Hello, it's Anthony Chadwick from the webinarett welcoming you to another episode of Vet Chat, the UK's #1 leading veterinary podcast. And I'm super pleased and privileged to have two fantastic guests on the podcast today. We've got Natalie Daray who is the head of the International Society for Feline Medicine, and we have Jody Lulich, who is the, a professor of medicine at the Minnesota Veterinary School.
He's also the director of the Minnesota Eurolith centre. And of course this brings back a lot of memories from my early career as a vet in the 90s, when I used to be finding stones in cats, sending them off to the Hills free service and then getting a report back from the Minnesota Euralist centre with Carl Osborne's name on it, . You're a very worthy successor to Carl Jodie, and I really enjoyed the lecture that you gave at ISFM in in Dublin.
A couple of pints of Guinness were all so drunk while we were there, but, a fantastic conference, and of course well done Natalie, for organising such a great event. Well, thank you for inviting me and certainly you're right, I have big shoes to fill. Carl is not only a very bright but very kind veterinarian and has contributed tremendously to the profession and to the welfare and health of cats.
Just before we go on to the, the, the theme of today's podcast, which is very much all about improving feline urinary tract health, we know that cats can have problematic waterworks sometimes, but I thought it'd be really nice just to perhaps introduce yourselves, the sort of background, how you found yourself one as the head of ISFM and and another a person who looks at urinary stones quite a lot of your time. Jodie, do you wanna go first? Sure, so, I have a very interesting career in the sense that I came as an intern to the University of Minnesota and I really did not want to be an internist, but Carl Osborne sat me down in the middle of my internship and offered me an opportunity I couldn't refuse.
He said that, would you like to be an internist and would you also like to do a PhD so it was not like a small venture. And you know originally I told him no but Carl's a very persuasive person and when he came back the week later he told me that, well he asked me that question again and I told him no again but then he didn't take no for an answer he told me that I needed to respond to him within a week or two because the University of Minnesota didn't have a residency with a PhD and he had to create it and that's what got me on that realm. I thought that .
He saw something more in me than what I saw in myself, and he was certainly a wonderful mentor and a wonderful contributor, not only to the profession, but to my education and also to my career. And how about you, Natalie, how have you made your way to be the head of such an august organisation? Oh gosh, my career is, well, like Jodie, in some ways, it's been taking up on opportunities when they've they've sort of appeared.
So, I very much am a general practise vet, as my background, but I've always been exceedingly speciesist, I have to say. . I've, I've, I'm a cat fan and I've always wanted to be working with cats.
So even as a GP vet, feline medicine was always my area of interest and where I started to focus my CPD, people like Jody had a massive influence on that. I listened to his lectures. I'm not gonna say how long ago for both of us, but he attended one of, the previous ISFM conferences in Edinburgh, and was such an inspiring speaker.
In the sense that still, when I do a cystocentesis on a blocked cat, I hear his voice in my head. And so it was, it was that kind of, sort of side of things that I got my interest growing more through my, just being a member of ISFM and then I actually segued into feline only shelter practise for a number of years. And then a PhD opportunity presented itself and I thought, why not go for an interview?
And then I, I sort of carried on, in the sort of academic world with my PhD, which is an ageing of cats. So I'm still very interested in that kind of more population-based medicine. And as the, the PhD was coming to an end, there was an opening, with the ISFM, where I sort of just had an email saying, we've got this job coming up, would you be interested in applying?
And yeah, I got very lucky actually that I was sort of successful with that application. So, I've been with the charity now. For 3 years.
And I still, am a very, very, very part time postdoc with the feline Healthy ageing Clinic in Liverpool as well. So I, I'm technically 1 day a week, which is kind of half a day plus floating time. So this evening, I'm going to spend some time doing, some statistical pictures for a paper that I'm working on at the moment, but, it is, it is still nice to keep my hand into that research world as well.
And it, it's good, Natalie, we, we can call you, an adopted Kiwi cos er an adopted scouse kiwi, cos of course you spent some time in Liverpool, which is, which is where I'm based. And just for those people who are listening or watching on, on video podcasts rather than just podcasts, if cats do go across the screen during. That that's quite normal.
This isn't a podcast actually, it's a podcast because of course we're just going to be talking about cats. So I, I have the cat that adopted me during the pandemic on my lap, and I know Natalie's cats are, are moving around. Jodie, I think you're at university, so you presumably have to be a bit more careful about cats all around the the actual building.
