,370 --> 00:05:50,460 to ask as the veterinary professionals. 100 00:05:50,650 --> 00:05:54,650 If the cat has been treated for societies, if it's hissing more at other people 101 00:05:54,660 --> 00:05:58,269 or cats, if it's attacking other cats or people more than before, if it's 102 00:05:58,270 --> 00:06:02,400 grooming to the point of the hair loss and if it's being blocked or prevented by 103 00:06:02,400 --> 00:06:07,470 other cats from access to key resources, more now in comparison with some past. 104 00:06:07,880 --> 00:06:13,680 So we asked these questions and we analysed data on 50 cats, so 27 of them 105 00:06:13,690 --> 00:06:17,729 were healthy, 23 were unhealthy, so almost equal number of cats in these groups. 106 00:06:18,100 --> 00:06:22,630 For the statistics enthusiasts, we used rock curve and regression models, so 107 00:06:22,630 --> 00:06:26,650 the rock curve, or this, the key finding was that we found this association 108 00:06:26,660 --> 00:06:31,250 between this physical health, and which we call it as real binary thing. 109 00:06:31,259 --> 00:06:35,229 So came out as healthy from the basic physical examination or not healthy. 110 00:06:35,230 --> 00:06:38,130 So usually this where cats come in with a problem, healthy cats were 111 00:06:38,130 --> 00:06:40,300 coming for checkups and vaccinations. 112 00:06:40,770 --> 00:06:43,880 And we found this association between this physical health, this 113 00:06:43,880 --> 00:06:48,010 binary state, and the mental health represented by this stress score. 114 00:06:48,460 --> 00:06:51,830 However, this association was quite weak, so it was the 115 00:06:51,860 --> 00:06:54,370 significance, the p value was 0.49. 116 00:06:55,090 --> 00:06:58,020 So it was really on the borderline with randomness. 117 00:06:58,040 --> 00:07:02,220 But there was an association and so it really seemed that the sick 118 00:07:02,270 --> 00:07:05,980 cats tended to have higher stress score and we could suspect that cats 119 00:07:05,980 --> 00:07:08,900 scoring high on HFSS to be sick. 120 00:07:08,940 --> 00:07:13,150 So hence there is another confirmation how the health does not only have the 121 00:07:13,150 --> 00:07:15,450 physical aspect, but also mental as well. 122 00:07:16,020 --> 00:07:19,780 But there were also cats which scored relatively high on the stress score, but 123 00:07:19,870 --> 00:07:24,099 came out from the clinical examination clinically healthy and vice versa. 124 00:07:24,620 --> 00:07:29,570 So what this result can tell us is that no such tool we develop is about 125 00:07:29,600 --> 00:07:32,799 proof and probably, that wasn't really the point of developing this tool. 126 00:07:33,220 --> 00:07:36,400 But and it also tells us that we shouldn't be, if you're a vet, 127 00:07:36,480 --> 00:07:40,579 relying on caregiver's report is not, it's not a hundred percent thing. 128 00:07:40,910 --> 00:07:44,070 And the caregiver's report is, might also not be a hundred percent 129 00:07:44,090 --> 00:07:47,609 accurate, but often, because of very understandable reasons. 130 00:07:47,639 --> 00:07:51,310 And on the other hand, we also as vets need to be honest with ourselves. 131 00:07:51,310 --> 00:07:55,060 The basic clinical examination may not reveal some of the physical 132 00:07:55,060 --> 00:07:58,710 problems, especially chronic ones with a good example for osteoarthritis. 133 00:07:58,710 --> 00:08:03,100 We are just learning just now how cats can mimic these signs of the chronic 134 00:08:03,139 --> 00:08:07,039 pain, for example, and we might not reveal this during the examination 135 00:08:07,040 --> 00:08:10,500 because we only see the cat in this unnatural stressful environment 136 00:08:10,680 --> 00:08:12,330 and it behaves very differently. 