After all of this time working hard at our PT, a bit over a month ago we were confronted with a new challenge: poor Feta had an infected claw. This could have something to do with the claw caps we tried, or may also be due to her habit of biting at her feet (which had been under control, we thought? but perhaps had simply become better hidden).
Whatever the cause, the nail bed was infected, and it was not good. Her toe became extremely swollen and she was no longer able to bear weight on it without severe discomfort. Additionally, the quick of the nail retracted almost all the way, so her claw had to be trimmed down to practically nothing. This is not helpful for traction!
After two rounds of antibiotics over about a month (as well as numerous foot soaks, toe scrubs, and some NSAIDs; not to mention vet bills!!) Feta’s toe was finally back to normal(ish; the claw still needs to grow back out). However, we had to put a stop to our major PT work while she recovered, which set us back significantly. While we were able to maintain her core strength reasonably well, her bum leg is stiffer than ever 🙁
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That said, we’re back on track again – more or less – with healed toes and more PT work. In another post I will share some of the videos and exercises that we have been working so hard on. Essentially, we are focusing on “gait training” to teach Feta how to use her bum leg to hop rather than butt-scoot.
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To keep her entertained and working at least a little bit while on “medical leave,” I picked up a couple of puzzle toys for her to force her to work for her food (even if she wasn’t using that leg).
Here you can see her using it, with the “help” of one of my foster kittens!
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(Also during this month I had a foster cat and her four kittens who all came down with ringworm! While actually a fungus, not a worm, ringworm is highly contagious and not species-specific, so it was a super fun month of daily laundry/bleaching, excessive disinfections, frequent cat/kitten baths, and complete paranoia over spreading the fungus through the rest of the house! Fortunately, they all recovered and the babies are all in new homes now. I still have mama, who needed some additional socializing, as well as a new litter of 6 orphaned babies! Plus Chewy, featured above, who is an only child. It’s a full house, but it’s a lot of fun! Pictures of all the cuties can be found on my instagram, as seen above, and sometimes on the Facebook page of the group I foster for 🙂 )
After our neurologist appointment a while back, we went to find a place to do some more physical therapy to work on getting Feta Cat’s immobile hind leg a bit more mobile again. This time we headed to Aqua Dogs (& cats!), where they have more equipment (such as a pool and underwater treadmill) to work with.
I didn’t get any pictures (once again, it was a very hands-on session), but we got a tentative diagnosis. Basically, as best I understand it, her nerves are not firing correctly. The wiring has gotten a bit… off. So Feta says, “Hey leg, let’s extend!” and the leg pulls up towards her stomach. Basically, her hamstrings are on strike and not really responding to any calls for action. This problem is compounded by very weak abdominal muscles. Put these together, and we can see why she “scoots.”
This time, in addition to stretches (which were a bit more forceful than we were doing before, sorry, Feta) we tried electrical muscle stimulation, or e-stim therapy. Nerves transmit signals using electricity, so what makes a muscle move is really an electrical current. E-stim therapy uses this principle to make a particular muscle contract. We place two electrodes (to complete the circuit), then the machine sends a pulse of electricity through the electrodes that tells the muscle to contract. This way we’re working the muscle even if the nerves are a little bit out to lunch.
Feta doesn’t seem to mind this treatment at all – in fact, she thinks the electrodes are the best cat toy EVER.
This is what it looks like when her leg starts going.
(You’ll note the bare strip – we had to shave her bum so that the electrodes could get good skin contact. Sorry, Feta!)
We are renting an e-stim machine from the PT office, and are doing the e-stim twice a day for 5 minutes at a time. We are also working on the “scrunching” stretches to get her stifle bending, as well as stretching her leg out behind her to get the hip and muscles going. Finally, we’re practicing her weight-bearing / standing, with particular attention on good posture to activate the abs and light “bouncing” pressure to encourage bend and flexibility. I will try to get some video of this if I can get my phone tripod to work!
The hope is with all of these exercises we can “re-train” the nerves in her leg to work the way they are supposed to. By practicing the correct way of moving and stretching, we may be able to restore those wonky or forgotten neural pathways and get some real movement back in her leg!
If we manage to get that far, we will want to get her on the underwater treadmill. So, her water desensitization continues, though it is taking a lesser role while we focus on our other exercises. She is still on a fairly strict diet, but with all this torture physical therapy she needs a lot of rewards, and there’s only so much kibble she can eat! (The cat food bag suggests 1/2 cup per day, yikes.)
Despite all of this unpleasantness, Feta Cat remains truly delightful, kind, and gentle. All in all, I think she is enjoying life, even if I make her do ouchy exercises and switched her to the “fat cat” kibble!
Reading up on horseback riding techniques in her spare time, apparently.
This whole process is extremely time-consuming and very expensive, but darn if I don’t love this ridiculous cat. She’s had a rough road so far, and I’m glad I’m able to help her enjoy some of the finer things in life <3 (like cardboard boxes and toilet paper rolls!)
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!
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.
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.
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.
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?
