Hello, and thank you so much for choosing to watch this webinar. My name's Sarah Caney. I'm a UK based specialist in feline medicine.

And in this session, I'm gonna be talking all about compliance in feline patients. I'm gonna start by explaining what we mean by the term compliance and what we know in a veterinary context before moving on to share with you some information from a pretty recent large owner survey, where owners shared their experiences of medicating cats and also their preferences for different medications. And then I'll finish the session by sharing more of my tips and tricks for achieving successful medication and compliance in my patients.

So firstly, what do we mean by the term compliance? Well, in human medicine, this is the patient's adherence to a recommended course of treatment. Of course, the main difference in veterinary medicine is that we have a client in there as well.

So we, as a clinician, are going to be making a recommendation, whether that's for an investigation or a treatment, and then our client often is going to be the person. medicating that cat if medication is indeed involved. And so compliance, therefore, not only involves, the recommendation that we make, but also being accepted by the client and also followed through by the client.

So it's a much more complicated three-way process, requiring good concordance as well. So good teamwork, and agreement between us all, as well as hopefully compliance from the cat at the end as well. So how good compliance, or how good is compliance rather, in our own medicine in human medicine?

Well, the figures that are quoted do vary quite hugely and often, perhaps unsurprisingly, are better, as in higher compliance rates for people. Have more serious illnesses and tend to be also higher for medication versus lifestyle changes. So people tend to be more compliant to taking a medication than perhaps making big changes to their lifestyle, their diet, their drinking habits, for example.

In the world of our cats, compliance can be quite challenging. We often are dealing with individuals that perhaps are not too happy about whatever we want to do with them, whether that's handling them or medicating them. So that is certainly something that we do have to face and perhaps is more challenging in an average cat compared to an average dog.

And unfortunately, there's relatively little published data in terms of how good a job we generally do in terms of our compliance for, for different things. So this is a relatively old study, as you'll see, from the American Animal Hospital Association, 2002, but it's one of the more recent studies that I was able to find some actual figures for, and you can see. Under the, the bullet headings here that for different things, there are differing levels of compliance.

So compliance generally quite high in this study for vaccination, the core vaccines, also quite high for heartworm testing in this, in this study, but lower for therapeutic diets under 20% compliance, typically for therapeutic diets, for example. But this is an area where, as, as you can see, we, we just don't have good data. Indeed, this more recent paper in the vet record specifically cited, you know, that there isn't much evidence available to us.

The the data that is published related to compliance is, is thin on the ground and relatively poor quality, which does make it really difficult for us to know, therefore, what actually might have a positive impact on compliance. And this is one of the reasons why, a couple of years ago, I and colleagues at International Cat Care, so Samantha Taylor, was my co-investigator in this study, decided that we really wanted to learn more about the owner experience, the end user experience with medications. There's one component of compliance.

Clearly, this is just relating to, primarily oral medications, although a variety of medications were, were covered in this survey. And we opened up this survey to anyone who was a cat owner. So we did actually have a number of vets and vet nurses that participate in this study.

So thank you if you are one of those and also thank you if you help to share it with your clients as well. The aims of the studies were to ask what owners' experiences were of different medications. So what had they given to their cats over the years in terms of tablets, liquids, or spot-ons, for example.

And specifically with respect to oral formulations, what were their preferences? We also asked about potentially negative experiences that they'd had in terms of behavioural changes in the cats, so I'll share some data from that with you as well. And it was a reasonably long survey, 35 questions, and we got 2500, what I would say useful responses.

So some of these were not completely, every single answer every single question answered for some of them, but the majority were. And we subdivided that into what we called our, our cat owners, which were just, people who, who owned a cat and ticked that box versus the cat owners plus who were cat owners that also had some professional or, life experience that meant that they were likely to be more experienced handling cats. So, we had vets and nurses in this category, but also people who worked in a vet clinic, behaviourists, cat breeders, people who worked in rescue shelters were also in this category.

So about 2/3 cat owners, 1/3, cat owners plus. The majority of participants from the UK, as you can see. And so, firstly, we asked these people what experience they had of medicating cats.

Now, perhaps people who participate in a survey that is all about medicating cats will be self-selected as those that have had some experience, but you can certainly see here that was very much the case. 99% of respondents had given some medication to their cats at some point in the past. And the vast majority.

