2022 Pearls of Wisdom

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American Association of Feline Practitioners
2022 Hybrid Conference • October 27 – October 30, 2022
Enriching Feline Care & the Veterinary Experience 
Elevating the Standard of Feline Medical Care & Integrating Cat Friendly Techniques

Pre-Conference Day
Thursday, October 27, 2022

 

Hands-on Feline Orthopedic Evaluation Workshop, Drs. Duncan Lascelles & Margaret Gruen

  1. Critical to a successful hands-on orthopedic evaluation of a cat is having a calm, relaxed approach and being willing to perform the examination in whatever position the cat is most comfortable in.
  2. Assessment of muscle mass can provide clues as to where OA-pain may be located. Cats are relatively flexed creatures, and often initially resist extension of joints.

 

Crusty, Crusty Cats! Pathway to a Diagnosis, Dr. Melissa Hall

  1. Feline patients can be good at hiding their diagnosis. Do not forget to rely on the dermatology minimum database (skin scraping, cytology and dermatophyte cultures) to help guide a diagnostic pathway. 
  2. A Wood’s lamp evaluation by itself is not adequate to diagnose or even rule out dermatophytosis. PCR and culture testing are required.

 

Allergic Kitties: Tips & Tricks for Successful Diagnosis & Management, Dr. Melissa Hall

  1. No allergic feline patient will present like another. It is a multifactorial disease process with many different presentations. It may take several examinations and trials to get an appropriate diagnosis and find the most effective therapeutic plan.
  2. Client communication is vital for the understanding of this confusing disease process and will reduce frustration in a disease process that requires lifelong therapy.

 

To the Bladder & Beyond: The Role of Stress in Feline Urinary Health, Dr. Julia Albright

  1. Environmental stressors are a primary or contributing factor in many diagnostic categories of feline lower urinary tract disease (FLUTD), and affected cats often suffer from other behavioral and physical health dysfunctions.
  2. Addressing the effects of stress in cats requires a multimodal approach of environmental and pharmaceutical and/or nutraceutical therapies. Dietary formulations for optimal urinary health and anxiety reduction can be a lower-stress and higher-compliance treatment for lower urinary tract disease in our feline patients.

 

Fabulous Felines but Difficult Diabetics: Approach to Complicated Diabetic Patients, Dr. Laura Greene

  1. Communication and monitoring are the cornerstones of successful diabetic management, and difficult diabetics require both of these components in abundance. The successful management of difficult diabetics requires individualized treatment strategies that are decided upon following identification of pet owner capabilities and preferences for learning about diabetic management and what is required in terms of treatment.
  2. Especially for cats, owners may prefer to do most of their diabetic monitoring at home, and successful monitoring may benefit significantly from reliance on technological advances in monitoring that facilitate the communication of changes in the patient to the veterinarian.

 

Novel RNA Particle Vaccine Technology, Dr. Laura Greene

  1. RNA particle vaccine technology represents an advantageous new method for generating a balanced (antibody-mediated and cell-mediated), targeted, and potent immune response in a formulation that is clean and non-adjuvanted, and which functions as a platform from which many potential vaccines could be generated.
  2. As an example of the potential utility of such a vaccine platform in companion animals, an RNA particle vaccine was generated that was capable of providing sterilizing immunity to cats who were challenged with SARS-CoV-2.

 

Feline Addison’s & Cushing’s: Cat Adrenals are Not Small Dog Adrenals!, Dr. Patty Lathan

  1. Cushing’s in cats is very similar to Cushing’s in dogs, but has some significant differences. Most cats with Cushing’s are diabetic and have dermatologic abnormalities. Diagnosis is usually made using a dexamethasone suppression test, but the dexamethasone dose is different than that used in the LDDS in dogs.
  2. Addison’s is rare in cats. Signs are frequently gastrointestinal, and hyponatremia and hyperkalemia are the most common clinicopathologic abnormalities. Diagnosis requires an ACTH stimulation test, and replacement of aldosterone and cortisol with DOCP and prednisolone generally results in a good prognosis.

 

Feline Hyperaldosteronism & Acromegaly: Are We Missing These Patients?, Dr. Patty Lathan

  1. Hypokalemia, azotemia, and hypertension are often found in cats with primary hyperaldosteronism (PHA), so PHA is a significant differential diagnosis for chronic kidney disease. Diagnostic workup includes measurement of aldosterone concentration. Treatment usually requires management of hypertension and hypokalemia prior to adrenalectomy (if a tumor is present); medical management with spironolactone is also recommended.
  2. Feline acromegaly is almost always caused by a pituitary adenoma. Almost all cats with acromegaly are diabetic; severe insulin resistance (>10U insulin BID) may be present. Diagnosis relies upon measurement of IGF-1 in the US, where a growth hormone assay is not commercially available.

 

Friday, October 28, 2022

 

Cat Friendly Interactions, Drs. Sarah Heath & Ilona Rodan

  1. Cat Friendly interactions include both non-physical and physical interactions that respect the cat as an individual while achieving the required clinical outcome. An individual’s protective emotions are based on its genetics and previous experiences.
  2. By understanding a cat’s emotional motivations and behavioral responses, we recognize that there are no bad or aggressive cats. When we understand why cats behave as they do, we can then develop a plan for how we can best respond to support the patient and improve future veterinary visits.

