Feta’s PT Progression

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Greetings, Feta Fans!

We’ve been hard at work doing our exercises, and while it’s hard to document well since it takes two hands to really do them right, I wanted to at least attempt to show our progress.

We sent a video to the lovely tech who is helping us, and she is happy with how we’re doing so far! Good job, us!

About a week ago, she was still showing a lot of tenderness in her back, though Awesome Tech Jenn still thought it showed improvement compared to how she’d been at her consultation visit.

Her weight bearing practice was going well, though, and continues to improve!

When we practice, I’m scratching her back/butt to get her to really use her abs and her leg to hold good kitty posture, and also to force her to distribute more weight onto that back leg (as opposed to basically doing a handstand, which she prefers at this point) and also to use her muscles to keep maintain her balance. This also helps her back as well as the leg and hips.

As she’s getting better with this, I’m also scratching her back leg a little bit, in the “crook” of the “knee” of her stifle joint, to get her to flex that a bit more, too. We also do some gentle “bounces” where I very gently and carefully press down on her hips to get her to bend and flex a bit more while bearing weight on the leg.

She tends to want to bend only in her hock, to the point that it’s all the way down on the ground, so I’m really trying to encourage her to bend that stiff stifle joint as well.

We’ve been working very diligently with her leg stretches, working on them at least 2x/day. Doing short but frequent sessions is really important for healing – keep at it too long and you stress both the leg and the cat, and push it too hard and you could get a lot of inflammation that is actually counter-productive. Gentle and consistent is best. And remember, the more relaxed the animal, the better stretching and movement you’re going to get! Keep it gentle and positive!

You can see our massaging and stretching from last week here (note: it may look like I am squeezing or forcing her, but while it’s important to be firm, always err on the side of being gentle! I am holding her leg with a loose hand, and mostly gently applying pressure with the flat of my hand):

Then today, I took some more video to show her progress – you can tell she is still quite stiff, but look how much more bend we’re getting! And how much more comfortable she seems!

I’ve found that letting her lie down with the stiff leg dangling off my lap down towards the ground is a great way to get a relaxing passive stretch. Works great on humans, too! (Some variation of this was very helpful for me when I was recovering from broken ribs! Although my PT had me doing it with the top leg dangling down and the bottom leg bent upwards.)

To get the “bicycling” movement, we start by loosening and working on the stifle, then very gently combine it with the easier hock flexing. In general, you start at the top, loosening the hip, then the stifle, then the hock, then the ankle, before you expect them all to start moving together.

This type of healing and strengthening is not a quick process, so we’re going to just keep on doing what we’re doing and hoping for continued gradual improvements. It will likely be a long time yet before she’s really using that leg voluntarily (she is quite lazy, and won’t want to use it until it’s easy) but the more we get it loose and strong, the sooner that day will come!

Thanks to all her fans for your encouragement as we trudge along through this process!


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Cat-Butt Anatomy (and what our PT is working on)

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I am not a vet, or anything close to one, so to try and help Feta I’ve been doing a lot of research.

For example, massage. How can I give her a really good massage if I don’t know what, exactly, I’m rubbing?

One of my favorite guides is actually a drawing done by the talented Raven-Scribbles and hosted over at DeviantArt. Check out this beauty:

You can see another representation here:

This gives a much better sense of what we’re working with on Feta’s hind end. Looking at that big, swooping hind-end muscle that connects to the leg bones, you can imagine how if it were weak and pulled too tight the cat wouldn’t be able to bend the leg normally, and would have a very stiff, straight hind leg. The same holds with all those other smaller muscles, like the ones around the hips and going into the stifle (that upper joint on the leg).

This seems to be what’s going on with Feta, and why we’re working so much on massage, heat/electromagnetic therapy, and passive range of motion stretches. By relaxing those tight muscles, we are hoping she can get some range of movement back. Then, we can work on strengthening those muscles so she can better support her own weight.