So 96% had given tablets. Nearly 80% had given spot-ons or liquid treatments. And actually, as you can see, quite a, a chunk had had given insulin to the cats, 16%.

So we obviously attracted some owners of diabetic cats to this survey. We've done some previous surveys on diabetes in cats, which may well have, have biassed to that, subset of the population. About 25% of the owners had used an online pharmacy to obtain their medications.

We asked about the support that they got from their vet clinic. For example, were they given information and advice on how to give medication? And just under half of the owners said, yes, this, this information or advice was always given, mainly as a verbal explanation, but, sometimes with a, with a demon from a nurse.

And as you can see, overwhelmingly popular. So 92% of owners said that when they received this information, it was very helpful. So a little bit disappointing in that context to see that 51% of owners said only sometimes or never were they given information or advice on how to give the medication.

And for those that did find giving medication difficult, they didn't always contact their vets for advice, only 42% did, which again is a little bit disappointing because, of course, we would want our clients to feel free to contact us immediately. Those that did contact the clinic, generally found the information and advice they got helpful. But I guess a lot of people perhaps struggling in silence or using other resources of information such as, as the internet.

We asked with the different formulations how owners administered these to their cats, and of course, slightly different techniques employed for the slightly different, or for the range of, of different formulations that were offered to the cats. So, for example, giving directly by mouth was pretty common for liquids. 61% of liquids administered this way.

A bit less common for tablets, 40% given directly by mouth. Hiding the medication whole in food or a treat, was fairly common, so 20 to 25% of owners did this for liquids, tablets, and pastes. Capsules typically opened more often, as perhaps we would not be surprised to hear.

Pill giver for tablets and capsules used about 10% of the time, and nearly 20% of tablets crushed before hiding in food or in a treat. We also asked owners in general, how easy it was for them to administer different formulations of medication where they had experience of this. And this is on first inspection, probably a little bit of a difficult slide to interpret, but I will talk you through it and, and hopefully all will become clear.

What we have on effectively our Y axis or each of these rows corresponds with a different formulation of medicine. So we've got insulin on the top line, eye drops, eardrops, creams and ointments, spot-ons, powders, paste, liquids, capsules, and tablets are the bottom row of data. We then have asked owners how difficult was it on a scale of 1 to 10, where 1 is easy and 10 is impossible.

And they were, asked to give just a, a number for each of the medications they had experience of giving. And so what we can see here is the data according to how easy or, or difficult it was for each of these different medications. And I actually find it easier if I just block out some of that data.

So if we just look at the, the values of numbers 1 to 3, so pretty easy. Let's block out the, the rest of the data. What you can see looking at the percentage of respondents, that, gave these responses, so that is the, the X axis at the bottom there.

Is that, for example, with insulin therapy, about 70% of the people who had experience of insulin therapy said it was pretty easy. They either gave a number 1, number 2, or number 3. You can see just over 40% of people who gave insulin said it could not have been easier.

They gave it a number 1 grading. And that was similar results were obtained with the spot-ons. You can see if you just track your eye downwards.

So spot-ons and insulin got the sort of easiest ratings, if you like, followed by creams and ointments. And we didn't specifically ask About transdermal medications because this was actually prior to the launch of Miritas in the UK, the the first authorised transdermal medication for cats, but that obviously would fit into that category or likely to fit into that category. And then after that, in terms of ease of administration, you can see that powders and liquids, probably look the, the next easiest category.

And then at the bottom, the hardest ones, eye drops. And, similar sort of overall results, looking at, those people that said it was a 12, or 3 with, with eye drops to capsules and tablets. So I hope that sort of makes it a little bit easier to interpret this data.

We asked the sort of challenges that people saw in their cats, the sort of behavioural challenges, that they saw in their cats. So things like spitting the tablet out, not eating the medication in the food, the cat running away from the owner, the cat scratching and biting the owner. And you can see in the table below, very, very heavy on numbers, but we've subdivided into our cat owners versus the cat owners plus.

These are owners who are also vets, nurses, breeders, rescue shelter workers, all those sorts of things. And then the total data in in the far right column. And what you can see certainly is that there are some rows where the cat owners seem to be having fewer problems.

So fewer problems with the cats spitting the tablet out, for example, they're probably better at putting a tablet in the cat's mouth. Fewer problems in terms of injuries, and, finding it generally a bit easier to, to hold the cat and give the pill. But nonetheless, still a significant number of cat owners plus having problems in giving their cats medication.

