Thanks very much, Paul, and good evening and welcome everybody on behalf of Purina to this talk. We've had such lovely feedback from everybody on these talks and we're delighted to be able to help bring them to you with such great calibre of speakers such as Danielle. This series, this is part of our commitment to the veterinary, profession and practise, and we're looking forward to start to bringing you further talks.
So we've got ones coming up in neurology and diarrhoea. So really looking forward to connecting with you on those, but without further ado, I will hand over to Paul and back to Danielle and enjoy. OK.
I think it means it's come over to me. Well, it is wonderful to be here this evening. I am settled into my spare room.
The cats have been evicted. They're outside with the, with their daddy. If you hear squeaks and squalls, one of them is now quite demented.
My apologies ahead of time. So tonight's talk. Feline you urinary tract disease, and we're gonna concentrate on causes and management.
So, this is otherwise known as my pissy pussy talk. You know, you know, all my talks have have cute, cute names. Big thank you to Purina.
Definitely, it's an important topic, such an important topic. So without, the, sponsorship, we wouldn't be able to, to have it. And also always, massive thank you to the webinar for hosting these.
I just love them. So, you all know what this looks like. So playura, increased frequency, periura.
I love that word. That means pissing around. So I accuse my, my final year students of doing that quite a lot.
Hematuria, etc. You know the other causes. But I do also want to draw your attention to the little photo at the top.
This is a cat who's got serious cystitis. Now, I know people who are into dermatology might go, Oh, this cat's got fleas. Mm.
Yeah, it could be, but this cat has got bad cystitis, and she's got a painful bladder, and the pain is radiating down her legs and down her tail, and hence, she's, she's plucked her fur. So that's an important one to look out for. The clinical signs of FLUTD, which is just the umbrella term, which encompasses all the different reasons to have an inflamed bladder.
So we'll go to individual causes in just a bit. Tends to be episodic in nature, unless you block, and obviously, then you go to unblock them. And you can get altered behaviour.
Initially, the cats tend to get, a little bit more, friendly. Sometimes that is because they've got kind of perineal tingling, potentially interpreted as something quite pleasant, and that unfortunately, then switches over to being pain and they then get grumpy, not surprisingly. So they're the kind of clinical signs that we're thinking about, make sure we're all on the same page.
Certainly in Britain, it is incredibly common, and certainly in all the different countries where I've seen data, it's up to about 10%, between 1 and 10% of of all the cases, cases that come into clinics. But I do think it's worth flagging this statistic up of cases that are referred for behavioural problems, where they've been referred for periura, so inappropriate urination. And over 90% of those have had blood in their urine at some point, which really goes to show that the, the, the difference between stress cystitis, which I'm gonna call idiopathic cystitis, which obviously, that's crazy because we know what's causing it, and true behavioural, it's just completely all muddled up.
It's all the same thing. And stress most certainly can cause bloody urine. Tend to be young to middle aged cats.
When you look at this graph below, you can see that the cats kind of peak between 4 and 7, while as dogs, would just increase with age. So it shows you the situation and the cat is really very different than the one in dogs. Persian cats and black and white domestic short hairs are predisposed.
This is a fat black and white boy at the top. This is the absolute archetypal cat to get blocked. I really worry when I see black fat black and white boys.
If anyone wants to know the black and white theory, ask me at the end. Obviously male and female are affected, but because the boys block and that's life threatening, you'll see far more of those in referral centres. So, what about causes then?
That's all I've got to start with. OK, what causes this? And straight away, what you see is FIC, which, yeah, it stands for feline idiopathic cystitis.
It's had a few other, acronyms over the years, but that is what its current name is. And certainly, 5, 10 years ago, we weren't quite so sure about the role that stress is playing with this disease. Now we are much more aware.
And yes, we don't know what the absolute primary trigger is, that means that this particular cat that when stressed shows bladder signs, whereas another cat when stressed, for example, might show gut signs. We don't know what makes an individual cat be bladder predisposed. So maybe there's a virus, maybe there's some kind of infection.
We honestly don't know, but people have looked and not found it. So really, when I'm talking about idiopathic cystitis, I'm talking stress cystitis. And I think it's actually important that we really use that term because it really helps our owners understand what we're talking about, because they don't understand what idiopathic means.
Yes, it means we're idiots. We don't know what the pathology means is what I was, taught that it means. I don't know what pathology is, but our owners don't know that.
If we call it stress cystitis. And make a point of saying, look at the numbers. You know, between 55 and 75% of all cats showing signs of bladder pain have got stress cystitis.
So we should use that, and I think it'll really help owners understand just how important it is for us to correct that stress. About 20% are urethral plugs. And the thing about plugs is it's a combination of the protein that it is just caused by.
So look at the middle image for you. So a plug is just the inflammatory cells and the inflammatory proteins that are being released horribly in. Blamed bladder wall.
And then you add to that, urethral spasm, which is because of pain. That particularly occurs at the level of the prostate, as you can see the first arrow, my point is being silly. OK, the first arrow, and at the issuearch.
Yes, some cats do have a little bit of a narrowing there anyway, but it gets that much worse when you've got an associated spasm. Yeah, crystals can get stuck in it, but You know, if you look at normal healthy cats on a normal dry diet, they will have a urine specific gravity. Way, way, way above 1050, it will be 1070, 1080, and almost 100% of them on a health, normal healthy cat, normal dry diet will have crystals in their urine.
Now, they don't all block, which shows you the presence of the crystals per se doesn't mean anything. They're just getting stuck in the jelly that is the inflammatory debris that's getting stuck in the in the spasm. Obviously, the presence of crystals does show that you've got super saturated pee, and that does increase your risk of uroliths.
And neuralist bladder stones do form about 20% of cases. So we can't ignore them, but you can see that, you know, add these numbers together and you've got stress cystitis actually causing over 75% of cats showing signs of cystitis. So I hope that really shows that's where we really need to focus.
Urinary tract infection less than 5% by the time cats are referred, higher in, general practise, but often associated with stress cystitis anyway because the urothelium isn't working properly. So, If we then look at the difference between ages, there is a little bit of an age. Remember, all the cats, it's unusual for them to prevent with present with signs of cystitis, but when they do, it is different.
So if we look at cats older than 10, that's the maroony side. The the lilacy colour is exactly the same graph we were just looking at. But we can see that in cats older than 10, then a urinary tract infection is far more common.
Now, clearly, cats don't get to their 10th birthday and suddenly go, oh, my bladder hurts. Of course they don't. Why are they getting urinary tract infections?
That is because diseases of ageing, particularly chronic kidney disease, hyperthyroidism and diabetes mellitusis all cause PUPD, which means the urine is less concentrated and in the case of diabetes, there's also glucose in there to to ferment. Also, all three of these conditions cause systemic immunosuppression. So it is not surprising that all of these conditions, Increase the risk of a urinary tract infection.
What this means if you've got a cat younger than 10, it's by far most likely to be stress cystitis. A cat older than 10, then, you know what, it's likely to be a systemic disease, and we need to do more work to investigate to find out what that is. If we look at cases of obstructed FLETD, well, look at the numbers.
OK, plugs make about, this is just stress cystitis, 60%. Pure spasm makes about 30%. So stress.
Is actually causing 90% of the obstructions. Stones only make 10%. So this is really important because now think about unblocking those cats, and you can see where your priorities have got to go.
And we'll, we'll get to that, I promise. So we really need to focus on FIC. We know that really, it is a case of a sensitive individual in a provocative environment.
Great phrase, Tony Buffington coined it. You put that cat in a different environment, when it's less stressful, it'll be fine. But a different cat in this environment, it might be able to cope.
