1 00:00:04,870 --> 00:00:07,330 Hello, and welcome to Chattering With iCatCare. 2 00:00:07,430 --> 00:00:11,040 I'm Yaiza Gomez Mejias, iCatCare Veterinary Community Coordinator 3 00:00:11,070 --> 00:00:12,350 and host of this month's podcast. 4 00:00:13,610 --> 00:00:18,540 Our clinical spotlight today is focused on physical rehabilitation in cats. 5 00:00:18,540 --> 00:00:21,290 Dr Kelly St. Denis will be interviewing Mary Ellen Goldberg 6 00:00:21,350 --> 00:00:23,020 on therapies and exercise. 7 00:00:23,770 --> 00:00:27,810 The interview on the first part of this article series was released in 8 00:00:27,810 --> 00:00:32,199 July as part of another episode where Mary Ellen discussed common conditions 9 00:00:32,200 --> 00:00:34,559 benefiting from physiotherapy. 10 00:00:34,559 --> 00:00:38,470 Remember, if you want to read it, that all articles in the Journal of Feline 11 00:00:38,470 --> 00:00:43,010 Medicine and Surgery are open access and can be found on the journal website. 12 00:00:44,920 --> 00:00:48,720 Before completing this comprehensive overview on rehabilitation though, I 13 00:00:48,720 --> 00:00:53,980 will be interviewing Morgan Debuigne first author of a JFMS article on 14 00:00:54,550 --> 00:00:58,880 supraglottic airway devices, which won the resident best paper award in 2024. 15 00:01:00,460 --> 00:01:04,989 The full title of this article is "Placement of the feline V-gel-Advanced 16 00:01:04,989 --> 00:01:09,250 supraglottic airway device and tracheal selectivity during controlled 17 00:01:09,299 --> 00:01:13,609 mechanical ventilation: a clinical and tomodensitometric evaluation". 18 00:01:17,070 --> 00:01:20,000 So thank you very much for your time, congratulations 19 00:01:20,000 --> 00:01:20,749 for your award. 20 00:01:20,880 --> 00:01:24,339 Thank you very much for having me and thank you for this amazing prize, 21 00:01:24,380 --> 00:01:26,380 that was really a very nice surprise. 22 00:01:26,440 --> 00:01:30,469 So what were the primary objectives of this study? 23 00:01:30,490 --> 00:01:32,789 What exactly were you trying to find out? 24 00:01:34,090 --> 00:01:40,090 So the primary aims of the study were to see if using the manufacturer's 25 00:01:40,090 --> 00:01:44,830 recommendations, can we be sure that the device is correctly placed? 26 00:01:45,020 --> 00:01:51,150 The second aim was to see if after controlled mechanical ventilation, if 27 00:01:51,150 --> 00:01:57,200 we could have aerophagia or let's say gas trapping in the digestive tracts, 28 00:01:57,660 --> 00:02:02,479 because it had been shown that we could ventilate cats and rabbits with the 29 00:02:02,480 --> 00:02:07,979 V-gel with quite high pressures, but we wanted to see if we were sure that it was 30 00:02:07,980 --> 00:02:13,150 going only in the respiratory tract and not in as well in the digestive tract. 31 00:02:13,200 --> 00:02:17,549 So how did you assess whether the tubes were positioned in the right way? 32 00:02:19,139 --> 00:02:23,940 So to assess if the V-gels were correctly placed, we performed 33 00:02:23,969 --> 00:02:25,730 a CT scan of the cats actually. 34 00:02:25,970 --> 00:02:29,870 So what we did is that we performed four CT scan of each cat. 35 00:02:30,240 --> 00:02:33,120 One CT scan without anything. 36 00:02:33,190 --> 00:02:37,309 So the cat was just heavily sedated and the CT scans were going from the 37 00:02:38,110 --> 00:02:43,069 nose to the stomach to see as well the digestive tracts and to evaluate 38 00:02:43,130 --> 00:02:45,180 the gas in the digestive tracts. 39 00:02:45,720 --> 00:02:48,079 One just after the placement of the V-gel. 40 00:02:48,710 --> 00:02:53,139 One after a five minute period of controlled mechanical ventilation, 41 00:02:53,790 --> 00:02:58,029 and one after intubation with an endotracheal tube. 42 00:02:59,469 --> 00:03:06,790 And so to evaluate that the V-gel was correctly placed we looked on the CT scan. 43 00:03:06,840 --> 00:03:08,700 We looked at five criteria. 