Speaking of which, Miss Feta is on a diet – it’s especially important for Tripawds to stay lean, so excess body weight doesn’t strain their remaining legs and joints, which are already working overtime! Unbeknownst to me, Feta the Fatty has been raiding the automatic cat feeder, so she’s been sneaking extra kibbles when I’ve not been looking. We’re (okay, I am) now working to get her a little leaner so she can work on her hind-end exercises more easily.

Sorry, Feta!

Let’s Get Physical (therapy) – for Cats!!

Welcome to Feta’s torture physical therapy exercises! It’s time to get moving!

“Noooooooo!!!! I do not like to exercise!!!!”

As we humans who have endured physical therapy can tell you, it is not designed to be fun or even especially comfortable. However, the end results are well worth the struggles.

Embarking on our exercise journey, there are three very important things to keep in mind: 1) discomfort is good, 2) pain is bad, 3) safety is paramount.

As my human PT doctors said, the goal is to exercise “to the pain” but not “through the pain,” because that can set you back even further. You want to just tickle the edges of your comfort zone, with the goal of stretching them just a little bit further each day, such that eventually you are back to life, back to reality! Since in this case we are working with animals, whose instinctive response to human-inflicted discomfort is to bite/scratch/claw/paw/etc., it is very important to keep your delicate parts (e.g., face) away from the pointy bits and also to be sensitive to your animal’s unhappiness threshhold – and do not push it to the point that your animal responds negatively!

(Full disclosure, Feta is a lovely, forgiving cat, but one time trying to snap a picture I got lazy, she got upset, and she clawed my arm pretty hard while trying to escape me poking at her. It was nothing serious, but if that had been my eyeballs, I would not be writing this post right now!)

With that out of the way, we start with our warm-ups. For Feta, whose primary current challenge is muscle tightness, we work on relaxing her muscle tissue through heat and electromagnetic therapy.

Since it is winter, and she enjoys being snuggly, I often begin by wrapping her up in her favorite soft blankie (a gift from our fabulous Auntie Meaghann) to warm her up all over.

ZzzzzZZZzzzz….

 

We also do a 15-minute session with the Assisi Loop, which was kindly donated by someone to Westfield Veterinary Group, who then generously donated it to us.

“The warmup is my favorite part of PT because it involves sitting comfortably and getting treats, both of which I am very good at.”

We then move to some gentle massage, which is hard to describe and even harder to video! Basically, imagine gently petting your animal’s major muscle groups using your fingertips. With Feta Cat, imagine the pressure you would use for a gentle cheek rub, and using that pressure (or lighter) down the spine and legs, stopping and reducing pressure if you feel any signs of tension. Remember that your pet is likely to be sore, so be very careful and gentle.

This isn’t quite what I mean by “cat massage,” but you get the idea!

In this video, you can see my (unskilled) demonstration of some of Feta’s sore spots – she has a lot of back pain, no doubt caused by her odd two-legged movement and posture, so we are working on reducing that through gabapentin medication and our massage/exercises.

After a bit of relaxing massage, we move on to the “passive range of motion” stretches. These are especially important, very gentle, and are useful for almost all animals with any sort of physical/orthopedic challenges (I do them with my arthritic dog, also).

I place Feta lying on her side, with her stump down and her stiff leg on top. Then, according to the vet’s instructions:

• To perform PROM for flexion and extension of the stifle, place the upper hand above the stifle and lower hand below. Try to keep your hands close to the joint. Be certain that the stifle is supported to avoid any undue stress.
• Slowly and gently flex the stifle. The other joints of the limb should remain in a neutral position. Try not to move the other joints while working on the affected joint.
• Continue to flex the joint until the patient shows initial signs of discomfort, such as tensing the muscles, moving, turning the head toward you, or trying to pull away, but do not cause undue discomfort.

My best attempt at a video showing our stifle stretches can be found here!

One of the most important things to remember with these stretches is to work on keeping the animal relaxed. If your pet is upset and fighting you, they will be tensing their muscles and you will not be getting the stretching you need. You may want to have someone helping you keep your pet calm, have treats on hand to soothe them and reward them, do it in a quiet, comfortable location, whatever you need to do. Relaxation is really, really important!

