Hello and welcome to Chattering With iCatCare. I'm Yaiza Gomez-Mejias, iCatCare Veterinary Community Coordinator and host of this month's podcast. This episode will include two second parts of interviews we started to share with you in previous episodes. The topics will be skin and urinary tract. Dr Kelly St Denis will complete the conversation she started in April with Dr Banovic about immune-mediated skin diseases in cats.
But first you will hear the second part of the interview I started in February with Sam Taylor and Rachel Korman on the new iCatCare consensus guidelines on lower urinary tract diseases in cats. So what are your thoughts on supplementary or complimentary therapies? It's always important to evaluate the impact on the individual cat. We always talk about easy to give and easy to administer.
For example, plugins have the very minimal impact on the cats sort of day to day lifestyle and it may be very helpful, I think that's worthwhile trying. The flip side might be dietary add-ins or capsules and might just be another thing that sort of causes a change in the cat's routine.
If it's a cat reliant on routine and not having anything additional put into its food, or any additional medications, that could result in further anxiety and you have to weigh up the evidence for the benefit of what you might be adding into that patient. I agree. I think many blocked cats we get referred will be on some supplement, glycosaminoglycans supplements, you go on Amazon and they can buy all of these.
I'm yet to meet a cat in that acute phase of being blocked where that's been of benefit. I always wonder if it's a placebo for us and the client, but I agree with Rachel, that's not what that cat needs at that time. Change can be stressful for some of these very susceptible individuals. You just don't want to be changing anything.
I've got one cat that has very recurrent FIC, and he is a very hyper vigilant anxious cat and his latest episode of FIC was because a large leaf blew off a tree and went into his face and he developed hematuria. This is how sensitive some cats are. Giving lots of medications is not ideal. The other thing I would say about a diet is that changing diet during that acute phase is not the time, they like familiarity during that period.
There is minimal evidence for the benefit of some nutritional supplements. It's possible that some individuals would benefit longer term. But not in that acute period. The number one priority, that's got to be things like analgesics for what is a very painful condition. I was referring to the chronic or recurrent disease where owners, we only see them occasionally and they look for a way to sort out the ongoing problem.
Sometimes what helps me is to redirect the conversation towards the diet, not for the diet to be changed immediately in the acute phase, but in the long term that provides them with a tool to do something not necessarily dependent on the veterinary practice. It makes them gain a little bit of agency on that side. I feel like that's where you also have the ability to redirect into behavioural and environmental modification.
Often there are simple things owners can change, making sure they're aware of the different pillars of key resources cats need. Everyone wants a magic pill to fix the problem, but a lot of times making sure they have all of those key resources, that is really gonna be the thing that helps a lot of the cats. Talking about pain relief, which is very important, and Gabapentin is very popular among feline practitioners.
And in your experience, can it provide some analgesic effect in, in, in feline idiopathic cystitis? Yeah, I think Gabapentin is one of those drugs we over rely on for analgesia. I see it used a lot for many sources of pain and having had conversations with brilliant anaesthetists, when we wrote the acute pain guidelines, they were clear to state that there isn't a huge amount of evidence for the analgesic effect of this drug, that we need to not rely on it for that.
Having said that, I think we all accept it could be quite useful when you think of a disease that potentially has a sort of neuropathic origin. I do tend to use it. The other reason it can be useful is from an anxiolytic point of view, and cats are in the clinic. I know we are talking longer term here, but for blocked cats in the clinic it can help with tolerance of urinary catheters and things as well from that anxiolytic point of view.
So I may be relying on it sometimes for that as well as an analgesic effect, but I worry about using it as a sole analgesic. I wouldn't in a blocked cat or a cat that had an extremely inflamed bladder, I think then we need to think about multimodal analgesia, but I dunno what Rachels thoughts are on Gabapentin in urinary cases. I would agree. We use it quite a lot in our blocked cats, but not as an analgesic, often as an anxiolytic.
We'll also use it preemptively in cats coming to the clinic for assessments for potentially other disease processes, but where they've had a history of anxiety related urinary tract disease. We may use it after their visit for a couple of days to help and take the edge off their anxiety. But in that acute phase when cats are presenting with an obstruction, we are using opioids traditionally. Catheters have always been a big topic.
How long to leave and what do you do with the bladder distention in cats who present with inability to urinate? Would you like to talk about catheters on the most controversial aspects? Well, it was interesting doing the guidelines with international differences because some countries they routinely use red rubber catheters and find them cost effective. I haven't used one in the UK for a long time. We tried to illustrate different types of catheter in our guidelines.
I just wanted to mention that because I found it really interesting and I learned something from how the red rubber catheters are attached to the cat, we've detailed that in the guidelines, which is a slightly alternative approach from what I'm familiar with. Hopefully people will pick up some tips and information. The cat that that sort of recurrent blocks or doesn't urinate after catheterisation is a really interesting one. There are a few aspects to it.
Sometimes we have cats that have anxiety and there may be cats stressed in the clinic. They may be cats that are used to urinating outside. When we remove their urinary catheter, we expect them to produce a perfect urination in a litter tray so that we all feel better that they're no longer obstructed. But it's not entirely realistic. If you have a cat that is not familiar with using a litter tray in a stressful environment of the clinic, they're not gonna use litter tray.
