Good afternoon everyone and welcome to today's webinar, easing the compliance of medicating cats. I'm sure most of you by now will be familiar with our processes, but just a quick bit of housekeeping before we begin. If you do have any technical issues, please feel free to let myself or my colleague Dawn know who's online via the chat function on the webinar and we'll be able to, or we'll do our best to help.
If you have any questions, interaction is definitely encouraged, so please submit them via the Q and A box. If you cannot find this box, if you just hover your mouse over the screen, it should appear. On to today's webinar, and it's my absolute pleasure to introduce one of our most popular speakers, Danielle Gunmore.
Danielle graduated from the RDSVS University of Edinburgh with the Dick Vett Gold Medal in 1991. After a year in small animal practise, she joined the Feline centre at the University of Bristol, initially as the feline Advisory Bureau scholar, then the Duar Feline Fellow, and completed a PhD study into feline infectious peritonitis in 1997. After a short period as lecturer in veterinary ethology at the University of Bristol, she returned to Edinburgh to establish the feline clinic and became professor of feline medicine in 2006.
She's interested in all aspects of feline medicine. She's an internationally recognised expert in her area, has lectured extensively and published over 130 peer reviewed research papers, plus many reviews and book chapters. In 2009, she was awarded the BSAVA Woodrow Award for outstanding contribution in the field of small animal veterinary medicine.
In 2011, she was awarded the International Society for Feline Medicine, or Hill's Award for outstanding contributions to feline medicine. In 2012, the Royal Dick students voted her the clinician I would most like to be. I praise indeed.
In 2016, FECAVA awarded her increased vocalisation in elderly Cats, the most original paper in the European Journal of Companion Animal practise that year. And in 2017, she became a Fellow of the RCVS. She shares her home with her husband Frank, a 16 year old Maine Coon boy called Mortlak, which is named after a lovely Scottish single malt whiskey.
And a tiny little 16 year old black cat called Shiba Abeg. Just before I hand over, we're also joined by Nick, who's the managing director of Bova, who wants to say a few words. And today's webinar is free access thanks to their very kind sponsorship.
So thank you, Nick. Just wanted to give a brief introduction to Bovi UK as we're a new player in the veterinary industry. Boba is a specials manufacturer which is solely dedicated to supplying veterinary specials to UK veterinarians.
None of the products that Boba have are licenced. However, each product is available to UK vets if they follow the prescribing cascade. Veterinarians are allowed to go down the cascade and prescribe an off-license product such as a special, as long as there is a, as long as they believe there is a clinical benefit to their patients and them doing so.
A common misconception is that veterinarians must use a product from each step on the cascade before they can choose to go to the next step. This isn't the case. However, you do need to consider.
If each of those steps is it has an appropriate product in it or not, before choosing to go to the to a product further down the cascade. Thanks. Next one.
To be a specialist manufacturer in the UK we need to be licenced by the Veterinary Medicines Directorate, or the BMD. Boba is the first specials manufacturer to hold such a a licence to be able to produce both sterile and non-sterile products from the BMD. So in order to get that licence, the VMD needed to come to our facility and audit everything from our procedures, our products, our staff training, and all our protocols to ensure that we are compliant with good manufacturing practises or CGMP.
GMP is the quality standard that large pharmaceutical companies need to adhere to when they produce licenced products. So you can be confident in the quality of the products that are produced at Bova. I own a compounding pharmacy in Australia and have colleagues who own compounding pharmacies in the USA and I can assure you that the medicine standards in the UK are considerably higher than anywhere else in the world.
Next one. As a specials manufacturer, we're limited in terms of our advertising. So I'm not able to go through with you the types of products we have available.
However, I can go through the formulation list and prices, once we confirm that we are speaking with a licenced veterinarian. But for today, I'll just be saying that we do have these types of product classes available. So we have capsules, thermoreversible gel, which we dissolve antibiotics in, sterile ophthalmic preparations, flavoured oral pastes, flavoured oral suspensions, sterile injectables.
And our sin, our flavouring, for those of you who may be concerned, is synthetic flavouring, so there's no animal proteins in any of the flavours that we use. We also have transdermals, which is a very popular delivery route for administering, hard to peel cats, particularly in Australia, and over in the UK we now have, quite a few transdermal formulations available and many more coming. We've just finished completing our build of our cytotoxic labs and tabletting facilities.
Our equipment has arrived and we're just in the process of validating it, and we'll soon be able to prescribe, dispense low dose cytotoxic formulations with tablets, shortly to follow. Next slide. So just the last slide from me, if you are interested in ordering from Bobo, you just need to go to our website.
On the website, you won't be able to see any of the products, or prices again, because of advertising restrictions. So you'd need to set up an account. We then need to verify that you're a veterinarian, so there will be a step to upload a photo ID and put in your RCVS number.
We will then verify, cross-reference that and ensure you're a veterinarian. And then we would approve your account, and then you will be able to access our products pages and see what we have available and place an order if you wish. As we're a new business and we have new formulations coming onto the market very frequently, as we're constantly getting requests from UK veterinarians to add new formulations, we are unable to let you know about these new formulations unless you tell us that you want to be notified.
So if you would like to be notified when a new formulation is released, please email us at [email protected] and, ask to be put on that list.
Lastly, we also have 3 sales representatives in the UK, Northern, Southern, and London region representatives. If you would like a face to face visit, please take a screenshot and take those details down and the sales representative would be more than happy to come and see you. Thank you very much for your time and I'll hand you over to Danielle.
Thanks, Nick. OK, so I hope that was useful. Obviously, as usual, I'm gonna start with my thank yous because I like to start and finish with that because I think it's a treat that I get to speak to you guys from the comfort of my spare room.
I did put my clothes on. I just had pyjamas on earlier, so, you know, you guys are on it. I have got dressed.
Big thank you as always, to the whole of Webinar. It's just such a really brilliant system. And obviously today, particular thanks to Bova for funding this supervising it and it's sponsoring it so that it can be open to everybody, because I think this is a really important topic.
That I'm, I'm really chuffed to get a chance to talk to you about. Obviously, also, big thank you to my university, for keeping me on the payroll, which is great. It means I can continue to do all the things that I love doing.
Other people I've noted that International cat care, always remember to go to them. They were a fabulous resource, and I've added Caprofessional.com.
This is a website owned and run by Sarah Keney, another cat specialist. That is also a really good website for pussycat stuff. So, what are we gonna talk about today?
Well, this is kind of a list, and we'll see how far we go down it cause this is a, I had a little bit of this talk written before, and then I just kind of went to town and added a whole lot. So we'll see where we get to, you know, how it works. So I'm gonna start by thinking about the correct dose and dosing interval.
You won't believe how often this goes wrong. I see, for example, people write TID all the time. SID or UID, those two seem to be interchangeable.
BID, TID QID. What do you actually mean? Because actually, if you're saying TID.
Sorry, a bit of water. If you're saying TID. People mean, well, kind of 3 times daily, don't you?
No, you're actually meaning every 8 hours. If you don't tell owners that, then quite often what happens is all 3 doses are going to be given within the evening period because doing something first thing in the morning is a faff. And there is no reason for giving something 3 times a day, unless it's got a time dependent drug in it.
It needs to be given every few hours, or it's not gonna work. And I see us get it wrong regularly as a new grad, I was working in a place called, Ramsey near Huntingdon. It's in the fence, and anyone who's worked in the Fens know what the, the, the concept of people living in the fens is sometimes that they're a little bit slow, not always the case at all, but some of my clients were quite special.
