Paws in Motion: Part 2 On Rehab & Recovery for Cats

In the September episode of Chattering With International Cat Care, we bring together two conversations on how innovation and teamwork shape feline medicine.

First, Yaiza Gómez Mejías speaks with Morgane Debuigne, winner of the JFMS Resident Best Paper Award 2024, about her article on feline supraglottic airway devices. What does the latest research reveal about their role in anaesthesia and where do they fit alongside established practice?

Then, Dr Kelly St. Denis continues her discussion with Mary Ellen Goldberg on feline rehabilitation. In this second part, they explore therapies, exercises, and the practical ways veterinary teams and owners can play a role in supporting recovery. Catch up on the first part of their conversation by tuning into our July episode!

For further reading material please visit:

Placement of the feline V-gel Advanced supraglottic airway device and tracheal selectivity during controlled mechanical ventilation: a clinical and tomodensitometric evaluation

Computed tomography assessment of V-Gel Advanced supraglottic airway device placement in cats

Physical rehabilitation of cats: 1. Common conditions benefiting from physiotherapy

Physical rehabilitation of cats: 2. Treatment therapies and exercises

For iCatCare Veterinary Members, full recordings of each episode of the podcast are available for you to listen to at portal.icatcare.org. To become an iCatCare Veterinary Member, or find out more about our Cat Friendly schemes, visit icatcare.org

Host:

Yaiza Gómez-Mejías, LdaVet MANZCVS (Medicine of Cats), RCVS CertAP (Feline Medicine), iCatCare Veterinary Community Co-ordinator

Speakers:

Morgane Debuigne, Dipl. ECVAA, Winner of the JFMS Resident Best Paper Award 2024

Kelly St. Denis, MSc, DVM, DABVP (Feline), Co-editor of the Journal of Feline Medicine and Surgery and JFMS Open Reports, St Denis Veterinary Professional Corporation, Powassan, Ontario, Canada

Mary Ellen Goldberg, BS, LVT, CVT, SRA, CCRVN, CVPP, VTS, VTS-LAM, VTS Hon, Certified Veterinary Pain Practitioner & JFMS Author

Creators and Guests

Host

Yaiza Gomez-Mejias

Veterinary Community Co-ordinator @ International Cat Care

What is Chattering with iCatCare?

Welcome to Chattering With iCatCare, the official monthly podcast of International Cat Care, hosted by Yaiza Gomez-Mejias (Veterinary Community Co-ordinator). Each month, we chatter about cats and cat-friendly practices with industry experts and contributors to The Journal of Feline Medicine and Surgery. Each episode contains highlights from our longer discussions and interviews, which are accessible to iCatCare members at portal.icatcare.org. If you would like access to our full episodes, would like to become an iCatCare Veterinary Society Member, or find out more about our Cat-Friendly schemes, visit icatcare.org.

Hello, and welcome to
Chattering With iCatCare.

I'm Yaiza Gomez Mejias, iCatCare
Veterinary Community Coordinator

and host of this month's podcast.

Our clinical spotlight today is focused
on physical rehabilitation in cats.

Dr Kelly St. Denis will be
interviewing Mary Ellen Goldberg

on therapies and exercise.

The interview on the first part of
this article series was released in

July as part of another episode where
Mary Ellen discussed common conditions

benefiting from physiotherapy.

Remember, if you want to read it, that
all articles in the Journal of Feline

Medicine and Surgery are open access
and can be found on the journal website.

Before completing this comprehensive
overview on rehabilitation though, I

will be interviewing Morgan Debuigne
first author of a JFMS article on

supraglottic airway devices, which won
the resident best paper award in 2024.

The full title of this article is
"Placement of the feline V-gel-Advanced

supraglottic airway device and
tracheal selectivity during controlled

mechanical ventilation: a clinical
and tomodensitometric evaluation".

So thank you very much for
your time, congratulations

for your award.

Thank you very much for having me
and thank you for this amazing prize,

that was really a very nice surprise.

So what were the primary
objectives of this study?

What exactly were you trying to find out?

So the primary aims of the study were
to see if using the manufacturer's

recommendations, can we be sure that
the device is correctly placed?

The second aim was to see if after
controlled mechanical ventilation, if

we could have aerophagia or let's say
gas trapping in the digestive tracts,

because it had been shown that we could
ventilate cats and rabbits with the

V-gel with quite high pressures, but we
wanted to see if we were sure that it was

going only in the respiratory tract and
not in as well in the digestive tract.

So how did you assess whether the
tubes were positioned in the right way?

So to assess if the V-gels were
correctly placed, we performed

a CT scan of the cats actually.

So what we did is that we
performed four CT scan of each cat.

One CT scan without anything.

So the cat was just heavily sedated
and the CT scans were going from the

nose to the stomach to see as well
the digestive tracts and to evaluate

the gas in the digestive tracts.

One just after the placement of the V-gel.

One after a five minute period of
controlled mechanical ventilation,

and one after intubation
with an endotracheal tube.

