[00:00:02] Introduction: Welcome to All Cats Considered, a podcast from the Feline Veterinary Medical Association. Here we interview professionals from across the veterinary world and take deep dives into the latest evidence based research, developments, studies and guidelines that improve feline health and well being. We are the home for veterinary professionals seeking to enhance the care of cats through high standards of practice, continuing education and evidence based medicine. In each episode you'll hear interviews with a variety of experts in our field covering a wide range of topics and the latest developments in feline health. We'll share the key points you need to know to improve your patients care.
Let's dive in and listen to this week's experts.
[00:00:45] Cathy Lund: Hi, I'm Dr. Kathy Lund from City Kitty in Providence, Rhode Island. And I have the enormous place, pleasure and honor of talking with Dr. Joya Griffin. She is a partner in the Animal Dermatology Clinic in Louisville, Kentucky. And they have. How many doctors did you say?
[00:01:04] Joya Griffin: Somewhere between 80 and 90. I don't want to quote the wrong number, but a lot.
[00:01:07] Cathy Lund: Oh my goodness.
[00:01:08] Joya Griffin: A lot of veterinary dermatologists in our company, which is really exciting.
[00:01:12] Cathy Lund: Yeah. We may know Dr. Griffin from her television show Pop Goes the Vet, which is on the Disney Channel and you can find it online, I would assume on Disney.
[00:01:24] Joya Griffin: Yeah.
[00:01:24] Cathy Lund: Excellent. So dermatology in cats have not always been so close. I think it's dermatology we more frequently think about dog issues. Yeah, I think it really does have an impact on that. Human cat bond. Absolutely. An itchy cat, an uncomfortable cat.
[00:01:43] Joya Griffin: Yep. I mean, in many ways I think if the cat is itchy enough, sometimes they end up in cones which can make them hide and they don't eat well and they're upset about that. And then a lot of the medications that we have to use to treat itchy skin disease in cats, or skin disease in general, is going to be a daily medication, often a daily treatment that they have to do to the cat. And that can also affect the human cat bond. And I've had treatments that I've wanted to give and the pet parent will come back and say, that's just not possible. The cat's hiding, the cat doesn't like me anymore. And we need to figure out something else, maybe something less frequently or less obnoxious for the cat that we can administer in a way that keeps everybody happy.
[00:02:27] Cathy Lund: Right, right. Because the. A lot of dermatologic problems are chronic diseases.
[00:02:32] Joya Griffin: I would say almost all. Most of the dermatologic problems that I treat are chronic. I mean, outside of like mites.
I mean, you know, most of our skin disease is something that's going to be forever, that we have to manage. So you have to find the right fit for the pet parent and that cat, because it can be a challenging thing to treat a cat every day.
[00:02:53] Cathy Lund: Not everyone can bathe their cat.
[00:02:55] Joya Griffin: Absolutely not. But some people can. So I always try to remember to ask that, well, can you bathe your cat or are you willing to? And some cats can be bathed. I had a cat that could be bathed. I wouldn't say he loved it, but he tolerated it. And he didn't bite me or scratch me, and we could get it done. So you never know.
[00:03:11] Cathy Lund: So part of what you need to do really is counsel cat parents and help them understand that this may be not a simple fix or an easy solution and help them find ways to medicate these their children.
[00:03:25] Joya Griffin: We just have a conversation about what can be done and, you know, what options we have, and we think through what may work for them, you know, so I offer them sometimes compounded medications, topical therapy instead of oral meds. You know, immunotherapy for allergic cats is really great. And a lot of cats will tolerate an injection every two weeks better than they'll tolerate a daily oral medication. So we talk about that. And if we could potentially get this cat on immunotherapy, that may reduce the allergic flare and the symptoms enough that they won't need those chronic medications that are pain to give. So.
[00:04:02] Cathy Lund: Yeah. Yeah. And itchy cats. I feel like I see so many itchy cats and he has asthma, like all those kind of inflammatory conditions.
[00:04:13] Joya Griffin: Yeah.
[00:04:14] Cathy Lund: How are there tips you can give people like me, like an average practitioner, about distribution, patterns of itchiness and where cats lick their foot off and what should we expect?