 

The Challenging Cat, Dr. Sarah Heath

  1. Cats can be defined as challenging for a number of reasons. The most important thing is to determine the reason for the problematic behavior and consider the situation from a feline perspective.
  2. When challenging behavior is confrontational in nature, understanding how cats respond to their emotions will enable handling and interaction to be modified to ensure safety for all involved.

 

Optimizing the Use of Continuous Glucose Monitoring in Diabetic Cats: Case Selection, Report Interpretation, Troubleshooting, & More, Dr. Catharine Scott-Moncrieff

  1. Although blood glucose curves have long been considered to be the gold standard for evaluating glycemic control in diabetic cats, they have significant limitations, including the effect of stress, presence of day-to-day variability, possibility of missing hypoglycemic events, and cost.
  2. These systems allow continuous evaluation of interstitial blood glucose concentration for up to 14 days via a small flexible subcutaneous catheter, replacing the blood glucose curve. The newer systems are affordable, easy to use, and well tolerated by patients.

 

Neonatal & Pediatric Kittens, Dr. Sarah Heath

  1. The emotional health of cats is influenced by their earliest experiences. Interacting with neonatal and pediatric kittens in ways that optimize their emotional development and support emotional intelligence will influence their health and welfare throughout life.
  2. Preparation for pets living with people is a two-way process. During development it is important for kittens to be exposed to appropriate environments and interactions but it is also important for humans to actively consider the needs of the species that they choose to keep as companions.

 

Beyond Total T4 in Diagnosis of Feline Hyperthyroidism: Role of Concurrent Illness & Approach to Grey-zone Results, Dr. Catharine Scott-Moncrieff

  1. Concurrent illness in hyperthyroid cats may decrease the total T4 concentration into the upper half of the reference range. Clinicians should not rule out hyperthyroidism in a cat with a high normal TT4 concentration.
  2. Most cats with feline hyperthyroidism have a palpably enlarged thyroid gland. This is the most important physical examination finding in a cat with suspected hyperthyroidism.

 

Ticks Like Cats Too! An Update on the Threat of Ticks & Tick-borne Pathogens for Cats, Dr. Kathryn Reif

  1. Ticks pose a significant and commonly year-round risk to cats through the pathogens they can transmit including agents of cytauxzoonosis, tularemia, and anaplasmosis. Importantly, as tick populations continue to intensify and expand, cats living in areas with historically low tick risk may now be at greater risk for tick infestation and tick-borne diseases.
  2. Effective tick control strategies are available to protect cats, the most comprehensive of which include year-round usage of a feline tick control product as vaccines against tick-borne pathogens are not available for cats.

 

Expanding the Toolbox: Cutting Edge Diagnostics to Improve Outcomes in Patients with Early Renal Disease, Dr. Sarah Sweet

  1. International Renal Interest Society Guidelines for staging and sub-staging chronic kidney disease should be applied in the management of every cat diagnosed with kidney disease. This includes regular monitoring of functional biomarkers creatinine and SDMA, complete urinalysis with urine protein:creatinine ratio (UPC), blood pressure, and phosphorus concentration.
  2. Cats diagnosed with chronic kidney disease (CKD) may be at risk of developing chronic kidney disease – mineral bone disorder (CKD-MBD) secondary to mineral dysregulation involving calcium, phosphorus, PTH and calcitriol. FGF-23 concentration rises before phosphorus and PTH, making it an earlier marker for the potential development of CKD-MBD. Measurement of FGF-23 concentration is recommended in cats that have been diagnosed with IRIS Stage 1 or 2 chronic kidney disease (CKD) whose phosphorus concentration does not exceed 4.6 mg/dL (1.5 mmol/L).

 

Don’t Miss a Diagnosis: Comprehensive CBC with AI & Human Expertise in Your Practice, Dr. Eric Morissette

  1. The complete CBC includes the quantitative evaluation: values from the automated hematology analyzer (CBC), a PCV, and the qualitative evaluation: evaluation of the blood film.
  2. The blood film analysis is used to confirm the numerical parameters for RBCs, WBCs, and PLT from any automated CBC analyzer, providing a Quality Control Check. It is also used to evaluate the cell morphology of the cells, which is essential, since the CBC analyzer does not provide this essential diagnostic information.
  3. The Vetscan IMAGYST Multi-use platform is designed to give busy practitioners peace of mind that comes from fast, accurate, and reliable results.

 

Creating a Cat Friendly Veterinary Environment: Setting Patients Up for Success, Drs. Sarah Heath & Ilona Rodan

  1. Inexpensive steps that make each area of the veterinary environment more cat-friendly minimize feline stressors. The main goals of the changes are to meet feline essential needs and reduce sensory arousal.
  2. Feline stressors surround the veterinary visit start at home. Partnering with clients to resolve these stressors benefits the cat, caregiver, and veterinary team.