Just over half of cat owners said that giving medication to their cats at home had changed their relationship with the cat. Nearly half of them worried they would hurt their cat, about a third worried they would get bitten or scratched. Nearly 25% worried they would do it wrong.

So, significant issues here that we, I think are beholden to recognise and empathise with our, our cat owners. Whilst the cat owner plus typically had fewer concerns, they still did have concerns. So again, I think don't commit completely, diminish the behavioural impacts that even the experienced cat owners and the vets and nurse cat owners may experience in their cats at home.

We asked whether people always completed a course of medication, and as you can see, about 2/3 of, of the owners said yes, they did, quarter most of the time, but about 10% saying not always. And for those that didn't always complete the course, we asked, well, what were the reasons for stopping early? And you can see that medication being medication that was difficult to give cropped up in a couple of the reasons.

So, nearly 20% of people actually saying they stopped after a few doses as the medication was so difficult to give. And, between 25 and 30% saying they stopped near the end because the medication was difficult to give. Some people were stopping early on the advice of their vet clinic, which, of course, is fine.

Some people were stopping because either the cat was better or they didn't think conversely, that the treatment was working. So there were other reasons in there too. One of the most interesting sets of data I thought related to preferences of oral formulation.

Often as clinicians, I think we, we can make, tend to make predictions and, and, guess using our experience as to what people might want. But in this question, we actually ask them, well, what is your first choice formulation? And even those owners that didn't have any experience of giving all of the oral options were able to say what they thought their first choice and second choice might be.

And what we found was, certainly there was a clear preference for a first choice medication. That's the, the blue columns in the chart on the right hand side. So you can see just over half of owners, their first choice was a liquid formulation.

That perhaps is not a surprise to you. But nearly 30% saying their first choice was a tablet, so a significant number of people who do, like tablet medications. But the thing I thought really was interesting was actually the second choice medication, where you can see those orange columns are almost all similar height really, across the board, whether it's liquid, tablets, powder, paste, capsules, or, lastly, the, the.

I know, but certainly for those formulations, you can see it's a fairly even spread. So it doesn't appear to be that liquid is a first choice commonly, and then the people who have liquid as a first choice choose tablets as a second choice, and vice versa. It's really not that straightforward.

To me, it reads as owners might have a clear first choice preference. They may not have a clear second choice preference. Although overall pastes and capsules were were the least popular.

So the key findings from this study were that half of owners were only sometimes, or not at all, given information on how to administer medication. And those that were given that information did find it helpful. So I think that gives us an opportunity for just to remind ourselves and all of the staff involved in providing medication to owners.

So the receptionist that handed out, the nurses are all Also, that are involved in medications that we do need to have a checklist perhaps for, you know, is the owner happy about how to administer medication? Do they need more information and being able to provide good sources of information for them. Something I've not mentioned so far was that a third of the owners said they were not told whether or not the medication they, they were provided should be given with or without food, so a little bit of potential confusion there, but also something that could impact with certain medications on the success of the treatment as well.

Unless the half were not told whether they could crush a tablet or open a capsule which similarly may have consequences on, on the compliance and the treatment success. Under half of owners that did experience difficulties contacted their vet clinic, which is disappointing to read because these owners that do sort of surveys that I run typically are the really bonded owners to vet clinics, the ones that really listen to us and, and, take note of our opinion and our advice. So it was sad to see that they, they didn't feel perhaps that the first thing they should do would be to contact us if they had any difficulty medicating their cats.

Overall, liquids were the most preferred formulation, and interestingly, insulin injection, as you saw was the sort of winner of being easy. And perhaps the reason for that might be that we put a lot of effort into education and support when it comes to insulin injections. Perhaps something that we should take note of with respect to other formulations as well, particularly for those owners that are going to be doing this for, you know, a number of days, weeks, or, or longer in their patient.

Negative behavioural consequences do impact on owners. And so this is something that I think we do need to be mindful and I'll come back to the caregiver burden as well later in this presentation. So I think some action points following from that survey, certainly I've already pointed out things like having checklists, more information, perhaps simplifying how we provide information, perhaps following up, getting nurses to contact owners and find out how is medication going?

Do you need any support or advice? Of course, compliance extends beyond medication as well, so diet transitions would be another. Area where I think follow-up support would be extremely helpful.