For Feta, we also work on back-elongating stretches to help her spine. One of the most effective for her is nicknamed the “Lion King stretch,” for obvious reasons:

This stretch works best if done while singing the opening lines from the Lion King movie. Or at least, so I hear.

Holding the cat up in the air, with your hands supporting her behind her front shoulders and in front of her back hips, encourages her to stretch out the full length of her spine.

We are also working on any movement we can do to keep her actively stretching out her back – having her grip into something and pull while I gently hold/pull her hips back is ideal, but we can get similar movement from types of play, using some of her favorite toys, as you can see here. Brushing her briskly along her back while she lies on her side also encourages here to stretch out and elongate her spine.

We are also working on what we cal “tail walking,” which is encouraging her to bear weight on her “bum leg” and to essentially re-train her brain to recognize the sensation of normal movement in that leg. We do a lot of practice with that, and with “rear leg weight shifts” (basically pushing her mildly off balance so she has to re-adjust her position, using all those little balance muscles and putting weight on her leg), while she is eating her dinner. Since she is extremely food-motivated, and does not “guard” her food (again, be careful), she doesn’t mind me messing with her rear end during dinner time as long as she has some tasty cat food to distract her.

Video of the weight shifting and “tail bracing” here!

Note: be VERY careful using the tail in these exercises, as it can be strained/sprained, which would require additional rehabilitation.

As you can see here, she’s doing well with the weight bearing, even though the leg is still extremely stiff. I am also working on getting her to stretch her back while she’s standing – if I scratch her bum, she tends to kind of curl/flex away from the scratches, which puts her in a much better posture.

Me: “Stretch! Move! Flex! Hold!” Feta: “FOOD FOOD FOOD FOOD FOOD! FOOD!!!!!!!!!!!!!”

 

We have more exercises to work on once she gets some more strength and flexibility back. For now, we’re working on doing this routine 2-3x/day, which is keeping us plenty busy!!

I am thinking of trying clicker training with her in the hopes of making some of these exercises a little easier – what do you guys think? Should we go for it?

Feta Goes to Physical Therapy!

Even though Feta Cat is now some 6 months post-amputation, as noted in our previous entries, she has really been struggling with the use of her remaining hind leg.

However, physical therapy is a pretty fancy (expensive) treatment for a shelter cat, so we spent a lot of time trying to do what we could at home. Primarily, we tried to help her with stretches and with practicing the use of her leg.

Unfortunately, the vast, vast majority of online PT resources are dog-specific, which was our first challenge. Even more challenging were Feta’s own particular limitations. How far could we push “passive range of motion” on that stiff leg without hurting her? Were there additional underlying physical problems (such as nerve damage) that might be making it actually impossible for her to do some of the things we saw online? What movements would be the best for helping with her specific weaknesses?

When it ultimately became clear that Feta’s leg was getting worse, not better, I offered to sponsor her physical therapy myself. With the assistance of the fabulous Tripawds.com community and the amazing Maggie Moo Fund:

the shelter (Liberty Humane Society) set Feta up with an appointment at Westfield Veterinary Group, an amazing practice that had been extremely helpful with an earlier case of theirs, and the Maggie Moo fund covered the cost! Thank you, Tripawds Foundation and supporters!!!

So, off we went to the vet for our initial evaluation and personalized (cat-inalized?) physical therapy prescription.

The vet started by pinching Feta’s foot and toes, trying to gauge how much sensation she had in the foot. While she did not seem to have much reflex to pull the foot away from pinching, she did seem to be able to feel (and disapprove of) what the doctor was doing. This is a good sign!

“The only ‘good sign’ I’m looking for is the exit!”

Next, the doctor tested her range of motion, which was significantly less good. For whatever reason (and certainly compounded by months without use), the muscles in Feta’s back leg were extremely tight, leading to very little flexibility in the hock and, in particular, the hip and stifle joints (the one between the hip and the “elbow”).

“I hope you’re happy, human.”