And this is completely my fault, my misconception. I saw this lady, an elderly lady, with a German Shepherd dog who had a really sore right ear. So it was obviously pussy and disgusting.
So I put the dog on amoxicillin clavulinate to be given twice daily and, tablets, and to come back and see me in a week to make sure it was better. She came back 3 days later and said, I can't fit any more in. Yeah, she'd been putting the tablets in the dog's ear.
I hadn't explained that it should be given any other way. My fault. Another time I was in France.
I had a very sore throat, Malago, and I went into a pharmacy and asked for a, a painkiller. I didn't have any on me. And they dispensed this thing, which was huge.
And I asked for a glass of water. And I went, oh, no, no, no. And then made an indication with the hand that it was to go up my bottom, not in my mouth.
And I was like, sorry, you know, I'm British. Yeah, we don't do that. You know, I want something I can swallow.
Again, if I hadn't asked, it wasn't clear. So the first thing I want you to think about before you prescribe anything is how often does this actually need to be given? Can the owner do this?
If you're saying it's something that needs to be given every 8 hours, can they truly do that? I ask you, if you had a diabetic cat, maybe some of you do. Can you guarantee to get it insulin every 12 hours?
One of my cats was diabetic and I couldn't, I had to accept that sometimes it would be 16, sometimes it'd be 18 hours, depending how long I was away at work. So we need to really communicate much better with our owners, so that we can actually get the medications that are most effective into our patients. Thankfully, we have the easy to give awards.
I'll mention those. I want to think about all the different formulations that are possible because some may be more useful than others, which will take me to reformulation. But I'm also gonna consider some tips and tricks of getting drugs in, most of which you'll know, but some might be new to you.
But I also want you to consider. What about teaching the owners to give injections? What about considering inhaled drugs?
And if we get time, we'll consider what about using prescription foods. But first and foremost, get an accurate weight. If that's a dog, that's a reasonable sized dog, then you want to use dog scales.
If it's a small, dog, so it's certainly less than 6 kg, or a cat, you need to be weighing them on cat scales. If they're even smaller than that, like the little kitten in the corner, then you're gonna need postal scales or food scales. Because scales only accurate to within a certain percentage, and they become inaccurate when you're using them inappropriately.
And you'll all have heard me speak before about the importance of always writing the cat's weight down and then calculating the percentage weight change to last time. And that can be really important for a cat that's on long-term medication, because maybe it started treatment with that corticosteroid, for example, when it was a 6 kg cat. Maybe he's now only 4 kg.
Well, his dose just went up a lot, didn't it? So I want you to consider that as well. And then when we consider medicating cats, we want to think about compliance and then you need to think about efficacy.
So the compliance is, can the owner actually get the medication into the cat? So this is obviously a two factor. There's the owner factor.
If there's only one person, is that person physically able to find the cat, hold the cat down, etc. If that owner has memory problems, is that gonna be, an issue that they can't remember when the cat has been medicated or not? I can certainly tell you, now that I'm a, a, a pain, person, so I take a lot of medication for my back pain.
If I didn't have a chart to fill it in, I wouldn't have a clue. And that's me who's, at least in theory, you know, fairly educated with a husband who's also a professor. But between us, we can't remember what I'm doing if I don't have it written down.
So suggesting the owners actually have a chart is an important thing because people won't necessarily think about it if you don't suggest it. Can the owner physically get hold of the cat, hold the cat to give the medication, or physically open the bottles? I tell you, I can't open some of those bottles.
You know, do they have arthritis or in my case with my back, I can't bend very well. So if I had to orally medicate my cats, I couldn't do it for that reason. And then what about the cat factors?
Oh, is the cat physically in the book, but can you find it? Is it hiding outside? Does it disappear for weeks on end?
Or does it hide right at the back and in the middle of under the big bed where you can't get it for a lot of money? Does it get grumpy? Or does it get so stressed that then the other spits it up or vomits it once you've given it.
So the first bit of medicating cats is can you get it into the cat? The next bit you do need to consider is, is it going to work once it gets into the cat? So can it actually be absorbed, for example, from the gut.
So if it's something that should be given on an empty stomach, so a classic there would be a tetracyclines that binds to milk products. Another one would be a laundreate, which I use a lot. It's a bisphosphonate that I use for idiopathic hypercalcemics.
The absorption on with any amount of food at all is not good. So we need to consider that because there is no point in going through the trouble of giving a drug, if it's all being bound into the gut because of the things you've given with it. If you're getting transdermal medication, then that's really important, and we're gonna come back to that.
So certainly I I will say a little bit more about that because I've written it there. The actual molecular nature, the, the, the nature of different drugs is very varied as to whether or not they can be absorbed through the skin. Obviously, it is how they're absorbed through the gut, but even more so through the skin.
And I'm really pleased that in Britain, we have these really demanding. Laws from the, the BND to, for the formation of these different products. So at least we know we've got quality products in this country.
In the states, literally anybody could set up a company that could reformulate anything. And what they do is offer these massive ranges of, oh yeah, absolutely anything. Munch it up, crush it up, stick it in, an oily substance that may or may not be absorbed through the skin and say, yeah, put that on the cat's ears, the cat will be fine.
Despite the fact that if you look at the nature of that product, there is no way on this planet it would ever be absorbed through the CAT skin, and certainly not in the large volume or the large concentration. You know, if you need high numbers of milligrammes and certainly your grammes worth of something absorbed, it's never gonna be absorbed. You could shave the whole cat and cover it in baby oil.
It's still not gonna absorb all the drugs that you'd need. So we do need to factor that in whenever we're thinking about drug efficiencies. And then if it gets into the cat, then is it actually going in as the active form?
If it isn't the active compound, is the cat able to turn it into something that's effective? So the classic one here would be Oh, there's quite a few. But if I think of something like morphine in the dog and the human, that we metabolise it to through UDP glucuration to the active molecules pretty easily.
The cats, of course, don't do glucurination very well, which is why morphine is nowhere near as effective in cats as it is in dogs and humans. With tramadol, it seems to be going the other way. In cats, they're pretty good at metabolising that to the active form.
It's dogs that don't do it. So all those dogs that you give tramadol to vast majority, you might as well have just peed in the ear. So, it's a lot of things we need to factor and a lot of it is, to be honest, even if you've got a big textbook in front of you, it's not the easiest thing to work out.
So we have to try and do our best. So, I think this kind of continue on from here with all drugs that we are giving, we need to think, do we need to give this or not? And then, could it be interacting with anything else?
But also, if we're going to give it. Can we assess whether or not it's useful or not? And it's really important that we discuss with the owners.
I know in a 10 minute consult that is only so much you can do, but at least we need to explain why we're using the drug, and to say that there often are other options of other medications that either it's the same medication and different formulation or other medications that are in a different formulation that could be used. Because if we just say Take this drug, this is what the cat needs. Come back to me in 2 weeks and we'll see if it's any better.
If we don't tell them that it's OK to say, actually I couldn't get it into the cat, they won't own up to that. They won't say, yeah, actually, yeah, my cat's really easy to give medication to. I can just go with twice daily medication, whatever the best drug is for.
And in one study, that Sarah Canney did, treatment hyperthyroidism, that is actually what it came out as, something like 80% of owners said they'd rather try and give the right drug twice daily. Than the wrong drug or and not quite such a good drug, once daily, because they understood how important it was. Whereas other owners, other conditions maybe aren't as motivated or just home situation is different and with the best will in the world, and medication's only gonna happen once a day.
So we need to find out what the owner can and can't achieve. And we need to have that conversation. Antibiotics, I'm gonna come back to you a couple of times during the talk.