But this cat, this environment, bad news. Yes, genetics plays a role, but also it's developmental, what stressful thing happened to the kitten's mom at about the time of, of, of birth. What's really good way of thinking is a bladder migraine, because the disease is actually in the brain, and yet we see changes all the way down the spinal cord and into the bladder.
So this is the whole system is affected. And the stresses we're looking at, these are chronic stresses, not acute in most cases. The one that comes out very frequently is into cat conflict.
So living with a cat that you don't get on with, which if you think about it evolutionarily, that wouldn't happen. But we do see it occasionally in single households where they're really bonded to their owners, and we see separation anxiety. Moving house comes up time and time again, but then let's be honest, it's horrible for the humans, it's not surprising the stress rolls over to our cats.
He's another cat looking stressed or my husband says just looks like me first thing in the morning. So, normal cats, they get stressed. They get activity in the hypothalamus, increase called trophic releasing factor that acts on two places on the brain stem and the anterior pituitary.
I'm sorry, I know it's like. This is the only bit of heavy pop I'm gonna do, I promise. So acts on the brain stem and on the locus cereus, which is the area in your brain stem that does vigilance.
It also makes more your adrenaline than anywhere else. So this is up regulation of the sympathetic nervous system. But this also acts on the anterior pituitary, where you produce ACTH, which goes to the adrenal glands to make you produce cortisol.
So this is activation of hypothalamic pituitary adrenal axis and we all remember that from college, don't we? Yeah. OK, it is a controlled, regulated stress response.
It is the combination of adrenaline. Or epinephrine from the sympathetic nervous system, plus cortisol that allows us to do fight or flight. That's really important because cortisol also turns off this cascade.
And that's really important, hold that thought, the need for cortisol to turn off the cascade. Because what we see in FIC cats is masses of displacement activity. They are stress eaters.
It's one of the reason they get so fat. Massive upregulation of the sympathetic nervous system. But no plasma cortisol, and that is because their adrenal glands have shut down.
The stress is too much. They've shut down, and the lack of cortisol means you can't shut down the sympathetic nervous system. So these cats are incredibly stressed, but they can no longer fight or flight.
They only have freeze, and then the other ref faff and fiddle about displacement activity. We will come back to that in a little summary slide in a minute. And as I said, the changes go all the way through the spinal cord down into the bladder.
We have increased pain receptors, increased, pain fibres, and we know that stimulation of these fibres, either to, appreciation of stress in the cat's environment or local triggers from a concentrated bladder, concentrated pee in the bladder, you get release of substance pee. And what these neuropeptides do is cause pain, basic dilation, increased vascular and bladder wall permeability, that's important. That is why these cats can pour blood so quickly, almost spontaneously sometimes into their urine.
It means that they can leak the contents of their urine back into their, their body, which is not great. You get edoema of the bladder wall and smooth muscle contraction, which can give you a small hard bladder, but this also gives you the spasm of the, the urethra that we were talking about. So important.
This is neurogenic inflammation. We also know that the gag layer is altered in a lot of these cats. And that means if you haven't got the gag layer lining the bladder wall, that means that the concentrated urine, which is a pretty noxious sub substance, can diffuse straight into the urothelium to trigger more of those C fibres.
So it's a combination. So I'm gonna put that together in a pretty horrible graph, ready for it. Well, not graph, picture.
So let's start at the top. Summary, stress, affecting the brain affects your brain stem and your anterior pituitary. You're gonna get activation of the sympathetic nervous system and through the adrenal cortex, production of cortisol.
But with these guys, they don't get any cortisol. So it means instead of fight and flight, they can't do that. Which means they show stress responses.
They also show other systemic signs of stress. Tony Buffington coined the phrase he wants to call this disease Pandora's syndrome. It's very pretty, but I think we should call it, I don't know, aberrant stress response syndrome, something that actually says what it does.
And what we see in these cats is they also have more vomiting, GI problems, increased respiratory. Effort, increased respiratory disease, particularly stress will bring out feline herpes and feline calicivirus. So there's a lot going on in these poor cats, but interestingly, it's the bladder appears to be the biggest problem.
So, a couple of things I think it, it's worth I kind of underlining with this. I've already mentioned that in general practise, we see more infection, more UTIs than we see in referral. What we do know, as I was mentioning, is that this urothelium is incredibly leaky.
So, it means that it can't actually repel bacteria very efficiently. So not surprisingly, they, they do get bacteria. So if ever you see what appears to be a bacterial UTI in a young middle-aged cat.
Be very suspicious that this is not a primary UTI. Be very suspicious that what you're actually dealing with is stress cystitis. It's got a secondary UTI.
Does that make sense? I hope so. What we do know is, because this urothelium is so poor at fighting infections, whenever you catheterize these cats, they will get a UTI 60%.
I've got a UTI within 3 days. And where people have done perineal urethrotomies, which is rarely the right procedure for these cats. Interestingly, same number again, do get 60% recurrent UTIs.
But someone's done a pretty hideous experiment with normal healthy cats. They have done perinonearthotomies on them. Guess what percent get recurrent UTIs after all, male cats, they need that penis, don't they?
They need that prep use. Apparently not, because they don't get UTIs. They only get UTI's if they had FIC to start with.
Interesting, OK. Nothing that we've shown is that chronic FIC can result in what we used to call transitional cell carcinoma, but is now called urothelial carcinoma. It can take a few years and it tends to be the cats with a very thickened wall, as you're seeing in, in these images.
And I'm just gonna leave the thought with you. In humans with this disease, oxalate stones actually part of the, syndrome of presentation. So maybe the oxalate stones we're seeing are partly stress-induced as well.
I shall leave that as I thought. Scary, hey? Don't stress cats.
There's a moral. What about stones? Well, certainly, we know, a few decades ago, strovis were the biggest player, and people found cats with urinary obstruction.
They found the strovite, crystals, and so it made sense to go, OK, well, let's change modified diets so that we get less strovites, which we've done. They're far less common now, but we see a lot more oxalates, and we need to do more work as to working out why. What I will point out is that all the cats tend to have oxalates, that's an important one to look for.
And really importantly, any cat that presents to you with a bladder stone and you find out that it's an oxalate, please, please, please check that cat's blood calcium, because about a third of them are gonna be hypercalcemic. And it's hypercalcemia for lots of reasons. Sometimes they see the idiopathic, very frustrating, but it can be vitamin D toxicity from licking psoriasis cream or exposure to certain plants like the the night scented jasmine.
It's got a a vitamin D analogue in it as well. But you can also see this with kidney disease. You can see it with some neoplasia, etc.
So please look for high calcium because high calcium can be eminently treatable. If you treat it, then you can stop the cat forming new oxalate stones, which has got to be. And underlining that because we see so much big kidney, little kidney syndrome nowadays.
This is bilateral urethral stones. About 97, 98% are due to calcium-based stones, mostly calcium oxalate. So if you see a cat with a calcium bladder stone, Please, please, please make sure you get radiographs or ultrasound so that you can see whether or not this cat's already forming stones in its kidneys.
Because that cat won't tell you when its first kidney gets a stone, its first ureter gets a stone. It'll just block. You'll get a hydronephrosis.
This kidney will get hyper hyperplasia. The cat won't tell you a thing. It's only when the second ureter obstructs and you got hydronephrosis in this kidney and this one's already atrophied and useless.
Now the cat tells you it's got a problem and it's already quite late. So if you can identify your potential stone form as early, you keep check on them with regular radiographs or ultrasounds. What we have, which is great, is this.
