FreeStyle Libres in Feline Diabetes and a Spotlight on Cat Friendly Principles for Veterinary Professionals

Show Notes

This month, as we are discussing topics that are very close to our hearts, we have
made the full version available to non-members. Yaiza Gomez-Mejias interviews the winner of the JFMS Resident best paper, Marieke Knies, about feline diabetes and the FreeStyle Libre. We're also featuring our monthly JFMS clinical spotlight interview in which Nathalie Dowgray discusses Cat Friendly Principles for Veterinary Professionals with her fellow authors.

To begin our episode, Yaiza is joined by Marieke Knies who won the 2022 JFMS Open Reports Best Practitioner Paper with her study on feline diabetes and the FreeStyle Libre. They discuss the advantages, complications and clinical accuracy of the study as well as feedback from the cat owners involved.

Nathalie then sits down with some of the team at International Cat Care who helped to develop and write Cat Friendly Principles for Veterinary Professionals: Dr Sarah Ellis, Vicky Halls and our former CEO Claire Bessant. They discuss why there was a need to develop these principles, what they entail and how the veterinary profession has evolved over the years to improve the care available for cats.

For further reading material please visit:

https://journals.sagepub.com/doi/epdf/10.1177/1098612X221104051

https://journals.sagepub.com/doi/epdf/10.1177/1098612X221128750

Host:

Nathalie Dowgray, BVSc, MANZCVS, PgDip, MRCVS, PhD, Head of ISFM, International Society of Feline Medicine, International Cat Care, Tisbury, Wiltshire, UK

Speakers:

Yaiza Gomez Mejias, LdaVet MANZCVS (Medicine of Cats) CertAP (SAM-F) Acr AVEPA, ISFM Community Coordinator and small animal clinician

Marieke Knies, DVM, MANZCVS (Feline), EMSAVM (Internal Medicine), Winner of the 2022 JFMS Open Reports Best Practitioner Paper

Dr Sarah Ellis, Bsc, Pg-Dip, PHD, Head of Cat Advocacy at International Cat Care, Visiting Fellow at the University of Lincoln and Author.

Vicky Halls, RVN Dip Couns, Registered Veterinary Nurse, Clinical Animal Behaviourist, Member of Cat Advocacy team at International Cat Care and Author.

Claire Bessant,  BSc (Hons),  MBE, Former iCatCare Chief Executive of 28 years

For ISFM members, the full recording of this discussion is available for you to listen to at portal.icatcare.org. To become an ISFM member, or find out more about our Cat Friendly schemes, visit icatcare.org

Creators & Guests

Host

Nathalie Dowgray

What is Chattering With ISFM?

Welcome to Chattering With ISFM, the official monthly podcast of the International Society of Feline Medicine, hosted by Nathalie Dowgray (Head of ISFM). 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 ISFM members at portal.icatcare.org. If you would like access to our full episodes, would like to become an ISFM member, or find out more about our Cat-Friendly schemes, visit icatcare.org.

Nathalie Dowgray: Hello, welcome
to the June 2023 episode of

Chattering with ISFM. I'm
Nathalie Dowgray, Head of ISFM

and host of this month's
podcast. This month Yaiza

Gomez-Mejias is interviewing the
2022 winner of the JFMS resident

best paper award, Dr. Marieke
Knies, and they're going to be

talking about monitoring
diabetes with Free Style Libres.

We're also featuring our monthly
JFMS clinical spotlight

interview. This month, I'm
speaking with some of my

iCatCare colleagues, Sarah
Ellis, Vicky Halls and our

former CEO, Claire Bessant,
about cat friendly principles

for veterinary professionals. As
this is a topic very, very close

to our hearts, we've made the
full version available to

everyone on our podcast channel.
We hope you enjoy this episode.

Yaiza Gomez-Mejias: Thank you so
much for being here today. We

really appreciate your time.
Could you tell us a little bit

about why is it that you wanted
to perform the study that you

won the award for?