Yeah, I, I have a wonderful cat at home, but my dog comes to work with me, so my dog is somewhere under the under there, under my desk there on a on a nice cushion sleeping. I suppose we should start off seeing as you mentioned it, Natalie, in your intro. Decompressive cystocentesis, I, I found, you know, as a vet in practise, obviously seeing cats, loving cats, but sometimes it could be really, really difficult to actually get a catheter in there.
Is that something that we're allowed to do as general practitioners, or is it something we really mustn't do? I don't know if Natalie, you want to go first and then let's get Jodie's opinion. Yeah, I mean, I can give my thoughts and then I think Jodie will be the, the more definitive answer.
But, especially when we've got a blocked cat, personally, I find it easier to pass a catheter once I've done a decompressive cystocentesis. And when I said earlier that Jody's voice is in my head, at the conference that he spoke at for ISFM, he did this wonderful demonstration with a balloon. And I always think about that.
I think actually if your techniques right and you're careful, . It is a reasonably safe procedure to do in these circumstances. It helps stabilise the cat, perhaps more rapidly in terms of you get that pressure off the kidneys, gives you a little bit more time to sort things out potentially.
And one of the things that I think was really important that came up in Jodie's talk in Dublin this year was that importance of not just diving in with a catheter but imaging. These cases and working out what is causing the blockage, if there is a stone causing the blockage, what is going on before you dive in with a catheter. But it is something that people have really mixed opinions on, and some people think there is a real concern that you might cause a euro abdomen.
So I'd love to hear Jody's thoughts on this because he is, he is more the expert than I am. Yeah, I, I think it's a wonderful thing to do so, you know, it, it helps the cat in several aspects. Number one is these cats are very painful because their bladder is over distended.
If you can minimise that over distention, you can reduce their pain and they'll be more cooperative and you may not have to use so much pain medication. The other thing is at least 50% are metabolically abnormal and so you can start that process of allowing the kidneys to recover and also recover that metabolic abnormalities much sooner than if you're trying to do more medication and things like that and then last that Natalie already mentioned is that if you're going to go ahead and and flush material from the urethra back into the bladder, you have less pressure. So what the studies show is that it's very safe to do there.
I think there have been 2 or 3 now. I think I'm really aware of 3 contemporary studies, 2 that are retrospective. And one that was prospective that said that it really wasn't associated with any harm or anything like that but it doesn't mean that you should do it cavalierly.
What it means is that if your animal is very painful before you do a decompressive cystocentesis give medication so the cat's more calm so that you're more calm. Think about what you're doing so I like when Natalie said she hears my voice because that tells me that that we're really thinking about what we're doing. How we're getting the equipment together and that we're being kind in the process of doing it so I think those things are are really just so so important and when we're talking about, you know, when we treat disease what we wanna do is treat the cause.
So one of the reasons why they're so metabolically abnormal is because they're obstructed in this way you can alleviate their obstruction it'll buy you some time and allow you to do other things that will allow you to take care of this cat better. The last thing is everyone has ultrasound machines in their practise today so if they're worried about going in the wrong place or any of those other things, they can actually put an ultrasound probe there as well and it can help direct them and hopefully alleviate that veterinarian's anxiety about doing this procedure, but I think it's very helpful in many aspects in terms of the care for our cats. I know, at the lectures that you gave at Dublin this year, .
Talking a lot about how rare idiopathic cystitis is, and part of that rationale was, again, you know, a GP in a rush, maybe does some decompressive cystocentesis and then . You know, hasn't taken a radiograph, maybe has missed a urethral plug. You've then put a catheter up, the urethral plug is obviously pushed up into the bladder and disappears.
And so therefore we don't see any evidence of any stones or whatever, and we call this a idiopathic cystitis. So it's really important, would you say that we should be pretty much X-raying all the bladders we see, or is that not an essential thing to do? No, I, I think it's really important.
So when I look at a cat and looking at the, the, maybe the three most common diseases, it's gonna be idiopathic cystitis. Remember, that's a diagnosis of exclusion, stones and plugs. Those are gonna be the 3 most common.
Now, in order for you to make the diagnosis of idiopathic cystitis, because we still need a lot more research and we need a marker. We don't have a marker yet for that disease, so we have to exclude the other things in order for us to exclude those other things, medical imaging is going to have to be performed. I think an X-ray is a good way to do it because it looks at the urethra, and some of our animals could have urethra obstruction because of neurologic disease and so the X-ray will also pick up abnormalities in the spine as well.