This is the, it's the humane mouse trap. Great. So it's a, this is a CT machine.
And you just put a cat in there and it's also an oxygen box. This was my little Bengal cat. She was blind, which is why her eyes look so big.
And the sort of images that you can get, this is cut through a kidney level. You can see one small kidney with a stone, one big kidney with big, distended ureter. Which you can then do your ureteral stents or subcutaneous ureteral bypasses.
This isn't, that's not what this talk is about. I'm putting it there because if you diagnose oxalate stones in the bladder, please look for them elsewhere. I've already mentioned bacterial cystitis, mostly a thing of old cats because they've got chronic kidney disease, diabetes, or hyperthyroidism.
But you'll also see this with neoplasia around big time when we've got involved, so I had to. I do want you to think about neoplas yet. It's not common.
I've seen quite a few urothelial carcinomas. They can either look like this one. This used to be a TCC or used to be called.
Sometimes they're a nice big mass like that. More often they're very diffuse. I've also seen a few prostatic carcinomas which are presented as obstructed cats.
So please look for those at the rectal exam to find those. Other things, polyploid cystitis, that is usually chronic inflammatory, chronic infectious. And then malachoplachia.
We had our first case pretty recently. I did not even know what the word meant. This is a case of malacoplachia.
My colleague Nick Bomer, was the primary vet on this case. It's a chronic inflammatory response where the macrophages can't fight off the infection. If you see one, let me know.
We kind of want to collect them. Occasionally we see incontinence, but this is nowhere, nowhere near as common as in the dog. So common in the dog, it's boring.
But in the cat, it's really unusual. It's usually due to chronic obstruction, which has resulted in then bladder ay and then overflow or a spinal lesion. So when you see this occurring in older cats, you're worried about a spinal lesion.
So I hope that backgrounds, they're the causes. Yay. What's the biggie?
It's stress. So given that the biggie is stress, we've really got to focus on the stress side. OK?
Definitely. So I'm gonna talk you through relieve some tips for relieving obstruction because I have done too many of these to want to not share it. And we're gonna talk about how to manage the clinical signs of FIC as well.
What I want to set the scene with is if you don't do anything to change this cat's lifestyle. This cat is very likely to recur. To re-block and ultimately be euthanized.
If the owner really can engage and is able to change the cat's environment, diet, etc. Etc. Then you can get really good recovery rates, in the Memo study, which is Tony Buffington, he got an 85% recovery rate, and we're a little competitive.
So I'm always very proud of the fact that in, in my study, I beat him. But you've really got to have dedicated owners. If you haven't, this is gonna likely keep recurring.
And once the cat has done it 2 or 3 times, it will keep recurring. If the owners cannot change the cat's environment and will not consider rehoming the cat to a less stressful environment. Then offering euthanasia for the cat is not the wrong thing to do.
I know it seems pretty radical, but think about the stress and the cost this is going to put the cat through. OK, the cost is not the cap, you know what I mean. So there's my patent stiff kitty stiffy picky.
There's not too many people have one, let alone can say it. So first thing we do, I'm not going to talk about the, the really intense medical side. Basically, you want IV access and you want to resolve the hyperkalemia, the high potassium.
Best way to do that is give calcium because 75% of these cats have got low calcium at this point, and it's that low calcium that makes the heart exquisitely sensitive to the high potassium. So push calcium gluconate. Some people I know will just sedate the cat.
They're fighting against nature doing that because if you don't anaesthetize the cat, then the urethral spasm will stay there, particularly if you're using ketamine as a sedative. So make life easy, anaesthetize the cat. Then look at the penis for signs of trauma.
You might be able to milk out that little plug, and then along will follow the pee, sorted. At this point, what I want you to do is a rectal examination. And you're going what?
Unless your fingers are bigger than your average cat poo, which can get out of a cat's bottom, your fingers can get up a cat's bottom. The cat is gonna be anaesthetized after all. If this was a dog, you wouldn't think twice of it, would you?
And what I want you to feel for is I want you to feel what's a normal urethra in other cases. And then, you know, is there a stone? Is there a spasm?
If you've got a really strong spasm, it actually feels like a really tight little piece of muscle. What would you do if you had cramp anywhere else? Yeah, you'd rub it.
So do per rectal urethral massage. Quite often, that's all you need to unblock these cats. So rectal examining rectal exam first.
I should actually change the order on this slide. I will do that next. At that point, if you can feel a stone, then you want to get ultrasound to see if you've got more stones in the bladder to try and work out what you're dealing with.
If you can't feel a stone, you can still do an ultrasound. That can be certainly very, very helpful. You're gonna try to unblock this cat.
The problem is, if that bladder has really built up some tension, then you are very unlikely to be able to relieve the pressure to pass a catheter without some kind of cystocentesis. What I will say is don't do it like this. This is fine if you're just taking A sister on a perfectly otherwise healthy cat, which is what Sarah's doing.
But when you're doing this on a cat that's blocked, the eurothelium is very fragile. It's under a lot of pressure. I can tell you, because I did it, 100% of these cats, when you do cystocentesis, will get a euro abdomen.
Do I worry? No. What I do now is simply don't turn the ultrasound machine on that way I don't get anxious about it.
If they're not infected, it's gonna be fine. It'll all get reabsorbed. What I do say, though, is don't use a syringe and needle direct like that.
Use a syringe, three-way tap, and an extension lead, because that way, the pressure, you know, you get that hand tremor, it's not transferred to the bladder and use the finest me you can, and empty the bladder as fully as possible. I hope that makes sense. Then you got to pick a catheter.
Depending where you are in the world, you're likely to have the little red top here. This is a fixed red top, and then this is otherwise known as the Jackson or Tomcat catheter. If you look at the tip of it, it's got, it's made of hard plastic and it's got little holes.
This is cheap, but you do not get long ones, and these are pretty traumatic. Please don't leave these in the cat. That is not good.
The next cat it's good for unblocking because it's so cheap. If the blockage is at the urethral tip, you could use an over the needle cath with the needle taken out. This is something called a slippery Sam.
If you're in a country that has slippery sam, fine for unblocking, that's the little her that that goes into this very soft tub. What I would say is, do not ever leave this in situ. It doesn't say it on the packets, but it says it on the website.
Don't leave them for more than 6 hours. And that is because the white bit will come apart from the black bit, and you will be doing surgery to get that black bit out of the cat's bladder. Mm, yes, definitely suboptimal.
So we then started using soft, easy go catheters. No use for unblocking, and we used to put them in the freezer before placing them to make them a bit stiffer. They're good because they're a good length, but you then have to put the wings on to make mark the length of the catheter.
And if you put this little clip on to hold it there, it's too heavy and it will twist. You can put little sutures here. And that works so you can make it the right length, which is good because short catheters, these are just 10 centimetres, it's no use unless the cat's very little.
But then this cat that came out. This was the original cat cat from fight one vet and it was grey, and this bit swivels from this bit. They've now turned it into a black and orange one, black and red one.
It's actually black and orange. This colour doesn't look great. It swivels.
That is really good because it means you don't tangle up on your collection system. It's Teflon catheter, which means it's very non-reactive, which is really good with an open tip at the end. I like this.
This is a 14 centimetre. This has now become my absolute standard catheter. I do the unblocking with it, and then I suture it in.
Less cost, very effective. Really like this catheter. If you've got a really fat cat though very big cat, then this might not be long enough.
Soyon also do an adjustable length catheter. And this is its little widget on the end which you flip and I think that's open and that's closed, and you can set that at any length, the same way as you can this easy go catheter. So you do need at least 14 centimetres.