Marieke Knies: In feline
medicine, I really like

endocrinology, and especially
like the chronic patients like

the diabetes mellitus. And I was
always struggling to get proper

readings. And then so I thought
this would be really cool to

write something down about it,
because then we can actually

maybe use it on a bigger scale,
and people get more information

on it. And what I did is, I
placed a Free Style Libre. And I

recorded a lot of things like
how are the cats reacting? How

long does it work? How long does
it stay on? Is it even reliable?

Do we get numbers that mean
anything? Or is it just

completely, like a random number
generator? And also, how do the

owners like the use of it? Is it
something that I would recommend

to other owners for diabetic
cats? So I thought, I have to do

something that is super
practical, and that other

practitioners and owners can
read and think oh, this is

usefulfor me and my practice.

Yaiza Gomez-Mejias: It was a
brilliant idea. And what are the

advantages of continuous blood
glucose monitoring devices

compared to in clinic, glucose
curves or even at home the blood

glucose curves?

Marieke Knies: Especially in
clinic, you never get a proper

reading. Because even if you're
super cat friendly, the cat will

be stressed out, it won't do its
normal routine. So you're

sticking it in a cage, it might
not eat as much as it's eating

at home because it's scared or
it might eat more. It's not able

to move around, you have to get
it out of the cage and get a

reading so it's not so reliable.
It's similar at home, it's, of

course, probably more reliable
than in the clinic. But still,

it's quite a burden for both the
owner and the cat and it might

be a big thing for them. And I
think that's what I got back a

lot from owners, is that they
say, 'Oh, this really reduces my

stress, this is so much less
invasive for me. Instead of

basically poking my cat with a
needle every few hours, for 12

hours.' It makes it just so much
more easy for owners.

Yaiza Gomez-Mejias: Are there
any complications associated

with its use? Have you got any
tips, any advice on how to avoid

them?

Marieke Knies: I think the
biggest complication is they

stop working, which is annoying.
And I think communication is

really important. If you inform
an owner look, even if it works

for two days, I'm super happy
because then at least, already,

I got 48 hours of information.
And everything extra we got is

just a bonus. I think that
really helps. In our study, I

think it was about 25% of cats
that it actually worked for the

full 14 days and the median time
was 10 days, so it's still

pretty good. I use glue to make
sure it sticks on a bit better,

surgical glue, and that really
works well. At the beginning of

the study, like half of the
cats, I'll do them dorsal neck

and the other half of the cats,
I'll do the thoracic wall. And

halfway through the study I
basically gave up on the dorsal

neck because I find it easy to
have a flat surface to put the

freestyle on and the dorsal neck
is not flat. Now I'm just doing

the lateral thoracic wall and
that for me works pretty well.

And actually what I didn't put
in this study because I was

already way over the word count.
I also looked at if it makes a

difference if you cover it up or
not. I talked to the owners and

I asked, look do you think your
cat is going to try to get this

thing off? So I think in about
two thirds of the cats I did not

have it covered with anything,
and in one third, I added with a

medical pet shirt. It didn't
make a difference in whether you

have it covered or not. You have
to be a bit lucky that your cat

will allow for this Free Style
Libre to be placed on top of the

cat.

Yaiza Gomez-Mejias: After
working on this study, can you

predict or identify certain
traits in the cat that will help

you anticipate whether or not
they are going to keep the free

style on for longer?

Marieke Knies: I think the
owners really know a lot.

They're like, 'Oh, I'm not sure
you know, about this one.' If

you see them in the cage
immediately going to the free

style, 'What's this on my
thoracic wall?' then I'm like,

Oh, I'm not sure if this is
gonna stay on. And actually I

had one cat, he came home and
his sister was like, 'what's

that on you? That's not going to
be there.' So she took it off

within two hours. So that
happens as well. And I think one

of the other cats was stuck in
something and then he ripped the

the freestyle off. So it's like,
really silly stuff like that can

happen as well. If you look at
other complications, I think

some cats have a sensitive skin.
So in most cats, I really had

no, or almost no, reaction on
the glue or on the sticker. And

I think it was only out of the
41 cats, three cats, that skin

was really red, and inflamed and
a bit thickened as well. I think

you'll find it hard to predict
which cats are gonna have that.

And there was another study done
in cats where they didn't use

glue, but they use sutures. And
it also had a comparable amount

of reactions on the skin. So I
think it's probably the sticker

itself and not as much the glue.

