Nathalie Dowgray: Hello, welcome to the February episode of Chattering with ISFM.
I'm Nathalie Dowgray, Head of ISFM and host of this month's podcast.
First up this month, I'm going to be speaking with iCatCare's own Vicky
Halls about her work in unowned cats and also some exciting news about
the cat friendly homing program.
We're also featuring our monthly JFMS Clinical Spotlight interview.
And this month, we're focusing on hyposomatotropism
induced diabetes in cats.
I'm going to be speaking with Dr.
Chris Scudder about this comorbidity that might be a bit
more common than we realize.
So, to start with Vicky, I wondered if you'd introduce yourself and explain your
role at International Cat Care because a lot of our veterinary audience will know
you as Vicky Hall's feline behaviourist.
But they won't necessarily know about the work that you've been
doing with International Cat Care.
Vicky Halls: My relationship with International Cat Care goes back
to the Feline Advisory Bureau days,
it was a conversation between myself and Claire Bessant, who
at the time was our cchief exec.
I said to her, do you know, I've been to a few homing centres and shelters.
And I'm so sad to see some cats have been there for years.
How can that be?
If we could start from scratch about how we care for unowned cats, and
we allowed the cat to come into the conversation, what would it look like?
And then we realized that there was a way to do things that was more
strategic and more efficient, use resources more efficiently, put
cats front and centre of everything.
This is no critique of the tens of thousands of people all over the
world that are working in shelters.
Their passion, their devotion, their hard work is absolutely extraordinary.
But when we started to look at how this model was developing, we
realized we can support you with a way of working that will take what
you're doing from good to even better with regards to your productivity.
That traditional model of rescue reactive is painful.
It's psychologically difficult.
It leads to burnout.
But this new way of working allows things to work in a
more strategic, proactive way.
The great thing about that is that the cats benefit, but the people who
are working in the sector benefit too.
So we developed these ideas.
Key players have contributed their incredible skills and
understanding of the sector.
So it's like all this wonderful knowledge, all coming together.
So this was going on for years with me as a sort of consultant, working with
various other people in the project.
And then in 2019, there was an opportunity for me to start the new phase of my
career, to close my behaviour practice and actually become an employee for the
first time in a few decades, and actually to work with International Cat Care.
So I consider that to be a huge joy and privilege.
So here I am, four and a half years later, an employee still.
And my title is Head of Unowned Cats, which means that I continue
to develop the cat friendly homing model, develop training courses,
coaching courses, the website content, resources, that kind of thing.
And also expanding beyond the homing centre side of things and looking at
cat population management in general.
And that's very much a sort of global thing, talking to people around
the world who do this wonderfully and understanding what good and
effective looks like and trying to pass on good practice information.
Nathalie Dowgray: We had some exciting news coming into the
charity at the end of last year.
So I was wondering if you'd be happy to tell us about the Battersea grant that
we've been lucky enough to receive.
And what the next three years with that grant is really going to hold for us
as a charity, but specifically for your work in the cat friendly homing program?
Vicky Halls: I couldn't be more excited.
We've had a long standing collaborative relationship with Battersea over the
years, and we had the opportunity to apply for a grant last year and we
were awarded that grant as part of Battersea's Global Enabler program.
And that grant is for three years work and we're calling the program
Lucy the Cat Friendly Homing Program.
And it gives us the opportunity to take all our collective learning and go
forward over the next three years with more people and more resources to spread
the cat friendly homing internationally, to develop more courses, more training
opportunities, both online and face to face, resources, events where we can
involve people who maybe aren't aware of what we've been doing or even who we are
as an organization in some countries.
So this is really exciting for us.
It's like a massive acceleration of our work, as a result of this grant.
Over the next three years, we're actually targeting the UK, Portugal,
Greece, Cyprus, and Australia.
This doesn't mean the other countries won't matter for the next three
years, you know, all our resources are available to all countries.