Also, I think where possible, if people, certainly if people are struggling and finding things difficult, having an awareness of choice in formulations is helpful and making sure that the owners also are aware of that, so that if they are experiencing difficulties, they don't feel that there's no hope. They've just got that one option, otherwise, you know, nothing. So what else, what other sort of insight support can I share with you, that I, I've gleaned over my career and that I believe helps with compliance in, our cats, whether it's medication or diet, or indeed, investigations.

Well, I think the first thing Really, is to recognise factors which can have a negative impact on compliance. And I've put some ideas on here. I'm sure it's not an exhaustive list, but, understanding why something has been recommended, whether that's a test or a treatment.

And the prioritisation of that, the relative importance of that, I think makes a big difference, really. Like it or not, I think we are often, need to have a sales mindset when we speak to owners, you know, this is our recommendation in terms of the best possible outcome for your cat, is that you follow my advice, and this is why. So we need to really explain clearly, why we think that.

So why, why we think this is so important, what the objectives are, and really get our owners on side with us, because the compliance, the end result does very much involve that owner. So getting the good concordance, this term that I, I think I mentioned at the start as well, this, this shared decision making, this agreement. In the team.

So the owners had their face cropped off on the right hand picture, but the owner is absolutely pivotal to all of these discussions as well. Everything, of course, is focused around the health of that cat. But to get to that point, we need to very much involve that owner, get them into our team so that we're all acting together, to, to get that end results that we all want.

I think for chronic health conditions, so things like chronic kidney disease, hyperthyroidism, diabetes, all those sorts of conditions, education really is key as well. So that our carers understand what is this illness? What impact is it having on my cat?

You know, how can treatment help? What should I expect treatment to achieve? What potential side effects, what potential concerns.

It's, it's almost like we, we have to train them up to being, you know, a, a, a sort of mini, mini nurse or, animal care assistant that has, you know, at least some understanding so that they can be a really helpful part of our, of, of the team and feedback that really good data to help us, in terms of modifying the treatment plan so that we can work together, and really achieve the best outcome for our patients. So concordance again comes into it, understanding that individual situation. So what is the best way we think we can support collectively, this cat with its condition and its home background.

And again, some awareness, of the emotional impact many chronic health conditions can cause to the owner as well, I think it's really key here. And then when it comes to follow up and checkups, I think we also need to, work out what is appropriate medically for that patient, but also, what can be supported in, in a low stress way for that cat and that owner in an ongoing basis. So I'll come back to talk about, stress associated with vet visits a little bit later as well.

So for me, it's trying to have an approach that really is as individual based as possible, so focused around that patient, it's, it's home life, it's owner situation, the other animals in the household, or the other parts of the owner's life that may be impacting on management. Involving the carer to the extent that they want to be involved, which of course does vary, but if they are keen to get involved, that is absolutely brilliant because then we can hopefully, in a way, train them up to be that, additional clinician, or semi-clinician at home that is, is, providing information, to us and allowing us to collectively make the best treatment plan to support that cat. Education again, really helpful.

So, providing whatever sources of information we can. Luckily, the internet does have a lot of good information. But if we can direct owners to the sites that we trust, then that is, you know, obviously the ideal rather than them going off on their own and perhaps, falling down a rabbit hole of, of, something that we would not agree with as much.

And I think the main thing that I would always emphasise to my clients is that whatever plan we make today here and now, it's, it's just the plan that we feel is appropriate today. If anything changes, whether that's in the next half an hour or the next 10 days, we can review that plan, we can change that plan. So, you know, just keep in dialogue, keep in discussion.

My own website, vetprofessionals.com has a lot of information on chronic health conditions like kidney disease, hyperthyroidism, for example. So, there are a lot of good client resources there.

The books as well that I publish are Aimed at cat owners. But if you look at the top menu, helpful info and go down to video tutorials, you'll see a mention at the top of the video tutorial page about, the cat cafe sessions that we ran during lockdown, 2020, 2021. And there are a lot of different topics covered on there.

So for example, webinars that are free to access on things like hyperthyroidism. So whatever you can provide, wherever you can point your own is in terms of educational resources, I think will very much be appreciated by them. Also, of course, bear in mind that anyone who is coming into your clinic, is generally doing so because they do actually trust your recommendations and they trust your advice.