137 00:08:12,700 --> 00:08:17,450 And these two things, these, like how caregiver is able to observe the 138 00:08:17,450 --> 00:08:22,379 cat, how they can report on these 10 questions and also how accurate is 139 00:08:22,379 --> 00:08:26,669 our basic clinical examination when we are using just our like basic 140 00:08:26,670 --> 00:08:29,479 things we do as initial examination. 141 00:08:29,700 --> 00:08:33,089 These things could have been responsible for the weaker relationship 142 00:08:33,130 --> 00:08:36,770 and would like to learn more if we will collect the, the more data. 143 00:08:36,820 --> 00:08:39,809 . Yaiza Gomez-Mejias: And now I will be interviewing Sam Taylor and Rachel 144 00:08:39,809 --> 00:08:44,450 Korman about the JFMS guidelines on diagnosis and treatment of lower 145 00:08:44,450 --> 00:08:46,380 urinary tract disease in cats. 146 00:08:46,750 --> 00:08:50,860 Did you find it challenging to coordinate the work in these guidelines? 147 00:08:51,530 --> 00:08:53,370 Sam Taylor: The challenges are, we've wanted to write these 148 00:08:53,370 --> 00:08:55,310 guidelines for some years actually. 149 00:08:55,310 --> 00:08:59,719 And the hesitation has been, there's quite conflicting literature on certain 150 00:08:59,719 --> 00:09:02,130 areas of urinary tract disease in cats. 151 00:09:02,420 --> 00:09:04,930 And there are some areas that are quite poorly studied. 152 00:09:05,310 --> 00:09:09,670 And so we weren't quite brave enough before to launch into it. 153 00:09:09,730 --> 00:09:14,490 And then we thought, actually, although there are those controversies, that 154 00:09:14,490 --> 00:09:18,119 shouldn't put us off writing a guideline because people still need to deal with 155 00:09:18,129 --> 00:09:22,339 these cases, which are extremely common in both primary care and referral. 156 00:09:22,340 --> 00:09:27,080 So we decided to be brave and face some of those controversies, look at 157 00:09:27,090 --> 00:09:30,619 the literature and acknowledge that there are areas that are understudied, 158 00:09:31,059 --> 00:09:36,110 but to get that consensus from people who see a lot of cases, like Rachel, 159 00:09:36,420 --> 00:09:41,170 from different countries around the world and from experts like Professor 160 00:09:41,170 --> 00:09:46,049 Buffington, who spent their whole life studying FIC and bring them all together 161 00:09:46,320 --> 00:09:49,745 and produce something that hopefully is really practical for people to use. 162 00:09:50,070 --> 00:09:51,410 And I'm really glad we did. 163 00:09:51,700 --> 00:09:56,109 And I hope we've navigated some of those challenges effectively, but I 164 00:09:56,120 --> 00:10:00,490 think there's a real need out there to support people in managing these cases. 165 00:10:00,500 --> 00:10:04,189 So yes, challenging, but hopefully we've managed it. 166 00:10:04,550 --> 00:10:07,900 Yaiza Gomez-Mejias: And why has the terminology in this area of 167 00:10:07,900 --> 00:10:09,869 medicine changed so much over the 168 00:10:09,870 --> 00:10:10,310 years? 169 00:10:10,340 --> 00:10:14,560 Rachel Korman: It's similar with many other different sort of processes where 170 00:10:15,320 --> 00:10:20,430 different groups have similar names for similar presentations and I think it 171 00:10:20,430 --> 00:10:26,480 just takes a combined focus group to sit down and really try and make sure 172 00:10:26,480 --> 00:10:31,680 that everybody's on the same page and understanding sort of the specific aspects 173 00:10:31,690 --> 00:10:33,560 that we're talking about for each group. 174 00:10:33,560 --> 00:10:37,170 So I think that's where sort of the consensus part of it really comes 175 00:10:37,170 --> 00:10:40,183 into it is just to try and bring all of the different aspects of it 176 00:10:40,183 --> 00:10:43,770 under one umbrella so that we can try and get better comparisons. 