44 00:03:08,760 --> 00:03:13,176 We looked at the epiglottis lying freely in the larynx. 45 00:03:13,420 --> 00:03:18,220 So it included the fact that the V-gel was not occluding the larynx. 46 00:03:19,170 --> 00:03:24,020 We looked if the tip of the device was in the oesophagus because 47 00:03:24,090 --> 00:03:26,060 this is how it's supposed to be. 48 00:03:26,170 --> 00:03:28,920 The tip of the device should be occluding the oesophagus. 49 00:03:28,929 --> 00:03:34,959 So the third criterion was to see if the tip of the device was occluding 50 00:03:35,139 --> 00:03:39,340 the oesophagus so that we had no leaks around the tip of the device. 51 00:03:39,370 --> 00:03:40,290 in the oesophagus. 52 00:03:41,360 --> 00:03:47,510 We looked if the device was rotated or not regarding with the axis of the 53 00:03:47,510 --> 00:03:53,440 larynx and we looked as well at the laryngeal symmetry just to see if we were 54 00:03:53,440 --> 00:03:55,430 inducing or not a rotation of the larynx. 55 00:03:56,430 --> 00:04:00,660 This enabled us to create a specific score from zero to five. 56 00:04:00,680 --> 00:04:06,010 So one point for each criterion, that we were having and then a score of 57 00:04:06,020 --> 00:04:09,850 five was a device perfectly placed and a score of zero was a device 58 00:04:10,129 --> 00:04:11,990 perfectly misplaced, let's say. 59 00:04:13,610 --> 00:04:14,900 Very thorough indeed. 60 00:04:15,220 --> 00:04:17,330 And what were the key findings in this study? 61 00:04:19,010 --> 00:04:24,240 So the key findings were that globally the devices were correctly placed. 62 00:04:24,730 --> 00:04:30,830 We were a little bit surprised in the good way regarding the results. 63 00:04:30,890 --> 00:04:36,500 We never found a laryngeal compression or a device that was very misplaced. 64 00:04:37,240 --> 00:04:42,200 There was just only one cat that had a score over five, which 65 00:04:42,200 --> 00:04:45,080 is a device perfectly placed. 66 00:04:46,049 --> 00:04:50,560 The majority of cats had a score of three over five or four over five. 67 00:04:50,660 --> 00:04:56,690 The decreased score was due to an incomplete occlusion of the oesophagus, 68 00:04:56,909 --> 00:05:02,430 or a mild rotation of the device that didn't induce rotation of the larynx. 69 00:05:02,929 --> 00:05:08,099 So it was minor abnormalities of placements that were observed. 70 00:05:08,820 --> 00:05:14,450 The only thing is that this complete inclusion of the oesophagus could 71 00:05:15,290 --> 00:05:22,613 be quite a problem because what we found as well was that we could have a 72 00:05:22,613 --> 00:05:28,130 lack of complete tracheal selectivity because we found that we had some gas 73 00:05:28,300 --> 00:05:34,110 trapping in the digestive tract after the placement of the device and after 74 00:05:34,130 --> 00:05:36,420 the period of mechanical ventilation. 75 00:05:37,540 --> 00:05:44,849 So we know that maybe we can induce a kind of small gas trapping in the 76 00:05:44,870 --> 00:05:49,510 digestive tracts after placement of the device and after the ventilation period. 77 00:05:50,099 --> 00:05:54,180 And maybe this could be due to the incomplete seeding around the oesophagus 78 00:05:54,880 --> 00:05:56,529 during the placement and the ventilation. 79 00:05:57,119 --> 00:06:01,210 Which was not really a problem during our study because it was 80 00:06:01,330 --> 00:06:03,800 only five minutes of ventilation. 81 00:06:04,060 --> 00:06:08,460 But what is unknown if we go for a longer period of ventilation, we don't 82 00:06:08,470 --> 00:06:10,460 know what could be the consequences. 83 00:06:10,830 --> 00:06:16,039 So it could be a problem actually, but for a short period of ventilation 84 00:06:16,299 --> 00:06:21,310 as we did, it was not, the gas scores that we had after the 85 00:06:21,800 --> 00:06:24,289 ventilation were quite acceptable. 86 00:06:24,310 --> 00:06:30,950 And on a CT scan, the amount of gas that we found was not something that appeared 87 00:06:31,000 --> 00:06:33,579 completely abnormal to our radiologists. 