The end of the catheter has got to get into the bladder. There is no point leaving it in the proximal urethra. It's gonna cause a lot of damage there, especially if you use one of these cheap ones.
Use a smaller catheter, so a 3.5 is the best size that's been proven to use, not a 5. OK.
Hopefully that's all good. Then look at cat's anatomy. There is a natural kink.
It is at this natural kink at the issue ch all catheter trauma occurs. All right. Here we've got the urethra catheter going into the colon, rectum, yummy.
Here there's been a tear, bladder catheter is now in place, and here there's a horrible tear that has occurred because the catheter has been put in and pushed. So, it's pretty easy. Just look at the anatomy.
What have you got to do to make that into a straight line? You hold the prep use and you pull it up here. So that it's a straight line from the tip of the penis into the bladder.
So, what do we do? We start with the rectal exam. Then an aseptic preparation.
Remember these cats have got exquisitely sensitive urothelia that's really gonna get infected. Using sterile prep, invert the penis. Put the catheter into the tip of the penis, and in most cases you can do that.
And then, stop holding the penis because it bruises so easily and you get hold of the prep use and you pull that towards the tail and upwards. Straighten that line. Let's go back to it.
Straighten this line, all right? We prep use to tail. Then, if it won't pass to, to start with, do perecttal massage at the same time or flush some saline at the same time.
Actually, both is really good. And then once I've got my catheter in, I do want to flush out all those inflammatory cytokines, bits of grit, etc. Etc.
There is a really good set of photographs with words on the Vigon website. They did a really good job on this. They contacted me and said, what would I want as the perfect catheter.
I described it to them. I forgot to say I'd like some money. Damn, so I've never made a penny out of it, but you know what, I'm just happy we've got a decent catheter that I'm very happy to use.
If you find a stone, then you need to do retrograde hydropulsion. So this oopsy again means one person's got to go for rectum. The way I find this works best.
You put one finger per rectum and then, get someone to place the urinary catheter into the cat's penis and then hold the catheter firmly. So prep use around penis, around catheter to hold that firmly and start injecting in saline. I actually find it easiest if I do the injecting in of saline so I can feel how much pressure I'm squirting in.
And I've got my finger per rectum, so I can feel the urethral column starting to dilate under my finger. So then I'm in control of both of them. If, and that way, as soon as I feel like I'm really building up, then I go now to myself.
And at that point, I raise the finger and give a good flush, and you'll feel the, the stone roll under your finger into the bladder where it can then be removed. OK. That's the easiest way to do it.
Obviously you can do it any combination of one person doing per rectum and the other person doing the the flushing bit. You've now got a catheter in, you can do contrast studies, etc. By way of leaving a catheter in.
This is an important one. Because do you really need it? You just take a glug of water.
OK, so you've been thinking, do you really need it? Because if that went in really easily, And it really was just a spasm, and it wasn't even that bad a spasm cause you got there quickly. Do you need to put the cat through a stress of having a catheter in and a collection system and a bucket on its head?
This is a stress induced disease. Do we really want to do that? So where you were able to unblock really easily, then Have a think about it.
Could you keep the cat in overnight on lots of fluids, on Prazocin or a similar drug, urethra relaxant, so that you can make sure it's peed in the morning and you can then send it home. Maybe we keep it slightly sedated. Just a little bit to take the edge off.
Maybe gabapentin, good as a take the edge off and for analgesia. Sounds good to me. However, if you are gonna leave it in place, you need to make sure it is in the bladder so that it doesn't damage the proximal urethra, particularly if you're using one of those cheap catheters.
In fact, please don't use those really cheap 10 centimetre catheters, they're just a disaster. And then you want to suture it in place, attach it to the tail, however you prefer, and then tape it to the top of the kennel, just in case you don't want the poor cat carrying all of this around on, on the weight of his tail or or or we're still on his prep use. Keep going with the fluids and the post-obstructional diuresis potassium that he's gonna need.
And then how long you leave it in place. Initially the urine is bloody. Once the urine stops being bloody, you should remove it.
What we tend to do is all wait too long, don't we? Yeah, it goes bloody again and we're out, go take it out now. So I try to leave them in only 1 day, 2 days really max, unless I know there's been a tear.
I do keep them on painkillers. This is painful. And I keep them on muscle relaxants.
So prazocin, which is a smooth muscle relaxant, the dose being a 0.5 to 1 milligramme per cat every 8 to 12 hours. If I'm going high, which I usually am with these guys, at a Mig per cat, and I'm going every 8 hours, I will check the cat's blood pressure to make sure I'm not going less than 100 systolic, and above 100 systolic, I'm happy.
Don't give antibiotics, but check the pee when you're removing the catheter to see if you need antibiotics. I remember when this paper first came out, everyone was a bit shocked by it, and we didn't know whether we should share it with people, but how arrogant is that? It's ridiculous.
People actually worried about that. So, I'm gonna talk this through. Remembering 90% of urethral spasm causes blockage.
It is stress related. It's a pretty scary protocol. They only do it where it's no recurrent spasms, so this is a recidivist cat, he's done it before.
And there's limited biochemical changes. And it's where you want to avoid your eal catheterization, either for cost or because this is a very stressy cap. And they used a combination of ACP, buprenorphine, and meatomidine.
Now, but clearly you could use different combinations. They did do decompressor cystocentesis and they gave them some subcu fluid. They then left them in a calm, quiet, dark environment until they peed.
Yeah, pretty scary. But they had success, spontaneous urination, in less than 72 hours in 11 of the 15 cases. Do I do this?
Yeah, I do. Selected cases have been very, very successful. And for my cats that really do this a lot, I will actually have them have, you know, the, the, the selection of drugs they might need that they can have them at home, so they can actually do at home with supervision.
The, the ones I've done that has actually been where the owners are medical in some degree. So I wanted to share that with you. It is something to consider, but you've got to pick your cases carefully.
So We've now got our cats unblocked. We now have to think in our last bit of our talk, long term, how do we keep them unblocked? Well, the first thing is urine concentration.
We know that these cats have a medium urine specific gravity of 1050, that's simply because most refractometers stop at 1050, 1.050. Where I've looked with my digital refractometer, most of them are 1060, 1070.
They are super concentrated. So we really want to increase fluid turnover. Really make sure that the cats want to drink, offer them water in any way you can, dripping taps, water fountains.
Most importantly, get them onto a wet food. Wet food is classically 90% water, whereas dry food is classically only 10% water, or those numbers thereabouts. So, moist diet's always going to be better.
And in the two studies that have managed to pull urine specific gravity down below 1035. Good success rates, really good success rates. But remember, go back to thinking about what this disease is.
That means we're not showing clinical signs of cystitis, which means we've reduced the stress this little cat is on because he's no longer got cystitis, but he's still stressed. He is still unhappy with his his environment. He's just coping with it a little better because he's not got raging cystitis at the same time.
So doing this alone isn't enough. How can we do this? Well, 20 years ago.
There wasn't anything to offer in diets, even 15 years ago. It was really a case of just trying to get them onto moist diets. But now we are so lucky.
We have these three groups of diets. So you've got the Purina, you are STOX, the Hills CD Mulcare, and it's got other things to, and the Royal Cannon Aso, I've given you a selection of them here. But here's some data from Purina.
And this is the specific gravity. So this is on a standard dry diet. The specific gravity of this cat, this particular cat was 1057.
Actually not that high for some of these guys. But on, this is old data, they've improved the diet a lot since then. This is probably data from I say this is 10 years old now.
