1 00:00:05,170 --> 00:00:05,560 Hi. 2 00:00:05,570 --> 00:00:08,120 Thanks for joining us and welcome to another episode 3 00:00:08,120 --> 00:00:09,469 of Chattering with iCatCare. 4 00:00:09,950 --> 00:00:13,610 I'm Yaiza Gomez, Veterinary Community Coordinator at iCatCare Veterinary 5 00:00:13,610 --> 00:00:18,520 Society, and this month we will start talking about the new JFMS oral and 6 00:00:18,550 --> 00:00:23,070 dental health guidelines which not only offer evidence-based instructions 7 00:00:23,070 --> 00:00:26,779 about assessment, diagnosis, and treatment of oral disease in cats, 8 00:00:27,250 --> 00:00:31,190 but also touch upon anaesthesia and analgesia, use of antibiotics 9 00:00:31,230 --> 00:00:33,019 and education of cat caregivers. 10 00:00:33,900 --> 00:00:39,090 Then Sam Taylor will interview Ian Wright about the use of anti parasitics, also a 11 00:00:39,170 --> 00:00:41,190 very relevant topic in general practice. 12 00:00:42,080 --> 00:00:45,360 Let's start with a conversation between the two co-chairs of these 13 00:00:45,360 --> 00:00:51,270 new guidelines, Heidi Loprise, a veterinary dental specialist, and Dr 14 00:00:51,270 --> 00:00:52,800 St. Denis, who is also JFMS editor. 15 00:00:57,800 --> 00:01:00,860 I feel like that cat friendly experience is really something that does make a 16 00:01:00,860 --> 00:01:04,560 difference for caregivers in getting them to the clinic, but also in 17 00:01:04,560 --> 00:01:08,359 interacting with their cats at home and even cooperative care training for 18 00:01:08,370 --> 00:01:12,770 getting them to let us handle their mouths to do an awake oral exam, but 19 00:01:12,780 --> 00:01:14,930 also in how to do some home care. 20 00:01:15,780 --> 00:01:18,720 Our listeners will find in the guidelines a lot of information about home care 21 00:01:18,720 --> 00:01:23,350 with a lot of good supplemental links to some resources from feline VMA, 22 00:01:23,350 --> 00:01:25,520 for example, for those purposes. 23 00:01:25,870 --> 00:01:29,519 It's very important to start talking about it at kittenhood, and you're 24 00:01:29,570 --> 00:01:31,169 mentioned the cooperative training. 25 00:01:31,260 --> 00:01:35,149 They can do home care with wipes, getting them used to it early on, 26 00:01:35,540 --> 00:01:37,940 and then we'll notice problems early. 27 00:01:38,389 --> 00:01:41,769 One of the key things that you and I have talked about during the process 28 00:01:41,770 --> 00:01:45,789 of developing these guidelines is how we've moved away from the concept of 29 00:01:46,129 --> 00:01:51,150 toothbrushing for cats as opposed to using something like wipes or gauze. 30 00:01:51,450 --> 00:01:55,910 And I certainly try to show caregivers in my appointments how to take a gauze 31 00:01:55,950 --> 00:01:59,260 on their finger and just get onto the canine and then work their way back 32 00:01:59,280 --> 00:02:03,619 to the upper premolars even to get that plaque off on a daily basis. 33 00:02:03,700 --> 00:02:06,900 So it seems to be something that people are more comfortable with. 34 00:02:06,960 --> 00:02:09,479 It can be really helpful to show caregivers that trick. 35 00:02:10,259 --> 00:02:12,010 There's even a video in the toolbox. 36 00:02:12,420 --> 00:02:17,869 Yes and so we talk about caregivers and what they are willing or able to do, 37 00:02:17,880 --> 00:02:21,230 and that kind of dives into something else that we spoke about early in the 38 00:02:21,230 --> 00:02:25,500 guidelines, and that is the spectrum of care in feline oral and dental health. 