Yaiza Gomez-Mejias: In your
study, you compared the clinical

accuracy of this free style with
that of alpha track. You

reported that free style over
and underestimated the blood

glucose readings in some cases.
Could you explain in easy terms

why those under and over
estimations are not clinically

relevant? And if there are any
specific situations in which you

should keep them in mind?

Marieke Knies: In humans, they
don't look at the specific

values so much. Of course, it's
also important but they look at

will this change my strategy for
treatment of this patient? So

will this change how I look at
the patients if I have the value

from one monitoring device
compared to the other one. And

if you still make the same
advice, or you still do the same

treatment, it doesn't really
matter clinically. And if they

say look, if you have this much
different it actually it will be

dangerous to the patient,
because you will make a

different clinical decision
based on one monitoring device

compared to the other one.
That's of course clinically

relevant. So if you say in one
case, for example, I will

increase the insulin dose and
then if you get another reading

from your other device, say oh
no, we have to actually either

decrease the insulin dose or
keep the insulin dose the same.

Of course, that's clinically
relevant. And that's why I

looked at that. And then I think
in about 95% of the cases, the

differences between the two
machines were not clinically

relevant. So it would not really
influence your decision on your

insulin. No. So I think that's
more important. But I always

tell the owner, if you get a
really weird measurement, I

would always recommend checking
it with alpha track.

Yaiza Gomez-Mejias: Perhaps in a
non clinic situation where you

have an unstable diabetic cat,
would you still consider using

the free style in that situation?

Marieke Knies: Yeah, I do. For
example, in our clinic, when we

have a cat with DKA, we always
take a free style on. Because

otherwise, we have to really
take so much blood samples from

the ears or from the jugular
vein. It's just not very nice.

So we always put a free style
on. But then again, I still

think if you get really weird
measurements, we just recheck to

be sure.

Yaiza Gomez-Mejias: And you said
before that the owners

impression of the free style
libre was positive? Did you get

any more feedback on them?

Marieke Knies: Yeah, they said
it really gave me much more.

Also, it was easier to use. And
also, it gave them a lot of

insight. I think that's also a
possible drawback. Because once

you put a free style on, and
some owners are really checking

every five seconds, basically,
and then you get an email every

day, like, oh, today, the
glucose was this and that. This

can be quite full on, if they
send you like emails every day.

And I think it's also not
healthy for owners to just check

it so much, they're so hung up
on numbers, then. And I think

it's also really important to
communicate with an owner. Look,

it's not, we're not treating a
number, we're treating the cat

around number. So we also have
to look at a clinical situation,

that's, for me, the most
important. I think a drawback

that owners gave back to me was
the cost of the free style, it's

not cheap. And of course, then
if it falls off after two days,

or it stops working, it's quite
a big investment for them. And

also, sometimes they were just
annoyed that it didn't work for

the full 14 days. But I think
communication is key. If you've

really communicated, I know it's
a big investment and just count

on the fact that we're gonna
have it two days. And then if we

have it more, it's great.

Yaiza Gomez-Mejias: When do you
consider the management of a

diabetic cat has been successful?

Marieke Knies: I think for me,
it is successful if everybody's

happy. So the cat is happy but
the owners happy as well. I

think we underestimate how hard
it is for an owner because you

have to stick a needle in it
twice a day and worrying about

hyperglycemia or DKA. And what
can I do if I go on holiday? I

can't ask a neighbour to do
this. And so I think it's really

important to not be too strict.
If you can get 12 hours that's

great, but if it's going to be
13 hours or 14 hours, I can live

with that and I try to help them
like, there's a special cat

sitters that will come out if
you're on holiday that are

really experienced with cats
with diabetes, so you don't have

to ask your neighbour. We should
make it easier on the owner

because if the owner gives up
and can't do any more than

euthanasia is really basically
the only other option.

Yaiza Gomez-Mejias: How much do
you talk about remission?