But for those who have an ultrasound that may be a good starting point. You may be able to see stones in the bladder, but we haven't gotten our machines or our techniques, so well that we can look at the urethra completely, so you may need to do a combination of both, but you may also find the an an answer just by doing an ultrasound too since I know that's very convenient and your staff and yourself are not exposed to ionising radiation, and it's very easy to do quite quickly. But I, I, I presume that plugs are actually much more difficult to see on an ultrasound, whereas they'd be easier to see on a radiograph.
And I think Natalie was bringing up a point, before we started that actually some clinics, some cat only clinics don't have X-ray machines, so maybe that's something that we need to look at if we are running a cat clinic, that an X-ray machine is actually quite an essential piece of kit. Yeah, I, I think it is an essential piece, especially since cats get diseases in other parts of their body, and the X-ray machine is a wonderful thing to look at the lungs, although we can see some things with the lungs like if they're overhydrated, but it's difficult to see pulmonary pathology. As well, without having that benefit of an X-ray, but who knows what the, the future will bring?
I think the, the future is gonna bring newer imaging modalities that will allow us to look even better and have more accurate diagnoses and have a more accurate picture. So hopefully that's coming. Yeah, Natalie, do you, you've obviously looked at this with ISFM is that a, a survey that you've done that you've seen that there are, you know, quite a number of cat only clinics that perhaps.
Don't have X-ray machines and this maybe is an area that we need to really consider and improve on. Yeah, it's definitely a trend that we're seeing through our cat friendly clinic programme as part of the application process. Obviously, we see a lot of branch clinics applying as well.
So some of them they may be availability of an X-ray machine and maybe the main hospital, but not Necessarily in the, in the sort of smaller satellite site. But yes, definitely with smaller clinics that may be establishing themselves when they haven't got an unlimited budget to be able to spend on things, there definitely seems to be a trend that imaging wise, they may be spending the money on getting a an ultrasound machine in place first and Because we are an international charity, I think the trends are really varying from country to country as well. My definite feeling when I moved to the UK from New Zealand many years ago, was that things were a lot more stringent in terms of having radiology in your practise.
So there was a lot more health and safety. Considerations that were involved in that. And again, I think that varies from country to country.
So sometimes an ultrasound machine is just an easier option for them to have available. And if they're having to make cost decisions, it's the piece of equipment they probably use a bit more. Yeah, so it is, but I think again, as Jodie said, The quality of ultrasound machines available to us in practise has increased significantly in the 20 years I've been working and, and it'll be very interesting to see what the future shows.
Jodie, what do you think about the, the new trend I think over the last 3 or 4 years we've, and we've certainly chatted to some of these companies, the sort of pocus ultrasound. Are those machines good enough, you know, to have in general practise and to be able to scan a bladder and to be able to pick up stones. Yeah, so, so, so the wonderful thing is that picking up the bladder is, is quite easy to learn and quite efficient as well, but there are some things that we need to worry about, and that is that when you're looking at the bladder, if two stones are touching each other, you may not get the accurate size of the stones because it'll look like one.
The other thing is that often when we try and predict the mineral composition of the stone, an X-ray a . An ultrasound doesn't pick up the different densities and it may also have a difficult time picking up the exterior contour and those are important things for us to try and predict mineral composition before we do surgery or to look for the underlying cause of of why that stone forms but the answer is it's certainly doable so when I think of the future, if we're gonna go to a more ultrasound, what they need to do is develop devices that allow us to look at the urinary tract. So you know, for you and for you and I, although it sounds a little disgusting, they can put a probe in your rectum.
And they can evaluate the lymph nodes that are that are in that area and they can also evaluate the urethra and other things so with time and with companies seeing that this is profitable for them because you know you don't, you're not gonna develop something sometimes out of your. Part of business needs to know that it's going to it's gonna allow them to continue their research development and grow the business that that I'm hoping with time we'll develop more tools and opportunity so that our ultrasound machine will become more versatile so that would be the goal I I'm really surprised because dentistry is very important in a feline clinic. And you cannot look at the teeth with an ultrasound machine very well, so they have to have some X-ray device in order to make sure that that preventative therapy works.
What we need to do for the future is we need to think of companies that can develop all of these attachments to our ultrasound machine that will allow us to to do a better job, to do a good job, to do an accurate job and to minimise our exposure or the patient's exposure to radiation. So do I think it's doable? I think it's very doable, and some of the models are already out there for us to do a better job.
