Hi.
Thanks for joining us and welcome to another episode
of Chattering with iCatCare.
I'm Yaiza Gomez, Veterinary Community Coordinator at iCatCare Veterinary
Society, and this month we will start talking about the new JFMS oral and
dental health guidelines which not only offer evidence-based instructions
about assessment, diagnosis, and treatment of oral disease in cats,
but also touch upon anaesthesia and analgesia, use of antibiotics
and education of cat caregivers.
Then Sam Taylor will interview Ian Wright about the use of anti parasitics, also a
very relevant topic in general practice.
Let's start with a conversation between the two co-chairs of these
new guidelines, Heidi Loprise, a veterinary dental specialist, and Dr
St. Denis, who is also JFMS editor.
I feel like that cat friendly experience is really something that does make a
difference for caregivers in getting them to the clinic, but also in
interacting with their cats at home and even cooperative care training for
getting them to let us handle their mouths to do an awake oral exam, but
also in how to do some home care.
Our listeners will find in the guidelines a lot of information about home care
with a lot of good supplemental links to some resources from feline VMA,
for example, for those purposes.
It's very important to start talking about it at kittenhood, and you're
mentioned the cooperative training.
They can do home care with wipes, getting them used to it early on,
and then we'll notice problems early.
One of the key things that you and I have talked about during the process
of developing these guidelines is how we've moved away from the concept of
toothbrushing for cats as opposed to using something like wipes or gauze.
And I certainly try to show caregivers in my appointments how to take a gauze
on their finger and just get onto the canine and then work their way back
to the upper premolars even to get that plaque off on a daily basis.
So it seems to be something that people are more comfortable with.
It can be really helpful to show caregivers that trick.
There's even a video in the toolbox.
Yes and so we talk about caregivers and what they are willing or able to do,
and that kind of dives into something else that we spoke about early in the
guidelines, and that is the spectrum of care in feline oral and dental health.
We have a figure in the guidelines that really shows how we have different
factors associated with clients or our caregivers, factors associated
with the veterinarian and the veterinary team, and also the patient.
All of those different factors will contribute to how that cat receives their
prevention and their oral and dental care.
And so for caregivers, a lot of us will sometimes think, oh, it's
probably about finances, right?
Especially if we're talking about anaesthesia and dentistry.
But what are some of the other things that you consider when you're talking
about caregiver factors in terms of how that impacts dental care?
If they're coming to us for a referral, we might have a
different category of clients.
But we have to realise what's gonna be the best combination for
that pet and for that caregiver.
Sometimes it is the cost, but just like when we talk about senior
care, there's other wallets as well.
Their time, can they get off work?
Their human companion animal bond.
If they have to do a lot to that cat and give them a lot of different
medications and do different things, is that gonna impact that bond?
So we have to be empathetic to the owner and look at these different
burdens and make sure that spectrum of care falls within their wheelhouse.
Yeah, that's a really good point.
Those budgets are really important to consider, and we do have a
really good section on anaesthesia and analgesia in the guidelines.
We hear a lot of things about anaesthesia free dentistry, and we don't always
think about cats as being painful when they have oral or dental disease.
So I don't know if you wanna pipe in about what your thoughts are
with regards to pain management for these patients at diagnosis and
through the preoperative period.
Absolutely.
So a big part of oral and dental disease is the discomfort, alright?
And in fact, there's gonna be a level of pain that cats will hide.
They're good at hiding things.
But whenever we see inflammation or ulceration, we know there is pain.
So managing that pain with good analgesic protocols before, during
and after dental surgery can be very important for these patients.
As we look at that too, we can help speed up the healing,
help their quality of life.
It's just so critical.
It's hard to convince caregivers that things are painful because
they don't see anything 'cause cats are so good at hiding it.
Yes.
So it can be challenging to get caregivers to get started on pain management
before they even book a dentistry.
Do you have any tips or tricks for us when we're talking about
getting caregivers to get on board with analgesia at diagnosis?
If you've ever had one of those cases where you did do the analgesia ahead
of time or even finally got them into the procedure and the cat felt better,
that's a key weight, using a testimonial.
Even giving the pain medication prior to, the owner will likely see a difference
in that cat, and hopefully that won't mean, oh well, I'll just give it pain
medication, not do the dental procedure.
We educate them to do all the steps that are necessary, but
it can really be impactful.
Yeah, and I've seen that quite often in my own practice.
Like I had a patient who used to fetch and the client hadn't really noticed, but the
cat had stopped fetching and then as soon as we put the cat on analgesia for the
oral and dental disease, they went home.
Two days later after starting, the cat was fetching again.
So they were like, yes, we need to do this dentistry right away.
When you hurt, you're not happy.
For sure.
Now Sam Taylor will interview Dr Ian Wright on the veterinarian's
critical role in choosing using and stewarding anti parasitic drugs in cats.
My first question for you is about different parasite risks that
cats face, because I think one of the reasons I love cats, they're
very diverse in the way they live.
We have indoor cats, outdoor cats, we have hunting cats.
We have cats that that don't hunt.
What should we be worrying about and why in those different lifestyle groups.
A hot topic in the UK over the last few years has been
taking a risk-based approach.
So to say we shouldn't just blanket treat all cats and dogs with
parasiticides that kill everything.
We should look at their lifestyle and see what sort of treatments we need.
Cats fall into very nice categories.
We have, in some cases completely indoor cats.
Now, depending what part of the world you're in, a completely
indoor cat is gonna be at very limited risk of parasite exposure.
Fleas still potentially, toxocara worms potentially, potentially
flea tape worm via the fleas.