Marieke Knies: I do talk about
it as a bonus. So my goal is to

have a happy life for the cat
and a happy life for owner and

avoid complications, if we
managed to get the cat into

remission, I'm super happy, but
just try to be in it for the

long haul. And if we are lucky,
then we can get your cat into

remission. And, of course, I do
try to get there by

incorporating a weight loss
programme if necessary, focusing

on the food and going for the
long acting insulin. So I'm

trying to make all the
surrounding possibilities as

good as we can. But it's not the
main goal, because I don't want

the owner to be disappointed and
give up if we can't get to cat

into remission.

Yaiza Gomez-Mejias: And
sometimes the best is the enemy

of the good. How do you think
technology is going to change in

this field? Do you think it's
going to change a lot?

Marieke Knies: The free style is
getting smaller and lighter,

which will be amazing. It would
be even more amazing if we can

get like a super tiny insulin
pump that we can get on to a

cat, that would be super cool.
And I think, not so much in

technology, but in medication, I
think there's exciting stuff on

the horizon with maybe oral
treatment for diabetics or like

ultra long acting insulin. I
think that's really cool. I

can't wait until that's coming
out

Yaiza Gomez-Mejias: Yeah, it
will be really exciting.

Nathalie Dowgray: And now over
to the iCatCare team to talk

about cat friendly principles
for veterinary professionals. So

the first sort of thing I wanted
to talk about, I was going to

direct towards Sarah and I was
wondering if you could just talk

a little bit about why we felt
the need to create the cat

friendly principles.

Sarah Ellis: I think the term
cat friendly is something that

we've used within the charity
for quite a long time. But what

does that term really mean? Cat
friendly? We knew amongst

ourselves, the cat experts
within the organisation knew

what that meant. It's our DNA.
It's, It's who we are. It's what

we do. But actually having the
opportunity to articulate that

means that we could share it
externally.

Nathalie Dowgray: Claire, I
think we were all quite

surprised with how quickly we
were able to write the

principles, why do you think it
was an easy project?

Claire Bessant: Often when you
say you work for a cat charity,

people think you are out there
working with unowned cats, they

don't really understand the
whole process of trying to

understand and treat our cats
better. So let's articulate that

DNA as Sarah said. We work with
vets. We work with breeders. We

work with owners, boarding
catteries, all sorts of things

like that on different aspects.
And that can be quite complex.

And there's always been a need
to simplify. While we sat down

to do it, it was remarkably easy
to see what was important. It

was almost a relief to put down.
I don't know what the rest of

you thought, but it felt really
good to get that down.

Nathalie Dowgray: Definitely, I
remember us thinking that we'd

put aside some meeting time, the
amount of time that we put aside

for it, really, we just didn't
need did we? The essential ideas

came very easily. And then we
spent a little bit of time

simplifying and refining the
language. We use a graphic of

the feline lifestyle spectrum to
really illustrate our respect

cats principle. And this graphic
was the result of your work

Vicky, and I was wondering if
you could just talk us through

what it illustrates, and why it
was a really important concept

for the veterinary profession to
understand?

Vicky Halls: There was this real
perception that the only happy

cat is one that lives in a home
with somebody to love them. And

we realised that may work very
well for those cats who are

comfortable being pets. But it
certainly was not the right

outcome for a lot of cats with
the particular lifestyles they

lead. So we produced this linear
spectrum. And we chose two

important factors of what made
up the individual cats and that

was the sort of lifestyle they
were adapted to, and their

attitude towards people. So we
put the Wildcat at the far end

on the left towards the don't
want to be near people don't put

me near people. And then in
between were the street cats, in

the UK we would know those as
community strays or semi ferals.

And we also put a category of
cat called the inbetweener.

Anybody who's worked in rescue
will know that they've seen cats

who have been pets before,
clearly weren't very happy pets.

So we put them on there as well
to recognise that they needed

something a bit different. And
then the pet cat at the other

end. So it really starts that
conversation, doesn't really

matter what you call them, as
long as you understand that

they're very different to others
and they have very specific

needs.

Nathalie Dowgray: Yeah, I think
it's such a useful diagram,

these different types of cats,
when they come into the vet

clinic, how we interact with
them potentially needs to be

different depending on where
they're sitting. The other

illustration that we use in that
section, Sarah, relates to cats

emotions and behavioural
responses, especially towards

physical interactions. Would you
just be able to give us a brief

overview on the types of
emotions that they experience,

especially around visiting the
vet clinic?

