Chattering with iCatCare

In the July episode of Chattering With International Cat Care, we explore what happens when the clinical picture doesn’t tell the whole story and why feline care often hinges on context as much as condition.

Ann Hohenhaus joins host Yaiza Gómez-Mejías to reflect on her widely read JFMS article about non-regenerative anaemia in cats. But beyond the lab values, what makes this condition so difficult to spot? The conversation touches on overlooked clinical signs, unexpected owner observations, and the real-world decisions veterinarians face when managing anaemia in everyday practice.

Then, Dr Kelly St. Denis speaks with Mary Ellen Goldberg about feline rehabilitation: when it’s needed, why it’s underused, and how it fits into modern pain management. In this first of a two-part conversation, they explore common challenges, the importance ofbehavioural sensitivity, and the value of a flexible, feline-friendly approach. Stay tuned for Part Two coming later this year!

For further reading material please visit:

Feline non-regenerative anemia: Diagnostic and treatment recommendations

Physical rehabilitation of cats: 1. Common conditions benefiting from physiotherapy

Physical rehabilitation of cats: 2. Treatment therapies and exercises

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

Host:

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

Speakers:
Ann Hohenhaus, DVM, DACVIM (SAIM, Oncology), AMC’s Director of Pet Health Information

Kelly St. Denis, MSc, DVM, DABVP (Feline), Co-editor of the Journal of Feline Medicine and Surgery and JFMS Open Reports, St Denis Veterinary Professional Corporation, Powassan, Ontario, Canada

Mary Ellen Goldberg, BS, LVT, CVT, SRA, CCRVN, CVPP, VTS, VTS-LAM, VTS Hon, Certified Veterinary Pain Practitioner & JFMS Author

Creators and Guests

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

What is Chattering with iCatCare?

Welcome to Chattering With iCatCare, the official monthly podcast of International Cat Care, hosted by Yaiza Gomez-Mejias (Veterinary Community Co-ordinator). Each month, we chatter about cats and cat-friendly practices with industry experts and contributors to The Journal of Feline Medicine and Surgery. Each episode contains highlights from our longer discussions and interviews, which are accessible to iCatCare members at portal.icatcare.org. If you would like access to our full episodes, would like to become an iCatCare Veterinary Society Member, or find out more about our Cat-Friendly schemes, visit icatcare.org.

Hello, and welcome to
Chattering With iCatCare.

I'm Yaiza Gomez Mejias, iCatCare
veterinary community coordinator

and host of this month's podcast.

Our clinical spotlight this
month is focused on physical

rehabilitation in cats.

Dr Kelly St. Dennis will be interviewing
Mary Ellen Goldberg on one of two JFMS

articles on feline pain management
through physical rehabilitation.

In this first part, she will be
discussing common reasons for

physical rehabilitation in cats.

We will share a second part of this
interview later on this summer, but

first, I will interview Dr Ann Hohenhaus
about some of the many things she has

published, including a JFMS article
that covers feline non regenerative

anaemia, which as you know, can be
challenging from a diagnostic point of

view.

Dr Ann Hohenhaus, double board
certified in oncology and

small animal internal medicine.

She works as a senior veterinarian
specialist in oncology and director

of pet health information at the
Animal Medical Center in New York,

where she also hosts a podcast.

Anne has contributed widely to
research articles of books, lectures

internationally, has won prestigious
awards in veterinary medicine and

journalism and chairs the oncology
working group at the World Small

Animal Veterinarian Association.

And she was just telling me
that she also works as a foster.

So Anne cowrote an article about
non regenerative  anaemia with Sarah

Winzelberg Olson and the Journal of Feline
Medicine and Surgery, which is actually

one of the most read JFMS review papers.

Which is the practical relevance
of this article, why do so

many vets want to read it?

I was stunned when Journal of
Feline Medicine and Surgery sent

me an email that said this article
had been downloaded 29,000 times.

That number of downloads
reflects that pretty much

every sick cat becomes anaemic.

Cat red blood cells are not very sturdy
and don't last long, when cats are sick

they last even shorter period of time.

And so I think that's one of the reasons
that this article was popular is that

it was hopeful to the veterinarian for a
really common problem that they face on

an everyday basis and that that is, is the
anaemia the primary problem this cat has

or is it secondary to some other disease?

This article's been published a couple
of years now, and there are more and new

treatments available for  anaemia in cats.

Even though this is a popular article
it's going to be out of date very

soon because there's new stuff
coming along, which is great because

we need new treatments for cats.