But analgesia, I've already touched on this, and this is particularly important because the only reason for giving an analgesic is because the animal is in pain. There is no point in adding to its stress by giving it medication that might be adding to its side effects and is not adding to efficacy. Really, really important, I've already mentioned about Tramadol efficiency.
We must ask owners, does it appear to be working? And yes, there's a big placebo effect. We all acknowledge that.
But if you make it clear to the owners that some painkillers don't work in certain individuals, it gives them permission to not see it work if it isn't see, isn't working. If I asked all of you guys, how many of you can take Panadol. Or not, or, or can take, it's paracetamol, or whether you can take aspirin or whether you can take codeine-based medication.
Some of you be going, oh, I can't take that one. It trashes my stomach, or that one, I can't take it at all. Oh, this one, it puts me to sleep and I feel absolutely hideous.
And different ones, we use them for different things, don't we? So if I've, I've got a headache, I'm gonna take rufen. Whereas if it's my back, then it's more opiates or paracetamol.
So, yeah. We don't know when we prescribe that particular analgesic, whether it's gonna work for this individual cat's problem. With opiates, particularly with buprenorphine, more and more of us are giving this.
It's not really by mouth, the better way of putting it, saying it would be, it is by mouth, but it's much as we want it to be absorbed through the mucous membranes. The problem is that if you try and put it under the cat's tongue or in the buckle pouch, a lot of cats don't like it. So a mechanism I have worked out and it does seem to work in as much as the cats that I've I've used it on have become sleepy within.
About 20 minutes and their pupils go huge and they start growing. So I think that's a pretty good way of doing it. You find a little bit of whatever their favourite sticky food is, something like pate or webbo, licky lick, something like that.
Take a flattish bowl and cover the bottom with a very, very thin smear of their favourite food. And then you drip the buprenorphine on top. So that in the process of licking at the the favourite food, they really get the beat all the way around their mouth, and they absorb it well.
Now, if an owner is doing that at home, it's obviously very important. The cat is either observed doing that and the bowl is then picked up and washed thoroughly. It's locked in a room until it's all gone.
And then, the plate again is washed thoroughly so that that doesn't get onto. And obviously, the owner needs to be wearing gloves. I will, it says it goes through the dishwasher, cause I figured that way it's guaranteed to, to get washed off.
But that's certainly a good way of gaining, gaining, getting into the cat. Tramadol, I've already mentioned, I find it very bitter for myself and most cats find it pretty bitter. So I have known quite a few cats where it's been efficacious, but not always.
Gabapentin is an interesting one. So like tramadol, the veterinary products that have been available until very recently have been tablets that are pretty bitter. And the wrong sizes.
Tramadol is now available from reformulation labs in small tablets, which means you haven't got rough edges and things, so that is a good thing. And there are new versions coming through, so keep watch out on that. The gabapentin, both to a really nice or if it's not already online, it's about to come online.
It's a chicken flavoured liquid preparation of gabapentin. And I was having real problems with my beautiful, Maine Coon. He'll meet in a younger form in a wee bit.
And, he, he's really bad dysplasia and patella luxation, so he is pretty crip. But the NSAIDs, I can't give him very much, Loxam cause he's so poorly on other bits of his body. And it was, as far as he's concerned, it's his arthritis that's causing him the problem.
And I really tried to persist with gabapentin, but the human version say is so bitter, and he kept being sick of it and he wouldn't take it if he put it, if I put it in his dinner. And you know, once I tried the, the chicken flavoured gabapentin, you just pop it in his dinner, doesn't even notice it. And he's running around now like an idiot.
I'm actually worried he's gonna hurt himself cause he's going back to having crazy half hours, but it's really lovely to see it. So with all drugs, you need to think, are they working or not? If you're, you know, if, as the only getting it in, give them permission to say, I'm sorry, I couldn't get that formulation in.
Is there something else I can try? You need to talk through all the other things we're gonna talk about the way of tips and tricks and if they're giving directly into a cat's mouth, do they actually know how and we'll just flick through that. I know you all know how, but can you show them how to know how to do it?
Analgesics, they really need to think critically, is this helping? Try and give them some kind of grading score about how mobile the cat is now, that sort of thing. You can put activity collars on them, but that's a bit going a bit far for for standard home cases and say for antibiotics, I'll come back to that on my next slide, but it is so important, you know, good antibiotic stewardship.
We have got to take it seriously. More and more countries around Europe are banning the use of so many antibiotics, and controlling the use of some, so many others that we don't want to be put in the same position as that. So we have got to get sensible.
And, you know, really think about what we're doing. So this is another one of my pussy cats. This is beautiful cardio.
You see the cats are all named after Mark Wike. Cario is as long as long lost him, but he's, he's, he's a great case to, to introduce you to him. So he's 12 at this point in time when I first present him.
And he'd been diagnosed with iris stage 2 chronic kidney disease, as you can see. So he had PUPD and then he was having episodes of really hideous halitosis, and he was a really kissy, kissy boy. So it was really quite manky.
And he'd be off cholera and hypoorexic rather than anorexic, he was quite, he ate well up until the last two days of his life, so he was only really hypoorexic. And you can see his results there. So yeah, he had developed hypertension and we needed to, to treat him with that.
And it was really difficult getting the amlodipine into him because that's what we had to use then and with a systolic blood pressure of 200, that's really where you've got to go. Because where we've said there, I've said 120 to 180, we've now pulled that right down. That should be 150.
So, it's actually 150 millimetres of and actually IRS are going to bring that down even further. I know they keep changing the rules, very frustrating. It's about to come down to 140.
So he really did have hypertension, so he really did need amlodipine. And they're tiny tablets now, which is great. They've got a veterinary licence, but even then that wasn't always easy.
So there is a new transdermal, so there's something to think about. What's interesting is this USG is really pretty hideous. He's just, he's very low hypo hypothenuric, so he's, he's not asoenuric yet, but he, he's heading in that direction.
And whenever I see a poor concentration like that. And yet he's not got that severe kidney disease. I'm thinking this is gonna be a UTI and it's gonna be no E.
Coli UTI because E. Coli causes paralysis of the collecting ducts, so that you get this really poorly concentrated pee even before you start seeing significant aotemia. And interestingly enough, E.
Coli doesn't cause that much inflammation in a lot of cases, and you can see that here. He's UPC ratio, is urine protein to creatinine ratio is only 0.09.
It's absolutely nothing to worry about. You could easily look at that and go, oh, it's fine. But then look at his pee.
He's got obvious, well, increasing white cells, etc. And cultural E. Coli.
So, I was doing a lot of travelling then, this is before my back went. And I was worried about how often we would be able to get medication into him. So my husband is a professor at St.
Andrews, and, he's got to drive up there. We, we live in Edinburgh, so he's got 3 hours of driving every day. And I do ridiculous hours still.
So, I was worried about it. So. Even before I got the urine culture, I knew my top choice would be amoxicillin or amoxicillin clavulinate.
That would certainly get at least 80 to 80 to nearly 90% of all UTIs would be covered by going with amoxicillin or amoxicillin clavulinate. So, obviously the first choice. Did I start him on, on a oxy?
No, I didn't because he wouldn't take it easily. And I really felt that I wouldn't get 12 hour spacing. So I went with Marbafloxacin on the grounds that it was once daily.
And when the culture and sensitivity came back, yeah, the E. Coli was, sensitive, so not a bad choice. But remember, he has got kidney disease.
I wanted to do a two-week course on him, and then I wanted to recheck it. So, I prescribed him his 2 weeks. He got the 1st 57 days' worth, and then I had to go to a meeting.