Sarah Ellis: The cat can
experience the whole range of

emotions actually, and those
emotions may sound, in first the

impression, similar to ours. But
of course, they don't have those

levels of cognition. And it's a
really individualised

experience. And we're never
going to know it fully. But

there are these sort of very
ancestral mammalian emotions

that are there to help animals
survive. And those are

incredibly useful for us to
know, particularly in the

veterinary clinic environment,
which a cat may find quite

threatening, or quite stressful,
no matter how much we try and

minimise that stress, we can't
get rid of it all. Some of these

cats are in pain, they have
injury, they may have disease or

illness, they may be
uncomfortable. And so they are

going to experience feelings
that are going to be very

protective to try and keep them
away from further threat or

harm. But before I dive into
those, I'd probably just quite

liked to start with thinking
about a very engaging emotion or

a positive emotion. And that's
one called seeking. And that's

what cats do when they're
motivated to find pleasurable

experiences. This is an emotion
that we really want to promote

in the clinic. And we can do
that through play, through food,

through gentle social
interactions if it's appropriate

for that individual cat. And not
only just appropriate for that

individual cat, but at that
time, that's something else we

need to consider. But then we
need to think about those more

what we call protective
emotions, the ones that are

designed to really help keep
that cat safe. And the first two

that spring to mind are fear and
anxiety. And they are about

avoiding threat and harm. And
that's a threat that the cat can

perceive straightaway in front
of it. It's really obvious

there's a dog in the waiting
room, and I'm scared of that

dog. Right up to the things
that's a bit more like, I'm not

quite sure what's making me feel
a bit worried. I can't pinpoint

exactly what it is, but I am
anticipating that something good

is not going to happen. But
something bad might happen. So

that's fear and anxiety. The
last one I really wanted to

cover is frustration. And
frustration occurs when a cat is

prevented from doing something
that it wants to do. So for

example, if it wants to access
food, and it can't, but also

when it wants to access things
like escape. Less is more when

it comes to handling. And by
giving those cats the autonomy

to move positions, to stop, to
rest, to sniff, actually helps

keep those frustration levels
much lower and keeps an animal

in a much safer place because
cats that are frustrated can

show responses such as
scratching and biting. And the

last one is pain. That's one
that covers not just a sensorial

experience, but also an
emotional experience as well.

Cats will learn to avoid pain,
they will be fearful of

anticipating pain. So yeah,
that's a quick synopsis really.

Nathalie Dowgray: We might do a
separate podcast on each one of

the emotions maybe. Claire, one
of the points of difference for

ISFM as a veterinary association
has been championing equal

consideration to the cat's
mental well being as well as

their physical health. As the
charity CEO for 28 years, I'd be

really interested in hearing
your reflections on how this was

received.

Claire Bessant: I was looking up
one of the quotes from 1960, in

the very early days of the
charity, it said there are two

recognised diseases in cats. One
is cat flu and the other one

isn't. And I thought that really
just summed up where we were. We

talked to those vets who were
funded by the charity to

specialise in feline medicine,
when we started to talk to them

about what was important, at the
same time, cat behaviour was

coming to the fore, people were
understanding cats much better

and taking them seriously. And
so we began to think about

mental wellbeing. It's a credit
to the vets in those early days.

I found another quote that says
that FAB, since its

inauguration, advised against
declawing due to many cases

reported of changed personality
and psychological upset. So

there's nothing there about
physical health. It was about

how the cats were behaving. And
that was the really early days,

When you think about where we
were, where we had cats flu and

nothing else. I think the
profession was extremely

grateful for a tiny charity such
a lot of work was done. And

those cat people within the
profession and around it, found

a home, found a place where they
could help develop that and take

things on. You look now at where
we are with cats and how we

treat them. It's fantastic. And
it isn't just iCatCare and ISFM

who were talking about it and
that's the aim of the game.

Nathalie Dowgray: I think that's
true, isn't it? A lot of the

things that we talked about,
especially in those early days,

have really become mainstream
within the veterinary

profession, which is lovely.
Vicky, I wanted to talk to you a

little bit about what we see in
a lot of pet cats that are

relinquished to shelters,
potentially due to medical

conditions that have some degree
of a behavioural component.