Next, Dr. Fellen used laser therapy to work on relaxing some of Feta’s tense muscles and, hopefully, reduce some of the pain she detected in Feta’s leg and back. (Animals are very stoic, and cats especially so, so it can be very difficult to detect pain if you don’t know exactly what you are looking for. And, despite experience with dogs and horses, I didn’t know how to evaluate a cat! But by feeling particular areas around Feta’s spine, Dr. Fellen was able to figure out areas of discomfort. This is another reason that evaluation by a professional is so important – wouldn’t it be awful to know that your pet had been in pain and you didn’t even know?)

Dr. Fellen applies the laser wand to Feta’s stifle joint. (“Worst. Spa. Ever.” -Feta)

Although she didn’t like the pressure of the laser wand, the warmth of the laser treatment must have eventually begun feeling pretty good to Feta, as she relaxed and started happy-purring while Dr. Fellen worked. (Note: cats can also purr when under stress, but her body language suggested that in this moment, they were happy purrs.)

Next we moved on to exercises and massage, which poor Feta liked significantly less. As I was holding her and being instructed how to do the exercises myself, I didn’t get a lot of photos, but it was great having individual, customized instruction on what she specifically needed for exercise and what would best address her particular problems. I will write more about them, and share some pictures/videos of our practicing, in future posts.

“Seriously uncool, you guys.”

For Feta, the most important things for her right now are stretching and exercising that leg, to get the muscles looser and more relaxed, and getting her re-used to the sensation of weight bearing on the leg, even if it’s not done in perfect form. Towards both of those aims, we are to start every “workout session” with 5-10 minutes of gentle massage, “passive range of motion” stretches, and heat (if possible) to loosen the muscles, coupled with forcing her to walk actually using that hind leg (rather than jutting it out stiffly in front of her as she crawls).

In our next post, we will talk more specifically about the stretches and exercises we are working on, as well as how Feta is faring with them. Stay tuned!

Bathrooming Battles (and Litterbox Hacks for Tripawds)

Having a tripawd cat can be very rewarding, but is not always easy – especially when it comes time to use the litterbox. Feta cat, in particular – due to her problems with her remaining hind leg – has been having some serious struggles.

When I first brought Feta home, I used the same shelter-issue, easily-sanitized, stainless steel litter pan that I’d used with previous fosters (like these cute lil guys):

Kittens included for scale and adorableness.

The shelter had warned me that Feta might need a low-sided litterbox so she could get in and out more easily, so this seemed likely to do the trick. However, after a few days of her making a tremendous mess, it seemed that the steel tray was too small for her – since she couldn’t easily turn around to dig and bury and squat to do her business, she was throwing litter all over the place and occasionally missing the box (such as the dreaded “four paws in, butt sticking out over the side” litterbox disaster position!). Also, despite my daily attempts to help her stretch and exercise, her leg seemed to be getting worse. Or at least, she was choosing to use it less. Thus, the creation of the cardboard monstrosity you saw in our earlier post!

If I’m really polite with this, will you agree to clean up after yourself?

This did well enough for a time, but cardboard is not quite as durable/cleanable as stainless steel (who would have guessed?!) and poor Feta could get in the box pretty well, but had trouble turning around and getting out, so she’d go in, do her thing, then try to leap out the sides and/or flail around while trying to turn in a circle. (In retrospect, back pain may have contributed to this?)

Also, full disclosure here, my lease was almost up and I needed a way to quickly hide evidence of Cat if my landlord wanted to show the apartment. After consulting with a number of people/websites, I decided on modifying a cheap plastic under-bed storage container, cutting (with my best kitchen shears, obviously – who has tools?!) a lowered lip for easier entry. To further try and minimize the mess (and keep my stupid cat-turd-eating dog out of the box – easy accessibility for cat means easy accessibility for dog, too!) I nested the storage bin in an extra big cardboard box with entry AND exit holes cut. To top things off, since she was getting litter all over her, I tried switching her to a more natural, more edible (you’re welcome, dog), non-clumping pellet litter. We tried both Yesterday’s News and Feline Pine (mixture pictured here).

Wow, so luxurious. Doesn’t it make you just want to sit down and have a poo? No? Okay, how bout a nice pee??