And I love my husband, but he's not very good at medicating the cats. And he then couldn't get the medication into cardio while I was away. So I came back.
Cardi was clinically very much better, and he hadn't got the rest, of course. So I said, oh well, it doesn't matter. But then within probably about another week, Halicosis was back, etc.
I got a urine sample and yeah, the bugs are back. And, OK, let's put him back on the Mabo. Well, the same thing happened.
I had another conference to go to. Again, he got about 6 days this time. And when I came back, he was no better at all.
He hadn't got the whole course, and he was still showing clinical signs. So I had a look at that urine. That urine was already resistant E.
Coli resistant to fluoroquinolones. That is how easy it is to make E. Coli resistant to something like a fluoroquinolone.
And that's a professor managed to do it. OK, it was before I was a professor, but you know what, next case. But it shows you how easy it is.
So I'm quite happy to, to show my disasters to help you realise how easy it is. So I got the treatment of my cat wrong because I didn't consider how to make it easier to get the medication in time. This is another case, another vet case.
This is a cat, beautiful, British short hair who was owned by a vet from up north, a 3 year old who the boy who had stress cystitis. He had blocked because his stress cystitis had a urinary cath placed. His urine was sterile initially.
After he had the cath for a while, it was pulled, but he was then showing dysuria. The his owner found E. Coli, which was sensitive to most things, obviously amoxicillin, etc.
And was sensitive to effervescence, so it's convenient. So she put him on convenient. Because it wasn't very easy to medicate.
He then it for whatever reason, it doesn't appear to have been very effective, which we do see, unfortunately. And the UTI came back straining again, so she gave him another shot of convenience. It didn't make him any better, so she caught another urine sample.
It's now resistant to cepherfecin. What did she do? Well, I know you won't guess what she did do.
She continued to give himself a vein. And she did it for 9 months. Yeah, 9 months.
By which time she then asked for a referral because he was in a right mess. And she saw my face as soon as, she was explaining what happened. She said, I did it wrong, didn't she?
Didn't I? And she said, I, I just felt I had to do something, was actually doing nothing would have been better because that's his E. Coli.
It's now filamentous. It takes a lot to make E. Coli go into filaments like that.
His bladder wall is completely dissecting. You can see that here, all the way across here. There's urine in the bladder wall and this bladder wall has become so thickened and inflamed, it's actually gone across to forming a urothelial carcinoma, what we used to call a transitional cell carcinoma.
A horrible case. We resected the, the, the tumour and we got him through it. We put him on tramethopprine sulphur.
No, it wasn't easy to get it into him, but we succeeded. But he had another bout of stress cystitis and he blocked about 3 months later. He was euthanized at that point.
Really sad. So there's two cases as vets, we get it wrong with our own cats. Were our own patients.
We have really, we, we all need to, to think about it and try harder about how can we get the right drug in. So, here's a little bit of data for you. We know that loads of human studies.
I was, googling or submitting, and it's literally hundreds and hundreds. And on average, about 50% 50% of people on chronic medications are only a compliant, which meant 50% of them aren't. And do I get my own medication absolutely perfect all the time?
No, I don't. I try my hardest because I'm in pain if I don't, that's a pretty good motivator. But, it's not easy.
And here's a study by Pfizer, about 70% of cat owners have difficulty giving pills. And over 70% of vets believe that poor compliance is one of the main reasons for antibiotic failure. And it's probably higher in cats, I would agree with that very much so.
And not surprising compliance falls further if the medication causes nausea, and we're gonna come back to why that might happen more in the cat than the dog in a second. And a lot of owners abandoned treatment. And all the clients are willing to pay more for more effective and easier medication.
And The particular study, they looked at injections over tablets, not surprising owners go, yeah, if you can give a tablet and I, if you give an injection, I don't have to worry. Of course they're gonna prefer that. But they weren't asked about what about liquids, etc.
Here's a bit of information for you. This is a study by my friend Mike Lapin, and he gave me tablets out of like basically a compounded barium and then capsules of barium in them. And he just gave them as a dry pill, dry capsule.
Tablets, none had passed down to the stomach within a minute. And about 40% got to the stomach in 5 minutes, which meant more than 60% were actually stuck in in the oesophagus at 5 minutes. If you time 5 minutes and think about something stuck in your throat the whole time swallowing going.
Just hideous. I think if that's an acidic drug. If you add water in the study, then 90%, were down into the stomach, at least by 30 seconds.
It's still taking half a minute. You know, half a minute's a long time. If you take a pill, you expect it to be down there within a couple of seconds.
Cats have got very slow oesophagus. And the data on capsules, but it was less than 20% actually get to the stomach in 5 minutes. So it's 80% stuck, which is gonna cause discomfort, pain, and ultimately structure formation.
So, and the drugs that are the biggest ones at risk are the acidic antibiotics. So doxycycline is the top one, and that's doxycycline hylate, and I'm gonna clarify that why in a second. Then you want to think about clindamycin, then you're gonna think about the non-steroidals.
And what this results and you can see is stricture in this oesophagus here, it's really inflamed oesophagus. Yeah, a very unhappy cat, not good. So how can we improve it?
And what kind of what are the options? Well, in an ideal solution, we have cat friendly drugs that are made in a really cat palatable way that you can just hand them the tablet or I've got a video next from Kerry Simpson, which is the cat just eating a a Singulox tablet. Then to put a video in of my boy, more like taking his medicam off a teaspoon, which he'll take that just off a teaspoon, which is absolutely great.
Yeah, that's the ideal world because you're not having it messed up by adding any food for them. But that's your next one down, you just make a very small amount of food or treat with it. It may affect drug absorption, but hopefully not so much, and at least you get it into the cat without a struggle.
Then you've got to consider if it's, if it's not that, and you're gonna have to actively put it down the cat's mouth. Well, some cats are actually really good. Sarah Kaney's old cat, Hoby was so good.
She literally would just touch him on the top of his head and tipped his head back and he just drop his bottom jaw, and she could pop it in and it eats up amazing. But there aren't very many cats like that, which means you do then need to consider reformulation. Because I don't think many owners, certainly the studies say there aren't many owners who are willing to have or once or even not twice daily fight to medicate their, their cat.
And then we'll finish off with these others if we get a chance. So here's this brilliant video from Kerry took in the clinic. Isn't that perfect?
He's, he's looking for another one. Can I have one another, please. Good, I like that, tasty.
Brilliant. So what has really helped is that what was Feline advisory Bureau, now international cat care, you know, through I've been associated with them for years and obviously absolutely support them. And we pushed for these very early on, pushing the different drug companies to make the formulations cat friendly.
And the good thing is that these companies appreciate there is worth doing this because it gives them a good selling point. So it's to have it metacas I've already mentioned and cementra, which is another product by Bro and Engleheim, that's Talmasartan, which is for kidney disease, proteinuric kidney disease, but actually now it's been, it's not quite it's licence for treating high blood pressure yet, but it's been shown to be very effective and in cats where you can't get things like amlodipine in, then that is a good liquid, alternative. It's something to consider.
So, next thing, hark back to what I started with. Ask the owner, does the cat have a preference? Because you can't presume that all cats aren't easy to medicate.
Say, Sarah's hobby is so easy. And Sarah did this study, where it was to do with, hyperthyroid medication, and 25% of their owners couldn't medicate their cat. But they didn't even realise that liquids might be available or that they might be more palatable.
And certainly, I've got one hyperthyroid cap, having two old cats, great, you get to try all sorts of medication on them. And with, you know, it's just the same, it's more like, you know, he wouldn't take the other forms of, methimazole or carbemazole, and he takes the thyroor. He won't take it on the teaspoon.