 

Pancreatitis in the Diabetic Cat, Dr. Catharine Scott-Moncrieff

  1. Chronic pancreatitis is diagnosed in as many as 50% of diabetic cats but in most cases it is subclinical and the contribution of pancreatitis to the pathogenesis and progression of diabetes is unclear.
  2. The effects of pancreatitis on management of diabetes depend on the severity of inflammation. Severe pancreatitis can result in insulin resistance and lead to poor control of clinical signs of DM. Clinical pancreatitis may also make diabetic remission less likely. Waxing and waning pancreatitis can lead to varying insulin requirements which can make DM challenging to manage.

 

Cat Friendly Hospitalization: Optimizing the Inpatient Experience, Dr. Sarah Heath

  1. Cats are territorial creatures and being in an unfamiliar environment is challenging. Hospitalization is therefore potentially difficult for feline patients and working to optimize the inpatient experience is essential.
  2. Considering the emotional and cognitive health of feline inpatients is not only of benefit to their mental well-being but also impacts their physical health and recovery. Increased physiological stress due to prolonged protective emotional bias can compromise wound healing, increase susceptibility to infection, and compromise responses to medical treatment.

 

Practical Tips & Pearls for the Management of Feline Urolithiasis, Dr. Anne-Marie Germain

  1. Ruling out hypercalcemia is an important aspect of calcium oxalate prevention in cats. In various studies, hypercalcemia was observed in 33 to 36% of cats with calcium oxalate urolithiasis and uroliths formed in 35% of cats diagnosed with idiopathic hypercalcemia. An important focus of urolith prevention in those cats will need to be managing the hypercalcemia. This is a good reminder that management recommendations and priorities will vary based on the urolith type therefore knowing the mineral composition of our patient’s urolith(s) is key in order to elaborate a successful prevention plan. Uroliths removed should always be sent to a laboratory offering quantitative analysis to confirm their composition.
  2. Urine dilution plays an integral role in the management of urolithiasis in cats helping to decrease the concentration of calculogenic substances in the urine and the larger urine volumes also promote more frequent micturitions, offering less time for crystals to form in the bladder and more opportunities to flush any potential stone nidus. That said, achieving urine dilution is challenging in cats! Studies support that the moisture levels provided by feeding the equivalent of a 100% wet food diet will increase the urine volume and decrease the specific gravity of some cats, yet may not be enough moisture to dilute the urine of other patients. The level of moisture provided by feeding a mix of dry and wet food is also unfortunately unlikely to be enough to result in urine dilution in our feline patients. It may therefore be prudent, especially in patients fed a mix of dry and wet food, to automatically implement other strategies (such as adding water to the food, feeding a formula with a moderate increase in sodium etc.) in order to further increase their water intake and help ensure urine dilution.

 

Addressing Distress in the Home Environment, Dr. Ilona Rodan

  1. Many cats suffer from distress in their home environment because of the physical or social environment. This negative impact on mental health often causes physical disease as well.
  2. These cases will help you prevent and manage behavior problems using behavioral first aid. Although psychopharmacology may be necessary, it should only be used once the emotional state and underlying causes are identified, and in conjunction with behavioral management.

 

Saturday, October 29, 2022

 

Feline Leukemia Virus (FeLV): More Complex Than We Thought, Dr. Richard Ford

  1. RISK of infection following FeLV exposure is virtually 100% for kittens.  However, by 6 to 8 months of age, cats enjoy significantly reduced infection risk due to a phenomenon called “age-related resistance”, probably associated with production of one or more interleukins as they become mature.  That’s why FeLV vaccination is considered ‘core’ for kittens, and non-core for adults.
  2. In some cats, the ability of FeLV to develop a “Regressive Infection” (previously called a “latent infection”) is a common outcome of exposure and infection in kittens; these cats will test NEGATIVE for p27 antigen and do not shed virus.  A small number of these cats may develop a “Progressive Infection” months or even years later and may actually become FeLV + and develop clinical disease later in life, despite limited or no exposure risk.

 

Practical Side for Implementing Monoclonal Antibodies, Dr. Elizabeth Colleran

  1. Pain recognition and acknowledgement is the break through step to managing chronic pain in cats. Pain manifestation is different both between cats and other species and between individual cats.
  2. The veterinary visit must be expanded to include data collected from the home including pain assessment tools and smart phone videos.
  3. Achieving a pain management plan which includes monthly visits to the veterinary establishment requires accomplishing a feline friendly environment within which both client and cat are comfortable with frequent short visits.
  4. A monthly visit with a veterinary staff member is a tremendous opportunity to follow older cats more closely, identify problems sooner and intervene more successfully.

 

Nutrition in CKD: Focus on Calories & Calcium, Dr. Jessica Quimby

  1. Weight loss and poor body condition are associated with a poorer prognosis in CKD. Ensuring adequate caloric intake and maintaining body weight is therefore a crucial part of CKD management as dysrexia is common in these patients.
  2. CKD-Mineral Bone Disorder refers to the dysregulation of phosphorus, calcium, PTH, FGF-23, and calcitriol in CKD. Hypercalcemia is common in cats and iCa is the most accurate assessment. Significant dietary phosphorus restriction in early-stage CKD has been associated with hypercalcemia and necessitates monitoring and modification of the diet plan.

 

The Critical Cat: Part 1, Dr. Christopher Byers

  1. The examination of a patient in respiratory distress should begin before laying hands on a patient. A clinician should strive to characterize a dyspneic patient’s breathing pattern to determine when the problem is within the respiratory tree.
  2. The four most common types of shock are hypovolemic, cardiogenic, obstructive, and distributive. A single patient may be living with more than one type of shock.