39 00:02:26,090 --> 00:02:30,270 We have a figure in the guidelines that really shows how we have different 40 00:02:30,270 --> 00:02:34,100 factors associated with clients or our caregivers, factors associated 41 00:02:34,100 --> 00:02:37,220 with the veterinarian and the veterinary team, and also the patient. 42 00:02:37,630 --> 00:02:41,630 All of those different factors will contribute to how that cat receives their 43 00:02:41,639 --> 00:02:44,480 prevention and their oral and dental care. 44 00:02:44,970 --> 00:02:47,920 And so for caregivers, a lot of us will sometimes think, oh, it's 45 00:02:47,940 --> 00:02:49,200 probably about finances, right? 46 00:02:49,200 --> 00:02:52,270 Especially if we're talking about anaesthesia and dentistry. 47 00:02:52,660 --> 00:02:55,429 But what are some of the other things that you consider when you're talking 48 00:02:55,429 --> 00:02:59,429 about caregiver factors in terms of how that impacts dental care? 49 00:02:59,779 --> 00:03:02,240 If they're coming to us for a referral, we might have a 50 00:03:02,240 --> 00:03:03,980 different category of clients. 51 00:03:04,700 --> 00:03:09,100 But we have to realise what's gonna be the best combination for 52 00:03:09,100 --> 00:03:11,260 that pet and for that caregiver. 53 00:03:11,719 --> 00:03:14,980 Sometimes it is the cost, but just like when we talk about senior 54 00:03:14,980 --> 00:03:16,680 care, there's other wallets as well. 55 00:03:16,920 --> 00:03:18,990 Their time, can they get off work? 56 00:03:19,600 --> 00:03:21,810 Their human companion animal bond. 57 00:03:22,110 --> 00:03:26,290 If they have to do a lot to that cat and give them a lot of different 58 00:03:26,300 --> 00:03:30,229 medications and do different things, is that gonna impact that bond? 59 00:03:30,740 --> 00:03:35,090 So we have to be empathetic to the owner and look at these different 60 00:03:35,100 --> 00:03:41,280 burdens and make sure that spectrum of care falls within their wheelhouse. 61 00:03:41,830 --> 00:03:43,110 Yeah, that's a really good point. 62 00:03:43,110 --> 00:03:47,400 Those budgets are really important to consider, and we do have a 63 00:03:47,400 --> 00:03:52,309 really good section on anaesthesia and analgesia in the guidelines. 64 00:03:52,340 --> 00:03:56,550 We hear a lot of things about anaesthesia free dentistry, and we don't always 65 00:03:56,570 --> 00:04:00,830 think about cats as being painful when they have oral or dental disease. 66 00:04:01,300 --> 00:04:04,420 So I don't know if you wanna pipe in about what your thoughts are 67 00:04:04,420 --> 00:04:08,120 with regards to pain management for these patients at diagnosis and 68 00:04:08,120 --> 00:04:09,810 through the preoperative period. 69 00:04:10,350 --> 00:04:11,200 Absolutely. 70 00:04:11,200 --> 00:04:16,050 So a big part of oral and dental disease is the discomfort, alright? 71 00:04:16,470 --> 00:04:20,210 And in fact, there's gonna be a level of pain that cats will hide. 72 00:04:20,480 --> 00:04:21,690 They're good at hiding things. 73 00:04:22,290 --> 00:04:27,559 But whenever we see inflammation or ulceration, we know there is pain. 74 00:04:27,849 --> 00:04:32,410 So managing that pain with good analgesic protocols before, during 75 00:04:32,410 --> 00:04:36,210 and after dental surgery can be very important for these patients. 76 00:04:36,740 --> 00:04:40,280 As we look at that too, we can help speed up the healing, 77 00:04:40,599 --> 00:04:42,039 help their quality of life. 78 00:04:42,469 --> 00:04:43,840 It's just so critical. 