177 00:10:43,960 --> 00:10:47,250 Sam Taylor: Yeah, I think it helps if you can have some clarity in this, because 178 00:10:47,250 --> 00:10:50,790 then when you talk about it or you study it, everyone knows what you mean. 179 00:10:51,130 --> 00:10:53,950 And it was important to me in these guidelines that we did really 180 00:10:54,550 --> 00:11:00,540 talk about the fact that flitted or FLUTD is not a diagnosis. 181 00:11:00,750 --> 00:11:04,570 I found that quite frustrating and I hear people say the cat's got FLUTD. 182 00:11:05,350 --> 00:11:07,160 And that's not really very helpful, is it? 183 00:11:07,170 --> 00:11:07,720 A cat's got FLUTD. 184 00:11:08,460 --> 00:11:09,580 What does that mean? 185 00:11:10,000 --> 00:11:13,199 And we tried to explain in the guidelines that actually there are quite a few 186 00:11:13,200 --> 00:11:17,189 different diseases that can cause lower urinary tract signs, but we shouldn't 187 00:11:17,190 --> 00:11:19,460 just label these cats as having FLUTD. 188 00:11:19,759 --> 00:11:21,220 We still need to investigate them. 189 00:11:21,220 --> 00:11:24,719 We need to see if they've got urolithiasis, if they've got cystitis. 190 00:11:24,719 --> 00:11:28,580 And so there's a real drive to move away from some of those terms. 191 00:11:28,580 --> 00:11:32,930 And actually, feline idiopathic cystitis is not the best term. 192 00:11:32,930 --> 00:11:36,600 The trouble with that term is that owners don't understand the word 193 00:11:36,639 --> 00:11:41,239 idiopathic and owners associate the term cystitis with infection. 194 00:11:41,830 --> 00:11:46,590 So it gives you a very problematic way of explaining a disease to owners. 195 00:11:47,030 --> 00:11:49,970 We don't really need the feline bit, it's a cat in front of us. 196 00:11:50,260 --> 00:11:54,249 And in human medicine, that is called bladder pain syndrome, 197 00:11:54,880 --> 00:11:57,520 rather than idiopathic cystitis. 198 00:11:57,870 --> 00:12:02,110 And so we discuss in the guidelines, should we give that a better name so 199 00:12:02,110 --> 00:12:06,330 the owners understand it's a syndrome and actually a systemic disorder. 200 00:12:06,440 --> 00:12:10,709 And what we see in the hematuria and things is just the bladder's 201 00:12:10,719 --> 00:12:12,670 expression of that systemic disease. 202 00:12:12,690 --> 00:12:13,520 And I love the way that 203 00:12:14,250 --> 00:12:17,170 Professor Buffington describes it, that we should think about this condition 204 00:12:17,170 --> 00:12:21,390 affecting the whole cat and it's just that the bladder is expressing that 205 00:12:21,390 --> 00:12:24,959 stress so there's work to do and we'll still need more conversations about this 206 00:12:24,990 --> 00:12:29,980 terminology, but hopefully people can think about this not being a diagnosis. 207 00:12:29,980 --> 00:12:32,949 That's not an end point, FLUTD, we've got to do a bit more. 208 00:12:34,730 --> 00:12:37,215 Yaiza Gomez-Mejias: Yeah, there are so many challenges when it comes 209 00:12:37,240 --> 00:12:40,199 to this type of science, not just because the problem in some of the 210 00:12:40,200 --> 00:12:44,659 diseases seems multifactorial, but also because the urinary tract has a very 211 00:12:44,660 --> 00:12:47,360 few ways of express itself as well. 212 00:12:47,700 --> 00:12:50,980 Starting from the beginning, from the history taking, what's the most 213 00:12:50,990 --> 00:12:56,720 relevant information we should gather before deciding on the testing and 214 00:12:56,720 --> 00:13:01,680 deciding how proactive we should be in obtaining an accurate diagnosis? 215 00:13:02,490 --> 00:13:06,970 Rachel Korman: I guess there's a, quite a few things that I always want to 216 00:13:06,970 --> 00:13:10,930 know right at the very start, the first is obviously if you're dealing with 217 00:13:10,930 --> 00:13:18,010 a male or a female cat because that also just helps to highlight a little 218 00:13:18,020 --> 00:13:22,850 bit the urgency, for example, complete obstruction of the urethra, which is 219 00:13:22,850 --> 00:13:25,409 obviously a lot more common in male cats. 220 00:13:25,809 --> 00:13:33,140 A lot of the history taking that I start off with is really evaluating whether 221 00:13:33,450 --> 00:13:39,900 the cat is an indoor or outdoor cat, how many cats are housed together? 