So it's not as good as Metaam and Sementtra, but you know what, he'll take it in the dinner and not even notice. So that is good. That's the yer norm.
So something where a company has gone to the effort to make a really good palatable product and they've got their, their licence for it. It's an interesting study. If you're going to mix medication into cat food, make sure they don't see you do it.
I know. Isn't that great? That's a study that actually proved it.
One of the major things is if they see you contaminate the food, then they go, Oh, you've done something nasty. Obviously, you will know about strong flavoured foods, etc. Tuna flavoured ice cubes are a pretty cool way of doing it.
So some of the more water soluble things. Obviously, whenever you are reformulating, and this is a formula form of reformulation, this may affect. Absorption, so you need to really look at the cat and decide is it affecting it, is it working properly?
If it's a hyperthyroid, then make sure Fiona is doing this, you need to check the thyroid levels after a couple of weeks to make sure that it is still working well. Hand pill with butter. So basically, if you, some cats just love butter, if you cover the pills with butter, that can work really well.
The other thing I will do is butter patties. The drug that I've used with this more than anything is, is dantrolene, for cats with, bladder problems. And it's bright yellow and it's a powder, but it's not particularly bitter, but there's something about the taste that the cats really hate.
And so what I'll do is now you can get Daly made up so our our pharmacy will actually make up the, the small sized versions as well and, and some of the other reformulation pharmacies are now doing that, which is really good. But the other thing you can do would be to do, and I have done it for years, you put up new capsule of butter, open new capsule of dantrole into the butter, mix it through really evenly. And then freeze it.
Take it out, roll it into a little sausage butter patty, and then you can cut it into the right number of pieces that each piece can be given each day from the freezer into the food. So that way it goes in frozen cold and frozen and buttery. The cats don't notice it.
So that's certainly a trick that I've used, over the years. And it doesn't appear, certainly potentially to affect efficacy. I'd love to see a proper study done.
Coating tablets for direct administration obviously would be something as well, but we'll come back to that. And then cat treats, what is really good is in the last, really only about 5, 10 years, we've got more of these coming through. Easy pill.
I've had quite a lot of success with. Some cats think it's disgusting, but we actually keep boxes of this at work, and we just offer the cat a little piece of just take a little slice off the end and offer the cat it doesn't like it, it does, right? Offer them another little piece uncontaminated, then put the little piece of the pill into the next mouthful, and that goes down in the second mouthful.
So those can be dispensed, once you've checked the cat likes it. The pill pockets, I haven't had as much success with, but I know some people swear by them. Webbox, I don't know what's in them.
I think it might be some version of cat liquid cocaine or or or I don't know, marijuana or something. A lot of cats go crazy for this, and I'll come back to that in my next slide. And then the gourmet cat soup.
I have been really pleased with these. There's 3 different varieties that I know of. And despite the fact it's a small amount of liquid, it's designed, that it's fine for cats with kidney disease, which is good.
So I do use it to top up a little bit with my early kidney cats. But yeah, it's great for, putting some medication into too. It's very tasty.
Well, I'm vegetarian, I wouldn't know, but my cats tell me it's tasty. He's two little videos for you of Webbo and to show you the fact the way some cats like this stuff. I would have held into it that.
We actually use a lot of these in the clinic to help with blood sampling and things like that. So we're distracting the cat by feeding Webbo or feeding the licky licks and that way you're able to distract them and and certainly the now that's Kerry in the background. She was still whether she's much better at taking videos and Kerry Simpson who used to be a partner at the clinic.
And the Webbox licky licks, the one that's still going, that's a really good way of getting quite a lot of different medication into a lot of cats, but you need to try them with it first to see if they like it. And if they don't like one flavour, try a different flavour. Other things to think about is advising the owners about how it might, you might make it easier.
So you want to think about not chasing the cat around, taking it from the litter box to medicate it, not, pulling it out of its safe place. Old cats raising the bowl, adding in feely way, things like that to take the edge off. Which brings us to reformulation, and there are now more and more versions available .
Which is really, really good, because ultimately, there is no point having a really fancy drug if we simply can't get it in to our patients. When we talk about reformulation, it can be at all levels, even cutting it in half is reformulation. Obviously, if you crush a slow release capsule, it is no longer a slow release capsule.
So you'd have altered the bioavailability. If you mix things up with butter, etc. Etc.
You may, for example, if that was a a tetracycline or a doxycycline, it will bind to the the calcium in the milk, or the butter, and that would reduce its absorption. So you do need to be a little bit sensible about it. But ultimately we've got to give it a go because there are just aren't enough good drugs available for for cats.
We often put multiple bits of pills within a single gelatin capsule each day so that we just have to give the owners have 11 capsule rather than lots. What is now very helpful is we've got these commercial laboratory. So we've got 3 licenced in Britain, and they've all got GMP licences, as Nick explained at the beginning.
So they're BMD assured, which means that if it says it's got 100 milligrammes of X per tablet, that is what's there, and there won't be anything else there that they haven't stated is there, and they have to give stability data. So that is great. What they don't have to do is know the bioavailability or do the efficacy studies.
That's up to you and me. Now, the good thing is there are more and more of these studies coming through, and some products, there's been a lot done on others, not so much. I'll kind of pick out a few things that I think are interesting.
Now, where these companies are simply making, taking a a big size tablet, big size capsule, and reformulating it into a small capsule, smaller tablet, then obviously that doesn't change the bio bioavailability at all. It's exactly the same. It's just now in a small size, which is much easier to give.
That's really useful, I think particularly with the therapeutics because you mustn't cut those up in your clinic or have owners do it, so you really have to get those made up. You've then got putting the powders into flavoured pastes or suspensions. Obviously, there is a potential for alteration in formulation at this.
The doxycycline monohydrate monohydrate, I'm gonna come back to it in Couple of slides time. The other one that I think is really good is the haylovia, because obviously, if you've got a cat who's got herpes snots, you really need to be able to get antibiotics into them easily. You need to be able to get antivirals into them easily.
And so if you've got a chronic snotty cat that's got herpes, so feline herpes virus plus mycoplasma plus orrano border teller, then actually you're looking at doxycycline and foundcyclov for that cat. And they've got snotty nose, they're not gonna want to take medication easily. They're not gonna want to have stuff pushed down their throat.
So having them in a flavoured paste is really gonna help. And then the final one is the transdermals. The product that's had more work on done than anything else is methimazole.
This has been worked on in many studies all over the world and on many different systems. There are different types of liquid or oily liquid that you can formulate it with and some of them cause more skin irritation. Than others.
So there's a lot of work done there, and we know that there's good data that shows that the transdermal products with methimazole, the ones that are available from these labs, that they're good products, which for all cats aren't easy to medicate and you're talking about medicating them for the rest of their life. I like that. I like that a lot.
But obviously, I want to see more studies coming through, particularly on the amylodipine. I'm really excited to see how that works because not stressing out cats with hypertension sounds like a good plan for me. So Nick mentioned Cascade, it's really important that we always stay cognizant of it.
You've got the EU me that medicines directive, which certainly until after Brexit will be very much governing what the UK regs do. And what they allow is for prescribing veterinarians either us, we can go on clinical freedom, particularly for non-food animals. We need to consider things sensibly, but if there were really lots of good products around, we wouldn't need to at all.
But where we don't have the appropriate drug in an appropriate formulation, then we can look at this list and go, OK. Are there any ways that we can do something more practical that means, particularly if you're talking about antibiotics, if we can do something that is going to improve antibiotic stewardship and make it better for the cat, that's gonna be a win-win. So, ideally, you've got a veterinary medical product available.