Probably the most common of
those is urinary issues that may

or may not be lower urinary
tract disease, and how do you

speak to both pet owners but
also shelter personnel about

relinquishment under those
circumstances, where maybe there

are situations where the mental
well being issues may not be

able to be addressed in their
current home, or that current

environment is causing
unintended harm to the cat.

Vicky Halls: That stress
cystitis situation was a really

big thing while I was working
with clients, and we all know

that in order to manage that
condition, it's a very complex,

multifactorial solution to get
good management. And there were

times in my career where there
was something so wrong about the

environment, irrespective of how
wonderful, conscientious, or

loving the owner was, that
particular cat had very specific

needs, and those needs were not
being met in that home. That

requires a very difficult and
sensitive conversation with the

owner. And when the owner
decides for themselves, that's

going to be the best option for
their pet, because they just

can't manage those symptoms,
then it's important that they

understand how well the cat does
in the future. Information is so

important. And to get that kind
of information from somebody

giving up their pet, because
let's face it, if their pets had

stress cystitis, they may have
messed around the house, people

can censor that information. And
they can actually hold it back

thinking it may act to the
detriment of their cat or its

future. So they start saying
things like, my child's allergic

or got to move, can't take the
cat. That relationship of trust,

whereby the person understands
that whatever they say, it will

be positive, because we need to
have information, warts and all,

about the cats that are going
into care for very specific

reasons. The most important
thing is building that

relationship, finding out what's
going wrong for that cat to

establish what that cat needs.
And that's what you look for in

the future home. They homing
centre staff have to do a

similar sort of thing to the
clinical behaviourists. They

have to establish what the issue
is, and try and establish what

that cat needs that it doesn't
have in existing home. And the

bottom line is get that
relationship working and you

will get that information.

Nathalie Dowgray: And when we
were writing the principles, it

really did become apparent quite
quickly that we'd written three

that were very much focused on
the cat, respecting the cat,

keeping cats well and doing cats
no harm. How would you summarise

those three principles?

Sarah Ellis: We're lucky that
we're all really on the same

page at iCatCare. And I think we
do take a very holistic approach

to cat welfare, we consider all
aspects of the cat. Everybody

knows what we mean by the
physical health of a cat. But

mental well being is really an
umbrella term for the cat's

emotional health. And we've
talked a bit about some of the

emotions that cats can
experience, but also its

cognitive health. So we're
thinking about the ways it

learns as well. Helping that cat
to learn through positive

reinforcement and not through
punishment based techniques. So

no spraying it with water or
shouting at it, none of those

types of things. And when we
think about doing the cat no

harm then we're thinking about
not just no physical harm, we're

also thinking about no emotional
harm. We want to keep that cat

in a safe emotional place where
it's not feeling threatened or

at risk of harm, and also no
cognitive harm. So we want to be

supporting that animals
cognition as it gets older, we

want to be making sure it learns
in the most efficient, positive

and safe ways. Finally, if we
think about our respecting cats,

it's going back down to that
individualised approach that

one, we understand what a cat is
when it comes to its welfare,

but also that not every cat the
same. They're all individuals.

And I think one of the things
that we've said for a long time

at iCatCare is cats are not
small dogs, their cats, they're

a species in their own right,
every single cat is different.

They're all individuals. That's
really what we're talking about

in our cat centric sort of
welfare approach is considering

the physical health, emotional
health, the cognitive health,

and not just what that means at
the species level. But what that

means for every individual.

Nathalie Dowgray: Our principle
about being solution driven for

cats encourages people to find
evidence based pragmatic,

sustainable solutions for cats
and sometimes in the veterinary

world, there's a sort of
perception that pragmatic is

seen as less and that we should
be striving for gold standard or

a high level of care. Would you
be able to explain what we mean

by pragmatic when we use it and
how being pragmatic can really

advance feline welfare?

Claire Bessant: I thought I'd
look up gold standard and I'd

look up pragmatic, just to be
sure. Gold standard, a thing of

superior quality which serves as
a point of reference against

which other things of its type
may be compared. Bear that mind.