Pulled it down to 1046 and on the wet version, 10:43. And these diets have gone on from that. Are they physiological diets?
No, I wouldn't say they are. Do they save lives? Absolutely.
If you told me I couldn't have these diets anymore, I would be saying, Well, you are condemning so many, probably hundreds of thousands of cats to death because we couldn't stop them having recurrent cystitis. Because what these diets do, they don't just treat the stress side, the stress side of things by reducing the specific gravity. And hence not having the pain of cystitis.
They are also designed to actually start dissolving struvites and certainly preventing new struvites and new oxalates being formed. I'm not gonna talk specifically anymore about, the stone side of things, but that's what these diets are doing. So they actually do.
We don't have to have one for struvites. Which I remember we used to have, and there are still some out there. And one for one for stopping stre rights reforming, and one for stopping oxalates reforming, and another one to try and reduce the specific gravity.
It's very careful, design of these diets means that they can do all of them. It's a busy slide, but we go over it at your leisure. So what we've got is is the Purina diet, the hills and the Royal Cannon.
And what you'll see is they've all done different things to achieve the same kind of ends, similar ends. They've added B6 that reduce oxalate formation. That's important.
And then reducing the specific gravity of the urine. A hills have done that more with the potassium citrate down here. Whereas Nestle, as a Purina have done it with added sodium has has royal cannon, and it has been shown initially there was concern that these cats were very high in sodium chloride, but they have now been studied, at least up to 2 years and shown that that's not a problem, even in older cats.
So, do it in different ways. The important thing is, if you've got a cat that won't eat one of these, and they come in different versions, different flavours. So here we've got dry pouches and tins, tins come in different flavours, and you'll find that the same with the the the other companies as well.
So you have choices. And with these cats, it's so important to have the choices because these cats are often very fixated on one particular diet. I like this study.
This one happened to be done by Hills, but I'm hoping that Purina will be doing, doing a similar one. Here they were using, say, CD multicare, which is the same as urinary stress, but then they've added some things to potentially reduce stress. Was one year, double blinded, placebo controlled, all good.
Cats had an option of wet or dry, good, and they could have what they preferred. This was aute FIC so stress cystitis in single cat households, not the most common presentation, but it does occur. And what's really important is that these diets can so significantly reduce the incidence of recurrence of cystitis.
Isn't that great? Let's at least take away the cystitis stress. We can then deal with everything else that's going on with these cats.
Because to do that, we need to understand cat behaviour. And it's important to remember, cats are not. Truly social.
We describe them as facultatively social. Certainly they are solitary hunting, animals, so they would eat on their own, and yet we expect so many cats to eat together. And they would only form social groups, which would actually be matriarchal groups.
It would be a mom and a couple of daughters that would then look after each other's kittens when the other one went to hunting, that sort of thing. And so you only get groups forming where there are lots of key resources and the big one seems to be to be food. Obviously that goes down right back to the evolution in the fertile crescent when we started growing grain and having grain stores, and hence lots of mouses and with lots of mouses, the cats moved in.
So it is important to remember. That cats do form bonds, can form bonds, but they're very fussy about it. So here we've got kind of two households.
So we've got Millie, sorry, Tilly and Tammy are sisters, and they groom each other and love each other. And Fred and Millie, our brother and sister, they love each other too. But then Bobby was brought in.
Bobby really wants to be friendly with Fred. Fred doesn't want to know him, but he doesn't do anything negative to him. He just walks off.
Milly would like to know Bobby. Sounds like a soap opera, doesn't it? Fred hates Tilly and Tammy because these guys were here before Tilly and Tammy moved in, and he thinks that garden is his.
So when he sees either of those girls, he goes and attacks them. So that's the red line, that's the aggressive behaviour. And Bobby, who wants in with Fred, will come and join him, particularly if they're chasing Tammy, who's the smallest cat.
So it is important to understand cat groups. So here, this is obviously one group in household A. Whereas in household B, there are two groups.
If you've got two groups, that means you need 3 sets of key resources. So people talk about litter boxes as in 1 per cat, plus 1 extra. But, you know, that isn't right.
Actually, if you've got two really bonded cats, they'll share the litter box happily. In fact, when one goes, the other one I'll join in. But when it comes to social groups, so it's per key resources, and this, these are your key resources, food, water, latrine site, resting places, and food means feeding places, feeding stations.
And then hiding places or places to to escape. So I hope that makes sense. It's quick.
I could do a whole lecture on this. I love a whole lecture on this cat behaviour. So when you're helping advise about cats like this, you have to ask the questions.
It's a longer consult. You're gonna have to give yourself time, which means you need to charge for it. Or if you got, hopefully, you've got a nurse who's really interested in cat behaviour.
One, they tend to be more patient than us, and it means they can take on dealing with this side and then the cost won't be quite as much to the owner. So when we're looking at cat groups here, obviously these two cats here, they will happily go together. That's a group.
And these guys, it's one group. You tend to find Orientals group up very easily. Whereas in this photo by Sarah Heath, now, there are 3 cats in this environment and they clearly all hate each other.
So you need 4 sets of resources there. And that doesn't mean, as I had a case last week. Owners were so proud.
Oh yes, they had 8 litter boxes because they knew that their 7 cats needed 1 each. They had them all in the downstairs bathroom. Which meant that the one cat, effectively this cat, could just stand outside that bathroom door, sit there, and the other cats couldn't get in.
Effectively you had one big litter box. So that's really important. Overcrowding, you need to reduce numbers.
I could do a whole lecture on, urination stress. But enough to say, really think about it, how it's cleaned, etc. And because it's so difficult to, to do this advice, and it does take long, Sarah Kenney and myself wrote this little book a few years ago.
And you can get it from her website. I think it's about 10 pounds, $10 something like that. It's not expensive.
It's designed for vets, nurses, clued up owners. It's designed really for, for high, high intensity owners is what we designed it for. And it's got all this information that you need to give this advice.
I also direct you to the indoor pet initiative because if these cats, indoor cats, they need enrichment. Any diet changes need to be done gently. Mm, I stress.
I'm gonna take a second here. One, because I've been speaking very fast and I did a study where I was looking at 40 cats with stress cystitis, and I asked all the owners about stress in the home, for me to try and get a handle on what the cats might be dealing with. 39 of those owners volunteered spontaneously that they were either on, SSRIs, so serotonin reuptake inhibitors, or TCAs, tricyclic antidepressants themselves.
And certainly the 40th most certainly should have been, she was hard work. So, the more I've looked into this, and this comes out in some of the papers published as well by Tony Buffington. Owner stress and an inappropriate cat owner dynamic underlies a lot of these cases.
It tends to be where the owner wants to all little squid woody kid and I want to give you kisses and huggies but they want to do that the whole time, and the cat's going, bugger off, this is horrible. So it's that mismatch. So we need to gently find that out when we, interview the owners as well.
Other things that can help the pheromones, we've got the classic feely, feelyway classic, that's anti-stress. And then we've goteway friends. That is where you've got cat on cat dynamic that's not working or you're introducing a new cat.
Another, plug-in is Pet Remedy. This is, both being anxiolytic. I there's only actually published data oney way at the moment.
The milk protein hydrolyzate, the classic we think of as zilke in this country. I know it's available in other countries too. There are at least 6 or more papers on that showing it's pretty good at reducing stress in a number of different species, including people, dogs, rats and cats.
So certainly something to consider. And that product is effectively been added into I'm sorry about this, everyone, we seem to have lost Danielle, so what we're gonna do is give her a quick call now just see if we can get her back online cos it seems that the internet has gone for her. Come on, what's the matter with you?