 

Feline Thermal Imaging: What the Pretty Colors Tell Us, Dr. John Godbold

  1. Thermal imaging changes the conversation about how we can evaluate feline patients and what we can learn during our examinations. The images display real-time physiological information and create a road map for further diagnostics and treatment.
  2. The images give us a non-invasive gateway for further and more accurate diagnostics, improved communication with clients, improved client compliance with our diagnostic and therapeutic recommendations, and improved patient care.

 

Inter-cat Conflict, Dr. Sarah Heath

  1. The most important consideration in multi-cat households is the issue of social compatibility. While cats may co-exist under the same roof that does not necessarily mean that they belong to the same social grouping.
  2. Understanding the emotional motivations involved in conflictual interactions between cats is essential in order to create an effective treatment plan. The emotional health of all individuals involved needs to be considered.

 

The Critical Cat: Part 2, Dr. Christopher Byers

  1. Basic life support (BLS) is more important than advanced life support (ALS), and thus, one’s resuscitation efforts should initially be focused on providing high quality chest compressions and assisted ventilation.
  2. Major causes of hypotension are due to reduced cardiac output (CO) induced by reduced cardiac contractility and/or preload (PL), as well as loss of systemic vascular resistance (SVR).

 

But I Can’t Pill my Cat: Options for Non-pharmacologic Pain Management in Cats, Dr. John Godbold

  1. For feline pain management to be successful, a multimodal approach is necessary and should include consideration of non-pharmacological modalities. All components of pain management must be delivered in ways that do not interfere with the feline-human bond by creating fear, anxiety, or discomfort for either the patient or the owner.
  2. Rather than a cookbook approach, a patient-specific pain management plan should be formulated with consideration of the individual cat’s tolerance of handling, transport, and veterinary visits, and the owner’s capability of being the caregiver at home. 

 

Cat Friendly Homes: Setting Clients up for Success, Dr. Sarah Heath

  1. Creating a Cat Friendly home involves optimizing the environment from a feline perspective. Enrichment involves providing something in excess of requirements but optimization involves ensuring that the feline home meets all of the cat’s fundamental needs.
  2. The veterinary practice has a responsibility to ensure the welfare of its feline patients. This involves advising clients about the optimization of the home environment as this directly impacts the health of cats from an emotional, cognitive, and physical perspective.

 

QOL in CKD: Make Every Medication Matter, Dr. Jessica Quimby

  1. Caring for the feline CKD patient should be a balance of necessary therapies and quality of life in order to promote the best outcome for the patient. It may be necessary to prioritize therapies based on their medical necessity, evidence-based benefit to the pet, and the caretaker’s ability to administer them.
  2. Factors that may affect perceived QOL in cats with CKD include hydration, anemia, appetite, hypokalemia, constipation and pill burden. These aspects of disease may therefore be a priority in late-stage patients.

 

Bringing Up Baby: A Practical Guide to Feline Pediatric Nutrition, Ms. Ellen Carozza

  1. Never assume the commercial diet being used for bottle babies is the source of diarrhea or constipation. However, homemade and RAW diets can be a concern for food-borne illnesses and it is NOT recommended for feeding.
  2. Investigate diarrhea. You should not only check for parasites but fecal cytology should be utilized to check for clostridium, campylobacter, and cryptosporidium. This can be easily performed using GRAM Stain or DIFF stain techniques. Treat the kittens for diarrhea if symptomatic in a multimodal fashion: medication + a multi strain probiotic.
  3. ALL medications are considered OFF LABEL in neonates and pediatrics, however, risks vs. benefits should be taken into consideration.
  4. Healthy kittens start with a healthy queen! One should consider removing kittens if the mother is ill herself as she cannot provide proper nourishment to her kittens. Focus on mom and hand-rear the kittens. This also prevents the kittens from catching her illness and preventing pediatric mortality.
  5. NEVER force-wean a kitten. While they do start to become interested in moist or dry diets starting at 3.5-4 weeks of age, the kitten should dictate when they are ready to fully wean. This prevents food aversion and potential GI stress. If the kitten has a set-back, that’s OK, continue bottle feeding and continue to offer a variety of food until the kitten is ready.

 

COVID-19: A New World in Human & Veterinary Vaccines, Drs. Randal Gregg & Madeleine Stahl

  1. Human SARS-CoV-2 mRNA and vector vaccines deliver a piece of the genetic material coding for the viral spike protein to the vaccinate, which once translated induces the production of neutralizing antibodies that block viral attachment to cells and can stimulate a cell-mediated response to kill infected cells.
  2. A feline SARS-CoV-2 vaccine utilizing RNA particle vaccine technology, which differs from mRNA and vector vaccine technology, demonstrated that it can induce a targeted, balanced immune response (humoral and cell-mediated) utilizing a clean, nonadjuvanted formulation and can serve as a platform to generate other vaccines.