79 00:04:43,870 --> 00:04:46,800 It's hard to convince caregivers that things are painful because 80 00:04:46,800 --> 00:04:49,790 they don't see anything 'cause cats are so good at hiding it. 81 00:04:49,790 --> 00:04:50,080 Yes. 82 00:04:50,370 --> 00:04:54,850 So it can be challenging to get caregivers to get started on pain management 83 00:04:54,910 --> 00:04:57,409 before they even book a dentistry. 84 00:04:57,969 --> 00:05:00,960 Do you have any tips or tricks for us when we're talking about 85 00:05:00,960 --> 00:05:04,269 getting caregivers to get on board with analgesia at diagnosis? 86 00:05:04,869 --> 00:05:10,050 If you've ever had one of those cases where you did do the analgesia ahead 87 00:05:10,050 --> 00:05:15,820 of time or even finally got them into the procedure and the cat felt better, 88 00:05:15,960 --> 00:05:18,810 that's a key weight, using a testimonial. 89 00:05:19,230 --> 00:05:26,349 Even giving the pain medication prior to, the owner will likely see a difference 90 00:05:26,390 --> 00:05:29,310 in that cat, and hopefully that won't mean, oh well, I'll just give it pain 91 00:05:29,310 --> 00:05:31,000 medication, not do the dental procedure. 92 00:05:31,100 --> 00:05:34,569 We educate them to do all the steps that are necessary, but 93 00:05:34,570 --> 00:05:36,050 it can really be impactful. 94 00:05:36,770 --> 00:05:39,170 Yeah, and I've seen that quite often in my own practice. 95 00:05:39,179 --> 00:05:42,719 Like I had a patient who used to fetch and the client hadn't really noticed, but the 96 00:05:42,720 --> 00:05:46,910 cat had stopped fetching and then as soon as we put the cat on analgesia for the 97 00:05:46,910 --> 00:05:49,110 oral and dental disease, they went home. 98 00:05:49,180 --> 00:05:51,960 Two days later after starting, the cat was fetching again. 99 00:05:51,960 --> 00:05:55,160 So they were like, yes, we need to do this dentistry right away. 100 00:05:55,860 --> 00:05:57,190 When you hurt, you're not happy. 101 00:05:57,339 --> 00:05:58,339 For sure. 102 00:06:01,210 --> 00:06:05,100 Now Sam Taylor will interview Dr Ian Wright on the veterinarian's 103 00:06:05,120 --> 00:06:09,920 critical role in choosing using and stewarding anti parasitic drugs in cats. 104 00:06:14,080 --> 00:06:18,000 My first question for you is about different parasite risks that 105 00:06:18,000 --> 00:06:21,360 cats face, because I think one of the reasons I love cats, they're 106 00:06:21,430 --> 00:06:23,820 very diverse in the way they live. 107 00:06:24,120 --> 00:06:27,370 We have indoor cats, outdoor cats, we have hunting cats. 108 00:06:27,370 --> 00:06:29,140 We have cats that that don't hunt. 109 00:06:29,509 --> 00:06:34,179 What should we be worrying about and why in those different lifestyle groups. 110 00:06:34,529 --> 00:06:39,030 A hot topic in the UK over the last few years has been 111 00:06:39,100 --> 00:06:40,960 taking a risk-based approach. 112 00:06:41,300 --> 00:06:46,160 So to say we shouldn't just blanket treat all cats and dogs with 113 00:06:46,160 --> 00:06:48,869 parasiticides that kill everything. 114 00:06:49,070 --> 00:06:53,670 We should look at their lifestyle and see what sort of treatments we need. 115 00:06:53,969 --> 00:06:57,820 Cats fall into very nice categories. 116 00:06:57,840 --> 00:07:01,260 We have, in some cases completely indoor cats. 117 00:07:01,640 --> 00:07:04,880 Now, depending what part of the world you're in, a completely 118 00:07:04,880 --> 00:07:09,639 indoor cat is gonna be at very limited risk of parasite exposure. 119 00:07:10,059 --> 00:07:15,760 Fleas still potentially, toxocara worms potentially, potentially 120 00:07:15,760 --> 00:07:17,900 flea tape worm via the fleas. 