Right, OK, are we back, guys? That looks good to me. Yay.
OK. Seriously, two webinars go down and I'm just doing my heart in. I have very large whiskey after this.
OK, well, I'm really, really sorry, everybody. I have no idea why that one was. That's my laptop playing up, I think, and it was a desktop at work.
So, to continue, wherever we got to, I think we were talking about milk protein hydrolyzates, weren't we? And the fact that there is some pretty good data on the use of silke. So definitely something to consider.
If the cat has outdoor access, or even if it doesn't have outdoor access, but can see outside, then be aware of the stress that can be caused by it seeing cats outside that kind of sit on a high wall and glare in at it, particularly if it can see them from wherever it's litter boxes. And if it does go outside, you can see this little guy having to pee in the snow doesn't look very happy. And we know that stress cystitis is pretty seasonal.
Do never start a study to recruit these cases in the summer because you see very few. And then Mimo. MEMO stands for Multimodal environmental modification.
This is Tony Buffington's study. This is detailed questionnaires with the owner. So you have to determine how many groups of cats, and then you need to look at your stations for each of them.
And then you're looking at educating the client about what what does the groups mean, what they need to supply. A little book can be very useful here. Also Tony Buffington's website, which is the indoor cat initiative.
And if you do all of these things, then you can get 95% recovery and these cats stay good. So you can really resolve this condition. But if you don't do that, recurrence is going to happen.
Because the problem is we don't have a golden bullet. If you look at the treatment of this condition in humans, which is called interstitial cystitis, they have tried so many interventions. But actually, things that have got some degree of pooled estimate of benefit, relative risk of 1 to 1 means the same as nothing.
OK, so none of them have a very positive, but we can see some slight positive effect to the use of pentan polysulfate, which is a gag. Tricyclic antidepressant, which is amitriptyline. Hydrazine, or hydroxyzine.
I never say that right. It's antihistamine. Potentially, yeah, cyclosporin, we're not gonna go there, are we?
I'm going to summarise the gag studies. They're all there, so you can look through them. They make no statistically significant difference.
To be honest, they don't make any clinic significant difference. OK, so in this study, a short study, potentially a little bit of a change in hematuria, but there really wasn't. It wasn't significant.
This is using oral, as an acetyl glucosamine. This is a gag. Using pentan polysulfate, this is a 6 year, 6 month study, 1 year study, no difference.
Using penstone polysulfate in the bladder, no difference. And then mix it with a whole load of other stuff. This is a initially it looked a little bit good, but then no statistical difference.
So it might help in certain cats. It may be, as in people, it seems to be that certain gags in certain people at certain times may be of benefit. But these are expensive.
Water is pretty cheap. So which way am I gonna go? I know that getting the year in specific gravity down to 1035 is almost guaranteed to get these cats not having signs of cystitis, whereas all of these drugs are pretty expensive and they, they really don't work.
What about spasmolytics? Here, the data is much better, particularlyrain. That's where most of the good data comes from, and I've already mentioned it.
This can be used immediately after unblocking cats, can also be used for cats that have spasm regularly. They can either stay on it for life. I have had cats on it up to 8 years.
Not really what I wanted to do, but every time we stopped, he blocked. More typically, I give the cats a 2 week course of this, from the point where they block. So after they've then left the clinic, and that keeps them covered for the first week, 10 days, and they keep some more at home, so if they start showing signs of re-blocking, they've got some there to give.
For skeletal muscle, dantrolene tends to be what we use. The data's not so good on it and it's pretty expensive. Certainly if you go IV it's very expensive.
Interestingly, no, amitriptyline, it wants to jump ahead. Amitriptyline actually can be a pretty good, smooth muscle relaxant. It's certainly got lots of other effects as well.
Just look at the list of what this does. But, but, but, but. Pretty impressive side effects.
The obesity and the sumulant means you've got a cushion that occasionally shits and pees. You know, it's not a pet anymore, let alone the liver failure. And in two studies, short courses of amitriptyline showed these cases got worse when you stopped.
And only in one case, which was an open label and the cats are going to get euthanized if this didn't work. Then in those cases, some of those cases appeared to improve. So if you're gonna use this, it's got to be long term.
I will actually use it where I know there's going to be a pretty hideous stress that can't be avoided, moving house, going into a cattery. And I will put them on starting before the stress, and then for a little while after the stress. SSRIs like fluoxetine, there's no studies, but again, I have the same concerns.
It's one thing for us to live a stressful lifestyle that results in us needing to take antidepressants. But we know that these cats get better if we rehome them to a house that doesn't have other cats in and that isn't stressful. We have done that experiment repeatedly, and they don't block again unless the ex-owner comes back to visit.
So, can we really justify having our cats long term on these drugs when we could change their environment and sort it out for them? So, what about other drugs? Well, non-steroidals, certainly, it's painful, so analgesia is gonna help.
I think what I want to add after NSAIDs there now very much is gabapentin, because we're using that as a painkiller, much, much more, and it does have mild anxiolytic effects without all the other side effects. So, I think that might be something to consider. I'd love to see studies on it.
There are none yet. It's been used for things like osteoarthritis pain and visiting to the clinic, anti-anxiety, but Not for this yet. Watch this space.
hydro hydroxyzine, I can't say it, has been tried. It was not effective. Oxybutynin has been tried, not effective, corticosteroids not effective.
Invesicular lidocaine not effective. Antibiotics not effective, although they did use chlorrophenacol, which was an odd choice. And we have talked about the fact these cats are at risk of getting secondary infections.
I like the idea of Marropotin because it's named K1 antagonist. It's also visceral analgesic, so you know what? Take the pain out.
Yes, please. And this works on mast cells, and mast cells play a significant role, in these cats. So I'm waiting for that paper, and I must admit, I have used it on a few cats, which are my bladder cats on the grounds, I want a visceral analgesic.
In literally ends of 1s and 2s and 3s, I less than 6, they all did well, but we need a proper study. So the important thing, management can only be palliative. We don't have a golden bullet.
We don't have a way of curing this. There is no point sending them out with truckloads of gag supplements. It's not going to make a difference.
So what can we do? What do we know works? We know Memo works.
We know reducing the urine specific gravity works, which is part of Memo, reducing stress works, part of memo. And getting them onto the appropriate, ideally wet diet. If they I really want them to take wet food.
If they won't, if they will only take dry, then please, please, please make sure that it's one of these diets that it is designed like the Purina diets, to reduce the specific gravity, to reduce further oxalate formation, reduce further strovite formation. It makes a huge difference. Then what I'm gonna be thinking of, I do use anti-spasmodics.
I use anti-spasmodics a lot, actually. All my cats, the block, go onto it unless there's an absolute reason why they can't. They've got con concurrent heart failure, for example.
And I do send owners home with a packet of it for emergency times, including females that get spasmy. We can help those. I don't think gags work.
We may find at at some point, certain gags in certain cats, but we can't get that yet. I don't use tricyclics unless it's those chronic stress situations where I know the stress is gonna come to an end, like moving house. Monitor closely.
I'm gonna come back to that on the next slide. If not, rehome. I know it sounds terrible.
Owners are always horrified. Nobody loves little Fluffy more than I do, and they truly believe it. The problem is, they want a relationship with this cat that this cat doesn't want.
So I always introduce this to the owner as respite. That the relationship between them and the cat has become very, very stressed. And is there somebody in their family or a friend who doesn't have any cats, preferably doesn't have children or dogs either, but, you know, is it a very mellow kind of person who would allow the cat to come and stay for a couple of weeks.
