This week, Dr. Andy Sparkes joins the podcast to discuss his role as co-editor in the Purina Institute’s brand new Handbook of Canine and Feline Clinical nutrition. Dr. Sparkes and Dr. Roark walk through the chapters on feline idiopathic cystitis and urolithiasis while discussing what’s new and important in the newest edition of the handbook.
This episode is brought to you ad-free by The Purina Institute!
LINKS
Get the new Purina Institute Clinical Nutrition Handbook for free!
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ABOUT OUR GUEST
Dr. Andy Sparkes BVetMed PhD DipECVIM MANZCVS MRCVS graduated from the Royal Veterinary College (London) in 1983, and after four years in practice joined the University of Bristol as a resident in feline medicine. After the residency, he completed a PhD, and was then appointed as Lecturer in Feline Medicine. In 2000, he moved to the Animal Health Trust in the UK where in 2008 he took over as Head of the Division of Small Animal Studies. In 2012 he was appointed as Veterinary Director of International Cat Care and the International Society of Feline Medicine (ISFM), and since 2019 he has been an independent consultant. Andrew has published widely, is a diplomate of the ECVIM and is the founding and current co-editor of the Journal of Feline Medicine and Surgery.
EPISODE TRANSCRIPT
Dr. Andy Roark:
Welcome, everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a good one. I am here today with my friend Dr. Andy Sparkes, and he is a, for those who don’t know him, he is… How do I describe him? Oh man, he does a lot of stuff. We’ll get his accolades at the very beginning of this episode. He is a feline medicine specialist. He is one of the co-editors of the new Purina Institute Clinical Nutrition Handbook. That’s a big deal, and we talk about that. We talk about talk feline cystitis, we talk about urolithiasis. We talk a lot about the handbook.
So just to fill you in real quick, the Purina Institute Clinical Nutrition Handbook is a magnificent resource and it’s 100% free. You can grab a copy of it in the show notes right now. I just got to pause and say, I love that Purina has done this. I love that they’re putting this out. I love that they’re giving away free. Just grab yourself a copy, grab two. They’re free. You can get as many as you want. Back the truck up. They’re digital copies and you can have them. But guys, this is a great resource. I love that they’re putting it on.
We talk about how it came together, about how to best use it, we talk about how it’s different for other resources that are out there. So all that stuff is woven into some really good pearls of feline medicine. Gang, let’s get into this episode. Oh, and this episode is made possible ad-free by the Purine Institute. Let’s do it.
Kelsey Beth Carpenter:
(singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark!
Dr. Andy Roark:
Welcome to the podcast, Dr. Andrew Sparkes. Thanks for being here.
Dr. Andy Sparkes:
Thanks very much. Thanks for the invitation.
Dr. Andy Roark:
Oh, it’s my pleasure. You are fascinating. You are a feline specialist. You have been in academia and private practice. You have been all over the place. You are an editor or co-editor of the Journal of Feline Medicine and Surgery. You are a co-editor on the new Clinical Nutrition Handbook that Purina has just put out through Purina Institute. You do so many things, and so I appreciate you making time to be here.
I wanted to talk to you a little bit about specifically the Clinical Nutrition Handbook that Purina is putting out. So this is kind of a big deal. This is a pretty monumental size project that’s being put out and they’re putting it out for free, which I think is absolutely wonderful. I love it. Can you start to go ahead and just give me an overview of what were the goals going into this handbook?
Dr. Andy Sparkes:
Oh, yeah, interesting. I think when it was set up to produce this second edition, which is effectively a complete rewrite of the handbook, I think the key goal was to provide information on clinical nutrition that is really accessible to everybody in the veterinary healthcare team across the world, literally. So this is designed to be a kind of global resource. And behind that I think is this vision that we need to have meaningful nutrition conversations at every appropriate appointment in the clinic. And the resources to be able to do that should be available to everyone, and that’s really what we envisage this handbook would help achieve.
Dr. Andy Roark:
So how do you set that up from a structural standpoint? How is it different from a textbook? One of the things I really like about this resource is the hyperfocus on practicality and the ability to use it in between appointments in a very efficient way. How do you structure that differently from a textbook to make it accessible like that?
Dr. Andy Sparkes:
Yeah, good question. So I think three things that I think are worthwhile highlighting is its global focus. So it really is designed to be a global resource relevant to anyone in the world. There’s a collection of over 40 international authors that contributed to this handbook.
Second thing is every chapter is really focused. There is enough information within each chapter to get a good handle on the background of the particular disease or condition that’s being talked about, but really focusing in on understanding nutritional recommendations as well. So that’s a kind of tough ask when you’re dealing with international specialists to really focus in and make the information succinct, but that has been really well-achieved, I think, and to make this really practical. The chapters are short. They’ve got a good overview of the condition, but it’s really focused on understanding those nutritional recommendations and really putting that into practice.