88 00:06:33,920 --> 00:06:39,380 And the other results that we found is that we didn't find that we needed 89 00:06:39,380 --> 00:06:45,200 more time or more attempt to place an endotracheal tube which contrasts 90 00:06:45,309 --> 00:06:49,409 with the results of previous studies where the time required to place 91 00:06:49,410 --> 00:06:51,729 an  endotracheal tubes was increased. 92 00:06:52,879 --> 00:06:58,250 And when you said that it's appropriate for short procedures because you 93 00:06:58,250 --> 00:07:02,020 were talking about the potential complications associated with gas, with 94 00:07:02,020 --> 00:07:06,769 the distension of the gastrointestinal tract due to gas accumulation and 95 00:07:07,030 --> 00:07:09,150 you referred to short procedures. 96 00:07:09,179 --> 00:07:11,850 What's the short procedure in this context? 97 00:07:12,449 --> 00:07:12,819 Yes. 98 00:07:12,850 --> 00:07:17,980 Actually, it's a good question because I think the indications for 99 00:07:17,980 --> 00:07:21,289 using V-gel are not super clear. 100 00:07:21,700 --> 00:07:26,720 If you read the manufacturer's recommendations, you almost could 101 00:07:26,730 --> 00:07:30,680 use it in every case or procedure. 102 00:07:31,039 --> 00:07:35,780 What we concluded with in our study is that endotracheal intubation remains 103 00:07:35,780 --> 00:07:40,200 the gold standard and the V-gel doesn't replace an endotracheal tube. 104 00:07:40,520 --> 00:07:46,840 So yes, when I said short procedures, the question of when should we use a V-gel? 105 00:07:46,990 --> 00:07:49,870 And actually the indications are not so wide. 106 00:07:50,380 --> 00:07:56,539 I think it's very in interesting in those procedures that are quite minor and quite 107 00:07:56,550 --> 00:08:04,989 short, such as castrations for cats, a small wound, radiotherapy, especially when 108 00:08:04,990 --> 00:08:09,140 you have to anaesthetise the cats several times in the same week, for example. 109 00:08:09,140 --> 00:08:13,159 Or abscesses procedures, maybe for abdominal ultrasounds as well. 110 00:08:13,170 --> 00:08:17,079 When you have a critical patient that you have to induce and to maintain with 111 00:08:17,079 --> 00:08:20,180 volatile anaesthesia it could be more interesting to have the V-gel rather 112 00:08:20,180 --> 00:08:25,080 than to intubate the cats and finally I think it can be very interesting 113 00:08:25,150 --> 00:08:30,245 in respiratory endoscopies for bronchoscopies in cats, tube or almost. 114 00:08:30,245 --> 00:08:36,150 You can't have an intubated cat and the bronchoscope is going in the endotracheal 115 00:08:36,150 --> 00:08:39,719 tube, so often what we do is that we have cats that are not intubated, and 116 00:08:40,679 --> 00:08:44,160 it can be a little bit problematic when you have to ventilate the patient. 117 00:08:45,180 --> 00:08:50,160 So, with the V-gel, it can be an alternative where you can pass 118 00:08:50,170 --> 00:08:52,500 your bronchoscope into the V-gel. 119 00:08:52,980 --> 00:08:57,110 And then you have this control of the upper airways and this ability 120 00:08:57,110 --> 00:09:01,939 to ventilate with the V-gel during your bronchoscopic examination. 121 00:09:02,020 --> 00:09:06,370 Again, I'm not saying that you can ventilate a patient for half an hour 122 00:09:06,380 --> 00:09:09,750 with a V-gel because we don't know what could be the consequences, but 123 00:09:09,760 --> 00:09:13,570 for several rescue ventilations let's say, it can be very interesting. 124 00:09:14,990 --> 00:09:18,569 I've used it once in a patient that was very, very critical. 125 00:09:18,569 --> 00:09:23,800 It was diaphragmatic hernia that we had to ventilate for a little 126 00:09:23,810 --> 00:09:25,790 bit longer than the surgery. 127 00:09:26,360 --> 00:09:32,000 And the cat was too awake to tolerate the endotracheal tube, but we could actually 128 00:09:32,000 --> 00:09:36,119 place the V-gel and then we could have the complete control of the upper airway. 