And so to evaluate that the V-gel was
correctly placed we looked on the CT scan.

We looked at five criteria.

We looked at the epiglottis
lying freely in the larynx.

So it included the fact that the
V-gel was not occluding the larynx.

We looked if the tip of the device
was in the oesophagus because

this is how it's supposed to be.

The tip of the device should
be occluding the oesophagus.

So the third criterion was to see if
the tip of the device was occluding

the oesophagus so that we had no
leaks around the tip of the device.

in the oesophagus.

We looked if the device was rotated
or not regarding with the axis of the

larynx and we looked as well at the
laryngeal symmetry just to see if we were

inducing or not a rotation of the larynx.

This enabled us to create a
specific score from zero to five.

So one point for each criterion, that
we were having and then a score of

five was a device perfectly placed
and a score of zero was a device

perfectly misplaced, let's say.

Very thorough indeed.

And what were the key
findings in this study?

So the key findings were that globally
the devices were correctly placed.

We were a little bit surprised in
the good way regarding the results.

We never found a laryngeal compression
or a device that was very misplaced.

There was just only one cat that
had a score over five, which

is a device perfectly placed.

The majority of cats had a score of
three over five or four over five.

The decreased score was due to an
incomplete occlusion of the oesophagus,

or a mild rotation of the device that
didn't induce rotation of the larynx.

So it was minor abnormalities of
placements that were observed.

The only thing is that this complete
inclusion of the oesophagus could

be quite a problem because what we
found as well was that we could have a

lack of complete tracheal selectivity
because we found that we had some gas

trapping in the digestive tract after
the placement of the device and after

the period of mechanical ventilation.

So we know that maybe we can induce
a kind of small gas trapping in the

digestive tracts after placement of the
device and after the ventilation period.

And maybe this could be due to the
incomplete seeding around the oesophagus

during the placement and the ventilation.

Which was not really a problem
during our study because it was

only five minutes of ventilation.

But what is unknown if we go for a
longer period of ventilation, we don't

know what could be the consequences.

So it could be a problem actually,
but for a short period of ventilation

as we did, it was not, the gas
scores that we had after the

ventilation were quite acceptable.

And on a CT scan, the amount of gas that
we found was not something that appeared

completely abnormal to our radiologists.

And the other results that we found
is that we didn't find that we needed

more time or more attempt to place
an endotracheal tube which contrasts

with the results of previous studies
where the time required to place

an  endotracheal tubes was increased.

And when you said that it's appropriate
for short procedures because you

were talking about the potential
complications associated with gas, with

the distension of the gastrointestinal
tract due to gas accumulation and

you referred to short procedures.

What's the short
procedure in this context?

Yes.

Actually, it's a good question
because I think the indications for

using V-gel are not super clear.

If you read the manufacturer's
recommendations, you almost could

use it in every case or procedure.

What we concluded with in our study is
that endotracheal intubation remains

the gold standard and the V-gel
doesn't replace an endotracheal tube.

So yes, when I said short procedures, the
question of when should we use a V-gel?

And actually the
indications are not so wide.

I think it's very in interesting in those
procedures that are quite minor and quite

short, such as castrations for cats, a
small wound, radiotherapy, especially when

you have to anaesthetise the cats several
times in the same week, for example.

Or abscesses procedures, maybe
for abdominal ultrasounds as well.

When you have a critical patient that
you have to induce and to maintain with

volatile anaesthesia it could be more
interesting to have the V-gel rather

than to intubate the cats and finally
I think it can be very interesting

in respiratory endoscopies for
bronchoscopies in cats, tube or almost.

You can't have an intubated cat and the
bronchoscope is going in the endotracheal

tube, so often what we do is that we
have cats that are not intubated, and

it can be a little bit problematic
when you have to ventilate the patient.

So, with the V-gel, it can be an
alternative where you can pass

your bronchoscope into the V-gel.

And then you have this control of
the upper airways and this ability

to ventilate with the V-gel during
your bronchoscopic examination.

Again, I'm not saying that you can
ventilate a patient for half an hour

with a V-gel because we don't know
what could be the consequences, but

for several rescue ventilations let's
say, it can be very interesting.

I've used it once in a patient
that was very, very critical.

It was diaphragmatic hernia that
we had to ventilate for a little

bit longer than the surgery.

And the cat was too awake to tolerate the
endotracheal tube, but we could actually

place the V-gel and then we could have
the complete control of the upper airway.

We could ventilate a little bit when
it was necessary in a semi comatose

cat so it can be interesting on those
cats that, let's say for example, a

status epilepticus or something like
this where the cat is really too awake

to tolerate an endotracheal tube, but
to anaesthetise or to be happy with the

cat, having nothing to protect the, or
to trying to protect the upper airways.

Thank you so much for discussing all
this 'cause those are things that you

didn't talk about in the article and
I think it will be a great addendum.

Now,

Dr. Kelly St Denis will continue
her conversation with Mary Ellen

Goldberg on physical rehabilitation
in cats therapies and exercises.