So you’re absolutely right. I mean, this is designed to be a handbook that is used in consults. There’s material that’s really readily accessible, so in consults and between consults as well, just to have a look and see what’s going on. So up-to-date, really relevant information.
Dr. Andy Roark:
It seems like it would be really challenging to get specialists from all over the world to come together and write in a uniformly accessible way. Was that a challenge or was it pretty easy to get people to line up?
Dr. Andy Sparkes:
It’s always a challenge, and I would have to pay tribute to the lead editor on the book, Catherine Lenox from Purina Institute. She did all the heavy lifting on this and was twisting arms and getting people to write to a deadline. Honestly, I’ve never been involved in authoring or co-authoring, editing a book where the timeline was so short and so much was achieved within a short period of time.
So yeah, it’s challenging, but we got there. And I think also it has to be said that using an international group of authors, we chose people that were specialists in their field, not just nutritionists. We’ve got specialists in internal medicine and behavior, in surgery, all sorts of specialists that are contributing, and essentially they’re enthusiastic about getting people engaged with nutrition in their particular specialties and making this work. So, it’s been good.
Dr. Andy Roark:
When you sat down and kind of envisioned what this resource would look like, did it turn out that way or were there significant changes? Were you surprised? Did it morph or evolve from what you originally envisioned?
Dr. Andy Sparkes:
So I think in all honesty, when I sat down and looked at the kind of finished product and read some of the chapters that, as an editor, perhaps I was less involved with and less familiar with, I was super pleased with the way that it came together. I think that we have achieved what we set out to achieve. It is always challenging and it’s challenging keeping it brief and succinct and really practical, but at the same time, having sufficient information there to make it genuinely usable and useful. But I think we got that balance pretty well right, and I’m really pleased with the outcome.
Dr. Andy Roark:
What was it like to edit and then also have chapters that you wrote in the book? Was that different? Was it interesting writing your own stuff and then switching over and trying to sort of edit and read other people’s stuff, or was that pretty easy?
Dr. Andy Sparkes:
I didn’t find that too difficult to be honest, but it was kind of interesting. As I said earlier, Catherine Lenox at Purina Institute, she did all the heavy lifting. So she edited every single chapter, and then she worked with myself and Dr. Ronald Corbee from Utrecht University, and we were the co-editors with her, and we got to look at half the chapters each in terms of editing and contributing suggestions.
So Ronald and Catherine looked at my two chapters and came back to me with suggestions for improvement. It’s a good kind of organic process I think. Having at least a couple of people looking at chapters and making suggestions for improvement and refinement, it makes it good at the end of the day.
Dr. Andy Roark:
You have more than one chapter. You have a couple of chapters in this book.
Dr. Andy Sparkes:
Yeah. So idiopathic cystitis and urolithiasis, calcium oxalate and struvite stones in cats.
Dr. Andy Roark:
What are the significant updates in idiopathic cystitis from between the first and second edition? I know that there’s been some growth, and as I said, that we sort of overhauled the way the handbook was done. So what are the big takeaways? And we will start with idiopathic cystitis.
Dr. Andy Sparkes:
Yeah, yeah. I always enjoy writing reviews or book chapters like this because it gives you a chance to refresh yourself on all of the up-to-date information. And one of the things that always strikes me is how much we don’t know. I mean, there’s stuff that we do know, but there’s a lot of stuff we still don’t know. And that is definitely true of idiopathic cystitis. Worldwide, idiopathic cystitis probably accounts for about 60% of cases of lower urinary tract disease in cats that we see, but we still really don’t have a good handle on this disease. We don’t know if this is one condition or if it’s a syndrome with a lot of underlying causes.
A lot of talk obviously about the role of stress in idiopathic cystitis and stress perhaps as an underlying cause or major contributory factor to it as a disease, and there’s some fascinating research that’s been done in that regard. But I think that the picture honestly is still really unclear about that. We don’t really have a strong handle on how stress is actually involved, and indeed, the difference between cause and effect because if you’re looking at a cat, and a lot of the research has been done in cats with chronic long-term, quite severe idiopathic cystitis, and in those sort of cats, you don’t really know.
When you observe indicators of stress and perhaps maladaptive stress or abnormal stress responses, is that a cause of the disease or is that an effect of the disease? Because these cats are painful. They’re going through a lot of significant disease there, and so the disease itself is going to be causing stress for the cats. So I think although we assume that stress may be involved in the pathogenesis, I’m not sure that we’ve really been able to tease out how much it’s a cause and how much it’s an effect of the disease. So there’s still a lot of work to be done in that respect.