129 00:09:36,430 --> 00:09:42,319 We could ventilate a little bit when it was necessary in a semi comatose 130 00:09:42,320 --> 00:09:45,795 cat so it can be interesting on those cats that, let's say for example, a 131 00:09:45,795 --> 00:09:49,640 status epilepticus or something like this where the cat is really too awake 132 00:09:49,640 --> 00:09:57,200 to tolerate an endotracheal tube, but to anaesthetise or to be happy with the 133 00:09:57,200 --> 00:10:02,080 cat, having nothing to protect the, or to trying to protect the upper airways. 134 00:10:03,620 --> 00:10:07,060 Thank you so much for discussing all this 'cause those are things that you 135 00:10:07,060 --> 00:10:10,010 didn't talk about in the article and I think it will be a great addendum. 136 00:10:10,010 --> 00:10:10,030 Now, 137 00:10:16,060 --> 00:10:19,550 Dr. Kelly St Denis will continue her conversation with Mary Ellen 138 00:10:19,550 --> 00:10:23,670 Goldberg on physical rehabilitation in cats therapies and exercises. 139 00:10:29,940 --> 00:10:31,230 Welcome Mary Ellen. 140 00:10:31,280 --> 00:10:33,540 It's so exciting to talk to you again. 141 00:10:34,110 --> 00:10:36,060 Thank you so much Dr. Kelly. 142 00:10:36,060 --> 00:10:38,590 I appreciate y'all having me tremendously. 143 00:10:39,840 --> 00:10:44,860 So when we're talking about physical rehabilitation in our cats, I 144 00:10:44,860 --> 00:10:48,010 wondered is this something that any veterinary team member can do? 145 00:10:48,039 --> 00:10:52,260 Yes, there are things that are definitely set aside for people that 146 00:10:52,340 --> 00:10:58,360 are certified or have specialties in physical rehabilitation. 147 00:10:58,670 --> 00:11:02,063 They can teach others in the practice how to do this, whether 148 00:11:02,063 --> 00:11:02,468 it's other technicians or assistants. 149 00:11:02,549 --> 00:11:05,060 So what type of things are we talking about? 150 00:11:05,250 --> 00:11:14,300 Manual therapies such as massage or things like therapeutic laser or things like 151 00:11:14,410 --> 00:11:20,446 PEMF and passive range of motion, you can do things like a big one that helps 152 00:11:20,446 --> 00:11:21,900 with pain, cryotherapy, cold therapies. 153 00:11:22,639 --> 00:11:23,700 That can help. 154 00:11:23,969 --> 00:11:29,870 And the rule of thumb is the first 72 hours postoperative, 155 00:11:31,190 --> 00:11:33,690 they like to use something cold. 156 00:11:34,130 --> 00:11:39,610 After the 72 hours they like to switch it to heat. 157 00:11:40,170 --> 00:11:40,369 Cats aren't always overjoyed with cold now when the, it may feel good when 158 00:11:40,369 --> 00:11:40,509 they're waking up from surgery and that kind of thing, but don't get hysterical 159 00:11:40,509 --> 00:11:40,659 if they're not gonna lay there and let you put ice packs on a specific 160 00:11:40,659 --> 00:11:40,719 limb or something if they're mobile. 161 00:11:40,719 --> 00:11:44,660 Now, the, you also have to be very concerned if they're on things 162 00:11:44,660 --> 00:11:49,540 like opioids, postoperatively, they're not gonna be feeling 163 00:11:49,570 --> 00:11:51,200 things the way they would. 164 00:11:51,469 --> 00:11:59,170 And so you, as the person doing this, have to make sure that the time for cold 165 00:11:59,529 --> 00:12:06,050 is limited, 10 to 15 minutes and no more because you don't want them to have 166 00:12:06,060 --> 00:12:12,350 any problems that occur because of this, like frostbite or something like that. 167 00:12:12,790 --> 00:12:15,189 Same rules would apply is that, when we're trying to keep patients 168 00:12:15,200 --> 00:12:18,470 warm, is that we have to be very careful not to burn them, but. 169 00:12:18,500 --> 00:12:19,000 Yes. 170 00:12:19,310 --> 00:12:24,480 But what i'm saying is if you have an area where animals are recovering from 171 00:12:24,480 --> 00:12:33,860 surgery anybody can do this with some coaching, training, that kind of thing. 