Jodie, as I said before, I, I was a simple dermatologist and my favourite piece of kit was actually a microscope. Do you think that, so I love doing cytology, usually of skin, but I think urine is a great place to also do cytology, to recognise the difference between oxalate crystals and struvite crystals, and part of the problem, I, I used to see people sending off urine samples. And of course 2 or 3 days later they got a result back, which really bore no resemblance to what they'd sent off.
So perhaps talk to us a little bit about, because it was really interesting in the talk, how people miss things like strew back and then going to do an operation. Do you think there's a, there's a place for urinary cytology to look for things like crystals? Is that, is that something you would do routinely in Minnesota?
Yeah, so I always have to remind people that when we talk about lower urinary tract disease of the cat, this is mostly a young cat group. It's more common between like 1 to 71 to 9 years of age. It means that your serum chemistry profile and CBC are going to be less helpful.
So looking at that urinalysis will be good. The wonderful thing is business has began to respond to us now we have automatic analyzers that you don't have to centrifuge the urine or even if you have, even if you do, you can put it in a in a device that sort of you can have in your lab that will take pictures and you can get consultation on it so that's one good plus right away. The second good plus is that sometimes we as veterinarians don't rely on our veterinary technicians and nurses as often as we should, and this would be an opportunity where the veterinarian doesn't have to look through the microscope to begin with.
What the what the veterinary nurse can do is, get the urine sample and they can take a look first and if there's something questionable nowadays you can take a picture so easily and store it. That the veterinarian can look at it or even a specialist outside of your clinic with all the all the electronic capabilities we have today so I think they're missing a lot if they if they don't look at the urine sample shortly after it was collected and our profession is moving in that direction so I'm assuming that we'll be better at managing lower urinary tract disease and urinary tract disease in general in caps in the future. Mm great.
Natalie, you got anything to add to that? No, I definitely agree. I think we don't.
I think it's such an important thing that one of I guess the issues, especially when we have, say, a cystitis case presented is often at that point they have a small painful bladder. That's not necessarily the time we're going to do the cystocentesis. If we're lucky, the owner is able to collect that sample from home and bring it back into us, but I'm definitely going to say I'm guilty of it, and I suspect a lot of people are is doing that follow up piece to make sure we get the urine to then fully work them up because often they do recover, they recover from our treatment, our our advice, in terms of diet.
And water intake changes to the environment. And we never really get that chance to actually make a diagnosis. And maybe we don't come back to them until they've had a repeat episode.
So that sort of follow up and making sure we are doing the urinalysis, I think is really important. Yeah, so what I'm what I'm hoping will happen is, is, is once veterinarians think it's really important in their in their game plan, hopefully what they'll do is they'll set up a plan. And that plan could be is that the owner could give pain medication at home before bringing the cat in so the cat does have a bladder that has urine in it or what we do is is we realise that if it's not too stressful for the cat to stay in our hospital, tell the owner to go to work, leave your cat with us for the day we'll.
Hopefully be able to get a good urine sample whether it's a free a free pass voided sample or whether it's a cystocentesis with an ultrasound, that would be the best bet for us to reach a diagnosis sooner, provide a therapy that is more directed and hopefully also cost effective. And make your cat better in a shorter period of time instead of guessing what the disease is we'll have a better handle on what we could actually do, what's going on and provide the most up to date and the most effective therapy. I, I remember Jodie in the 90s, although I was a vet, and I think these exams were more for the nurses.
I did all the nutritional exams, I think there were 55 grades and I, I did all of those because I thought nutrition was so important. Obviously learned about struvite stones, realised that it was really possible to dissolve them with some of the fantastic diets that Hill's had at that time. So I was really quite shocked during the ISFM conference when you came up with stats that said 50% of struvite stones are diagnosed via surgery.
You know, nobody wants to go through a piece of surgery unnecessarily or to put a cat through. A surgery unnecessarily. Do you think that perhaps that is often down to the inexperience of the, the veterinary surgeon, so maybe is it a young surgeon or is it an old surgeon who hasn't looked at them.
What, what do you think's going on there that we're still missing? What is a relatively easy diagnosis to make and then but seeing stones on a, you know, on a, on a x-ray and then immediately thinking we have to go in and sort this surgically. Do you think we still, as a profession, haven't embraced nutrition enough in cats?