And this is something that very much came out, in an earlier paper that I did, with owners of cats with chronic kidney disease. Where we asked, whether they were feeding a therapeutic diet for kidney disease, whether that was a recommendation that they had been made by their vet clinic. And as you can see from the pullout quote here, perhaps, you know, superficially, very unsurprisingly, those owners that were aware of a veterinary recommendation to feed a therapeutic renal diet were much more likely to be doing so than owners that were not aware of that recommendation.

And, but you can see just how big that uptick is, if you like, in that we did have 7% of owners who, in spite of having not received a vet recommendation, were feeding some therapeutic renal diet because they've been off and done some internet research and found out that that was, that was a good idea. But the power of vet recommendation means that, you know, if it's something that you talk about with your clients in the consulting room, it's much more likely to happen. And I think that this same principle is likely to apply to other aspects of that care.

So whether that's preventative healthcare or compliance to medications that we're recommending. I think it is also very important though to have some flexibility in our approach and not to present either an all or nothing, or too rigid, a, a, a, a, a sort of presentation of the treatments that perhaps we think. Is needed for this patient.

A good illustration of that, it was this survey, which was a survey of veterinary professionals looking at reasons for, euthanasia in, animals with diabetes. And as you can see, over 1000 vets completed this survey. And what they felt was useful, having looked through, the responses that they got in this survey, was really that, people felt that a flexible approach with a, a range of treatment options from the really intense sort of, diabetes management to a more hands-off, low-key.

Less expensive approach was worthwhile because then the owners can to a certain extent, choose the style of treatment that fits best with them and their their aims and perhaps their resources available to them as well. So choice and involvement in decision making being really important considerations. In this second study, this was actually looking at compliance to dental surgery recommendations and involved videoing a large number of consultations where dental surgery was recommended and looking at factors that resulted in successful conversion, if you like, of that recommendation.

So which owners actually went ahead with that dental surgery. And what they found was that the best results really were where, the focus in discussions was, very relationship centred. So really focused around, that animal and that client and the discussions of, of the impact to them and where recommendations were as clear and unambiguous as possible.

It's really important that we don't prejudge what our clients might want and that we do present them with various options, or at least not lead them into just a, a, a narrow array of, of possibilities, but take some clues from them, in terms of or ask them really what, what they might feel most comfortable with where appropriate. And then I also mentioned the caregiver burden earlier on. This is something that has been looked at for some time in the context of human medicine.

So it's the emotional and psychological impact, that, and also physical impact of care. For another human being in a human context. So whether you're caring for an elderly relative or unwell child, particularly in a more chronic sense of of care, it's known that that does have a massive, potentially massive impact on the caregiver, what's called the caregiver burden.

And it's now something that's being looked at in a veterinary context. And Mary Beth Spitznagel, the author of this paper, she's an author and co-author on a number of caregiver burden papers that now have been published. It's finding that in the vet world, this, this also is something that we should very much consider as an important consideration.

When discussing medication and care, chronic care of our patients because it just may be that, depending what other things are, our carer is having to deal with as well, that, they are going to need more support or perhaps they will not be able to do, as much as we would want them to do because of, of other pressures in their life. And I also mentioned I would come back to stress associated with the vet visit. We all know that cats are often do find coming to a vet clinic difficult, and this is one of the surveys that illustrates that the impact that stress can have also on the owner's behaviour, because in this survey from 2010 of own Attitudes to vaccination, it was found that more than 25% of owners stated that stress to their cat during a visit to the vet clinic was a very important factor when deciding whether or not to vaccinate their cats.

In other words, those owners that found visiting the vet clinic very stressful were less likely to vaccinate their cats because they just couldn't bear to go through that stress. It was stressful for them as well as for their cat. And that's also emerged, similar data also emerged really through other surveys.

So this is a Bayer survey, in the United States. Nearly 2000 cat owners. Why don't you take your cat, to the vet?

Nearly 60% of owners said the cat hated going to the vets, and nearly 40% of the owners said even just thinking about a vet visit was stressful for them. So stress definitely has a big impact on our cats and our cat owners, and that can affect compliance as well. This is a more recent survey which I did with, again, the vet professionals.

Database of cat owners, and we found that almost all of the people who participated in the survey said witnessing stress in their cat had an effect on them, and it was moderate or severe in three quarters of the owners, with almost a third of them again saying witnessing stress in their cat puts them off visiting the vets. So we do need to be mindful of this in our patients. So for those, again, compliance to long-term follow-up, compliance to checkups, I think, the, the thought process should include, consideration of, well, is a clinic visit really necessary for this situation?