Pragmatic, meeting sensible and
realistic, based on practical

things, which is fairly
straightforward. So then I

thought back to those very early
days of the charity when it was

flu or not cat flu, and I
thought just about anything was

gold standard at that point,
because we knew absolutely

nothing. And what was
pragmatism, it was treating a

cat as a small dog, because
that's all we knew. So we've

come cquite a long way from
that. You're not just treating a

cat on a consult table, you're
working with the owners, you've

got owners who are very good at
dealing with their cats,

handling them, and owners who
can't do anything, people who

can pay, people who can't pay,
all sorts of things. To treat a

cat is just so much more complex
than that. And we've used the

word pragmatic, obviously,
because for cats, the reality of

the situation is what treatments
we can give pet cats, but can

they be given. And if you look,
in all those different countries

where people are striving to do
the best for cats, they don't

necessarily have the treatments
available that may be available

in other countries, people try
to do the best they can in that

situation. Our founder, Joan
Judd once said, and I thought

this was such a nice quote, in
our pursuit of knowledge we can

lose sight of compassion, we
must not get caught up in the

excitement of achievement to the
exclusion of all else, or this

will defeat our aims. If we
rephrased gold standard to gold

standard solution for that cat,
bearing in mind all our

principles, it may not be the
perfect medical solution. But

the gold standard is what can
actually be fulfilled. So I

think striving for knowledge and
gold standard, there's nothing

wrong with that. But if we think
of it as a gold standard

solution for that animal that's
actually being pragmatic at the

same time.

Nathalie Dowgray: Thank you,
Claire. That's a brilliant

answer. And I think it really
sums up the direction for the

veterinary profession that we
need to be moving. And Vicki,

your job requires a huge amount
of communication and

collaboration. And I wondered if
you could share with us why you

think, especially in that
relationship between the

veterinary sector and people
that work with and for unowned

cats, the collaboration and the
communication can be challenging

on both sides?

Vicky Halls: The whole unowned
cat world is all about cat

population management. A lot of
people who work in the unowned

cat sector, bear in mind that a
majority of them are actually

volunteers from all over the
world, they work incredibly

hard. And they don't stop to
think I need to build up a

relationship with this
veterinary practice because they

are our collaborators. And we
need to work in partnership to

make this work well. So it turns
into something quite

transactional. And I don't think
that's terribly satisfying for

the vets either because it's
quite often complex and

challenging work, it's often low
cost with regard to revenue. And

so often, the neutering will be
done, the cats will go out and

they'll say, oh, and that will
be the end of the relationship

between the two parties. The
other thing is, when they're

dealing with medical cases in
homing centres, there's that

need to know attitude. And this
is just what I've acquired

through conversations with
various people. And they say

we're not quite sure because we
didn't really understand what

the vet said. So there's that
breakdown in communication,

there's a sense that they've got
no common ground. The

relationship is just
transactional. Whereas there's a

huge movement now within the
unowned cat sector to become

more professional. They want to
be seen as a profession, as a

career pathway. And this is
really exciting. And they're

starting to lift their heads up
and put their heads over the

parapet and say, I think we need
to collaborate, I think we need

to evolve. I think we need to
improve things. I think if that

can be achieved, and if they're
just explicit with each other

and make it clear what their
needs are, they can build that

working relationship. At that
moment I think that's present in

pockets around the world but not
universally.

Nathalie Dowgray: Neither party
can do their job without that

communication and that
collaboration element, if we

want to have the right outcome
for these cats. Just to finish

up our session, I was wondering
if each of you would be able to

share what you think is the
biggest evolution for cats that

you've seen over your career,
Sarah, I was going to turn to

you first.

Sarah Ellis: So when I did start
my PhD, which was the first time

then I was studying just cats, I
was searching for scientific

papers and research done on
behaviour and welfare, any

aspects of the cat human
relationship, when it was like

digging for gold. When you found
one, it was so exciting. I could

mentally file those papers. I
could tell you, they were in my

brain, the date, the names of
the author, what they were

about, and I could reel them
off. And then I would wait

weeks, if not months, before
another one came. And that was

the state of behavioural
cognition, Welfare Research, for

cats at that time. And I think
now their coming in thick and

fast, not just every week, but
sometimes every day. Today

alone, there's three I've seen
that I've thought, oh, I need to

read all of those. So for me
that evolution, that development

of global interest in this topic
of behaviour and welfare is

just, for me, so fantastic.