So it's it's a difficult question for me to answer because I think it's a cultural question and that cultural question may have financial implications that may have implications of what the owner's expectations are and it may also have implications upon the skill and knowledge of the veterinarian . So I think we have to attack it from all those all those levels. So what we need to do is provide the veterinarian with the resources so that they have a way to communicate with the client and also that the veterinarian has some type of fallback plan.
So a goal would a goal would be is that a goal would be is that the most common stone in cats is struvite, and the good news is that we can resolve this very quickly. With dietary therapy and the owner needs to hear that as well and maybe the owner needs to also hear the financial implications and and everything and so I think we need to change the culture so we we need to say you know we're not right with everything we could have made the wrong prediction but what we're gonna do is we're gonna set up a plan so if this doesn't work we'll set up surgery. The other thing we need to do is we need to let veterinarians know that all owners come with us because of their, how can I say they're in a situation where they want the urine in the house or urinating in the house to stop tomorrow and I guess what they need to realise is yes we can manage the disease today.
But then we still have the recovery from surgery so the urine may in the house may not stop but you know so we just need to have those backup plans but I think what we need to do is we need to change the culture and we also need to tell the veterinarian that it's OK if you don't make the right prediction on the mineral composition of the stone but here are some things that we can give you to help you make that prediction easier it's a young cat, you know, it's it's not associated with infection. And it's not associated with stones in the kidney usually these stones are, are they have a unique shape some are disc shape and they don't have the density of, of bone and so hopefully giving them those tools as well as our Minnesota Euralist centre app hopefully what they can do is they can be more accurate in their prediction instead of feeling as though they failed and now we have to go to surgery anyway and so I think that's the reason why they do it sometimes is . If we don't give them enough of a fallback.
So that they don't feel like they failed, but what they feel like is they've done a good job in terms of in terms of listening to the client, listening to the cat, knowing that our goal is to is to minimise pain and suffering and I always think it's unique because when a surgeon does surgery they have to actually do surgery on healthy tissue before they even get to the bladder and so we just need to have that cultural mindset we're getting there we're just not there yet, but we are getting there. I think it's interesting and I know Natalie, this is, this is one of your areas of of er concern. When we're using Struac diets, we're obviously acidifying.
But is the dilution important as well, so should we be feeding dry or, or, or tinned foods, wet foods? I don't know if you want to, sort of give your thoughts on that, Natalie. Yeah, and it's, I guess as Jodie said, we're talking about a disease in young cats and my area of research interest is the older cats, and obviously there's often other things going on in terms of making sure they're well hydrated at that age, but Definitely my thoughts in terms of feeding a mixed diet, because some cats can be notoriously neophobic about new tastes and textures.
I'm definitely a big advocate from a young age of making sure that they're comfortable eating both. Cost wise, dry food. Foods are a lot more cost effective.
So, generally, I tend to feed a slightly higher proportion of those with younger cats, but I still make sure they're getting some moist diet, as well. And then as they get older, that balance slightly shifts as the kind of general plan I find. But I, again, it's something that I find super interesting in terms of that prevention question as well around, sort of trying to prevent stones from redeveloping, is how much do we need to rely just on the diet and the composition of the urine and the acidification and how much does the concentration of the urine play in that as well, because again, a lot of these cystitis cases, regardless of the underlying cause, seem to have extremely concentrated urine and To me, it was probably the big thing about the Memo study when it came out is when you sort of look at all the environmental modifications, a lot of it was really just aiming to dilute the urine as well as reduce stress if there were stressful events.
But when you talk about modifying behaviour of And it's to me creating an environment where the cat feels comfortable to go and have a drink. So it's sort of that side of it, I would, I would love to hear Jodie's thoughts on that wet versus dry debate, and how we dissolve them, but also what that prevention pieces as well. Yeah, it's a, it's a, it's a very interesting question, so you know I'm gonna answer it in terms of different stone types.
So what we know about struvite is, is that diets that moderately acidify the urine are very effective. We can get stones to dissolve in a week with a cat on a dry diet. If we have an animal on a wet diet, it's probably gonna dissolve quicker, but the question is what's the trade off?
Is it gonna take you longer to make the transition to a canned food and maybe a shorter time to make it to the dry food, which means the stone will still be gone at a very reasonable amount of time. So the wonderful thing is that diet companies have responded very well to struvite. We can use canned or dry, which I think is really good.