But targeting five specific countries enables us to do that deep dive to
find out what the issues are within the country, what the challenges are,
and bring this all together to see if we can create this suite of resources
and frameworks and training that will have the widest relevance possible.
That's what we're trying to do.
Cat friendly homing is not an algorithm.
It's very much a way of thinking and a way of working that has these core principles
as the foundations of everything.
This sector is full of people who are incredibly resourceful, devoted
and passionate to their work.
And we want to reach out to those people and get them excited
about the idea of evolution.
Because evolution, if you see it through the lens of change, it feels daunting.
But if you see it through the lens that we experience it, where
every time we learn something new, we get hugely excited about it.
It's a lovely thing.
We're always looking for ways of showing our love towards cats.
I think a really good way of showing our love is, for our own evolution,
find out as much as we can so that we know we can meet their needs.
What an exciting thing!
Nathalie Dowgray: Where can we direct people?
Where can people find more information?
Vicky Halls: Well it's all there on our website, we have a section
if they go to icatcare.org and to Unowned Cat and they'll see
that's a tab on top of our website.
If they click on that, they'll see a whole series of resources talking
about cat friendly homing model, humane cat population management, loads of
resources from different organizations.
We also have a sign up for a newsletter.
We have a bi monthly newsletter that has interviews, videos, articles, all sorts
of things every couple of months for those people who really want to get a sense
of what's happening across the world.
And we encourage people to get in touch with us.
My email is on the website.
If there's something you need with regards to the care for unowned cats that's not
on there, let me know and I will make a point of getting it on there if I can.
Nathalie Dowgray: Brilliant.
Now, that's a good point because we're always open to creating new
appropriate resources for people.
As Vicky said, if you're interested in following more, sign up to the newsletter.
Thank you for your time today, Vicky.
And now I'm speaking with Dr.
Chris Scudder on hypersomatotropism induced diabetes in cats.
This is part of our JFMS feline comorbidities series.
Thank you for your time today Chris.
I wanted to ask you why we now use the term hyposomatotropism and not acromegaly
in cats, perhaps the way we used to?
Chris Scudder: You might see it as a slight terminology quirk.
It stems from what each of the different terms trying to describe,
acro meaning height or large and megaly meaning, also large, so large height.
So it's almost a phenotypic description of the condition.
People in human medicine initially get recognized as having the
condition and they have demonstrable phenotypic changes, which then results
in additional testings to try and understand how that's come about.
In cats, what we've learned over time is either cats do not have those demonstrable
phenotypic changes, or we're just less akin to being able to identify them.
So there was some data published in one study, which asked referring vets
if they thought that the cat that they were testing had a suspicion for
excessive growth hormone of which only a quarter of which had a suspicion.
When the three quarters had the condition, but the phenotypic changes
weren't there to alert the veterinarian.
Hyposomatotropism is describing the condition of excessive growth hormone.
And maybe that is the more common presentation in terms of we're not
phenotypically identifying it, but we are identifying the growth hormone change.
So it might be a better descriptor.
So that's why we're leaning more to using that nowadays, although
I do fully appreciate it's definitely more of a mouthful.
Nathalie Dowgray: Definitely, for future questions, I'm going to say
HST rather than hypersomatotropism.
What sort of testing protocol do you recommend if we've got
a newly diagnosed diabetic case and we're concerned about HST?
Chris Scudder: The standard blood test of choice is measuring IGF-1 or insulin like
growth factor 1 and there's a few reasons why that's the diagnostic test of choice.
One being its half life is much longer than that of growth hormone,
so its concentrations in the circulation are a bit more stable
than that of growth hormone.
It's also stable after the sample has been drawn, so it doesn't
need any special handling.
Two, it does seem to correlate okay in patients that have
increased growth hormones.
And so if you have an increased IGF-1, then your confidence that
that patient truly has excessive growth hormone is reasonably high.
So again, its reliability is pretty good.
When are we measuring IGF-1?