[00:04:28] Joya Griffin: Oh, you know, cats are very unique. I would say there's not one way that a cat will present with allergic skin disease. You know, they have these kind of reaction patterns that are very interesting and unique to the cat and frustrating because these reaction patterns will often mimic other diseases. And it can be really confusing to us as vets. Like, what's going on is this. I mean, sometimes the lesions are quite terrible. Like with the eosinophilic granuloma complex, they get these, you know, plaques and erosions and nodules on their skin and granulomas. And that could look like something autoimmune or neoplastic even. And then the cat can present with just itchy skin or it can have like the little miliary dermatitis, little crusted papules. And so they do a Lot of, of odd things that are very unique to the cat and then they can just be itchy cats that over groom. So they do a lot of different things and that can be hard for us to put that into one disease process and to know what exactly it is. So I think that's what keeps cat derm fun. But a great challenge sometimes in getting a true diagnosis as to what's going on.
[00:05:35] Cathy Lund: Yeah, it's certainly challenging for me. And one of the big challenges is having clients accept that using parasite prevent flea control is one of the things we can do to maybe control the controllables.
[00:05:51] Joya Griffin: Yeah, but how do you convince that control the controllables? So that's what I, you know, a lot of indoor only cats aren't on consistent flea control. I think I can say that because I'm a cat parent and my cats don't get consistent flea control and one of them does go indoor outdoor and so he is at risk. I mean, thankfully he doesn't have skin disease. But if they do have itchy skin, you know, you'd really need to rule out ectoparasites. And so I just kind of say it simply like if we don't do this we may miss it and you may get mad at me later because we've moved on with all of these other diagnostics that may have been unnecessary when this whole time it was fleas or a somewhat evasive mite called Demodex Gatua that can cause itchiness in cats but is really hard to find. But if you put em on Bravecto plus or Abrecto or excuse me, Breville, if you put the cat on something like Bravecto or Revolution plus, you can rule out fleas as well as mites like you know, Demodex Gatoa very easily and then we just can move on from that. And so I try to just, you know, make it like, you know, this is more for me than for you. I'm not wor, you know, I, I, of course your cat does not have fleas. Of course it does not. But this would just help us, you know, remove some of those flare factors and complicators down the road and can move forward with a true diagnosis. But I mean, even as a referral facility, I had a cat that I saw last week literally that came in with a long history of pruritus. And the pattern, you know, you were talking about, how do these cats present with, they can do a lot of things, but sometimes pattern is key. And this cat just had a little Patch of alopecia over the tail base, kind of caudal dorsum area. And it was so itchy, like, even when I was just trying to touch the cat back there, it's like biting other areas. And I started flea combing the cat and found all this flea dirt. And the dad was so embarrassed, like he just couldn't believe that his cat had fleas. And I was like, it's okay. It happens. But I didn't find any fleas. And that's the point of it. I did not see any fleas on the cat. And cats are really good groomers, and they'll bite all the fleas off. And so you may not find fleas, but they could have flea dirt and flea allergy all the same. And so, you know, I don't place any judgment on people because I don't. I've been in their shoes, you know, and not done my consistent treatments the way I should.
[00:08:08] Cathy Lund: Yeah. Another thing that I see very commonly in my client base are cats with environmental allergies or insect bite allergies, some hypersensitivity. And their families are convinced that these cats are head cases, that they're anxious, they're obsessed. And I do think that some, maybe a type A cat reacts more violently to a certain stimuli. But how. How do you navigate that, help people understand that the allergies are allergies?
[00:08:40] Joya Griffin: Allergies are real. Yeah, there. There's. There's a couple different, like, misconceptions about itchy cats. I think one of them is that it's a psychogenic or crazy cat and this cat is stressed. And so I just, you know, talk about it a little bit and try to investigate. Does the cat have other behaviors of stress? Is it hiding? Is it inappropriately urinating? Is there some aggression with other cats in the house, things that have changed that may have led to this cat pulling hair out. And a lot of times they're, you know, mentally appropriate cats, like, they're not having any major stressors. You know, of course, the other big thing is has the cat been treated with steroids and does it respond to steroids? And, you know, psychogenic causes for alopecia usually don't respond to steroids very well. And then, of course, the pattern and the age of onset can also help us, you know, figure out whether or not this is more likely allergic disease. And the papers also show that psychogenic alopecia in general is less common than allergic causes for hair pulling. But it is hard sometimes to convince. I don't really know where that kind of idea has that ideology has come from about crazy cats? You know, I don't know, but it definitely is out there. Um, and we kind of have to just reduce the myth.
[00:09:51] Cathy Lund: Yeah.