 

Giving Your Cat a Voice: How Tracking Elimination Behavior Provides Insights into Health & Emotional Wellbeing, Dr. Ragen McGowan

  1. Cat elimination behavior is complex! Out-of-box elimination is a frustration for both cats and their caretakers and can be an indicator of issues with either emotional or physical health. Ahead of cats being driven outside of the box, there is value in understanding the intricacies of what they are doing inside the box, and how this may provide early indication of health or behavioral issues on the horizon. For apparently healthy cats, data for litter box use can be used to track fluctuations related to emotional wellbeing or satisfaction with the litter box environment. Fluctuations in feline elimination behavior can also reflect changes in physical health. Even latent or early signs of many health problems in cats can manifest as changes in elimination behavior.  For many common feline disease states, tracking elimination behavior can be instrumental in providing very early detection of shifts elimination patterns, saving critical time towards diagnosis.
  2. With advancements in digital technology, many fields are turning to the use of sensors and artificial intelligence (AI) to collect and track data over time. There is a definite place for such tools when we strive to care for our pets in the best way that we can. The Petivity Smart Litterbox Monitor is a sophisticated system that automatically tracks weight and elimination behavior of individual cats and translates this data into meaningful insights around cat behavior and health. It consists of AI paired with expert decision tree logic that provide a window into changes over time, empowering cat owners with knowledge to better understand their cat and provide the best care possible. Keeping tabs on litter box behavior with digital tools can move us from a reactive to a proactive approach to health and wellbeing for cats.

 

Uremic Toxins in CKD: Why Should We Care?, Dr. Jessica Quimby

  1. Interactions between the gut and kidney may have significant influences on the health of both organs. Dysbiosis has been documented in cats with CKD resulting in altered intestinal microflora. Gut-derived uremic toxins accumulate in CKD even in early stages of disease and their production is exacerbated by dysbiosis.
  2. Uremic toxins (e.g. indoxul sulfate) have multiple deleterious pathophysiologic consequences including direct renal damage and deleterious effects on muscle and bone health. They are also associated with progression of disease in multiple species. Thus, targeting dysbiosis and accumulation of uremic toxins may be an important treatment strategy in feline CKD.

 

Taking the Edge Off: Sedation Before and/or During Veterinary Visits, Dr. Robin Downing

  1. In the past, cats who resisted or even fought veterinary visits were labeled “bad cats”. These cats are NOT bad! They may be frightened, they may be anxious, they may even be painful, so for them the veterinary visit is torture. This session provided ideas for pre- and during-visit sedation options that will not mask pain if it is present but will allow both cats and veterinary team members to be safe and comfortable.

 

Practical Fluid Therapy: More than “Twice Maintenance,” Dr. Christopher Byers

  1. A balanced electrolyte solution (BES) may be superior to 0.9% sodium chloride for resuscitation and replacement fluid therapy.
  2. Third-generation hydroxyethyl starches are uncommonly associated with coagulopathies and acute kidney injury.

 

PURRfecting the Feline Exam: Communicating with Clients to Get the Information You Need, Drs. Elizabeth Colleran & Margaret Gruen

  1. Each small stressor accumulates in cats making coping more and more difficult. Each aspect of the veterinary visit should focus on abating or eliminating stressful experiences.
  2. Gathering information about behavior in the home environment expands the information useful in assessing health. Open questioning techniques, short videos of movement of interest such as jumping, running or climbing, and “homework” questionnaires can add significantly to analysis.
  3. Caregivers and their relationship with the cat as well as financial challenges, caregiver skills and our ability to understand their needs are crucial aspects of treatment planning.

 

Seek & Ye Shall Find: Pain Exams in Cats, Dr. Robin Downing

  1. Cats are notorious for declining to tell their humans when something is wrong. Particularly when pain is present, cats are particularly reticent. This session provided a demonstration of a feline-friendly (and effective) palpation strategy to help you look for, and find, pain in your feline patients.

 

Diagnosis & Management of Chronic Vomiting, Dr. Christopher Byers

  1. Chronic enteropathy and intestinal neoplasia are the two most common causes of chronic vomiting in cats.
  2. Morphologic evaluation of intestinal biopsies may not adequately distinguish lymphoplasmytic enteropathy from enteropathy-associated T-cell lymphoma; immunohistochemical staining and PARR testing may be required to obtain a definitive diagnosis.

 

Conducting Procedures in the Exam Room & Techniques for Obtaining Diagnostics, Dr. Elizabeth Colleran

  1. Acclimation to the exam room is a key step in creating a calm environment where the feline patient can more easily cope with stress.
  2. Many procedures or processes typically done in the treatment room (“The back”) can be accomplished more successfully in the exam room. Clients can be engaged in ways that distract them from the technical steps of a procedure with which they may be uncomfortable.
  3. It is more desirable to excuse clients from the exam room with phobias regarding blood, needles or other components of a planned procedure than to remove the cat. Talking through a process first can bring enough calm to a nervous client to prevent unwanted stress from being communicated from owner to cat.

 

Catupuncture & Meowssage in Cat Friendly Practice, Dr. Robin Downing

  1. Medical acupuncture is a useful tool that we can use to good advantage in Cat Friendly Practice.  So, too, medical massage. This session provided participants with some ideas for leveraging these physical medicine techniques to help cats. 