121 00:07:18,239 --> 00:07:24,329 In terms of other parasite exposure, by and large you have to go out and get 122 00:07:24,340 --> 00:07:30,330 those parasites either by eating stuff or go to places where they are and that's 123 00:07:30,350 --> 00:07:33,140 very much what your outdoor cat does. 124 00:07:33,160 --> 00:07:37,130 You know your outdoor cat that is living the dream, it's gonna go 125 00:07:37,390 --> 00:07:41,690 out, it's gonna meet other cats, it's gonna go and eat some stuff. 126 00:07:41,780 --> 00:07:45,969 It's probably gonna predate and eat some other small furry creatures 127 00:07:45,969 --> 00:07:48,699 or some lizards or some slugs. 128 00:07:48,960 --> 00:07:53,939 And then if it's bored it's gonna go to an animal burrow or nest, and you've 129 00:07:53,939 --> 00:07:55,810 been exposed to all sorts of things. 130 00:07:56,059 --> 00:07:59,919 You're going from a position of very little risk to suddenly 131 00:07:59,969 --> 00:08:01,800 a position of very high risk. 132 00:08:01,889 --> 00:08:06,060 A lot of cats are gonna be on that spectrum, and it's just a question of 133 00:08:06,060 --> 00:08:09,830 where your cats lies on that spectrum. 134 00:08:10,230 --> 00:08:16,090 One of the interesting challenges about cat owners and cats is that 135 00:08:16,099 --> 00:08:20,890 in my experience, a lot of cat owners have absolutely no idea 136 00:08:21,089 --> 00:08:24,014 what their cat gets up to at all. 137 00:08:24,039 --> 00:08:27,220 The first question we have to ask, when the owners says, 138 00:08:27,640 --> 00:08:29,789 oh my cats completely indoor. 139 00:08:30,740 --> 00:08:31,720 Is it really? 140 00:08:31,760 --> 00:08:33,960 Does it have a catio? 141 00:08:34,270 --> 00:08:36,735 Does it have back garden access? 142 00:08:36,770 --> 00:08:39,410 Does it nip out when their owners aren't looking? 143 00:08:39,919 --> 00:08:45,470 And equally, once cats do get out, once their owners allow them to roam 144 00:08:46,020 --> 00:08:51,130 and go and live that outdoor dream, unless they're bringing prey items back. 145 00:08:52,750 --> 00:08:55,330 It's very unlikely they're gonna know whether they're hunting, 146 00:08:55,370 --> 00:08:56,699 whether they're visiting animal 147 00:08:59,109 --> 00:09:01,039 burrows, you know, fighting, doing a lot of these activities. 148 00:09:01,520 --> 00:09:06,199 So that is part of the challenge, really, not only where your cat is on 149 00:09:06,200 --> 00:09:09,698 the spectrum, but how much knowledge individual pet owners have about that. 150 00:09:09,710 --> 00:09:09,840 I 151 00:09:13,000 --> 00:09:17,149 certainly don't know what my cat does for 99% of the time. 152 00:09:17,149 --> 00:09:18,379 It's part of the mystery, isn't it? 153 00:09:18,570 --> 00:09:19,020 Yeah. 154 00:09:19,060 --> 00:09:20,069 It's what we love about them. 155 00:09:20,230 --> 00:09:20,730 Definitely. 156 00:09:20,730 --> 00:09:25,209 You and I practice in the uk, but our audience are more diverse worldwide. 157 00:09:25,280 --> 00:09:28,250 Can you give me some examples of parasites of concern in other 158 00:09:28,250 --> 00:09:30,000 parts of the world with cats? 159 00:09:30,000 --> 00:09:32,719 Yeah, so first of all, we have the ubiquitous ones. 160 00:09:32,809 --> 00:09:37,410 So wherever you go in the world it's very likely you're gonna encounter 161 00:09:37,410 --> 00:09:40,600 some fleas, and that is really just a question of whether you're gonna 162 00:09:40,600 --> 00:09:45,530 encounter those fleas all year round or whether they're gonna have seasonality. 163 00:09:46,059 --> 00:09:50,530 And similarly, unless you're gonna go to the Arctic Circle, you're 164 00:09:50,590 --> 00:09:54,919 probably gonna come across some ticks as well, at least seasonally. 