[00:09:51] Joya Griffin: The other myth that I hear a lot is my cat is indoor only. It cannot be allergic. And that one is kind of frustrating. But it was really funny cause I listened to a lot of NPR because I'm old and I was listening to this article. It was just basically talking about how our season of allergies has increased because of how climate change and how it's warm now and warmer than it used to be. And so allergy seasons have expanded to being almost year round. And then it was talking about air quality and how the home environment is just the same almost as outside. There's very little difference. So even if you don't go outside, you're still going to be exposed to the allergens. And you know, that's just with humans. But I said, you know, so I'll just kind of make it seem like I've just recently discovered this, you know, and say, oh, you know, it's really interesting. The other day I was listening to this article and I go blah, blah, blah. And did you know that the air quality inside the home is almost the same as outside? So there are pollens in the house and we, you know, I'd say little funny things like, you know, your cat can't live in a plastic bubble, so it's going to be exposed to these things. You do open the doors and the windows and, you know, things like that. But sometimes people really, truly feel that their cats cannot have environmental allergies or pollens because they don't go outside.
[00:11:04] Cathy Lund: That translates into almost everything with an inside cat.
[00:11:07] Joya Griffin: Yeah.
[00:11:07] Cathy Lund: No, they can't have insects.
They're living in that plastic bubble in their family's minds, which is challenging. It isn't a paralleling. Speaking of myths and suppositions, can you address the grain free hanundrum that if we try to do a food trial.
[00:11:27] Joya Griffin: Yes. Yeah.
[00:11:29] Cathy Lund: Everyone always thinks I feed grain free. I can't possibly have a food.
[00:11:34] Joya Griffin: Can't possibly have a food sensitivity.
All of that really is just that poor messaging, usually through social media and the Internet. And a lot of it's just what we've been fed as humans that we. There's a lot of, you know, grain hypersensitivity in humans and you've got what I guess celiac disease or gluten. I have a gluten allergy and all that, which actually gluten allergies in humans is actually pretty uncommon. But I think people just have stolen that idea and put it on cats and dogs and just taken, taken that and run with it. And so, you know, I have to sit and talk about. Well, actually, you know, most of the time it's the protein and the food that they're reactive to. And it's good that you changed to a grain free diet or a different grain or removed corn or wheat from the diet. But now we need to investigate a little bit deeper because your cat's still itchy and let's now like take him off of what, whatever he's eating now and put him on a completely new diet that has a new protein and a new carbohydrate and we'll just start all over. So sometimes I just move away from it. Whether it's wrong or right. Your cat's still itchy on this grain free. So now we need, we need a, a new protein and new carbohydrate source. And let's do it. I find diet trials to be very challenging. And if I'm going to do them, I would prefer to do one diet trial and do it right once and then we can just move on for it. And with cats it's even more challenging. You know, they really.
And they don't want the change and you know, or there's multiple cats in the household and you have to change everybody. And, you know, it's very complicated.
[00:13:05] Cathy Lund: Yeah, it is incredibly complicated. I, we have some patients where if the pet food company changes the shape of the kibble, the cat will be like, no, I don't have those cats.
[00:13:16] Joya Griffin: But I know that they exist. My cats are just like chowhounds. One cat, this is very true. This is really weird. I have a Siamese mix and she will pant for food.
And you know that, that panting in cats is scary because it makes you think of cardiovascular disease. But she, if she, if you let her out a certain time of day and she thinks it's dinner time, she'll just start panting and it's repeatable. And she's kind of one of those like tiny fat cats. So you're like, you're really cute and small, but you're actually really overweight and you can't eat again.
[00:13:49] Cathy Lund: And she'll just go and you feed her.
[00:13:52] Joya Griffin: And we had a.
[00:13:53]Cathy Lund: Yes.
[00:13:53] Joya Griffin: I mean, we had an echo down on her because I was like, certainly this cat's gonna die. I'm really worried. It's just this weird thing that she's like, Kind of learned to do.
[00:14:01] Cathy Lund: And she's figured out, if she has figured it out, the adhesive Q.
She's figured out. So tips and pointers on common remedies for our common dermatologic problems. Can you speak a little about prednisone versus prednisolone?