Welcome Mary Ellen.

It's so exciting to talk to you again.

Thank you so much Dr. Kelly.

I appreciate y'all
having me tremendously.

So when we're talking about physical
rehabilitation in our cats, I

wondered is this something that
any veterinary team member can do?

Yes, there are things that are
definitely set aside for people that

are certified or have specialties
in physical rehabilitation.

They can teach others in the
practice how to do this, whether

it's other technicians or assistants.

So what type of things
are we talking about?

Manual therapies such as massage or things
like therapeutic laser or things like

PEMF and passive range of motion, you
can do things like a big one that helps

with pain, cryotherapy, cold therapies.

That can help.

And the rule of thumb is the
first 72 hours postoperative,

they like to use something cold.

After the 72 hours they
like to switch it to heat.

Cats aren't always overjoyed with cold
now when the, it may feel good when

they're waking up from surgery and that
kind of thing, but don't get hysterical

if they're not gonna lay there and
let you put ice packs on a specific

limb or something if they're mobile.

Now, the, you also have to be very
concerned if they're on things

like opioids, postoperatively,
they're not gonna be feeling

things the way they would.

And so you, as the person doing this,
have to make sure that the time for cold

is limited, 10 to 15 minutes and no
more because you don't want them to have

any problems that occur because of this,
like frostbite or something like that.

Same rules would apply is that,
when we're trying to keep patients

warm, is that we have to be very
careful not to burn them, but.

Yes.

But what i'm saying is if you have an
area where animals are recovering from

surgery anybody can do this with some
coaching, training, that kind of thing.

And they'd probably be using
those kind of in conjunction

with things like pain scales.

So acute pain scales like
feline grimace scale.

One of the things I've taught my students
to do is have the cage card on the cage

and it lets you know what time the next
evaluation for pain is supposed to be.

So let's say they come out 30
minutes later, here's a cage card.

They can fill it out from
the Glasgow pain scales.

And then if an animal needs intervention
someone is contacted and says, will you

come look at this animal and tell me?

And the assistants can do that easily.

I love the feline grimace scale
love, love it, and all the

work that has gone into it.

And that just really helps too,
probably with applying these techniques

postoperatively 'cause I know in the
article you do talk about the things

that you can do in that immediate
postoperative period, and there's probably

a list of things that you shouldn't
be doing in a postoperative period

in those kinds of situations as well.

So I know you covered that in the
article, but that helps probably with

the pain management scales there to
know if you're doing things, if it's

making a benefit for that patient, or
if we should adjust what you're doing.

Absolutely.

And when you think about, so for instance,
with passive range of motion exercises.

An animal that comes out of orthopaedic
surgery, why do you want them to be able

to move the limb immediately or whatever?

You don't want adhesions or things to
build up in that particular limb to

cause pain because if adhesions build
up, to break them up so that the limb

can move normally is gonna hurt worse,
is more painful.For our animal patients,

if they do a hip replacement or if
they're doing femoral head osteotomy

or whatever, they get the patient up.

They don't want them
just laying in the cape.

They may help them to
stand and just hold them.

They even have these things, they're
called physio balls that are used in

physiotherapy, whether the cat or a dog
has neurological problems or orthopaedic

problems, you can help them stand over
this so it supports their weight and they

can just touch their feet on the ground
to get sensation back into their pads.

And all of this is very important,
especially with neurological patients,

of stimulation and getting those nerve
connections back and working normally.

You can take something like a brush
or a toothbrush and rub it on the

foot, and those are the kinds of
things that owners can be taught.

Owners can be taught how to
do passive range of motion.

If people do their homework with their
pet, it can help them save money and

that may be a big consideration for some.

Thank you so much for listening.

If you want more CPD from iCatCare
and you're a iCatCare Veterinary

Society Member, on the 1st day of
October you can start with our Monthly

Member Webinar where Dr Katie Tolbert
will discuss gastroprotectants.

As always, a week later we will have
an opportunity to join the speaker

live at our Monthly Clinical Club, as
well as the other panelists, so you

can ask all your questions about the
topic discussed and share any related

clinical cases you may be dealing with.

Don't forget that as an iCatCare
Veterinary Society Member, you can

access the full version of this podcast
and all the other members benefits

including recordings of the webinars,
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the discussion forum and the resources
library at portal.icatcare.org.

If your interested in our open
access content, we have several

free access webinars coming.

On the 30th of September, Dr Becky
Mullis will discuss Caring For The

Aging Cat - Managing Common Conditions
and Maintaining Their Weight.

On the 16th of October, Dr Bill Saxon, a
renowned specialist in internal medicine

and critical care, will discuss diagnosis
and management of early feline cardiac

diseases if you want an update on this.

And a few days later on the 21st of
October, Laura Watson, iCatCares Welfare

Coordinator, will explain everything
about cat friendly kitten clinics.

So join us, spread the word and again
thank you so much for joining us.

We will be back again next month with more
from the world of Feline Medicine and the

Journal of Feline Medicine and Surgery.