So sometimes you have to be brave and discharge these cats to see if they will urinate within their normal environment. I would say that's like using your own toilet versus a toilet in public for them, they're not going to want to do that.
So that doesn't apply if they're straining or anything like that and that's where a retrograde, again, I keep advertising retrogrades, but it's reassuring because if you know you haven't got a physical obstruction, you might feel bolder in giving them more time to urinate. There are other reasons for cats not being able to urinate after an obstruction. In your clinic, Rachel, do you keep them in or do you try and get them home?
No, we actively try and get them home and I would say that it's more common to remove a urinary catheter and discharge them almost straight away. But we're hyper vigilant about making sure the owners understand the risk factors and what they need to be monitoring for. If those owners are picking their cat up at 7:30 in the morning, dropping him off and then going to work for the whole day, that's not a cat we'll discharge into that environment.
They need to be going home and being closely monitored for signs of straining and dysuria, but certainly my own cat, perfectly normal, never had an episode of lower urinary tract disease, but if she goes into the clinic, she's scared of her own shadow, won't urinate for a long time. For these cats where we know they're anxious and stressed, expecting them to do a large, normal stream urination in front of an audience is really not gonna happen.
And now Dr Kelly St Dennis will speak with Dr Banovic about the two articles he co-authored and published in the Journal of Feline Medicine and Surgery on Immune-Mediated Skin Diseases in Cats: Presentation, Diagnosis and Management. I know we talked a little bit about plasma cell pododermatitis in the last episode, but I also wanted to talk about PNOE, which is proliferative necrotising otitis externa, which has been interesting problem that we don't see very often in cats.
I've had a couple cases in my own career. That can look like ear mites, a food allergy response or, at least that's, I've seen a few cases respond to food changes. What sets them apart in terms of the things that we see with PNOE that we wouldn't see with ear mites? We're gonna do cytology to diagnose ear mites, but what are the other things that we see in PNOE in cats? Depends where you practice. Population-wise, majority of patients are getting some kind of isoxazolines in cats.
Isoxazolines are good medications that deal with ear mites efficiently. Suspecting ear mites with isoxazolines is rare unless the owner is not applying it and just keeping cubes at home. The ear mite itself versus this disease, this disease based on the images causes unique plaques, generally erythematous plaques, raised, bumpy, proliferative lesions, they can have hyper pigmented crusting on top, probably scaling with crusting.
The mites tend to be preauricular, so before the entrance to the ear canal, although sometimes we see them in the ear canal as well. The mites itself, they don't like to usually cause any proliferative epidermal lesions, like this entity. So just looking clinically, you probably would figure out, but just to be safe, you can always run cytology.
If you suspect you don't mites and you don't find them on cytology, doesn't mean they may not be there, still run your treatment to be certain it's this disease. We do not know a lot about proliferative necrotising otitis. It's called proliferative because like I said, they tend to be like raised elevated lesions and it's necrotising because there is a lot of cell death of keratinocytes in these lesions likely associated with a lymphocytic attack.
The most common reason lymphocytes would kill epithelial cells, you would think infectious, so like the herpes virus, because to kill viruses you send these cytotoxic T cells. But all the times that we have ever seen, we never find any virus, so we really don't understand the aetiology. It does happen usually in younger cats, but can happen in older as well. But. Usually tends to respond to immunomodulation.
I would say it's 50 50 with sometimes cats going in remission fully, and you can stop your immunosuppressors, but sometimes you may still need to do something that the lesions don't come back. Again, really unique, unknown to us why this would happen, but once you see it, I think it's very unique clinically. Sure. Specifically, if you look at the images we show there, those are the classic examples of the disease. Yeah, tacrolimus is the preferred treatment then for, as a topical?
As a topical, yes. People will use topical glucocorticoids depending what access you have. Tacrolimus is a calcineurin inhibitor, like cyclosporine, except it's more potent and it's topical in why we use it in veterinary dermatology. What probably usually happens is that people will use oral, like oral glucocorticoid. It's in a topical. You have to be careful that you apply it in areas that a cat cannot lick it off. So preauricular would be a good area because they cannot do that.
So yeah, we will try to do tacrolimus, but it's not wrong to do topical steroids either. They're just not ideal long-term for the skin because they can cause atrophy, commodos, and fragility. Tacrolimus would be a better long-term option if you can get that. Thank you. That's much appreciated. I really appreciated the conversations we've been able to have, like, Just really highlighting how practical these articles are.
I love how they're laid out in terms of each disease, how you have the pathophysiology signalmeant, how to diagnose and what are the clinical features that are hallmark to those specific diseases, and where to take your biopsies depending on the condition that might be suspected. And so I just wanted to thank you again for agreeing to write the articles for us and doing such a great job and for joining us today as well.
Again, we are talking about the clinical spotlight articles in the Journal of Feline Medicine and Surgery Feline Immune-Mediated Skin Disorders part two today. But we also have a part one that we discussed in our last podcast. So Dr Banovich, again, thank you for joining us. Thank you, Kelly, and thank your team as well.
We hope these articles contribute a lot to public knowledge of the diseases and hopefully people will have a better understanding of these entities and how to treat them in the future. 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 15th of July Prof. Dr Nadine Passlack will host an open access webinar on Nutritional strategies in Feline Urolithiasis, sponsored by Purina
We’ll be back again next month with more from the world of feline medicine and JFMS