[00:14:18] Joya Griffin: Yeah. So superior steroid, the type of steroid is really important. Prednisolone is the converted form of prednisone. And so some cats, we don't know if it's all cats, but they lack the ability to convert prednisone to prednisolone, which is what our body absorbs. And so ideally you should choose prednisolone if you're going to treat a cat. There are probably cats that respond to prednisone. The other thing that I find really important with steroids is that the dose is different in cats and sometimes we dose them at what we would dose a dog. And so cats need a lot higher dose, usually twice the dog dose. So a cat would be dosed for anti itch dose would be more of a 2.2mg per kig dosing of prednisolone. And sometimes I see that, you know, in the record the cat has failed a steroid, but I realize that it's a actually just probably too small of.
[00:15:07] Cathy Lund: A dose for that cat. Wow, interesting. Any antibiotics that you are more comfortable with using for your typical if you're going to use an antibiotic in a skin problem cat.
[00:15:19] Joya Griffin: So most of the time if I see a bacterial infection in cat, a lot of times it's a staphylococcal infection or we presume it is just based off what I'm seeing cytologically and that's most common in cats if you're seeing cocci. So usually you're going to choose acephalosporin. There is new recent guidelines on antimicrobial resistance Task force that are trying to, you know, have us do antimicrobial stewardship. And so the recommendation is, you know, you're going to use those first line treatments first and then second tier based off of culture. So according to those guidelines, if you need a systemic antimicrobial or antibiotic, you're going to be choosing clindamycin for a cat. That's probably the only first line choice based off of that document. And a lot of times, you know, as practitioners we're using a lot of Clavamox and convenient because it's convenient and that technically is a second tier choice. But you know, not to say that you can't do it, but I think it has to be for a pretty extensive infection. And we shouldn't forget that topical therapy can be done in cats and that will help to reduce the amount and duration, the duration of antibiotics that we have to use. And so if you can say you are going to do convenia, because that's easy for that cat, you can't do oral meds. Maybe we need to also add in topical therapy so we can get this infection resolved faster. So I usually ask my cat parents, you know, can you do topical therapy? How about a moose? You know, sprays on cats, probably not going to be useful. Wipes. You could do a chlorhexidine wipe. Usually they can apply those. And the cats don't hate it too much. Sometimes they can be bathed. So we'll just talk about different ways that they can maybe treat an error, especially if it's a pretty expansive area that we're dealing with, like maybe on eroded belly with secondary infection there.
[00:17:05] Cathy Lund: Thank you. And one of the takeaways I got from going to your lectures during this conference was we really do need to reevaluate these patients and make sure that what we're doing is working.
[00:17:16] Joya Griffin: Yes. I think that sometimes the family is going to think that it's better before it is and they're going to stop medications too soon. We've all done that. And they come back in with a whole pill bottle full of pills if they're giving, you know, oral medications. But that, that's something that really, really does happen quite often. And so you don't actually resolve anything. You could just improve the symptoms probably for a few days, and then it comes back and everyone's frustrated. So getting them back in is really important. And then that can also help us see what's left over. So if you're treating infection, now that that's gone, that removes a layer of pruritus. And now we can see where our baseline itch is. And maybe the baseline itch is very mild. And maybe the cat can be controlled with very little amounts of steroids or something like that, or even topical therapy and not need a whole lot of intervention.
[00:18:05] Cathy Lund: And we shouldn't be afraid to biopsy.
[00:18:07] Joya Griffin: Right.
[00:18:07] Cathy Lund: If things are not going the way we like.
[00:18:09] Joya Griffin: That's right. Biopsying is our friend, I think. And even with, you know, like I said, the itchy cat can present in a lot of different ways and it can be very confusing. And if you're not sure and you're worried it's autoimmune or cancerous, it's okay to biopsy it. And if it comes back and it says it's a egc, eosinophilic granuloma complex, that's okay too, because then you know, okay, this is what I'm doing dealing with and have a better idea of how to treat it.
[00:18:32] Cathy Lund: Well, thank you very much, Dr. Joia Griffin from the Animal Dermatology Clinic in Louisville. It's really been a pleasure. Thank you.
[00:18:40] Joya Griffin: Thank you for having me. It's been fun.
[00:18:43] Conclusion: Thank you for listening to this episode of All Cats Considered. We hope you enjoyed this interview. For more information on the topics discussed in this episode, please head over to catvets.com podcasts and explore. Explore the links in the show notes. Don't forget to subscribe to this podcast on your platform of choice so you won't miss any episodes as we release them. Have thoughts or ideas about the interview you heard today? Share them with us by leaving a comment on our Facebook page or shoot us an
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