Can I get the same information by speaking to the owner over the telephone or doing a video consultation? And of course, just emphasising here that, telemedicine video consults, really the benefit is not to see the animals. So that, picture of, the Zoom screenshot with the cats in shows is, something that will be familiar to any of you that were working during COVID.

But the benefit. It really is not seeing the cat. It's seeing, it's speaking to the owner and taking that history, and ideally training your owners to provide clinically useful, clinically relevant data that can allow you to make, useful decisions about the management of the patient.

So where a visit to a vet clinic is unavoidable, I think we need to be as cat friendly as possible and as understanding and empathetic to our cat owners as possible as well. So, particularly for those cats that get very stressed, you know, we need to minimise these visits, potentially book them at quieter times of day, potentially give advice on things, whether it's, you know, the cat. Comes in in an unsuitable carrier, which adds to the stress or whether the cat would benefit from pre-visit anxiolytics such as gabapentin, all these sorts of things, I think, are, are form an important component of successful compliance as well.

We need to keep everyone on board and, you know, with us in our treatment plan to get the best end results. And then I guess, last but not least, really just a bit more discussion about medication itself, and the sort of considerations here. So we've talked earlier about the owner insight from the, the recent survey.

From a clinician perspective, I think it's firstly important to discuss with owners if they do have preferences, but also if there are choices, you know, perhaps, you know, allow them to choose the formulation that they would like to go for. Make sure that we do ask if they need any tuition or support to achieve that medication. And bear in mind that the results may, may not always fit with your, preconceived notions as, as to what to expect.

I think a good example of that from my perspective was, a survey that, vet professionals did, several years ago on, treatment for parasites, fleas and worms, own. Preferences and owner experiences. And certainly, the, the feeling in the, in the profession really was that, well, lots and lots of spot-ons available.

You know, what could be easier than a spot on? You, you break open your tube or however it opens, and you squeeze it on the cat's skin, you know, surely that, that could not be easier. But then again, any of us that have cats will know that actually, sometimes it is not that straightforward.

And this survey really, bore out that because as you can see, about a third of the owners actually said they, they would prefer a tablet. So, you know, I, I think we need to, to be mindful of making assumptions, and, to make sure that we do involve owners in, discussions and decision making. And the, the date from this survey was, replicated in a more recent, market research done by, one of the manufacturers of, .

Anti-parasitic medications. So it does, does seem to be a consistent finding. And actually not that dissimilar to our, oral preferences in that a third of owners preferring tablets is, is not so far off the, the, I think it was under 30%, but more than 25% of owners in our large survey that said, they preferred a tablet as their first choice.

Tablet versus liquid, well, perhaps also we can't make generalisations because it maybe does depend on the liquid and the volume and perhaps on the individual as well. So again, ask the owner. Treatment frequency?

Well, again, I think we should be careful about making assumptions. The easy assumption might be, well, the less the cat, less frequently the cat needs to be medicated, the better. But this was a survey I did of owners of cats with hyperthyroidism.

And what we found was about 80% of the owners were quite happy dosing their cat twice a day. They didn't see once a day as a priority for them, or a motivation for them. They, you know, I think 3 times a day is difficult, as a frequency for many owners that, that are out at work, but twice a day often is, is reasonably practical.

So, perhaps, you know, don't always assume that, that, that once a day, priority is what the owner has as well. And this is, some data from that study where I can see, the number of owners that agreed with various statements. The bottom statement is once a day medication is the most important aspect when choosing a medication.

14% of people agreed with that, and, and we did later in, in. Or at different points in the survey ask how easy the cats were to medicate. And about 12% of the, owners said that the cat was almost impossible.

So, obviously, these people are going to prefer the less frequent option. But I guess many cats, either are not too difficult to medicate, or the owners get very confident and competent in medicating them, which means that killing my cat twice daily is not a problem, starts to, to rise up there. And you can see from their, their treatment factors with hyperthyroid cats in this study, the priority more was, well, what's best for my cat, you know, what's gonna be the right dose, what's gonna be, you know, the least risky for causing issues as well.

Some other important reminders. So some medications, do, either have historically been advised that we, we give on food, thinking of things like non-steroidal anti-inflammatories for chronic pain management. That's been a long-standing recommendation often made from, from a safety perspective.