 

Gabapentin Sedation in Cats With & Without CKD, Dr. Jessica Quimby

  1. Multiple studies have documented the usefulness of gabapentin for reducing visit-related anxiety in feline patients at a dose of ~20 mg/kg 1-2 hours prior to transportation. However, this dose may be inappropriate for cats with CKD as gabapentin is clearly only by renal excretion. Excessive sedation, ataxia, and decreased blood pressure may be seen in some renal patients at this dose. Similar toxicity is reported in human CKD patients and dose reduction is recommended.
  2. Dose reduction (50-75%) is recommended in cats with CKD as dose-normalized serum concentrations are significantly higher than normal cats. Serum concentrations are positively correlated with serum creatinine indicating greater caution is needed in advanced stage disease.

 

Cat Friendly: Getting (& Keeping) the Whole Team on Board, Dr. Elizabeth Colleran

  1. The consequences of COVID lockdowns are still being felt in many practices. It often takes the form of dissatisfaction, feelings of burnout, fatigue, and an abundance of negative energy that spread like another kind of virus through the team.
  2. Resurrecting the passion and shared vision of the veterinary team is the antidote to this condition and requires a different kind of leadership.
  3. This leadership takes the forms of compassionate listening, positive feedback, and an obvious energetic commitment to the shared vision of the group. Regular rounds that bring everyone together each morning or evening can set the positive energy for the day and rejuvenate the team.

 

Sunday, October 30, 2022

 

Hematuria Detection: A New Standard of Care, Dr. Kelly St. Denis

  1. Hematuria is a common finding in many diseases of the feline urinary tract. Caregivers are often alerted to the presence of urinary tract disease when their cats develop macroscopic hematuria. In most instances, microscopic hematuria likely develops well in advance of visible blood in the urine. 
  2. Hematuria Detection Technology by BlucareTM are easy to use granules that can be sprinkled onto the cat’s litter detecting low levels of hematuria equivalent to 12 RBC per high power field. Earlier detection of urinary tract disease would facilitate earlier medical care, reducing patient discomfort and reducing the risk of disease progression.

 

Maximizing Claw & Order in Feline Anesthesia: A Case Based Approach, Dr. Rebecca Salazar

  1. Providing cats with anxiolytics prior to any hospital event can decrease anxiety and stress. The medications are easy to given and have little no unwanted side effects. Anxiolytics can be especially rewarding when preparing cats for an anesthetic event thus leading to more favorable outcomes.
  2. Having a variety of options, drugs, and anesthetic plans allows the doctors and staff to provide the safest anesthesia. Monitoring closely allows the anesthetic provider to recognize specific side effects or complications that can or have occurred during anesthesia. It is important to have plans in place to address the latter if they are to occur.
  3. Feline anesthetic risk is greater in geriatric patients with multiple co-morbidities. These co-morbidities can include: unknown allergies to medications, diabetes, heart disease, renal disease, lower airway disease, and obesity. Understanding the pathophysiology of the latter can make anesthetic drug choices less stressful with more favorable outcomes.

 

Cat Friendly Interactions & Handling Workshop, Dr. Ilona Rodan

  1. Develop a starting plan for how to support the rest of the team with Cat Friendly Interactions in your practice. You do not need to be the practice owner to help lead change.
  2. Interactions and handling techniques include a preventive plan to promote engaging and minimize protective emotions and behaviors, improving patient welfare and increasing our safety and satisfaction.

 

Understanding & Managing Feline Hypertension the Cat Friendly Way, Dr. Kelly St. Denis

  1. Feline hypertension is a potentially debilitating clinical condition that is particularly important in senior cats as their risk increases with advancing age. Developing protocols and standards of care for assessing blood pressure in cats is imperative to obtaining accurate readings.
  2. Blood pressure can be falsely elevated by stressors in the environment and by inappropriate feline handling and restraint. Understanding Cat Friendly principles and developing and implementing Cat Friendly practice strategies contributes greatly to obtaining valid readings.

 

Chronic Pancreatitis: Diagnosis, Treatment, & Management, Dr. Megan McClosky

  1. Pancreatitis in cats causes vague clinical signs such as anorexia and lethargy. Diagnosis can be challenging, but the best test is the fpLI.
  2. Chronic pancreatitis may lead to disorders of both the endocrine and exocrine pancreas. Monitor patients that have had pancreatitis for the development of diabetes mellitus and exocrine pancreatic insufficiency. 

 

Elimination as a Problem: Is it Behavior or is it Medical?, Drs. Julie Byron & Meghan Herron

  1. Arthritis is an under recognized problem in older cats. In situations where the owners find urine or feces near the litter box of an older cat, a shallow, low-edged tray should be considered so the cat does not have to climb over a barrier.
  2. The majority of elimination problems are related to litter box management. Aversions, substrate preference, location, number, and overall cleanliness are all important considerations.

 

IBD to Lymphoma: How Do I Manage if the Client Won’t Biopsy?, Dr. Megan McClosky

  1. If biopsies are not an option, it is more important to rule out differentials other than IBD and small cell lymphoma than to differentiate between the two. Thorough testing for other neoplastic conditions and infections should be performed before starting empiric therapy.
  2. The treatment for refractory IBD and small cell lymphoma is the same. Patients that are not stable enough for a diet or antibiotic trial should be started on steroids and possibly chlorambucil provided other differentials have been thoroughly investigated.