Obviously, that started out as these were the, you know, the the primary ones that had the work done on them. So the singuloxes of the world. But then, of course, you've got all the generics have come in there.
All they have to do is prove equivalents. And then even if it's slightly different, then it's as long as it's equivalent, then they can get that licenced. So that's where you start and you can then go, OK, is there a product that's licenced for another species but for the same condition or for a different condition but in the primary species?
If there isn't, then you can say, OK, is there a human product that I could use that's in the UK? If not, is there a veterinary product from outside, outside the UK but within the EU? No, OK, well, what about the specials?
And nowadays, we're going to be looking down that list ever quicker because we know that we've got some good products that are very safe on that specials list. Of course, there's a 4th 1 I didn't even add in there because I just never think to do it. And that would be you can look for any products for veterinary or human use outwith the EU.
So that would be your 4th, but you really very unusual to get down to that. What is important is to keep good written records, get that saying, and you have signed owner consent. What I would say is certainly the Royal College are getting ever hotter on us making sure we've got signed everything.
And it's so easy to get that this is not quite as the drug has been licenced to be used. So the minute that you prescribe a course of antibiotics for, say, 8 days, well, yeah, prescribe a 7 day course, but actually that particular antibiotic is licenced for a 5 day course. You have then started on the cascade, you've gone, OK, I am gone actually the next one down, because you are using it as is different as it how it was licenced.
So you should really have a signature for every time you have accounts that has a slightly longer course now. I don't think they're gonna get worried about a couple of days, but certainly I regularly give long courses because I've got some very chronic cases. So we do just insist on signatures for everything now.
It's, it's much easier. And it goes without saying that I'm gonna say always report potential adverse effects. I really wanted to take a moment to think about antibiotics, because we have many, many guidelines now.
We have got to take this really seriously because I don't want to end up as it is in Sweden, where you're not allowed to give prophylactic antibiotics. You're not allowed to give antibiotics after a spay, you're supposed to give the animal a bath like before. I know I'm being facetious, but actually with dogs, that is what they're suggesting.
And, you know, so many antibiotics, you simply cannot prescribe unless you have proven that you have got an infection, which is sensitive to that antibiotic, which means you can't use anything acutely. Well, a lot of my patients would be dead before I can get proof of use. So that really worries me.
So we've got to do this seriously. Thankfully, if, actually, if anyone hasn't got the ground book, that's from Mariel, that is brilliant. Have a look into that, really, really fabulous resource.
The antimicrobial guidelines working group for the International Society of Companion Animal Infectious Diseas is a bit of a mouthful, but they have all the world leaders, and they come out with guidelines for all different types of infections. And I've just picked one and I've picked this one because this is in fact, this is infectious respiratory disease. So this is cats and dogs with acute or chronic upper respiratory tract disease.
Before you've proven it's got an infection, you suspect suspect that it has the ideal treatment is doxycycline. Or amoxicillin, if you're a cat or amoxicillin clavulinate if you're a dog. But given the high prevalence of mycoplasma species in cats and or a bronchoceptica in cats and dogs, amoxicillin moxili is clearly not appropriate.
So doxycycline is the first line used for any chronic or acute up respir case. It's also your first line for bacterial bronchitis in both species and for the primary treatment of pneumonia. But I don't know the last time you gave doxycycline to a cat.
I can't remember the last time I gave the standard doxycycline, which is, Renaxan, as I put at the top. It's Mariel now, but it used to be, Pfizer. The problem is that it is the most common cause of esophageal irritation that we see in the cat, which can lead to stricture formation.
I've dealt with way too many of these to cause one myself. I just won't go there. And that's not surprising.
It's got a pH of about 2 to 3. In fact, some studies say it's way, way less than that. As opposed to the doxycycline monohydrate, that's got a pH 5 to 6.
It's been shown to have, caused less esophageal damage and have equal bioavailability data. It's actually been licenced in Australia and New Zealand for about, I don't know, well over 20 years. I've been begging for this drug for so long, because it's like, how can we have this somewhere in the world?
I can't have it for my patients. But what is fabulous now is that we now can get it in Britain because Bova got the recipe from Pfizer in Australia, and they've been able to bring it over. So that is the monohydrate, not the hyclate.
So we now have a chicken flavoured paste monohydrate doxycycline, which means we can now adhere to the working group guidelines which says that doxycycline is our first choice. That makes me really pleased by way of antibiotic stewardship. And I know I want to get way better compliance and reduce side effects.
So that makes me happy, particularly as I know what we all end up doing with these cases. We end up using vein, which is just not the best way to be going. I mentioned UTI's earlier, and we know that the, yeah, I didn't do the right, didn't do right by my calf.
That wasn't the best choice of antibiotics, but that was because of lack of getting it into them, at least it was sensitive initially. But I see so many people with UTIs, they reach straight for cephervescent first off. Well, the second most common cause, bacteria in UTI is going to be an enterococcus.
They're all naturally resistant to cephervacin. So, actually, with your UTI I'm pretty chuffed. I'm amazed when it is sensitive to cephsin, that's a bonus.
Mostly I expect it's not gonna be. So, you know, I really like the fact we're getting better alternatives here. It's good.
Medicating at home, we all know how to open a cat's mouth. But do I own it? You know, actually talk them through, you know, that you want to put your fingers either side of the muzzle, don't mess up the whiskers, and then tilt the head back using your little finger as the fulcrum.
And then once the nose goes up to almost vertical, the lower jaw drops open and you can open the jaw with your finger. There's a video up next, but actually because I've waffled on, what I'll do is I will ask webinarve to put it on separately so you can run that through as you like. You'll see it's me in a slightly outdated, while ago, but it is still my beautiful Maine Coon.
He's, was just younger then. This is a really good web source, right? Look at, print that off.
That's a really good one. So. And plus there's lots of others, but make sure owners actually know what they need to do.
So that's a video, so I'll make sure that it is played in some way for you. Plus you get to see my beautiful cat. So talk them through how to give pills.
Talk them through how to wash the pills down. Remember those time frames I told you about how bad it is for the pills getting stuck in cats oesophagus. Cats, you know, I think they're perfect in almost every way.
Well, their oesophagus are a bit of a flaw. Their oesophagus don't work very well. When you are flushing down with water, what I would say is this poor little taughty cat, her head is too high up.
She's really at risk of drowning. This is a much more comfortable angle and you just gently ease the water in at the side. If you don't explain this to the owners.
They, why would they know? They haven't been to vet school. So if we are asking them to directly tablet, we need to make sure they know how to directly tablet.
If they are using pill poppers, which I use these a lot, I think they I think they really help. Are we gonna use this form where you just have the pill in the end. I do like them.
I think they're softer on the end at the tip. Or you can use these ones, which you can also actually hasn't shown it. You can pull up liquid and pull up water in these so that when you then give the tablet, you've then got the water in there to flush directly.
This is another study done by my mate, Mike Lappin and his team. They compared using one of these capsule guns, tablet guns, with a flavoured liquid. So so water, they put a chicken flavoured liquid in there.
Oh they used a tablet or the pill in one of those pill pockets. The average time for the capsule in the the gun was 16 seconds to get to the stomach. Now that's way better than we're looking at here, because when they did it dry, remember, that was only 17% of capsules.
Got to the stomach at all. Yeah, it's 80% didn't, so this is way better, 16 seconds, they all got there, but still think about it, 16 seconds is not quick. Whereas the .