I think that's going to in part be dependent on clinical suspicion.
So you can measure IGF-1 even before you start endogenous insulin, but then
their IGF - will increase after they receive exogenous insulin and then they
may breach that threshold of increased suspicion or underlying HST as the cause.
So you can definitely test them before you even start exogenous insulin,
the downside is you may miss a few.
So if you are going to wait, then the time to wait at the moment
seems to be about eight weeks will be a reliable time point to wait.
While I think it's entirely reasonable to see how patients do and to test
those that are doing things slightly atypical with their diabetic response,
if you only test those that have an atypical response to exogenous
insulins, I do think you'll miss some.
Not all of them are wacky diabetics to control and some of them seem
to respond very beautifully to routine doses and strategies of
diabetic management and insulins.
So if you've got an owner who's very unlikely to ever want additional
treatments, then I think not investigating and just managing that
diabetes, even if they're relatively routine and never knowing if they
had underlying HST is acceptable.
But if you've got an owner who may consider pursuing additional
investigations, additional more targeted treatments, then I think
even if you do have a relatively easy to control diabetic, I do think
there is merit in testing those.
Nathalie Dowgray: Brilliant.
One of the final questions I did just want to ask about medical management,
obviously it suppresses the hormones, but does it also have an impact
on the size of the pituitary mass, or does the mass continue to grow?
Chris Scudder: That's something that we looked at when we did the pasireotide
study in cats, pasireotide and other treatments in the same family, like
octreotide, can successfully reducethe pituitary tumour size of people with
acromegaly, and we're hoping whether or not we would see the same effect in cats.
We didn't actually see much of a change of size, and there was actually
one or two cats that went on to have progressive pituitary enlargement
while receiving the medication as well.
In the feline HST setting, then, pasireotide doesn't seem
to be shrinking the pituitary.
In terms of cabergoline, I'm not aware of any data looking into that.
My understanding from human medicine is it doesn't do too much for
growth hormone producing tumours.
There are other types of pituitary tumours like prolactin producing tumours,
which are responsive to cabergoline by reducing their pituitary size.
I don't believe the same happens with the growth hormone producing tumours.
In cats, their pituitary is either unchanged or they
continue to enlarge over time.
Nathalie Dowgray: So potentially, with some of the longer term cases,
we may just need to keep an eye out for any neurological changes?
Chris Scudder: Absolutely.
Nathalie Dowgray: What would your top tips to those of us in practice
where we potentially suspect HST as inducing the diabetes?
Chris Scudder: Most owners have enough on their plate to try and
initially manage the diabetes before considering too much else.
I would have a conversation with owners after 2 or 3 months saying, now we're
getting on top of the diabetes or we're not, there are other conditions which
can contribute or cause diabetes in cats.
One of which we can easily test for.
And at that time point, I would suggest doing the IGF-1 testing.
And if that owner wanted to go into the realms of learning about
additional treatment options, I would discuss that with them.
And that may include wanting to know the pituitary size.
So, if they're extremely polyphagic, or they are ones with phenotypic
suspicion, then you might want to do additional investigations to try
and determine whether or not that IGF 1 truly represents HST or not.
If they didn't have those characteristics, it would be reasonable to retest at a
later time point and see what that does over time, probably another 3 months.
If they are borderline again, yyou might entertain the idea of considering
pituitary imaging if the owners wanted to know if that cat had HST, because
they might do something pituitary specific on the back of that information.
That would be my general approach.
Nathalie Dowgray: No, brilliant.
That's really helpful.
And thank you so much for your time today, Chris.
I think I've learned a lot, both reading your article and talking with you as well.
Thank you for listening.
If you're an ISFM member, don't forget you can access the full version of
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If you're looking for more free CPD from ISFM in March, we
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The first is from Purina on 'How to manage the CKD patient with
comorbidities.' And the second is from IDEXX on 'Feline gunky-eyetis, when to
swab and when to test.' We'll be back again next month with another episode.
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