 

Multi-cat Households: Stress, Feeding, Inter-cat Aggression, & More – Part 1, Dr. Meghan Herron

  1. Fearful body language and signals tend to be the loudest and most noticeable, while offensive, confident aggression tends to be quiet and covert. Clients frequently blame and punish the fearful cat as they often don’t recognize the silent aggressive gestures from the more confident cat.
  2. Hissing, dilated pupils, puffed up fur, arched back, holding ears back are all signs a cat is fearful. A straight stance with ears forward, tail held parallel to the ground, and direct stare are all signs a cat is being offensively aggressive, but not fearful.

 

Felines with Cardiomyopathy: Is it Safe to…?, Dr. Henry Green

Pearls to come

 

Multi-cat Households: Stress, Feeding, Inter-cat Aggression, & More – Part 2, Dr. Meghan Herron

  1. Enrichment is essential for success for all cats, but especially in multi-cat households. The four pillars of indoor enrichment include: Hunting, Chewing, Scratching, and Viewing. Making sure there are multiple options for each of these as well as basic needs resources will reduce stress and alleviate social tension.
  2. Remember that cats often take time to adjust to cohabitation, whether it is an initial introduction or a reintroduction after inter-cat aggression forced a temporary separation. Moving at a slow pace is necessary to allow each cat to learn to trust the new social dynamics. Starting with scent exchange, then moving to limited visual exposure, gradually increasing that visual exposure, then allowing physical exposure and supervised interactions, using food and/or play at each step to create a positive emotional association is the pathway to success.

 

Feline Arterial Thromboembolic Disease: 24 Hours Can Tell a Story, Dr. Henry Green

Pearls to come

 

Early Prediction Advantages for CKD, Dr. Ashlie Saffire

  1. A non-invasive, oral swab-based screening tool that evaluates genetic predispositions, health markers, and oral microbiome is in development and may help identify patients at higher risk of developing certain diseases. Having access to this information earlier in a patient’s life may help guide monitoring recommendations and traditional diagnostics to allow for earlier disease intervention.
  2. CKD and periodontal disease are common in feline medicine and often the two present together. Although there is a large overlap between microbes in the oral cavity associated periodontal disease and CKD, new research has also identified predictive microbes for CKD, independent of PD. Further research is needed to better understand what the presence of these CKD microbes might indicate.   

 

Serum TSH: An Essential Tool for Diagnosis & Monitoring of Thyroid Disease in Cats, Dr. Mark Peterson

Pearls to come

 

Evidence Based Medicine Supporting Stem Cell Therapy in the Feline Patient, Dr. Anne Hale

  1. Newer information based on the characterization of the mesenchymal stem cell, specifically adipose derived, suggests that feline AD-MSCs are unique when compared with other domestic species and have significant immunomodulatory capacity relating to T cell regulation.
  2. A growing body of published work supports both the mechanism of action and disease control in feline patients. Administration, dosing, and length of activity is left to be determined through large placebo controlled clinical trials under the guidance of the FDA CVM. Support of our feline patients and their pet parents in the attempt to maximize quality of life and longevity means exploring new ways to prevent the aging and disease process.

 

My House is Not Your Toilet: Feline Elimination Problems, Dr. Meghan Herron

  1. Many elimination problems have a medical etiology, making a full physical exam and minimum database diagnostics (CBC, serum chemistry +/- TT4, and UA/fecal) essential at the start of each case. Pain, discomfort, and urgency all have strong effects on feline behavior.
  2. Cats have a natural preference for fine, sandy textures as their elimination substrate. For most cats, this mean a fine, clumping (clay/silica) litter is preferred.

 

Blocked Cats: Anything New?, Dr. Julie Byron

  1. Prazosin and other alpha antagonists do not appear to reduce re-obstruction, likely because they only impact the proximal urethra (smooth muscle) and not the distal urethra (skeletal muscle). Acepromazine, benzodiazepines and other skeletal muscle relaxants have not been studied enough to determine their efficacy.
  2. Beta-agonists such as injectable terbutaline, can be used to reduce life-threatening hyperkalemia without the hypoglycemic risks associated with insulin. They do this by moving potassium into the intracellular compartment. Dosing has been recommended at 0.01 mg/kg IM or slow IV.

 

Integrated Care: Feline Psychopharmacology, Nutrition, & Supplements, Dr. Meghan Herron

  1. Daily medications (aka standing/baseline) are indicated when a cat experiences fear, anxiety, and/or stress on a near daily basis. When triggers are not identifiable nor predictable, having full 24-hour coverage is needed. This is best accomplished with medications that, while they may take a few weeks to reach therapeutic effect, are maintained in the cat’s system round the clock (SSRIs, TCAs, azapirones, etc.)
  2. Event medications (aka PRN) are indicated when a cat experiences episodic fear, anxiety and/or distress and the triggers for the episodes are both identifiable and predictable. This allows for appropriate timing of a medication that will take effect within 30-90 minutes and last for several hours (gabapentin, trazodone, lorazepam, etc.). Some cats may benefit from both daily and event medications, depending on their circumstances and triggers.