The capsules Half a sec, a half a minute. Capsules in the pill pocket, about half a minute, and the tablets in the pill pocket took a minute. So that's still a minute, even with you using a pill pocket for that pill to get into the stomach.
OK. I hope this really underlines just how pretty useless cat oesophagus are. So where we can, we really should try to use liquid or paste preparations with cats.
Obviously, it's really important that we make sure that owners don't consider scruffing. If the cat is not easy to medicate, then a towel is by far the best way to go. And to be honest, if the cat's getting at all stressed with it, it's probably just gonna vomit it up afterwards.
We need to find a better formulation for that individual cat. What about considering use of tubes? I know it always sounds drastic.
I know owners are always like, oh yeah, that's scary. To be honest, I don't use nasal tubes very often to send home. I normally only use them for a couple of days in, for example, acute liver failure cap in the clinic while we're getting their clotting times up.
But I use loads of esophageal feeding tubes. Here you see I've placed one and it's finger trap, and then you cut off all this excess stuff and then I just so the, I'll do another finger trap with the, a little bit more than is there. I'll put that onto the behind the ear.
And then you can just put a little spigot in the top. That way the cat doesn't even need to wear a collar, etc. Around it, and they can comfortably wear these and feed past them, etc.
For, well, I regularly haven't been in for 6 months for my TB cats. And they can still do all the things they want to do. They can go out, etc.
Etc. So, if you've got to have long term tabletting, then look at this as another option. And certainly with my TV cats because any of my mic about cats, they're gonna need at least 4 to 6 months of multiple tablets, and I don't want to mess up the cat's quality of life.
This little cat, little fat cat Maisie, this is a low profile peg tube, so this goes straight into her stomach. That place she needed a year of antibiotics to get rid of her mycobacterial infection, and she kept pulling out her own tubes. So eventually we put that in.
And so she kept it for a year. Think about injections. You know, subcu fluids.
You can see my friend Marge Chandler giving Teddy his subQ fluids. He does not look stressed. Owners can do this at home.
We never think twice about teaching people to do insulin. But what about this? What about B12?
What about dexamethasone if they can't give pregnants alone? So consider these options. Owners sometimes they go, oh, I really can't, but often they go, yeah, yeah, I've, I'm a diabetic or I'm a, yeah, I'm a nurse.
I can do this. So consider these options. And consider inhale drugs.
These are particularly going to be for respiratory cases, obviously. I would always use the Araca, which is the one that is designed for cats. It doesn't have a valve and it's, is the right size.
It uses the drug's most most effect effect affect. Efficiently, so I couldn't find the words I do apologise. Bronchodilator, yeah, corticosteroids, maybe even an antibiotic.
I use inhaled, not normally nebulized gentamicin in severe up respiratory cases, particularly where they've got pseudomylysis. I don't recommend using things like the volumetic because it is too big and it has a valve, which is not in the air cat, and I wouldn't recommend one of these make yourself ones. Then you want to introduce it at home.
This is little Bailey, and he's got his favourite food being put into the the little muzzle, little mask. And when he's happily sticking his own nose in it, then his owner obviously takes out the chicken. And then puts it on his nose.
So, obviously you don't want to end up with it on his stuck on his nose, that would be wrong. And then you slowly introduce, the drugs in a non-threatening way. Very, very effective.
There's a, a, a table really for lower respiratory, particularly for my asthma type cases. To be honest, I don't see mild cases. So I actually put all of them on seretide, you can see over here, and that is a mixed long acting bronchodilator.
With fluticasone, which I usually use the 1 to 5. I don't really need the other strengths and use it. 1 to 2 puffs, usually twice daily, and that will work for most of those cases.
So, I will use that for chronic up respiratory cases as well because you do get pharyngeal spasm, which can be a significant problem for those. Don't forget other methods of use. Obviously it's getting slightly off-piste for this talk, but here I've got one of my patients who needs extra oxygen regularly in a day.
So our owners bought one of these little oxygen chambers with an oxygen generator. They were very, very generous, and they gifted that to me after Bella died. We use a lot of nebulization here.
It's been done in the hospital, but it can be done at home as well. This is Bailey again, Bailey have very bad lung disease. You can buy these units pretty inexpensively, slightly more expensive, but made for the veterinary market is the flexing it.
And then it moistens the airways. My computer is saying hurry up, you need to finish. It's right.
It's telling me the right thing, but I love the fact it's got a mind of its own. And then the lady's getting coupon, so it means that we've got those drugs deep into his lungs. We didn't need to give him systemic eucalytics.
We didn't need to give him immunosuppressive systemic corticsteroid. We could use non-immunosuppressive doses systemically, but enough to really work on his lungs. So think about other ways to get the drugs in that you wanna give.
There's lots out there, it's to give you options. And then absolutely last is, don't forget that sometimes the diets really are effective. So we know for example, that the renal diets, if the cats with kidney disease will take these diets, they will live on average full year longer than the cats that don't.
But what I see so often is people just mix the foods together. And I'm trying to remember who gave it as an example. Probably, Richard Malik.
He said, if you had only ever eaten lettuce and someone wants to eat you to eat curry, and they just double up the curry on your lettuce, you're not gonna eat either. So you put the two foods you need. So the one that cat likes in the bowl that's the new, but they'll still go to it, and then new fo food in a favourite bowl and you put them side by side.
And then over time you slightly slowly adjust them, reducing the amount of the old food and increasing the amount of the new. It means the cat gets the positive feedback of enjoying the food that it likes while it's smelling the new food. So the new food starts becoming part of what it's thinking about, part of its flavour profile from its scent.
What I would say is one study we did many years ago, it was part of the Benazepril Benri study. Those cats all have to go onto a renal diet. And when I asked people to guess what percentage of owners we got to get their cats onto the diets, people normally go, well, probably about 50%, I think I get in my clinic.
We got a 100% compliance. 100%. How did we do that?
It's because they were gonna get all the food for the cat for the next 3 years free. So the reason owners don't persist in the vast majority of occasions is because they're throwing expensive food away. So one, I use that as a throw out to them, which makes them be challenged, make them want to to prove that I've thought them wrong, so that they all my owners are very good at persevering and making it work, but also offer them other versions if there are other versions of foods available for different types of renal diets, the same way as if there are different versions of the drugs we need, consider all options.
Always think about how we can improve things for cats, keep abreast of all the things that are coming through. Loads of really good stuff on ISFM through ISFM we are regularly challenging new drugs, so new companies come to us old companies come to us with new products and say we want to get it licenced or we've got it licenced in this format. We want to get it licenced in a new format.
You know, will you help us see if this is palatable? And we will do that and, you know, if they've got it like, you know, they've got it there and then they go, OK, would you see if we can get have an easy to give award? And we'll try it and go, yeah, we agree, or no, it still sucks.
So that is coming through more and more, but also look atA professionals are really good resource. So I hope that gave you some interesting tips. It is a moving area.
I think there's lots of really important stuff here, but it comes back to why are we vets. We are here because we want to do the very best for our patients. And that means any medication that we give them, we need to think, is it appropriate?
Can I get it into the cat and then is it being effective? So I hope that has been useful and I'm very happy to take questions. Thank you.
Wonderful. Thank you very much, Danielle, a fantastic, and very helpful presentation. We still have most people, online, so if anyone does have a question, as Danielle's just mentioned, she's happy to stay with us if you submit those into the Q&A box, it should be on your screen if you hover your mouse over the presentation, and we'll take some of those.