When it comes to the other stone types, it's more difficult. They're difficult stone types we don't understand the underlying cause and so oftentimes what we're doing is we are minimising a variety of risk factors. One of them is nutritional, one of them would be hydration as well, so we, we need to take that into account and so in those situations where we cannot correct the underlying disease or can't modify it very well.
We can try with dry diets initially if that's what the cat really wants, but if that's not working and it's gonna require additional care for the cat, then making that gradual transition to a more canned diet or figuring out other ways, whether it's the environment, whether it's water fountains, whether it's the size of the bowl, all of those things are gonna be helpful in the long term to minimise a future surgery for a stone like calcium oxalate or urate. So it really depends upon the stone type, but I, I agree that as cats become older, some of their urinary diseases respond much better if they remain to be well hydrated and so if we can make that transition as a preventative thing later in their life, that would be great, . But sometimes it's difficult for not only our owners but also our cats, so getting them used to both of these types of foods early in their life may be a way to not have it be so stressful if we feel that a change to a canned food would be more beneficial to the long term health of the patient or can.
And, and also Jodie, having water freely available, cats are very fastidious and sometimes, especially if they're in multi-cat households, if you just have one source of water or, or for food for them all to dive into, you know, cats just really get freaked out by that sort of treatment, don't they? Yeah, giving them options is is really good and also for the pet parent to understand what options those cats really like so they can augment them in other places of their house or using the right water bowl or a low water bowl or or things like that so it would be good for the the owner just not to give water but also pay attention to what cats really prefer or what their cat prefers would be a way to modify this as well with less stress for the cat. The cat that adopted me during the pandemic actually likes to go out to the bird bowl and drink from the bird bowl, so I have to make sure he can get free access to that as well.
So it is they are their own character, aren't they? You can't tell a cat what to do. They are.
Is, is there a danger with Struvite diets that you can convert a cat that was maybe more prone to struvite to then having a calcium oxalate stone? Is that something that can happen? Is this why maybe oxalate stones are becoming a bit more common?
Do we have to remember to change from, I think the diet names are still the same, but from SD to CD. Yeah, so that's, that's a very interesting question and I'm not sure we have the right answer on, but I can tell you that the diet companies are doing a better job. So when I came out of school and looked at this data in the, in the, you know, late 80s, 1980s, the pH they were going for for the urine in a cat was 5.5.
We, they don't do that anymore so they have gotten better and so that may be one of the reasons why struvite, you know, went down but then calcium oxalate went up and now what we're seeing is we're seeing more modulation here so so that would be one of the risk factors that we've seen it depends upon who you talk to because some people will say that that's not a risk factor so much for calcium oxalate. But we don't know what the tipping point is we don't know what that perfect pH is that, that, that may do other things because pH not only acidic pH can be associated with increased calcium excretion, but it may also change the protein confirmation of inhibitors or other things in the urine that we're not really looking at or not familiar with so I would say we're we're doing better. I, I think as a profession.
Diet companies are also responding to the veterinarian who wants one diet to treat everything, and that's the reason why we have calcium oxalate and revi diets that are sort of mixed together. So we, we are doing a better job, but you're right, as that cat becomes older, as that cat develops other diseases, what we need to do is individualise our therapy as opposed to maybe going for group therapy or trying to treat multiple diseases that the cat really is at risk for. So you're, you're right, so, so nowadays I think you know they're using less SD which was more acidifying, and they're using more CD, to, to get that to get that effect and so I think that's what you're seeing with time and other diet companies are also looking at the effect of pH but but again there's this there's .
There's still research that needs to be done for us to figure out what is the perfect pH. What we've been looking at is super saturation and supersaturation won't look at things like how the protein conformation has changed once we change the pH, but we are getting there, so things are better than when I first came out of veterinary school. Brilliant.
I know Natalie's very kindly offered because it, it was a really enjoyable lecture. I know it was, it was last thing on one of the the afternoons, but I went in and and thoroughly enjoyed it, and I think Natalie, obviously, although the conference is usually just for the delegates, you're gonna make this particular session free. So for those of you who are listening, do look at the bottom of the podcast in the explanation notes and we'll try and explain how we can Let you listen to the to the lecture as it happened in in Dublin, I don't think you're, there's there's no free Guinness involved for people to listen, but they can hear the lecture, can't they?
No, I was about to say they can hear Jodie's fabulous lecture because it was definitely it made our top 10 favourite lectures from delegates at the event and it definitely provoked, I think a lot of discussion and Conversation. It was the party night that night. So I think the the discussion carried on into the evening.