And what happens is the cat spends 1 to 2 days hiding under the sofa or the bed. Then it comes out, notices that nobody's used the litter box in that time, happily uses the litter box and never looks back. That is unless the the owner's sister comes to visit, who was the original owner, and then just the sound of the ex-owner's voice is enough to make the cat pee blood again.
Unfortunately, I've done that experiment too. So by way of close monitoring, this has to be a relationship between you, preferably one of your nursing team as well. I think we've probably got some nurses, technicians here tonight.
I really hope so. It is such an important topic, and you guys, we need, it's a teamwork, and we need people who can be really patient with the owners. And that is so important.
So we want the owners to note when the cat's going in and out of the litter box more. This the owner said, oh, she could tell when he was going to re-block because he played the fiddle more. It took me ages to work out.
She meant this was playing the fiddle. This cat, the cat started over grooming her tummy more. These guys, they started scrapping when normally they were best mates and say this little book really can be very useful and to show that I I'm, I'm not biassed again.
I received no money for this. I helped write it as a gift to Sarah when she was starting up a business. So I hope that has been useful for you.
It's a topic that's so close to my heart. I regularly do, bladder sessions that are 3 and 4 hours long. You can probably tell by the time I've thrown in cases and diagnostics, I just love it.
But today, I've given you the absolute nuggets. I hope they were useful wherever you are. Huge thank you to the webinar vet for putting on this webinar.
And really to Purina for funding it, because with their support, it means it can go out. I understand it's going out to about 3500 people, which is great. So, apologies again for the computer glitch.
When computers work, it's fabulous. I can sit here in my spare room and talk to you in Bondi. But when it goes down, it's a little bit frustrating, definitely for you guys and, and definitely a bit for the organisers as well.
So with that, I will happily take some questions. Thank you. Thank you so much, Danielle.
That, that really was an absolute pleasure as always, and, there are many, many questions coming in. Fascinating to see where everyone's listening in from earlier. We had people as far away as the West Coast of America, Burkina Faso, Australia at 4 a.m.
Someone was listening in. They're crazy. No, they've probably got, they've got a cat with FIC.
Quite possibly. So let's, try to get through, some questions. Many of them coming in.
You mentioned about, VNs being on. Lucy said she's currently studying the DRPAVN in the UK. Do you have any, good, studies or any information as, using, she's using FLUTD as my applied math and phys assignment.
I don't quite understand the question. I'm sorry. Sorry, what do you have any articles or papers that you'd recommend that be good to use?
Hundreds of them. . Yeah, probably the easiest, to be honest, if you, if, if you don't have web access, then, The little book is a good place to start, but .
There's just so many. If you email me, I can send you my bulk bulk notes. I've got long notes.
And at the bottom of it, if you email me references FLUTD, and then it's got about 4 pages of references at the end, and then you can highlight the ones that you can then see which are gonna be the most sensible ones to chase down. That's probably the easiest way of doing it for you. That's great, thank you very much, Danielle.
So I have a question here from, Maria. Is there any well-known interaction between, zilke and L-tanine for treating FIC and anxiety? No, there's nothing published, at least yet.
Certainly, or not that I know of. And if someone's got something, please send it to me. I can't keep on top of, of, of everything, and you guys are come from such a diverse background.
I always want to know your ticks and trick tips and tricks as well. You know, we, we all gain. From from from these interactions.
Certainly, the silke studies, they some of them are pretty old because the drug's been around for a long time, which also I got hiccups, which also tells you it's it's very safe, which is great. It binds to the same receptors as diazepam, but in the non-addictive way. And certainly L carnitine, you know, there's more studies coming through that that does seem to have a calming effect.
It makes sense to put them together. And certainly, if anyone's done the combined studies, it will be the food companies that have combined them. It tells who've got the combined out, the Waltham one has certainly it's got the the calm has got, yeah, I would go to those two.
I think it'd be really interesting. You could do freedom of information and ask them for what studies they've got on the efficacy of the protein hydrolyzate with the with the . Tyrazine, and then when you get an answer, would you send it to me cause then I can put it in my next talk, which would be really good.
Thank you. Yes, please do send anything like that in, that's that'll be excellent and we'll try to add it to the site as well so it's there and available to everyone. A few questions about, catheterization.
The first question, should we use antibiotics or should we always use antibiotics if the catheter needs to stay in for 3 to 4 days? Nope, my slide, go back to that slide, it says no, no antibiotics. So, absolutely not.
Please do not use antibiotics unless the cat is actually spiking a fever, or the cat has got some other horrible trauma that means it must have antibiotics. So, for example, if it's a, a car accident, that its whole perineum is torn up, so it's gotta have antibiotics, then you, you have to. But go for the, the least effective antibiotic.
That sounds really weird, doesn't it? Go for amoxicillin. So that you've got somewhere to go when you get a resistant UTI.
Because, as I said, 60% are gonna have a UTI within 3 days. And we really don't want that to happen, because the risk of it getting resistant is very high. So hold off on the antibiotics, hold your nerve, unless the cat's got a fever, or it's got other serious damage, please don't start the antibiotics until you've taken the catheter out.
And then when you take the catheter out, you could presumptively start with something like amoxicillin, wait for the culture to see whether or not you need to change to something more specific. Does that make sense? Hope it does.
Thank you, very important information there and better to have it twice then, I guess. Oh no, I completely agree. If if if one person has misunderstood, I do speak fast.
So if one person is misunderstood, other people will have. So, no, I want you to ask those questions because it means I can reiterate such an important point. So thank you.
Excellent, thank you. Trinny's asking, do you always recommend using closed systems? I do.
In practise, a long, long time ago, we didn't because we couldn't afford them. But what you can use the, the, the, the, the risk of a UTI becomes everybody's gonna get a UTI. And the problem is it can then go up to the kidneys and before you know it, you've got bilateral pyelonephritis and, and you're not gonna win.
So please use a closed system. If you can't afford to buy the the clean ones, sterile ones, then use an empty drip bag. But which we always used to do, but please, label it very clearly that this is a urine collection system, because I was using one when I was still in, as a resident, and one of my very keen students thought, Oh, that's odd.
The drip bag's fallen down, and they lifted it up and hung it up. So the poor cat, yeah, by the morning was going, Well, well, I need a pee because his pee was just all going into him rather than the other way around. So label it clearly as urine only.
Oh dear, not envious of that, of that cat. All the student in the morning. I can imagine.
Lots of other questions, coming in here, so please, do keep them coming in. Thank you very much guys. many, many people asking, about the black and white cat theory.
Oh, I thought you might. OK, so anybody who I, I, this is my pet theory, OK, it could be complete Rollocks, but if anyone knows the work done. The, turn of the century before last on silver foxes.
These were when stupid women wore fur coats. You're right, some stupid women still wear real fur coats, but we can kick them. He threatened to.
And so, because these, silver foxes came from Russia, people had to go out and shoot them, and it wasn't much of a fun life. So they decided to trap them and make them breed together. The problem was they kept throwing themselves at the wire and trashing their pelts.
So they didn't actively select, they simply let the cats that the silver foxes breed that were the least reactive, the ones that sat there and didn't throw themselves around. And silver foxes have got pointy noses, pointy ears, this plush blacky silver coat, and they don't make a noise. Within 13 generations, they had got floppy ears, a round muzzle.
They yip all the time, and they'd gone black and white. So if you think about it, melanin is part comes from the neural crest originally. And so to do with, you know, your, so much of your, brain development actually is reflected in the colour of your coat.
