Feta’s Claw Conundrums (and minor PT update)

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Poor Feta Cat just can’t seem to catch a break!

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 🙁

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.

One example here:

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!

(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 🙂 )


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Feline Physical Therapy, Take 2

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Hello, friends!

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.

 

She really, really enjoys toilet paper roll rings.

A not-so-perfect circle?

 

“I haz box. Box is GOOD.”

 

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!)

Learning About Lasers (data nerds, read on)

Feta Cat’s neurologist suggested that we need to get her leg muscles to relax and loosen up before she will be able to regain strength and, hopefully, use of her remaining back leg.

Among many possible treatments, she suggested “cold laser therapy.” Being a pet owner on a budget, I wanted to know: is “cold laser” therapy supported by legitimate scientific studies, or is it likely to be one more form of medical snake oil marketed to people desperate to feel they are “doing something” to help their pets? (Or, for that matter, themselves – it’s a therapy used in people, too!) Unless it’s quite likely to work, I do not want to pay for it – the money could be better spent on her medication, wheelchair, food, etc.!

Disclaimer: I am not a veterinarian. I do not even play one on TV! I also know that there are important differences between humans and other mammals (and between different species of animals more generally) that cause problems when trying to apply medical findings from one animal to care for another. This is simply a lay-person’s internet research to get a rough idea whether a certain treatment is quackery or may have some therapeutic merit.

Googling on these sorts of topics can be tricky, because a lot of the sources that come up are unreliable – e.g., companies trying to sell you whatever it is you’re researching. So, we approach this carefully.

Also, fair warning: some of the papers do perform research on animals. If this is upsetting for you to read about, I recommend skipping this post!

That said, onwards…

First off, what is “low-level laser therapy” (LLLT) and how does it work? This paper does a great job of explaining the more technical details, though I don’t trust its objectivity in summarizing the data! So, now that we know more or less what it is, let’s see if we can figure out whether or not it works.

One of the best things to do when starting a new research topic is to look for trustworthy research summaries or meta-analyses.

In the case of laser therapy, one place to look is human insurance companies – they tend to be pretty conservative when it comes to treatment and are reluctant to pay for anything that isn’t backed by a large amount of compelling research. On this note, Aetna does not reimburse for laser therapy, saying there is insufficient evidence of its effectiveness. In that statement, they cite a great deal of research to support their decision, and it is a thorough and well-researched summary. Fair enough!

Similarly, a private site devoted to thoroughly researching such claims agrees with Aetna, concluding, “At this writing, the bottom line appears to be that LLLT devices may bring about temporary relief of some types of pain, but there’s no reason to believe that they will influence the course of any ailment or are more effective than standard forms of heat delivery.” (Devicewatch.org, a division of Quackwatch.org)

Those summaries are discouraging, but don’t necessarily say that laser therapy is a scam, simply that there’s not sufficient evidence to draw any firm conclusions. In other words, there’s no significant proof that it does work, but there’s no significant proof that it doesn’t work, either.

With that in mind, I was interested to look at some of the individual research studies / papers.

So, let’s see what PubMed has to say about low-level laser therapy!

Again, we start with a meta-analysis (in other words, an analysis of a whole bunch of other analyses; a research summary).

This one concludes, “This meta-analysis presents evidence that LLLT is an effective treatment modality to reduce pain in adult patients with musculoskeletal disorders. Adherence to WALT [World Association of Laser Therapy] dosage recommendations seems to enhance treatment effectiveness.” In other words, this summary suggests that laser therapy works, but works a lot better if you do it as recommended. Fair enough!

This paper – more of a summary than a meta-analysis, I think, though there’s a paywall for the full paper – also suggests that LLLT can be effective for controlling nerve pain. However, this paper rightly points out that there is a lot of variation in treatment protocols, so more work is needed to determine which wavelengths, treatment frequencies, etc. are the most effective.

Of note: just because something is a meta-analysis doesn’t mean it’s “right” or unbiased. All sorts of decisions go into a summary or meta-analysis, from which studies to include to how to weight the findings. As a result, we sometimes see contradicting meta-analyses on the same topic! Still, going for a summary of a lot of different researchers’ work is more likely to be helpful than relying on one single paper.

Next I wanted to look at a couple of sample individual papers.

These were not selected systematically, but were just ones that seemed relevant, recent, and came up from my first search of PubMed.

This study suggests that laser therapy can reduce pain sensitivity and decrease inflammation in rats that have constriction-related nerve pain (you can think of it as animal sciatica – something is pinching the nerves and causing a lot of pain). For our needs, and especially for mine with Feta and Rascal’s intervertebrate disc compression, this is very relevant!

Similarly, this study found that LLLT improved regeneration of the sciatic nerve as well as the animals’ ability to move normally.

Also note: beware the “file drawer effect”!

What do I mean by this? Basically, scientists are (unfairly, in my opinion) rewarded much more for studies that find a significant effect of something. This is for a number of reasons. You can imagine that you are trying to prove that eating sticks of butter leads to gaining weight. All you need is one good study that DOES show an effect – people who eat sticks of butter gain more weight – to suggest that an effect is there. To think of it another way, all you have to do is see Bigfoot one time, up-close and personal, with very little doubt that it is ACTUALLY Bigfoot, and you’re a Bigfoot Believer!

When research shows a null result, however – essentially, you try one thing and it doesn’t seem to work – there are a million reasons why that could be. If you do a study and find that people who eat sticks of butter DON’T gain more weight, does that mean that butter isn’t fattening? No, of course not. You could have measured poorly. You could have measured at the wrong time. You could have not controlled for some important other influence (what if the butter-eaters were also running marathons every day?). You can’t definitively prove the absence of something. If you go out into the woods for a month and do not see Bigfoot, does that mean he doesn’t exist? Not necessarily. You probably won’t see any snow leopards, either, but other people have some very convincing evidence that snow leopards are, in fact, a thing.

So, when scientists do not find evidence of a thing, people don’t usually get very excited. It’s generally harder to get the research published, and it’s not very beneficial to the scientist’s career. Since it takes a lot of time and effort to get something published, these “null result” studies often go unreported, hanging out in the “file drawer” for a “maybe some day I’ll get around to it” type of publication. In other words, we’re more likely to see papers that do show an effect compared to those that don’t show the effect, but that could be largely due to publication bias. Those “null effect studies” may exist, just not be published.

So, what’s the laser verdict?

Overall, there seems to be very little consensus on the “best” laser dosage and wavelength to use. This makes it difficult to compare across studies, since every one is doing something a little different!

My take-home is essentially: laser therapy may be helpful, but it’s far from guaranteed to work.

So, my totally lay person advice? If you can afford it, go for it. It won’t hurt and may help! However, if you’re on a tight budget, you may be able to skip the laser therapy for some quality at-home time with a heating pad, and save the money for other treatments that are more certain to be effective (e.g., time swimming, physical therapy exercises, medicine, etc.). This is, obviously, something to talk over with your vet and/or veterinary physical therapist! They may have their own biases – medical professionals are people, too, and are just as likely as the rest of us to do things like selectively remember what supports their beliefs while forgetting what contradicts them – but if you have someone whom you trust to help your pet, it’s always a good idea to talk to them honestly about your concerns as well as your finances!

Hope this long diatribe has been helpful – either for assisting others in making an informed decision about cold laser therapy or, more likely, for helping some folks fall asleep 😀

Feta’s PT Progression

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!

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?