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Nathalie Dowgray: Hello, welcome to the
February 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 iCatCare's own Vicky

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Halls about her work in unowned cats
and also some exciting news about

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the cat friendly homing program.

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We're also featuring our monthly
JFMS Clinical Spotlight interview.

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And this month, we're
focusing on hyposomatotropism

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induced diabetes in cats.

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I'm going to be speaking with Dr.

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Chris Scudder about this
comorbidity that might be a bit

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more common than we realize.

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So, to start with Vicky, I wondered if
you'd introduce yourself and explain your

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role at International Cat Care because a
lot of our veterinary audience will know

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you as Vicky Hall's feline behaviourist.

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But they won't necessarily know
about the work that you've been

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doing with International Cat Care.

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Vicky Halls: My relationship with
International Cat Care goes back

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to the Feline Advisory Bureau days,

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it was a conversation between
myself and Claire Bessant, who

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at the time was our cchief exec.

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I said to her, do you know, I've been
to a few homing centres and shelters.

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And I'm so sad to see some
cats have been there for years.

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How can that be?

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If we could start from scratch about
how we care for unowned cats, and

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we allowed the cat to come into the
conversation, what would it look like?

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And then we realized that there was
a way to do things that was more

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strategic and more efficient, use
resources more efficiently, put

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cats front and centre of everything.

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This is no critique of the tens of
thousands of people all over the

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world that are working in shelters.

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Their passion, their devotion, their
hard work is absolutely extraordinary.

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But when we started to look at
how this model was developing, we

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realized we can support you with a
way of working that will take what

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you're doing from good to even better
with regards to your productivity.

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That traditional model of
rescue reactive is painful.

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It's psychologically difficult.

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It leads to burnout.

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But this new way of working
allows things to work in a

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more strategic, proactive way.

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The great thing about that is that
the cats benefit, but the people who

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are working in the sector benefit too.

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So we developed these ideas.

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Key players have contributed
their incredible skills and

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understanding of the sector.

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So it's like all this wonderful
knowledge, all coming together.

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So this was going on for years with me
as a sort of consultant, working with

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various other people in the project.

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And then in 2019, there was an opportunity
for me to start the new phase of my

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career, to close my behaviour practice
and actually become an employee for the

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first time in a few decades, and actually
to work with International Cat Care.

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So I consider that to be
a huge joy and privilege.

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So here I am, four and a half
years later, an employee still.

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And my title is Head of Unowned
Cats, which means that I continue

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to develop the cat friendly homing
model, develop training courses,

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coaching courses, the website content,
resources, that kind of thing.

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And also expanding beyond the homing
centre side of things and looking at

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cat population management in general.

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And that's very much a sort of global
thing, talking to people around

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the world who do this wonderfully
and understanding what good and

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effective looks like and trying to
pass on good practice information.

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Nathalie Dowgray: We had some
exciting news coming into the

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charity at the end of last year.

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So I was wondering if you'd be happy to
tell us about the Battersea grant that

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we've been lucky enough to receive.

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And what the next three years with that
grant is really going to hold for us

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as a charity, but specifically for your
work in the cat friendly homing program?

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Vicky Halls: I couldn't be more excited.

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We've had a long standing collaborative
relationship with Battersea over the

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years, and we had the opportunity to
apply for a grant last year and we

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were awarded that grant as part of
Battersea's Global Enabler program.

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And that grant is for three years
work and we're calling the program

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Lucy the Cat Friendly Homing Program.

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And it gives us the opportunity to
take all our collective learning and go

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forward over the next three years with
more people and more resources to spread

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the cat friendly homing internationally,
to develop more courses, more training

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opportunities, both online and face to
face, resources, events where we can

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involve people who maybe aren't aware of
what we've been doing or even who we are

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as an organization in some countries.

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So this is really exciting for us.

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It's like a massive acceleration of
our work, as a result of this grant.

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Over the next three years, we're
actually targeting the UK, Portugal,

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Greece, Cyprus, and Australia.

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This doesn't mean the other countries
won't matter for the next three

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years, you know, all our resources
are available to all countries.