So it perhaps becomes slightly tempting, particularly with liquid medications to, to just assume, I think. Maybe clients maybe assume. That is that, you know, a, a, a good and correct way of doing it.

But in general, if we want that medication to, get into the cat at the time of day that we want it to receive its medication, then the best thing is typically to give it by mouth. So direct dosing of the cat. So that should be our first recommendation, and particularly thinking of things like thyroid medications.

We want that correct cat to get the correct dose of medication at the correct dosing interval. It is important to consider whether or not administration with food is likely to be better, worse, indifferent, when we're advising our clients as well. Also be mindful of numbers of medications.

If you have cats that start to be on multiple medications, 3 or more, almost inevitably, there's going to be the possibility of, of interactions, and some of these are known about and can be checked about, others perhaps less easy. There are a variety of ways of successfully giving a pill to a cat. This lovely video montage, which Dera kindly put together for me, was a competition that we ran through vet professionals asking owners to send in videos of them giving medication to their cats and sharing their tips.

And then this is put together. One of the really Lovely empowering things I see with this video is that, pretty much all of the videos were one owner on their own medicating their cat. So it's not multiple people involved.

Sometimes there's a second person doing the filming, sometimes not. But it's typically just one person. And, doing it, which is, I think, really reassuring to any owners that have not had to medicate their cats as to, you know, that this is something that's straightforward for them to do.

It's not gonna be a massive issue. And as you can see with the montage, just a, a variety of techniques, you know, including the pill shooters, treats as well, being employed. As, ways of hiding medication as well as, as a variety of ways of direct medication into the mouth.

So, all sorts of, of tips and tricks that are, are in that, that video. And that's on the, under the helpful info video tutorial section of the website. So important that when we do make any prescription that we do check whether the owner has experience with that cat, whether they know what to do, whether they need us to give a little tutorial or share videos that you might have put together yourself or feel free again.

To direct the video tutorial page of my website. This video is just myself with one of my former cats, who's very, very easy to medicate, as you can see, just demonstrating a technique, but the, the other video montage I mentioned is also there as well. And make sure our instructions are clear and unambiguous.

For cats on more than one medication or where the medication is perhaps 1.5 pills, the, the empty gelatin capsules can, can come in handy. A variety of pill pockets, treats, and pastes, as you'll know, are available that can also be very helpful.

And, it can be, Sensible recommendation in general to separate medication from eating, particularly with those cats that are unwell. We don't want them to associate being offered food with the sort of handling and restraint that might be stressful with medication because we don't want it to cause a food aversion. Important that clients know that whenever a pill or capsule is given to the cat dry, as in just administered directly by mouth, that it should be followed with either some water or food or a treat, where permissible with that medication to take that down to the stomach.

And a handy little, trick, which, I always delight in telling. Clients has been scientifically tested, which is absolutely true, is the butter on the nose technique shown on the left hand side. So, many years ago, an abstract it's ACVIM, was actually a study of cats being given, tablets and capsules dry.

And, they tracked what happened to those, using scintigraphy, so. I could see that they were, staying, sorry, not grey. I think fluoroscopy, apologies.

So, radiographically and could see that these, these pills and capsules were just sitting in the, oesophagus and not going down to the stomach, after. And, you know, half an hour. Whereas if you put a blob of butter on the nose and the cat licks it off, that will take the pill or capsule down to the stomach in 30 seconds.

So some, even a small amount of something is enough to just lubricate that pill or capsule and take it down to the stomach. So, in summary, compliance definitely can be quite challenging in feline medicine for a lot of different reasons, as, as we've talked about. Carers, I think, often do want to be involved in decision-making discussions and very much involved in the care of the cat, and it's up to us to come up with a formula which feels the best formula for that cat, it's medical condition, and also for the owner and their ability to achieve it, and, without, hopefully, adding too much burden to their life and too much stress to their life.

So involving them and making them part of the clinical team really would be my recommendation. I think where possible, but it have some flexibility in your approach, offer choice, you know, be a problem solver, and success hopefully will follow. And a final reminder of my website, vetprofessionals.com, the publications that are available there in, in the shop section.

But the helpful info is all the free to access things. And if you're interested in the surveys that I've mentioned to you, then the survey tab has got a page of, previous survey results on there as well, so you can see the sort of work we do. And of course, if you're interested in collaborating in future research studies, please do get in touch as well.

Thank you once again for listening. I do hope that you've found it helpful. Thank you very much.