 

Feline Ureterolithiasis: Big Kidney-Little Kidney, Dr. Julie Byron

  1. The presence of a big kidney and a smaller one on radiographs or ultrasound should alert the practitioner that the cat may have had ureteral obstruction in the past and thus is potentially at risk for future obstruction, particularly of the larger, presumably more functional kidney. The renal pelvis of both kidneys should be carefully examined for evidence of nephrolithiasis.
  2. Cats with ureteral obstruction often present for non-specific signs such as vomiting and inappetence. A cat with acute azotemia, even mild, and general signs of illness should have imaging of the kidneys, preferably ultrasound, to evaluate for ureteral obstruction.

 

On-Demand

 

Bring Back the Bounce: Managing Osteoarthritis in Cats, Ms. Kara Burns

  1. Recognizing signs of OA in cats is difficult as cats often suffer in silence. Thus, the healthcare team must rely upon the owner’s evaluation and a thorough history to ascertain potential signs and symptoms of OA in cats.  Typically, the changes that may be noted by owners can be categorized into four groups: mobility, activity level, grooming, and temperament. Therefore, it is important for the veterinary nurse/technician to take a thorough history and ask open ended questions that may help uncover otherwise overlooked signs of OA in cats.
  2. It is imperative that nutritional management be part of a multimodal approach to managing feline mobility. Dietary factors can potentially modify some of the underlying processes involved in arthritis, including modulation of the inflammatory response, provision of nutrients for cartilage repair and protection against oxidative damage.

 

Feline Hypertrophic Cardiomyopathy & the Role of Nutrition, Ms. Kara Burns

  1. Nutrition should be considered an integral part of the overall care for Hypertrophic Cardiomyopathy as well as all stages of heart disease – from cats with a predisposition for heart disease, to cats with asymptomatic heart disease, to cats with CHF.
  2. Optimizing body composition, preventing deficient or excessive intake of various nutrients, and avoiding nutritionally unbalanced diets may help to slow progression of disease and improve quality of life.
  3. Owners appear much more likely to change dietary factors (e.g., diet, treats, and/or supplements) than they would a medication. Therefore, it is relatively common to have various aspects of the diet change from one visit to the next. Therefore, it is important to perform a screening nutritional evaluation and to make specific recommendations at every visit (even if just to say that what the owner is doing is ideal). Demonstrating and teaching the client to effectively administer medications and to evaluate the body weight, BCS, and MCS is beneficial for engaging the client in their cat’s care.

 

Feline IBD: Pathophysiology, Treatment Goals, & Client Communication, Ms. Kara Burns

  1. Veterinary nurses/technicians must be familiar with IBD and the causes of this disease and work with the entire healthcare team (including the cat owner) to alleviate the signs and symptoms observed in cats diagnosed with IBD. 
  2. IBD is often a chronic, frustrating condition for not only the patient but the owner. Educating the owner on nutrition and environmental enrichment to alleviate and manage GI signs is crucial in managing the disease long term.
  3. Consistent nutritional assessment of the feeding plan, current symptoms, and body condition along with client education will result in improved owner compliance and a better quality of life for the feline IBD patient.

 

Getting Cats to Eat: More than Pouring Food into a Bowl?, Ms. Kara Burns

  1. The veterinary team should develop an appropriate feeding plan for each individual cat. The goal of a feeding program should be to mimic the cat’s natural feeding behavior. Simulating normal feeding behavior in cats diminishes begging for food, feline frustration, and inter-cat conflict. It also helps reduce relinquishment and strengthens the human-cat bond.
  2. A stressed cat is not a happy cat, and if the cat avoids eating and drinking, it may become malnourished and/or dehydrated. It is important for the veterinary team to understand and uncover the reason the cat is stressed and work to alleviate the issue. Whisker fatigue, feeding puzzles, and various types of bowls should be investigated to allow for the cat to eat appropriately. Educating cat owners on the importance of optimizing not only what to feed but also how to feed is important to the long-term health of the feline patient.

 

Cats, Carriers, & Cars: A Cat Friendly Approach to Containment for Travel, Dr. Sarah Ellis

  1. Environmental set-up is a key component to success in creating calm, comfortable containment in the carrier during travel for the cat.
  2. Veterinary professionals with experience of training can work with clients on simple training programs to help their cats voluntarily enter the carrier and remain comfortable in there for the duration of the journey to and from the vet practice.

 

Interactions with Cats: How Can Human Behavior Change Theory Help?, Dr. Sarah Ellis

  1. Interacting with cats in a cat friendly manner involves understanding cat behavior, understanding cat communication, and putting the cat’s needs before your own.
  2. When considering whether someone can truly be cat friendly in their interactions with cats, consider their capabilities, opportunities, and motivations.

 

Triple Threat: Diagnosis and Management of Feline Triaditis, Dr. Megan McClosky

  1. Inflammation in one, two or all three organs involved in triaditis may cause similar clinical signs and bloodwork abnormalities. Diagnosis requires histopathology, but clinical suspicion may be increased based on clinical signs, bloodwork and imaging findings. Remember that cats can have severe inflammation associated with cholangitis and have normal liver enzymes!
  2. If diagnostics are not feasible due to patient stability or owner finances, consider empiric therapy with broad-spectrum antibiotics and hepatoprotectants. Steroids can be added after a partial response or no response to antibiotics.