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But targeting five specific countries
enables us to do that deep dive to

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find out what the issues are within
the country, what the challenges are,

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and bring this all together to see if
we can create this suite of resources

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and frameworks and training that will
have the widest relevance possible.

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That's what we're trying to do.

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Cat friendly homing is not an algorithm.

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It's very much a way of thinking and a way
of working that has these core principles

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as the foundations of everything.

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This sector is full of people who
are incredibly resourceful, devoted

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and passionate to their work.

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And we want to reach out to
those people and get them excited

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about the idea of evolution.

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Because evolution, if you see it through
the lens of change, it feels daunting.

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But if you see it through the
lens that we experience it, where

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every time we learn something new,
we get hugely excited about it.

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It's a lovely thing.

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We're always looking for ways of
showing our love towards cats.

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I think a really good way of showing
our love is, for our own evolution,

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find out as much as we can so that
we know we can meet their needs.

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What an exciting thing!

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Nathalie Dowgray: Where
can we direct people?

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Where can people find more information?

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Vicky Halls: Well it's all there
on our website, we have a section

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if they go to icatcare.org and
to Unowned Cat and they'll see

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that's a tab on top of our website.

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If they click on that, they'll  see
a whole series of resources talking

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about cat friendly homing model, humane
cat population management, loads of

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resources from different organizations.

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We also have a sign up for a newsletter.

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We have a bi monthly newsletter that has
interviews, videos, articles, all sorts

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of things every couple of months for those
people who really want to get a sense

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of what's happening across the world.

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And we encourage people
to get in touch with us.

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My email is on the website.

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If there's something you need with regards
to the care for unowned cats that's not

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on there, let me know and I will make a
point of getting it on there if I can.

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Nathalie Dowgray: Brilliant.

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Now, that's a good point because
we're always open to creating new

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appropriate resources for people.

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As Vicky said, if you're interested in
following more, sign up to the newsletter.

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Thank you for your time today, Vicky.

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And now I'm speaking with Dr.

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Chris Scudder on hypersomatotropism
induced diabetes in cats.

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This is part of our JFMS
feline comorbidities series.

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Thank you for your time today Chris.

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I wanted to ask you why we now use the
term hyposomatotropism and not acromegaly

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in cats, perhaps the way we used to?

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Chris Scudder: You might see it
as a slight terminology quirk.

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It stems from what each of the
different terms trying to describe,

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acro meaning height or large and megaly
meaning, also large, so large height.

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So it's almost a phenotypic
description of the condition.

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People in human medicine initially
get recognized as having the

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condition and they have demonstrable
phenotypic changes, which then results

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in additional testings to try and
understand how that's come about.

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In cats, what we've learned over time is
either cats do not have those demonstrable

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phenotypic changes, or we're just less
akin to being able to identify them.

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So there was some data published in
one study, which asked referring vets

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if they thought that the cat that
they were testing had a suspicion for

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excessive growth hormone of which only
a quarter of which had a suspicion.

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When the three quarters had the
condition, but the phenotypic changes

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weren't there to alert the veterinarian.

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Hyposomatotropism is describing the
condition of excessive growth hormone.

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And maybe that is the more common
presentation in terms of we're not

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phenotypically identifying it, but we are
identifying the growth hormone change.

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So it might be a better descriptor.

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So that's why we're leaning more
to using that nowadays, although

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I do fully appreciate it's
definitely more of a mouthful.

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Nathalie Dowgray: Definitely, for
future questions, I'm going to say

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HST rather than hypersomatotropism.

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What sort of testing protocol
do you recommend if we've got

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a newly diagnosed diabetic case
and we're concerned about HST?

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Chris Scudder: The standard blood test of
choice is measuring IGF-1 or insulin like

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growth factor 1 and there's a few reasons
why that's the diagnostic test of choice.

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One being its half life is much
longer than that of growth hormone,

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so its concentrations in the
circulation are a bit more stable

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than that of growth hormone.

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It's also stable after the sample
has been drawn, so it doesn't

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need any special handling.

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Two, it does seem to correlate
okay in patients that have

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increased growth hormones.

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And so if you have an increased
IGF-1, then your confidence that

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that patient truly has excessive
growth hormone is reasonably high.