222 00:13:39,900 --> 00:13:42,919 Is it a multi cat household or a single cat household? 223 00:13:43,240 --> 00:13:50,070 And we like to get a lot of information about litter box access, types of litter 224 00:13:50,070 --> 00:13:55,420 boxes, how many litter boxes, locations in the house, because a lot of that 225 00:13:55,570 --> 00:14:01,579 gives us risk factors potentially for some of the Behavioural aspects that 226 00:14:01,580 --> 00:14:06,029 we may want to focus on as part of our treatment further down the line. 227 00:14:06,549 --> 00:14:11,190 I'm very keen to find out the dietary aspect of what cats are receiving. 228 00:14:11,490 --> 00:14:17,759 So the history taking component takes an awful lot of time and it's really 229 00:14:17,880 --> 00:14:22,879 beneficial, I think, to have a pre written template, just to make sure 230 00:14:22,920 --> 00:14:27,000 that you're not missing any of the common aspects that you need to cover. 231 00:14:27,210 --> 00:14:28,840 Yaiza Gomez-Mejias: Would you like to add anything, Sam? 232 00:14:28,950 --> 00:14:30,420 Sam Taylor: Yeah, I think that's really important. 233 00:14:30,420 --> 00:14:35,300 As Rachel was talking, I was thinking about how often when I read the history 234 00:14:35,300 --> 00:14:39,500 of cats that are referred, that that kind of information is not included. 235 00:14:39,500 --> 00:14:42,779 And I'm really boring when I mark people's case reports for various 236 00:14:42,789 --> 00:14:47,360 things that I just find myself repeating myself saying, what's the diet? 237 00:14:47,660 --> 00:14:48,720 What's the lifestyle? 238 00:14:48,720 --> 00:14:50,900 Because that's the unique thing about cats, isn't it? 239 00:14:51,170 --> 00:14:55,910 You can have a cat, like my cat that goes out and kills moles and 240 00:14:55,910 --> 00:14:57,139 birds and all sorts of things. 241 00:14:57,139 --> 00:14:59,539 And you can have a cat that sleeps on the sofa all day and they're 242 00:14:59,539 --> 00:15:02,560 obviously going to have quite different risk factors for lots of things. 243 00:15:02,560 --> 00:15:05,319 So yeah, I really, I like what Rachel was saying about 244 00:15:05,320 --> 00:15:06,600 getting that complete history. 245 00:15:06,670 --> 00:15:08,849 It's not just this, they're fed a complete diet. 246 00:15:08,929 --> 00:15:11,699 It's what diet and do they have access outdoors? 247 00:15:12,020 --> 00:15:13,860 How many litter trays do they have? 248 00:15:13,860 --> 00:15:18,639 And we had a case just this week that came in for exactly low urinary tract 249 00:15:18,639 --> 00:15:22,890 signs and turned out there were about five cats in the home and one litter tray. 250 00:15:23,140 --> 00:15:25,380 And if we hadn't asked that question, we wouldn't have got that 251 00:15:25,570 --> 00:15:27,689 really crucial bit of information. 252 00:15:27,969 --> 00:15:29,879 So yeah, I think that's very important. 253 00:15:34,910 --> 00:15:35,959 Yaiza Gomez-Mejias: Thank you for listening. 254 00:15:36,180 --> 00:15:40,319 If you're an iCatCare Veterinary Society member, don't forget that you can access 255 00:15:40,320 --> 00:15:43,840 the full version of the podcast and all the other member benefits, including 256 00:15:43,840 --> 00:15:48,320 congress recordings, monthly webinars and clinical clubs, the discussion forum, 257 00:15:48,630 --> 00:15:52,170 and much more at portal.icatcare.org. 258 00:15:53,279 --> 00:15:56,510 We'll be back again next month with more from the world of 259 00:15:56,520 --> 00:15:57,640 feline medicine and JFMS.