165 00:09:54,919 --> 00:10:00,819 Tapeworms like flea tapeworms, roundworms, like toxocara, pretty much 166 00:10:00,820 --> 00:10:03,440 ubiquitous wherever you go in the world. 167 00:10:03,849 --> 00:10:09,389 You go out into Europe, aelurostrongylus is around 10% in a lot of studies, 168 00:10:09,400 --> 00:10:14,230 so close to 10 times more common in cats with outdoor access. 169 00:10:14,580 --> 00:10:19,870 And if we go down into the Mediterranean, we come across troglostrongylus, much 170 00:10:19,870 --> 00:10:25,369 more pathogenic lung worm of cats now spreading into Eastern Europe as 171 00:10:25,420 --> 00:10:28,899 climates and wildlife reservoirs change. 172 00:10:29,150 --> 00:10:31,910 We are seeing its distribution start to spread. 173 00:10:32,840 --> 00:10:38,640 If we head out to Asia, we're gonna hit flukes like opisthorchis. 174 00:10:38,690 --> 00:10:45,860 We're gonna get intestinal liver and lung flukes, which cats get through eating 175 00:10:45,860 --> 00:10:48,460 all sorts of raw fish, meat products. 176 00:10:49,000 --> 00:10:54,560 Much more common in those cultures and are maintained by the wonderful humidity, 177 00:10:54,710 --> 00:10:56,531 wonderful wide range of invertebrate reservoirs that they have there. 178 00:10:56,570 --> 00:10:56,790 That's 179 00:10:59,670 --> 00:11:00,969 about sort of Asian. 180 00:11:01,670 --> 00:11:06,439 Paragonimus, which is a lung fluke, North American, South American problem. 181 00:11:07,080 --> 00:11:11,830 So moving outta sort of Europe, they become more of an issue where we might 182 00:11:11,830 --> 00:11:15,319 not see those here and of course protozoa. 183 00:11:15,370 --> 00:11:20,400 So tick-borne protozoa, like the babesia felis down in South Africa. 184 00:11:20,770 --> 00:11:27,740 Huge problem that's relatively specific to African belts, cytauxzoon, really 185 00:11:27,740 --> 00:11:32,460 nasty tick-borne pathogen that we fought for a long time that was just 186 00:11:32,760 --> 00:11:34,850 actually present in North America. 187 00:11:35,240 --> 00:11:41,700 But we've now had  cytauxzoons identified and closely related to small babesias in 188 00:11:41,700 --> 00:11:44,720 South Africa and across the African belts. 189 00:11:45,010 --> 00:11:49,510 We've had unexplained cases of  cytauxzoon in Europe as well. 190 00:11:49,750 --> 00:11:56,210 We don't know where they've come from, so there's a perception not entirely 191 00:11:56,259 --> 00:12:02,459 unjustified in Europe that cat tick-borne pathogens perhaps aren't very exciting, 192 00:12:02,740 --> 00:12:07,780 certainly not as exciting as the plethora of dog tick-borne pathogens. 193 00:12:08,050 --> 00:12:12,660 We start moving out of Europe and there are very significant tick-borne pathogens 194 00:12:12,660 --> 00:12:13,955 that we need to worry about in cats. 195 00:12:13,955 --> 00:12:16,290 It does depend. 196 00:12:16,290 --> 00:12:18,979 It is very geographically regional. 197 00:12:19,100 --> 00:12:23,180 It's very important to know which parasites are in your locality 198 00:12:23,180 --> 00:12:26,790 and that adequate prevention is put in place against them. 199 00:12:27,360 --> 00:12:29,060 Let's talk about prevention. 200 00:12:29,120 --> 00:12:33,139 Many clinics have got protocols for parasite prescribing and they have 201 00:12:33,139 --> 00:12:37,819 health plans and subscription plans, and that can really clash with what 202 00:12:37,820 --> 00:12:41,939 you just discussed about the different risks for different lifestyles. 203 00:12:42,170 --> 00:12:44,800 What do you tell your colleagues with that kind of question? 