Someone is gonna call me and
ask me to revise this article.

One thing I noticed was the abstract
clearly states the evidence, the review

is based on, something not always
present in this type of publications.

In which ways do you think including
this information in peer reviewed

veterinary literature benefits
the clinical decision making of

practitioners working in primary care?

Peer review means Dr Winzelberg Olson
and I wrote this article, then it

got sent to experts in anaemia who
reviewed it and made suggestions

on how we could make it better.

And that's what peer review is, is
your academic peers look at your

work and help you make it better.

This article is held to a higher standard
than a non-peer reviewed publication.

It ups everyone's game.

When we wrote about non regenerative
anaemia, we wanted it to be visual and

reader friendly, which I think it is.

I attribute that to the Journal of Feline
Medicine and Surgery staff who helped

turn our concept into a beautiful reality.

It's a really pretty article to look
at with great pictures, and that

was a in a lot due to the staff.

Thank you very much for such a kind
compliment on behalf of of the JFMS team.

They will be pleased.

All veterinarians face the
diagnostic and therapeutic challenges

describing the article that will
benefit from reading this review.

What contextual factors of
non regenerative  anaemia

are relevant to primary care?

There are lots of contextual factors
veterinarians don't really articulate.

Journal of Feline Medicine and
Surgery published an article about

how many times people were bitten
trying to medicate their cats, and

it, I think the number was like 75%.

It's a really big number.

That's a huge factor in managing cats.

It's not about the disease.

Contextual factors are not about
the illness you're managing.

They're about the patient and owner and
how those impact management of disease.

So one contextual factor is
how hard is the cat to medicate?

And so that caused us last week to make
a decision not to treat a cat with pills

because the owner could not pill the cat,
but the owner was able to give injections.

And so we decided to treat the cat
with injections at home because that

was something that the owner could
manage because the cat was just

a tyrant when it came to pilling.

So that's an example of how to
work around a contextual factor.

The other thing is to think about
these wonderful little old ladies with

cats and the cat is their everything
because maybe they're, they live alone.

But bringing that cat to the
veterinarian frequently for

multiple treatments is a challenge.

You need to understand what their
transportation issues are, what

you can do to help mitigate those.

Some things we do, find a veterinary
nurse near their home that could go

and help them medicate or give subq
fluids, or maybe we collaborate with

the primary care veterinarian who's
just down the block and they can go

there for some of the treatments and
come to us for some of the treatments.

So those are kinds of things
that one needs to think about.

In rural areas, you have to
think about veterinary deserts,

meaning no veterinarians close by.

In New York City, we
don't have that problem.

There are lots of veterinarians,
and the other thing is we have

pretty good transportation.

Even if you don't have a car, you
can get around with your cat and

a carrier on the subway or bus.

If you live in a rural area, you
might have to drive two hours to find

someone to take care of your cat.

All those are things you need to
build into the treatment plan for

the patient that you're seeing.

I was thinking some owners tend to think
sometimes a sleeping cat is normal and

when they are anaemic, they sleep more.

It's very easy to miss signs
like lethargy and sometimes

owners realise the cat is anaemic
when the cat is very anaemic.

Cats are masters of disguise, and so
it's very easy for cats to hide the fact

that they're very ill until they cross
that threshold of illness to crisis.

And so things that might give you clues
to a cat being anaemic would be a cat

eating something that's strange, which is
called pica, non eating non-food items.

And I've had anaemic
cats who eat cat litter.

The other thing that I've seen is
cats licking the grout between the

tiles in the bathroom, tub, or shower.

That's a clue that cat might be anaemic.

Other subtle things owners will
say, he used to jump on the counter

and refrigerator, but he's not now.

Maybe he's too weak.

Is this cat anaemic?

Does this cat have arthritis?

Listen to the owners.

The most important thing in a
veterinarian's office is for the

owner to talk about what their cat
is doing, and for the veterinarian

to listen, I ask questions like
tell me why you're here today?

Tell me what's different about your cat?

If I get the owner to talk about those
things, then they will give me a lot

of clues, not only about the health of
their cat, but also about the contextual

factors involved in managing it that
I'm going to have in managing their cat.

And now Dr Kelly St. Dennis will
speak with Mary Ellen Goldberg about

her JFMS article on Feline pain
management and common reasons for

physical rehabilitation in cats.

Welcome, Mary Ellen.

Thank you very much, Dr Kelly.

This article is amazing because
it focuses on our feline species.