Definitely looking at stress and trying to improve stress in the environment and minimize stress, that’s always going to be helpful because that’s going to improve the welfare of the cat, whether or not it’s a trigger for the disease. So definitely worthwhile looking at that.
But I think the really interesting thing when you come to idiopathic cystitis, there’ve been a whole bunch of clinical trials looking at different drug therapies and interventions. The only clinical trials, controlled clinical trials, that have shown a positive effect from an intervention are looking at dietary intervention. And there are, to my knowledge at least, there are at least three studies that have been published which have shown a significant effect of dietary intervention. So stress may well be important, and certainly we need to be looking at stress in these cats, but we need to be looking at their diet as well and optimizing their diet.
Exactly what the most optimum diet is for a cat with FIC, I don’t think we have that sorted out yet, but certainly there are some good indications from some of the studies that have been published at least.
Dr. Andy Roark:
Do you think that there’s a specific… Do you think different cats do better on different diets? I mean, as opposed to saying, “This is the diet,” have you found in your hands that some cats, for whatever reason, seem to respond much better to diet A and then other cats to diet B, or do you think it’s not that simple?
Dr. Andy Sparkes:
Yeah, that’s a really interesting question. I think with some cats, we definitely, at least anecdotally, we see good response to certain dietary interventions. So historically, when I’ve seen cases of FIC, a lot of my emphasis has been on trying to improve water intake, so switching to a wet diet if they’ve been on a dry diet or looking at other ways to improve water intake. And certainly from my clinical experience, I think there are some cats that respond pretty well to that as an intervention. But having said that, I think clinical experience can be misleading. So you have those control trials that we really need to be looking at to have good quality evidence for what we do.
Dr. Andy Roark:
No, and I completely agree with that. And actually, I was toying with asking this question and now you’ve landed right on it, so I have to ask it. But our clinical experience can be misleading, and we are human beings and we tell ourselves stories about the experiences that we have, and we look for trends and sometimes they’re manufactured.
So it was interesting when you were talking about the stress component, and I thought about how many times I’ve had people come in and say, “Oh, well, we had friends visiting,” or, “there’s workmen in the house,” and I can’t help but wonder, Andrew, if that’s… I can completely see that not being a factor and me having made it up because if you go looking for it and you say, “Was there anything that changed?” And they say, “Oh, well, we had a repairman,” and you go, “Aha, yes.” And the truth is that may be completely manufactured.
Are you sold on that type of narrative at all? If a pet owner says to you, “I heard this was stress and we had visitors from out of town,” do you kind of nod and go along with that and say, “Yeah, it could be,” or are you more skeptical than that?
Dr. Andy Sparkes:
That’s a really tough one. I have become more skeptical over time, I have to say. As you say, I think we’re very good at telling ourselves stories, and we’re very good at looking at ways to affirm what we already believe is true. So if you’re sold on the idea that this is a disease that’s caused by stress or is triggered by stress, then it’s very easy to find something that’s happened in the recent past that could have triggered that.
The more objective way of looking at that is to do case control studies and see if you can identify environmental stressors that are genuinely associated with cats that have idiopathic cystitis and are just seen in those cats and not in control cats.
When you look at case control studies, and there’ve been a few that have been published, there is really no consistent findings in terms of potential environmental stresses. You would think that something like a multi-cat household would be an obvious stressor where there may be conflict between cats in the household. You would think that maybe indoor-outdoor access may be involved or ready access to a litter tray, all sorts of other things. But these case control studies that have been published do not find any consistent environmental stressors that are involved in cats, and that makes me a little bit more skeptical.
Dr. Andy Roark:
That’s interesting. Oh, I completely hear what you’re saying. I am absolutely sure that I’m guilty of creating stories in my own mind around that, but anyway.
Dr. Andy Sparkes:
Oh, me too. Me too.
Dr. Andy Roark:
Well, it’s human nature and we all want to understand. It’s hugely frustrating to feel like this is a common problem, and this condition, it kills cats. I mean, this is the number one reason cats end up in the shelter, and it is a significant health risk for cats. And to say, “I feel like my knowledge of why this happens is so limited,” it’s a frustrating experience. I think we all want to feel that we have control and an understanding and insight that can be really helpful.
Dr. Andy Sparkes:
I mean, I definitely wouldn’t… I don’t want people to get the impression that I’m dismissing stress as a potential trigger or as a significant component of the disease because as I said, whether or not stress is actually triggering the episodes, these cats undoubtedly are stressed, they’re fearful, and they’re anxious because of the discomfort and so on that they’re in anyway. So I think it’s absolutely important for us to be considering stress and trying to minimize that in these cases. I think maybe the narrative that we have about this is a stress-induced disease might just be a little bit simplistic.