While this contraption suited me just fine (aesthetic challenges of having a giant cardboard-enclosed litterbox in the middle of my living room notwithstanding), it was only somewhat helpful for our dear Cheesecat. The lip was still too high for her to go in comfortably, though she often preferred to go in on the high side anyway. Furthermore, she was unable to support herself in a good bathrooming position, so generally ended up falling mid-business. This was not enjoyable for either of us.

Was it the pellet litter (too slippery??), the plastic box (maybe that was slippery? maybe the sides were not ideal? maybe the shape was wrong?), or just a result of problems with that back leg? I didn’t have a chance to fully test any of these theories, because shortly after the birth of Big Plastic Potty Box, Feta got adopted!!! So into the trash it went.

Unfortunately, Feta continued to have trouble in her new home, and eventually came back to foster with me. This meant, among other things, that I needed to come up with a new litterbox solution.

Operating under the assumption (okay, blind guess) that the pellet litter was too slippery, we went back to regular clay litter. As a first, simple attempt, I jury-rigged a simple cardboard box by cutting it down and taping the inside (for some desperate semblance of waterproofing). (The baking pan with Feline Pine was for the current foster kitten’s use – more details and cute Tripawd-on-Kitten action to follow in a later post.)

Success! …if you describe success as making a box for your cat to effectively poop in. Turns out, I do. Success!!

The cardboard “wings,” as well as the towel underneath, were absolutely necessary for controlling the spill-over problems. Feta seemed to like this box setup well enough to use it with fewer butt-over-the-side mess incidents, but it was really messy. As her back leg was now worse than ever, she was essentially a 2-legged cat trying to use a litterbox. Awesome.

I tried several other variations – the two-tall-sided plastic-lined box being my personal favorite from a cleaning point of view – but they all had different drawbacks and all were still very messy. (It’s hard to avoid mess when the poor cat sits in her business and then drags her butt all over the floor!) So, our current state of affairs is clay litter (don’t buy the cheap stuff in the tub you see in that one picture, it’s gross, go for the name brand or something less dusty) and a wide array of litterboxing options, with LOTS OF RUGS AND FLOOR PROTECTORS (did I mention how I rent?! yeah…) and super-diligent cat-and-litter-cleaning.

Yes, that is a home carpet shampooer and a vacuuming robot on the right. Do not recommend the robot for litterbox issues (they will drag poo etc. all over the place worse than a bum-dragging 2-legged cat), but the carpet shampooer has been VERY nice to have.
FML. You're lucky you're cute, cat.
The current setup. The “puppy pads” do not work very well, since they get caught and dragged on the cat. The cardboard works well to absorb urine and catch litter spills, but for obvious reasons needs to be changed out frequently. The small rug I saved from the trash room when a neighbor threw it out because it had been peed on all over the place. (“A pee rug?! PERFECT FIND!” I say, taking it home, because I am insane. See also: carpet shampooer.) The larger rug is one I was going to throw away but decided to keep so I wouldn’t get too upset when that area of the floor got soiled and litter-sprinkled. The plastic sheet is one from Ikea designed to protect floors from rolling chairs – works very well as protection because it lies flat and is not too slippery, but stray urine can get under it and get disgusting, so additional protection is also recommended. Here, I have a full cardboard box flattened out with gaps taped shut to protect the wall and the under-boxes spaces.

So, that was a lot about cat bathrooms. My Cliff’s Notes version, based on what I’ve tried so far:

  • Pellet litter may be slippery. Clay or something like wheat or corn litter may be a better choice (though note: if there are any wounds or incisions still open, litter may stick to them, so something organic and non-clumping is likely to be your best bet).
  • Cats, especially limited-mobility cats, really like to have an entrance and a SEPARATE exit path from the litterbox. To help your tripawd feel extra comfortable, provide them with more than one way to get in/out of the box.
  • Low sides are essential, but are likely to contribute to mess.
  • Use floor protectors, cheap rugs, old towels, heavy-duty rubber litter mats, etc. to help contain the mess and save your floors/sanity.

Do any of you have tips on litter box hacks? Would love to hear what other tripawd owners have found effective!