Maybe we could start with the basics.

What is physiotherapy and what are
its potential benefits to cats?

Why are our clinicians
interested in these publications?

First of all in addressing the first
publication, it helps to outline

conditions cats can develop or have
where physiotherapy would be helpful.

Physiotherapy or physical rehabilitation
as they call it in the United States, that

is helping the animals’ quality of life.

So as they're aging, it helps
them to be able to move.

It tremendously helps with pain and helps
them to move, help them to get back to

a normal way of life, helps them not
have pain and as they age, have more

mobility, a happier quality of life.

Also, I compare my thoughts of
human patients with my thoughts

of animal patients because
yes, there are differences.

Absolutely.

The more you study and read, the more
you realise how closely connected we

are, and I believe that's why one
of the definitions for pain that the

International Association for the Study
of Pain developed is that, pain is not

just limited to patients that can speak,
but they now include non-speaking.

Whether that's patients that are
unconscious, whether it's patients that

are babies that you know, paediatric.

But it includes all
our none human animals.

The fact that, that they cannot speak
does not negate the necessity for

our knowledge of pain management.

And one thing back to the physiotherapy
is that, I find that we need to look at it

as part of complete veterinary medicine.

There are gonna be people
that say, I can't do that.

And that's understandable, but
if you want to offer the complete

package, more people are looking
at their pets as their fur babies.

And so when you have this, you
think, if my child couldn't walk,

would I just go I can't do this?

And there are ways, there's so many ways
that we'll do this in the second part of

the article, there's so many ways that you
can help the clients to do things at home.

So even if they can't bring them
in all the time and often, they can

have an exercise program at home.

So I wondered if we could talk a
little bit about that and where cat

friendly interactions and handling
come in to dispelling the myths

behind cats and physiotherapy?

If you do physiotherapy, it's
not imperative necessarily, but

with the Fear-Free approach, it's
getting more and more that way.

But it's imperative if you're gonna
be trying to do physiotherapy with

cats, that you want to have excellent
behavioural knowledge and handling skills.

The saying less is more it, it could
not be more true, and we need to

think of it in terms of, sometimes
you can have your dog in physical

rehabilitation or physiotherapy.

With dogs, sometimes we can prod them
along, help them, if you're doing

specific exercises that you have hands
on them and you want to move something.

The one thing that is absolutely true is
if you've got a cat that's having pain.

Whether it's from osteoarthritis or from
an injury, a trauma, or neurological

pain and you want them to do something,
they're not going to do it if they hurt.

They're just not.

one of my mentors, Dr Robin Downing, she
taught me years ago, you're not gonna get

them to do anything if they are hurting.

And if you try to make them do it
and they're hurting, it's, it, that's

the last time they're gonna do it.

That's it.

If it's a younger animal, you can
give them a dose of gabapentin or

have pheromones in your practice
to help them not be upset.

Techniques in physiotherapy can
help with pain management and I am

the big believer in acupuncture.

So you can have an elderly cat that
has kidney disease and liver disease,

they can't take drugs, and you can
bring them in, give them acupuncture.

You can use laser
photobiomodulation on them.

So you can use therapy, laser therapy,
you can send home pulsed electromagnetic

field therapy to lessen their pain
prior to starting any physical exercise.

And that kind of helps with
minimising the pharmaceuticals you

might need to use for analgesics if
the patient has contraindications.

Absolutely.

If you start them young enough and
their lab values are good, you can

start them on a multimodal pain
approach and then when they come for

physical rehab, they're more relaxed.

Dogs tend to want to please, cats
don't care whether they please or not.

You have to be willing to
change up your program.

You have it all planned out that you're
gonna do a specific thing and if that

day they happen to be in a bad mood,
maybe do some massage, maybe you can

do some of the therapeutic laser.

But I mean, you have to be
willing to change up your plan.

And I think a lot of us are
learning cat friendly handling

and understanding feline emotions.

We also do that in our physical exam.

A complete physical examination
will vary from cat to cat, depending

on their emotions and responses.

You can't push them, right?

You have to adapt to the cat's emotions.

Thank you for listening.

If you are an iCatCare Veterinary Society
member don’t forget you can access the

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

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

and much more at portal.icatcare.org

If you are looking for more free CPD
from International Cat Care, on the

20th of August, Dr Christine Pye will
host a CFC open access webinar on

Feline Ageing and age-related diseases.

We’ll be back again next month with more
from the world of feline medicine and JFMS