And we will make it available. People will be able to access the the, the, the recording that way through our platform. If they are an existing ISFM member, be it a practise member or an individual member, they will already have access to that.
Recording. And if they want access to all the other fabulous recordings that were taken in Dublin, they can, they can have access to those through becoming an ISFM member. So I'll do a little membership plug while I'm here, but, we were definitely really delighted when Hill said that they'd asked Jodie to come and speak at at Dublin because we knew it would be a good lecture and it definitely was.
It got the audience thinking. And you're in Malta. Yes, next year in Malta.
Yeah, yeah, next year I'm just doing the programme at the moment, but we're looking at ophthalmology and systemic diseases that may have ocular changes as well. So it's already shaping up to be an interesting one as well, I think. I don't know if we had time, but one of the, the last things that Jody covered was the announcement about this new stone at Dublin as well, and .
I, I just wonder, Jodie, if you're happy to mention that briefly as well, because again, I think that's quite important news to the general vet community, especially those that are treating FIP cats. Yeah, so, again, when looking at some of these stones that come into the centre, some of them are really difficult for us to analyse and, and really, especially if it's not a mineral that we've seen before, it was, it took us a little bit of time to figure out what this was we knew. That it was more composed of things like carbon and nitrogen and oxygen, which is very unusual we often see minerals, but when we understood and got more information about what diseases the cat had and what medication it had, it allowed us to go ahead and let's look for this medication in the in the stone so we went and purchased not only the chemical grade of it but also asked those clinics to send us what the cats were actually receiving.
And it was like a 99% match to the metabolite of the of the of the GS 44 1524 which is the metabolite of the of the medication that we're using to treat cats with FIP. I think it's a wonderful thing that we can actually help cats with this with this medication because the diagnosis used to be a death sentence and it's not a death sentence anymore . The, the bad news is like any medication, some probably have side effects some I'm not familiar with the good news is that we haven't seen many of these stones come through the, the of course the, the, the bad news is, is some stone labs may not have been aware of it, although we have had labs who are asking us now for our infrared pattern so hopefully even if you don't.
Submit stones to us we can still help cats out there and so my recommendation is is that if you see if your cat is on some of these medications, and you see lots of crystals or even stones or if you see lots of crystals, you may want to ultrasound the cat looking for a stone. And if the cat comes in for urinary tract problems, taking a good look at the at the pattern in the in the urine would be well good to do as well if it, I can't tell you what the crystal looks like because these were not our cases, but we're more than happy to analyse if you get enough crystals for us to analyse them or if the stone the cat has that type of stone, if you can send us a picture or send whoever you want to a picture, it would just be important to get the information out. It doesn't have to be us getting it out.
The good news is I think people are aware of it, . And hopefully, if they do find it, maybe we can either reduce the dose or things like that. I know I've gotten questions about is it dose dependent, is it pH dependent?
Is it the type of medication that they got? I can't answer those questions yet. We, we just don't know, we don't have enough cats, but now that information is out there, I'm sure there's some eager scientists who are willing to look further into this so that it can go beyond just making the diagnosis of a stone but how we can minimise it when we're giving this type of medication.
The coronavirus pandemic was a terrible thing, but in all times, we learn, you know, when we go through difficult periods, and of course we've been given this medication for cats, partly because of the coronavirus pandemic, so there are always, I suppose, silver linings in every cloud and problem, aren't there? Definitely. And, and as Jody was saying, it's still such a new drug and we're still, I think refining what the dosage is and the treatment patterns and it's useful to know that this is a potential side effect and just to be aware in in the cases that you are treating to keep your eye out for, for any signs of of lower urinary tract disease.
Natalie and Jodie, we could probably talk for hours about urinary tract disease. We haven't really gone beyond the sort of urethra and the bladder, and there's so much more other things going on in the in the ureter and the kidneys as well. Maybe we, we should do another podcast on that, or a podcast.
Because more than happy to, more than happy to. I really appreciate your time. I know how busy both of you are, and of course thanks to Hills for making it possible that we could do this podcast to all three of us.
Thank you for having me. I really appreciate the opportunity to share. Yeah, I know, and I really appreciate you both being on as well.
Thank you. Thank you. It's been great.
And thanks everyone for listening. I hope that we'll see you on a podcast very soon or a podcast. So this is Anthony Chadwick from the webinar vet, and this is the Vet chat.
Take care.