Same way as redheaded people, redheaded animals have got more blood vessel reactivity. Black and white, cats and a lot of other species, quite often have this ability to cope with stress by internalising it. So they end up with shrunken adrenals, the same way as the silver foxes had.
The, cats with FIC also have shrunken adrenals. So all the same changes that are seen in the silver foxes are seen in the, FIC cats. There's more work to do, but it's a great theory, and, you know, it can shoot me for it.
Find me a new theory. That's that is very, very interesting. I'm, I'm glad everyone asked that now cos that's fascinating stuff really.
I have, comments here from, Hanna saying that having worked in a shelter as well as private hospitals and seeing referral behaviour cases, alprazolam works really well for shy cats, for example, if you're rehoming them rather than hiding them for a few days in the new home, and they could have a day or two of alprazolam and won't even go through the trauma in the short term. And you know, I think we need more of the, this kind of data to come out because it makes such a difference if we can get through the initial stress and say the word's why I suggested gabapentin. We don't have any studies on it yet.
But we know it's been used in shelters, particularly as if you've got access to the bover reformulated drugs, there's a chicken flavoured liquid, which seems to be very palatable for cats. And there's a lovely study where they used gabapentin liquid in trap you to return cats, and the cats showed a far, far fewer signs of stress. So I, I think Hannah is absolutely right.
We need to find drugs that have Ideally, a temporary effect to reduce the stress, particularly in, in this kind of situation where you've got rehoming, that sort of thing, . Things that are better than tricyclic antidepressants, things that don't actually affect the cat in anywhere near so much, but reduce its stress. Completely agree with you.
Thank you, Hannah. Yeah, that's great, and Hannah's actually mentioned that she's a clinical wave excuse me, a c clinical animal behaviourist, I'll put my teeth in again. I thought, I thought she might be, she sounds like somebody who really cares about cat behaviour, which is brilliant.
Yeah, yeah, and she said she'd also recommend working closely with a referral behaviourist, which I will add the link into the, chat box now that you can go and search once if you so wish. She's absolutely right, because, if you haven't got someone in your practise who is focused on that, then yeah, it. This isn't stuff you can learn in a day.
And the clinic people who trained in clinical behaviour, they really understand this really well and can really talk to owners much better than an awful lot of, of us vets who can be, we're too medical and we need to take it back to the cat and the owner's relationship. You're absolutely right. Thank you.
That's great and and Hannah, Hannah said actually you taught her in Edinburgh too as well, so I thought, I thought she sounded like one of mine. Good on you. There you are.
So a couple of people asking, about gabapentin as well, dosage, how long you'd use it for, etc. Well, so we don't have any studies on FIC, but I am using it much, much more, particularly with my old soles. I do a lot of work with geriatric cats for arthritis, etc.
I start, starting dose is 5 milligrammes per kilo. I often, if they are very arthritic, I start with less than that because they're sometimes a little latetaxic for a day or so. So if they're very, arthritic, then start lower so they don't fall when they're wobbly.
But standardly, you'd start 5 makes per kg of an evening for a couple of days to get over that wobbly phase. And then, quite often, 5 makes per kg is enough. It often isn't for cats that are in quite significant pain.
They've got really bad, pretty bad osteoarthritis. The most I've got up to is about, I think I'm got one cat on 25 makes per cake twice a day. It's unusual to me twice a day, usually once a day, and you aim to get to 10 to 20 makes per cake.
But some cats, you'll do fine on 5 makes per cake. So definitely worth considering. And where we're treating.
For coming into a clinic. So if we've got a very stressed cat a referral practise, or that the clinical general practise, and they're referring it to us, and we know it's a very stressed cat, then we are having them give 50 to 100 milligrammes total. To the cat.
We try to get the owner to test it. So maybe 2 or so hours before travel, give 50 milligrammes, see how wobbly the cat is, see how sedated the cat is. If the cat looks just like it's the edges off, looks quite comfy, perfect, then they come and drive down to see us because they have long drives to get to us, and it just means the cat doesn't arrive covered in pee, poo and saliva.
You know, which so many of the stressed cats do, because, you know, that the whole thing they've never been in cars, etc. So I'm really liking gabapentin in that situation as well. Excellent, thank you very much.
Have a couple of questions here about blocked and obstructed cats. I'm conscious we are pushing, pushing on for time. We're well past the, the, the scheduled finish time.
So we'll like to take a couple more, and then, any other questions that, that, that the community has, if you email them in to us, and we'll be able to get, some answers back to you, once the recording's up on the site as well. So Rodolfo's asked, thank you, well, he said thank you very much for this brilliant web webinar. Several vets use diazepam as a striated muscle relaxant.
What do you think about it in obstructed cats? If you're using an IV, I'm less worried. My big problem is we know that per us, it has caused rather a lot of cats to go into fulminant liver failure.
It was behavioural cases that this occurred to. It was the oral formulation. So if you're using IV I'm less worried, and certainly it can help, and it's a lot cheaper than dantrolene.
I would prefer to use midazolam, because that hasn't been shown to have the same problem. If you are using it longer term perros, I really worry about the liver problem. If you need striated as well, and to be honest, the mix and match of those nerve endings, they don't do it as neatly as the photo as neatly as the pictures, shall we say.
Oftenrazin is plenty. I used to dorazin and dale. But it's harder for owners to get it into the cat, etc.
Etc. So I switched to higher doses of of prazocin, and I've worked out for my cats, that seems to work as well as using both the lower doses. But if you do need oral dantrolene, that's now being reformulated by some of the reformulation pharmacies as well, which will make it easier for you.
And it's a good skeletal muscle relax. Excellent, thank you very much for that information. So just final questions then.
So, Emily said, hi Danielle, thanks for another fab webinar. What formulation of dose of calcium would you supplement IV to combat hyperkalemia in blocked cats and Peter asked, would you give calcium or calum? Oh, I've never heard of Callum.
That's new to me. To be honest, my block cats now, I, I happily that when the electrolytes are a complete mess, I send them to the ICU. But the reason I like the calcium is it was really easy to do.
You take calcium gluconate, 10%. You make it, mix it 50/50, or it's, then it's a mg per it's a mL per kilo of cat. So mL per kilo of cat of 10% calcium gluconate, mix it 50/50 with saline.
There you go. And it was maths that I could do in the middle of the night when my brain wasn't working, which was my reason for, for thinking that that was a good thing. Other people were doing fancy things with insulin and glucose and stuff, which you then chasing, you know, because the blood glucose goes too low and then, .
And we now know that actually it is that combination of the low calcium with the high potassium that causes these hearts to get into such a pickle. So, given the calcium, moderately quickly, too quickly, and you'll mess the heart up too, but I get it moderately quickly. It gives you 20 minutes, and you can normally unblock a cat in 20 minutes.
If you remember to just pull that prep use nice and long and straight and do all the rectal stuff with your finger. The most important thing you need to unblock a cat is one human finger wrapped in plastic and rubbed with, covered with, lube. Brilliant practical advice as ever, Danielle, thank you so much.
Thank you, everyone, for joining us tonight. It's been a fantastic webinar. Thank you so much to Purina as well, whose kind sponsorship has made this, free for everyone.
If you do have any questions, as I mentioned, email them into office at the webinarvet.com, and we'll try to collate them and provide some answers, in the coming days. And thank you so much, Danielle, for another brilliant webinar.
You're very welcome. Thank you so much for organising it and definitely thank you to Purina for making this, so open. But my biggest thank you, as always, goes to all of you guys, all over the world, taking your time.
You could be doing so many other things, and yet you want to share it with me talking about cat medicine. And for that, I will be eternally grateful. Thank you.