Nathalie Dowgray: Thank you,
Sarah. The volume of papers has

been increasing year on year.
Claire, what have you noticed?

What's the biggest evolution you
have seen?

Claire Bessant: I've been
noticing what the charity did

even before I joined it probably
30 to 35 years ago. And it was a

time when suddenly all these
diseases were suddenly coming to

the fore. So we had FIV, FSE
FELV, diabetes, everything was

new, and so there was just
volumes of stuff coming out all

about the physical health of
cats. And that was a really

exciting time. And I think that
led to the development of ISFM

and the Journal Of Feline
Medicine And Surgery as well,

because there was so much to
say, because there was very

little before that. The charity,
it was probably fairly unique in

the beginning to even be
thinking about those things then

at the same time when we
couldn't treat anything. We

understood that we had to think
about the cat itself and how we

did that. So to see that
happening is just absolutely

fantastic. And we're talking
about health, we're talking

about well being, we're bringing
it all together and to see that

come together is just absolutely
fantastic and to be involved

with the people who are doing
that.

Nathalie Dowgray: And things
like if FIP being first

recognised, all the way through
to these recent years where we

are at the stage where we can
say we can treat this disease

that was previously untreated.
Well, it's a really fascinating

evolutionary arc to have
observed. How about you, Vicky?

What's the biggest evolution
that you've noticed?

Vicky Halls: The different
countries are starting to talk

globally about issues, we're
starting to recognise global

issues and there's, because of
the way we've become such a

small planet now, I think that
technology that has enabled this

to become a much smaller world,
has enabled that knowledge as a

consequence to spread. So for my
lifetime over the past 60 odd

years, the fact that we can
communicate and talk and share

across the globe.

Nathalie Dowgray: I think that's
a fantastic point Vicky and some

of that was behind the decision
making when we converted JFMS

into an open access journal this
year is that, we've gone from

having a very informal journal
back in the FAB days, a

newsletter as it were, and then
moving towards a peer reviewed

journal with JFMS. And now it's
an open access journal that's

fully available to anyone
virtually and that ease of

access just isn't something we
would have even realised was an

option 20 years ago. When I was
thinking about how I was going

to answer this question, I was
reflecting on my area of

research interest, which is
ageing cats and osteoarthritis,

and some of the very early
papers around radiographic

lesions of osteoarthritis were
just publishing while I was at

vet school. And we were starting
to recognise that yes, cats did

have osteoarthritis. But I don't
think we really recognised the

significance because we just
didn't have the skills and the

tools to truly understand
chronic pain. And to me pain

assessment, both acute and
chronic, our tools to be able to

do that, but also our drugs to
be able to treat it, have just

increased exponentially over the
last 10 years or so especially.

And some of that also has that
technology element, that a lot

of these tools that we use, we
can access through our

smartphones, through computer
algorithms. And I think all of

that is really having a massive
impact on that physical health

element of pain. But as Sarah
alluded to earlier, there's the

emotional element of chronic
pain especially as well. And I

think that's having a massive
advancement in feline welfare.

If you are an ISFM member don’t
forget you can access all the

other ISFM member benefit
including our 2020, 2021, and

2022 congress recordings. The
2023 congress recordings will

also be going live in July. We
also have monthly webinars and

clinical club, the discussion
forum and much much more and

that's all available through
portal.icatcare.org. If you're

looking for more CPD in July, we
have further open access

webinars. The first one is from
IDEXX, 'Management of feline

chronic enteropathy', and second
one is from Bova, ‘Feline

sleepy? Anxiolysis and sedation
tips.' So do keep an eye on the

ISFM social media channels for
more details on those. Don’t

forget, JFMS is now an open
access journal so if you wish to

read JFMS's Cat Friendly
Principles for veterinary

professionals, the link is
available in the show notes.

We'll be back again next month.
If you don't want to miss it,

then do make sure you sign up to
Chattering with ISFM on your

preferred podcast channel.