Dr. Andy Roark:
No, I like that. That makes total sense.
Talk to me a little bit about the urolithiasis. When you set out to write this, it’s clearly a staple when we talk about clinical nutrition and things like that, what were sort of the pearls and pitfalls that you wanted to highlight? And I say pearls, meaning what are the things that I think are most valuable for clinicians? And the pitfalls are what are the errors maybe or the missed opportunities that I see doctors make? So when you sat down to write the chapter, did you have objectives like that in your mind?
Dr. Andy Sparkes:
Yeah. I guess I wanted, again, just to look at recent literature that has been published in this area and really try and make this as up-to-date as I could. And looking at that, I guess there’s a lot of epidemiological information on stone formation in cats, which is mainly produced by the big laboratories where you submit stones to for analysis, whether that’s in the US or Canada or anywhere else in the world. And so there’s a lot of publications looking at epidemiological evidence for this.
We know that 90% of feline uroliths, more than 90%, are either struvite or calcium oxalate. Those are the two big ones for sure. I think there’s been some fascinating trends in the relative importance of struvite and calcium oxalate over the years where struvite used to be the dominant, certainly in the early ’80s, struvite used to be the dominant stone. There was a switch by the late ’90s for sure, so the calcium oxalate became more prevalent. Now, it’s perhaps a little bit more even again.
I think one of the things that did strike me, just going through all of that literature again, is that that’s potentially a misleading bit of information, though it’s very hard to draw information from stones that have been submitted to a laboratory which have either been removed surgically or may have been passed naturally. Stones that are submitted to a laboratory and looking at the composition of those stones and then trying to apply that to the general population of cats, that’s a tough one to do. So in terms of the genuine epidemiology of stone disease and the prevalence of these different stones, I think it’s a tough one to really get a proper handle on.
But the thing that really struck me, I suppose, is that even when you look at those figures, say roughly 50% of stones that are removed from cats right now end up being struvite stones, those cats didn’t need to go through a surgery. We can dissolve those stones with diet. So there’s a lot of cats that we’re still putting through surgeries that potentially could be resolved medically. I think that there’s a big opportunity there that we could avoid a lot of cats having to go under the knife.
Dr. Andy Roark:
That absolutely makes sense.
Dr. Andrew Sparkes, you were amazing. Thank you. Thanks for being here. Thanks for going through this with me. Are there any final pearls, as you start to look back and sort this work and put it out, is there anything else that you really want to make sure that clinicians take away from the chapters that you did? Any final parting words to say, “Hey, if you could give me one piece of advice going forward, what would it be”? I love the idea that a good percentage of stones can be dissolved and maybe we’re a little bit quick to go to surgery in those cases. I think that that’s something I’m absolutely going to put away and hold onto because that’s the type of information you like to have just nagging you in the back of your mind.
Dr. Andy Sparkes:
So, final thoughts. I guess I am a strong advocate of evidence-based medicine, and I think this handbook really helps us to achieve that. It provides succinct information, but it provides really up-to-date information and it’s unbiased information as well. The handbook doesn’t talk about commercial products. It’s talking about an approach to nutritional management of a whole variety of different diseases.
The book, I think you said at the top that this book is available free of charge. There is no charge for accessing this. All anybody has to do is sign up for communications at Purina Institute, purinainstitute.com, sign up for email alerts from them, and you get access to this resource completely free of charge. And Purina Institute itself, again, it’s not involved in promoting particular commercial diets. It’s about providing the science behind the nutrition, so they have a bunch of other resources there as well, including, well-pet nutrition. This handbook is focused obviously on disease management, but there’s well-pet nutrition there as well.
So I hope that this is going to be a widely used resource. I think it’s a lot of work gone into it and yeah.
Dr. Andy Roark:
I love this sort of model of distributing information from Purina. This thing is, I think it’s a PDF when you download it, and it’s just, I don’t know. I have a lot of PDFs. I just get a lot of information this way, and I keep them on my phone and put them on Google Drive and access it wherever I am. It’s an elegant solution. And the idea that you would get some sort of a reference material like this and said, “Oh, here you go, guys,” it makes me so happy. I love this project.
So anyway, Andrew, thank you so much for being here. Guys, thanks for tuning in and listening. Take care of yourselves, everybody. I will put links to Purina Institute and then also directly to where you can pick up the handbook in the show notes. Take care everybody.
Dr. Andy Sparkes:
Thanks so much.
Dr. Andy Roark:
And that’s the episode. Guys, I hope you liked it. I hope you got something out of it. Thanks again to Purina Institute for making this episode possible and also making the Clinical Nutrition Handbook possible. As I said, I’ll link it in the show notes. Go ahead and grab a copy for yourself. Take care everybody. I’ll see you later on.