In terms of other parasite exposure, by and large you have to go out and get
those parasites either by eating stuff or go to places where they are and that's
very much what your outdoor cat does.
You know your outdoor cat that is living the dream, it's gonna go
out, it's gonna meet other cats, it's gonna go and eat some stuff.
It's probably gonna predate and eat some other small furry creatures
or some lizards or some slugs.
And then if it's bored it's gonna go to an animal burrow or nest, and you've
been exposed to all sorts of things.
You're going from a position of very little risk to suddenly
a position of very high risk.
A lot of cats are gonna be on that spectrum, and it's just a question of
where your cats lies on that spectrum.
One of the interesting challenges about cat owners and cats is that
in my experience, a lot of cat owners have absolutely no idea
what their cat gets up to at all.
The first question we have to ask, when the owners says,
oh my cats completely indoor.
Is it really?
Does it have a catio?
Does it have back garden access?
Does it nip out when their owners aren't looking?
And equally, once cats do get out, once their owners allow them to roam
and go and live that outdoor dream, unless they're bringing prey items back.
It's very unlikely they're gonna know whether they're hunting,
whether they're visiting animal
burrows, you know, fighting, doing a lot of these activities.
So that is part of the challenge, really, not only where your cat is on
the spectrum, but how much knowledge individual pet owners have about that.
I
certainly don't know what my cat does for 99% of the time.
It's part of the mystery, isn't it?
Yeah.
It's what we love about them.
Definitely.
You and I practice in the uk, but our audience are more diverse worldwide.
Can you give me some examples of parasites of concern in other
parts of the world with cats?
Yeah, so first of all, we have the ubiquitous ones.
So wherever you go in the world it's very likely you're gonna encounter
some fleas, and that is really just a question of whether you're gonna
encounter those fleas all year round or whether they're gonna have seasonality.
And similarly, unless you're gonna go to the Arctic Circle, you're
probably gonna come across some ticks as well, at least seasonally.
Tapeworms like flea tapeworms, roundworms, like toxocara, pretty much
ubiquitous wherever you go in the world.
You go out into Europe, aelurostrongylus is around 10% in a lot of studies,
so close to 10 times more common in cats with outdoor access.
And if we go down into the Mediterranean, we come across troglostrongylus, much
more pathogenic lung worm of cats now spreading into Eastern Europe as
climates and wildlife reservoirs change.
We are seeing its distribution start to spread.
If we head out to Asia, we're gonna hit flukes like opisthorchis.
We're gonna get intestinal liver and lung flukes, which cats get through eating
all sorts of raw fish, meat products.
Much more common in those cultures and are maintained by the wonderful humidity,
wonderful wide range of invertebrate reservoirs that they have there.
That's
about sort of Asian.
Paragonimus, which is a lung fluke, North American, South American problem.
So moving outta sort of Europe, they become more of an issue where we might
not see those here and of course protozoa.
So tick-borne protozoa, like the babesia felis down in South Africa.
Huge problem that's relatively specific to African belts, cytauxzoon, really
nasty tick-borne pathogen that we fought for a long time that was just
actually present in North America.
But we've now had cytauxzoons identified and closely related to small babesias in
South Africa and across the African belts.
We've had unexplained cases of cytauxzoon in Europe as well.
We don't know where they've come from, so there's a perception not entirely
unjustified in Europe that cat tick-borne pathogens perhaps aren't very exciting,
certainly not as exciting as the plethora of dog tick-borne pathogens.
We start moving out of Europe and there are very significant tick-borne pathogens
that we need to worry about in cats.
It does depend.
It is very geographically regional.
It's very important to know which parasites are in your locality
and that adequate prevention is put in place against them.
Let's talk about prevention.
Many clinics have got protocols for parasite prescribing and they have
health plans and subscription plans, and that can really clash with what
you just discussed about the different risks for different lifestyles.
What do you tell your colleagues with that kind of question?
First of all, I sympathise with my colleagues.
As a vet myself, I understand that we have very, very limited time even using the
whole practice team, which is essential, to ask busy vets, nurses, to start
working out individual parasite protocols and what pets need is very difficult.
There is a temptation, you know, if you have a practice plan to say, well look,
you know, you can have this practice plan, it'll just kill everything.
It's a two-way process.
That is something that some clients are going to want.
Other people, when they get into minute 10, their eyes have glazed over.
They'll agree anything just so they can leave you freely.
I would argue that a practice health plan is really just a tool.
Like any other tool, it's a tree that you can just hang stuff off.
So, you know, traditionally it's been routine treatments, but it
could equally be diagnostic tests.
It could be a mixture of both.
What we've done in the practice is we have very broad options.
So spot on versus tablets, long acting versus short acting, you
know, minimum or no worm treatment versus frequent worm treatments.
You have all of those things in place.
Increasingly, some practices are offering a diagnostic option, so for clients who
wouldn't want to deworm their pets, they might want to test instead, you might
want to take that chance with fleas and check for them instead of having
routine treatment, there's an option on the plan to go down that route.
There is a way to tweak practice plans and incorporate a risk-based approach.
Practice health plans are a good way of spreading the cost of
vaccinations, flea, sort of worm treatments, which you know otherwise
they might not be able to afford.
We do want to make practice health plans more targeted over time.
I think we want to include more diagnostics, but we've
gotta bring clients with us.
If we don't offer them practical solutions, they will go off and try
and find ways to do it themselves, which may be less effective.
Thank you for listening.
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We’ll be back again next month with more interviews on cats and the
Journal of Feline Medicine and Surgery.