Just before we do that, you will, once this, webinar is closed, have a pop up, an internet browser pop up, which just asks you for a little bit of feedback about our talks and the speakers and, and whatnot. So it'd be really useful if you can submit any feedback you have there. OK, so we have just a message here for you, Danielle from your former intern from 2011, Yao, who's back in Portugal, keeping up to date with the best feline Webinars.
Wishing you all the best. Thank you, yeah, really lovely to hear, to hear from you and my apologies to all of you that I I've overrun a bit. You know, I tend to pack too much in.
Better too much information than too little, I guess, isn't it? Thank you. So yeah, some very, very positive, feedback coming through, .
Interestingly, we've got a question here from Charlie. So Charlie says, I welcome the number of medications now available that are palatable, but at present in the UK it's difficult to find out easily what protonnaceous palatability agents are incorporated in many palatable licenced drugs. The drug inserts are often unhelpful and bizarrely, even the SPCs do not describe them fully.
The protein is said to be hydro hydrolyzed, even the pharma companies cannot tell us to what degree. Are you aware of a database that vets can consult that lists the UK veterinary medications and the full breakdown of palatability agents? Charlie, you hit it on the head there.
I wish we had this. I really wish we had this. It other things I want to know are things like iodine content for my cats which have got hyperthyroidism and things like that, trying to get detail about degree of hydroly.
Or even more protein sources from a lot of them is really difficult. At least some of them, you know, like Bova will say they aren't animal products, but you can't even get that from a lot of them. And if you've got cats that have got potential GI sensitivities that you really want to steer clear of certain things, it is a case of at the moment, trying and seeing, and but yes, I think we all keep campaigning for that and we keep asking and you know, Nick from Bova will still be listening, so we want it all up front, give, give us as much information as you can about that sort of thing, and we will appreciate it.
Absolutely, thank you very much for that. Lots more comments coming in. Thank you very much.
Excellent presentation. Wonderful to hear Danielle, great webinar and thank you both for hosting. Absolutely couldn't agree more.
Alastair is asking regarding the cascade, how can you legally, as opposed to medically justifying going straight to the extemporised formulation if you've not actually tried the other options? The guidelines, they are not made 100% clear, and I am still waiting for from a reply for the VMD for the really specific. I, I gave them the two really specifics about the doxycycline and the gabapentin.
So, cause I, I thought good examples are a way to go. As soon as they come through, I will have webinar that send them out to all of you. So you will then have the VMD reply if they have come back to me, that is always the problem.
but we have to use the guidelines as they say, and I had a, I've had a lovely chats to, VDS as well. And so long as you are using it sensibly, you don't have to use, you know, it would be cruelty, it would be very poor medicine to use, OK, if I'm not gonna use the, the product that is in theory available for this, then I'm gonna try and use one that's for humans or shall I use one. That's yeah, for animals in other countries, then I'm going to try this then I'm gonna, that's not what they're asking you to do.
What we have to do is consider. Those other areas. Is there something in there that's appropriate?
No, there's not. Is there something in this one that is appropriate? No, there's not.
And so you can then go, OK, then I have considered it, and this is where I'm going. And you just are very clear, decision making, very clear with the owners that this is the most appropriate way to treat this particular cat. And, you know, providing you've done that, then there really is no problem at all.
Wonderful, thank you very much, Alistair, I hope that answers your question. I'm sure it does. I have a question here from Adriana, she says, thanks for your amazing presentation and information.
What opinion do you have about felaway or pheromones in general to decrease stress levels in dogs and cats in the clinic or in medication situations? Nice question. OK, well, obviously I wouldn't be using fellowway with doggies, that would be the adapter.
But I won't mention the lesser species again. So, with cats, I've been using Phil A for years, and obviously, it was Philli A classic before. I did one small pilot where I was using it with, cats with stress cystitis, and there's a trend towards improvement, but I made the study too complicated.
I was naive in my youth. But certainly there's interesting data. There's, there's good data.
There's certainly data for helping on some things like travelling cats to the vet and reducing signs of stress in the clinics and things like that overall. What I'm really interested now is with seeing the data from the friends, so feel away friends. So instead of the synthetic F3 pheromone from the face, this is the mammary appeasement pheromone, what used to be called dap, which is now adapt to for dogs, the feline version.
So mammary one. And it seems to be very impressive at getting cats who don't like each other or temporarily don't like each other, you know, so a cat who's been to the vet and then come back and fallen out with a lifelong sibling to help with those kind of cases, particularly plan ahead if you've got a stressy Burmese, you think that might happen to? But also bringing new cat into the household.
So, I really think that in particular seems to be very effective. And it's a case of trying to do everything we can. Obviously, these are more effective on some cats than others.
I've got some cats that will just rub and rub and rub on the infusers. Others will pee on them as cats for you. Yes, absolutely.
I have a comment here from Sue, great webinar. I'm a veterinary receptionist with a hyperthyroid cat on, limazole formatidine omeprazole. I'm trying all different methods to kill him at the moment.
I'm smearing a small amount of Marmite. Is this OK? Or does it interfere with the efficacy or?
Anything along those lines. The biggest thing with Marmite is it's got a high salt content. So if your kitty cat has also got hypertension, then that might be a worry.
Not that cats in general seem to be, salt intolerant. I've used Marmite as, a way of killing many, many cats and find it very, very effective. But cats seem to be like humans.
They take it, you know, they either love it or hate it. That's Marmite, but no, it's fine. Excellent, thank you very much.
Just a final one here then from Nicola. So do you have any other options rather than insulin injections for cats that are difficult to inject? Do you mean by way of diabetics?
I, I, I'm assuming so. That's all the information with, with diabetics at, at the moment, we're stuck with insulin. Obviously, if we're going to something like, so we have to go down Cascade to get to glargine, which, so obviously you're gonna most people now would start with PZI and count cause that's good for slightly longer acting, and that's gonna be twice daily.
If you really have to go once daily, then glargine is a better way to go. If that, if you really aren't succeeding with needles there, then the next one at the moment would be to go with the oral hypoglycemics, something like glipizide does work in some cats. But of course, it acts by making the cat release more insulin, which does, you know, it can effectively tyre out the the pancreas a little quicker.
But I have seen it used very successfully. I've used it myself very successfully. It's watch this space by way of the things like the long-acting extratites.
I think there will be these long-acting medications coming through within the next couple of years. I think it's gonna really revolutionise treatment of Diabetic cats, it's really starting on people. So that's to watch this space.
But where it comes, if that was the question about injecting insulin, there, there, we don't have as yet a type of insulin you could, you know, have the cat inhale or anything like that, unfortunately. Interesting, thank you. Just, a message to everyone.
The, the recording of this webinar will be up on our website within the next couple of days. So if there's anything you want to go back over or anything you've missed, it will, it will be available very shortly. We'll send an email around to everyone as well, just letting you know when that's available with some of the resources that Danielle's mentioned, and then we can always forward on the information from the VMD that we're waiting on.
I think that's it for now. Lots of very positive comments coming in, great webinar, thank you so much. All very, very positive as ever, Danielle.
Thank you very much. Obviously huge thanks to you for organising the webinars, as always, they, they just work a dream, to, to Bova for making this one open access and Always to you guys who've taken time out on a busy lunchtime or you'll be like me and you've taken time off your holiday to be here because you think that it's an important subject that doesn't get covered very often. So thank you so much.
I really hope that was useful. I will make sure that we put up the, the video of so you can see me. I'm trying to open my very big cat's mouth.
It's quite funny. You can have a giggle. All right, thank you very much.
Thank you so much, Danielle, and thank you both for sponsoring. Thanks all. See you on the webinar soon.
Goodbye. Take care, everyone. Bye.