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So again, its reliability is pretty good.

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When are we measuring IGF-1?

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I think that's going to in part be
dependent on clinical suspicion.

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So you can measure IGF-1 even before
you start endogenous insulin, but then

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their IGF - will increase after they
receive exogenous insulin and then they

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may breach that threshold of increased
suspicion or underlying HST as the cause.

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So you can definitely test them before
you even start exogenous insulin,

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the downside is you may miss a few.

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So if you are going to wait, then
the time to wait at the moment

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seems to be about eight weeks will
be a reliable time point to wait.

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While I think it's entirely reasonable
to see how patients do and to test

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those that are doing things slightly
atypical with their diabetic response,

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if you only test those that have
an atypical response to exogenous

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insulins, I do think you'll miss some.

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Not all of them are wacky diabetics
to control and some of them seem

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to respond very beautifully to
routine doses and strategies of

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diabetic management and insulins.

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So if you've got an owner who's very
unlikely to ever want additional

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treatments, then I think not
investigating and just managing that

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diabetes, even if they're relatively
routine and never knowing if they

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had underlying HST is acceptable.

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But if you've got an owner who
may consider pursuing additional

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investigations, additional more
targeted treatments, then I think

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even if you do have a relatively
easy to control diabetic, I do think

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there is merit in testing those.

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Nathalie Dowgray: Brilliant.

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One of the final questions I did just
want to ask about medical management,

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obviously it suppresses the hormones,
but does it also have an impact

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on the size of the pituitary mass,
or does the mass continue to grow?

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Chris Scudder: That's something that we
looked at when we did the pasireotide

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study in cats, pasireotide and other
treatments in the same family, like

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octreotide, can successfully reducethe
pituitary tumour size of people with

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acromegaly, and we're hoping whether or
not we would see the same effect in cats.

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We didn't actually see much of a
change of size, and there was actually

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one or two cats that went on to have
progressive pituitary enlargement

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while receiving the medication as well.

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In the feline HST setting,
then, pasireotide doesn't seem

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to be shrinking the pituitary.

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In terms of cabergoline, I'm not
aware of any data looking into that.

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My understanding from human medicine
is it doesn't do too much for

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growth hormone producing tumours.

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There are other types of pituitary
tumours like prolactin producing tumours,

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which are responsive to cabergoline
by reducing their pituitary size.

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I don't believe the same happens with
the growth hormone producing tumours.

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In cats, their pituitary
is either unchanged or they

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continue to enlarge over time.

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Nathalie Dowgray: So potentially,
with some of the longer term cases,

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we may just need to keep an eye
out for any neurological changes?

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Chris Scudder: Absolutely.

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Nathalie Dowgray: What would your
top tips to those of us in practice

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where we potentially suspect
HST as inducing the diabetes?

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Chris Scudder: Most owners have
enough on their plate to try and

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initially manage the diabetes
before considering too much else.

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I would have a conversation with owners
after 2 or 3 months saying, now we're

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getting on top of the diabetes or we're
not, there are other conditions which

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can contribute or cause diabetes in cats.

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One of which we can easily test for.

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And at that time point, I would
suggest doing the IGF-1 testing.

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And if that owner wanted to go
into the realms of learning about

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additional treatment options,
I would discuss that with them.

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And that may include wanting
to know the pituitary size.

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So, if they're extremely polyphagic,
or they are ones with phenotypic

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suspicion, then you might want to
do additional investigations to try

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and determine whether or not that
IGF 1 truly represents HST or not.

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If they didn't have those characteristics,
it would be reasonable to retest at a

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later time point and see what that does
over time, probably another 3 months.

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If they are borderline again, yyou
might entertain the idea of considering

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pituitary imaging if the owners wanted
to know if that cat had HST, because

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they might do something pituitary
specific on the back of that information.

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That would be my general approach.

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Nathalie Dowgray: No, brilliant.

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That's really helpful.

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And thank you so much for
your time today, Chris.

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I think I've learned a lot, both reading
your article and talking with you as well.

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00:14:51,890 --> 00:14:52,900
Thank you for listening.

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00:14:53,000 --> 00:14:56,640
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