204 00:12:44,900 --> 00:12:48,640 First of all, I sympathise with my colleagues. 205 00:12:48,740 --> 00:12:55,310 As a vet myself, I understand that we have very, very limited time even using the 206 00:12:55,310 --> 00:13:01,100 whole practice team, which is essential, to ask busy vets, nurses, to start 207 00:13:01,100 --> 00:13:07,050 working out individual parasite protocols and what pets need is very difficult. 208 00:13:07,450 --> 00:13:11,819 There is a temptation, you know, if you have a practice plan to say, well look, 209 00:13:11,819 --> 00:13:15,199 you know, you can have this practice plan, it'll just kill everything. 210 00:13:15,260 --> 00:13:16,620 It's a two-way process. 211 00:13:16,620 --> 00:13:19,500 That is something that some clients are going to want. 212 00:13:19,520 --> 00:13:23,899 Other people, when they get into minute 10, their eyes have glazed over. 213 00:13:23,900 --> 00:13:27,350 They'll agree anything just so they can leave you freely. 214 00:13:27,370 --> 00:13:31,160 I would argue that a practice health plan is really just a tool. 215 00:13:31,320 --> 00:13:34,930 Like any other tool, it's a tree that you can just hang stuff off. 216 00:13:35,530 --> 00:13:40,010 So, you know, traditionally it's been routine treatments, but it 217 00:13:40,010 --> 00:13:42,419 could equally be diagnostic tests. 218 00:13:42,590 --> 00:13:44,670 It could be a mixture of both. 219 00:13:45,339 --> 00:13:49,689 What we've done in the practice is we have very broad options. 220 00:13:49,910 --> 00:13:55,240 So spot on versus tablets, long acting versus short acting, you 221 00:13:55,240 --> 00:13:59,830 know, minimum or no worm treatment versus frequent worm treatments. 222 00:14:00,080 --> 00:14:02,780 You have all of those things in place. 223 00:14:03,089 --> 00:14:08,990 Increasingly, some practices are offering a diagnostic option, so for clients who 224 00:14:09,030 --> 00:14:13,849 wouldn't want to deworm their pets, they might want to test instead, you might 225 00:14:13,849 --> 00:14:17,509 want to take that chance with fleas and check for them instead of having 226 00:14:17,509 --> 00:14:21,500 routine treatment, there's an option on the plan to go down that route. 227 00:14:22,400 --> 00:14:28,630 There is a way to tweak practice plans and incorporate a risk-based approach. 228 00:14:29,100 --> 00:14:33,210 Practice health plans are a good way of spreading the cost of 229 00:14:33,220 --> 00:14:38,430 vaccinations, flea, sort of worm treatments, which you know otherwise 230 00:14:38,430 --> 00:14:40,249 they might not be able to afford. 231 00:14:40,690 --> 00:14:45,700 We do want to make practice health plans more targeted over time. 232 00:14:45,700 --> 00:14:49,630 I think we want to include more diagnostics, but we've 233 00:14:49,630 --> 00:14:51,250 gotta bring clients with us. 234 00:14:51,290 --> 00:14:55,469 If we don't offer them practical solutions, they will go off and try 235 00:14:55,469 --> 00:14:58,910 and find ways to do it themselves, which may be less effective. 236 00:15:03,829 --> 00:15:04,840 Thank you for listening. 237 00:15:05,410 --> 00:15:08,470 If you’re an iCatCare Veterinary Society Member, don’t forget that 238 00:15:08,480 --> 00:15:11,540 you can access all member benefits, including the full version of this 239 00:15:11,550 --> 00:15:16,880 podcast episode and other very valuable recordings at portal.icatcare.org. 240 00:15:17,740 --> 00:15:20,950 We’ll be back again next month with more interviews on cats and the 241 00:15:20,950 --> 00:15:22,670 Journal of Feline Medicine and Surgery.