172 00:12:34,139 --> 00:12:36,580 And they'd probably be using those kind of in conjunction 173 00:12:36,580 --> 00:12:38,150 with things like pain scales. 174 00:12:38,160 --> 00:12:40,940 So acute pain scales like feline grimace scale. 175 00:12:41,400 --> 00:12:49,460 One of the things I've taught my students to do is have the cage card on the cage 176 00:12:50,099 --> 00:12:59,949 and it lets you know what time the next evaluation for pain is supposed to be. 177 00:12:59,949 --> 00:12:59,980 So let's say they come out 30 minutes later, here's a cage card. 178 00:12:59,980 --> 00:13:04,359 They can fill it out from the Glasgow pain scales. 179 00:13:04,650 --> 00:13:12,289 And then if an animal needs intervention someone is contacted and says, will you 180 00:13:12,290 --> 00:13:14,339 come look at this animal and tell me? 181 00:13:14,590 --> 00:13:17,290 And the assistants can do that easily. 182 00:13:17,350 --> 00:13:22,230 I love the feline grimace scale love, love it, and all the 183 00:13:22,250 --> 00:13:24,019 work that has gone into it. 184 00:13:24,110 --> 00:13:26,839 And that just really helps too, probably with applying these techniques 185 00:13:26,880 --> 00:13:27,939 postoperatively 'cause I know in the article you do talk about the things 186 00:13:27,939 --> 00:13:28,158 that you can do in that immediate postoperative period, and there's probably 187 00:13:28,158 --> 00:13:28,395 a list of things that you shouldn't be doing in a postoperative period 188 00:13:28,395 --> 00:13:28,523 in those kinds of situations as well. 189 00:13:28,523 --> 00:13:31,730 So I know you covered that in the article, but that helps probably with 190 00:13:31,730 --> 00:13:35,080 the pain management scales there to know if you're doing things, if it's 191 00:13:35,080 --> 00:13:39,089 making a benefit for that patient, or if we should adjust what you're doing. 192 00:13:39,770 --> 00:13:40,740 Absolutely. 193 00:13:41,040 --> 00:13:47,420 And when you think about, so for instance, with passive range of motion exercises. 194 00:13:47,750 --> 00:13:53,510 An animal that comes out of orthopaedic surgery, why do you want them to be able 195 00:13:53,510 --> 00:13:56,060 to move the limb immediately or whatever? 196 00:13:56,070 --> 00:14:01,960 You don't want adhesions or things to build up in that particular limb to 197 00:14:01,990 --> 00:14:07,540 cause pain because if adhesions build up, to break them up so that the limb 198 00:14:07,540 --> 00:14:12,420 can move normally is gonna hurt worse, is more painful.For our animal patients, 199 00:14:12,630 --> 00:14:17,780 if they do a hip replacement or if they're doing femoral head osteotomy 200 00:14:17,780 --> 00:14:20,020 or whatever, they get the patient up. 201 00:14:20,070 --> 00:14:23,130 They don't want them just laying in the cape. 202 00:14:23,209 --> 00:14:27,860 They may help them to stand and just hold them. 203 00:14:28,300 --> 00:14:32,489 They even have these things, they're called physio balls that are used in 204 00:14:32,489 --> 00:14:32,729 physiotherapy, whether the cat or a dog has neurological problems or orthopaedic 205 00:14:32,729 --> 00:14:37,740 problems, you can help them stand over this so it supports their weight and they 206 00:14:37,740 --> 00:14:45,070 can just touch their feet on the ground to get sensation back into their pads. 207 00:14:45,090 --> 00:14:50,870 And all of this is very important, especially with neurological patients, 208 00:14:51,250 --> 00:14:57,890 of stimulation and getting those nerve connections back and working normally. 209 00:14:58,420 --> 00:15:03,580 You can take something like a brush or a toothbrush and rub it on the 210 00:15:03,580 --> 00:15:08,420 foot, and those are the kinds of things that owners can be taught. 211 00:15:08,660 --> 00:15:12,999 Owners can be taught how to do passive range of motion. 212 00:15:13,270 --> 00:15:21,699 If people do their homework with their pet, it can help them save money and 213 00:15:21,860 --> 00:15:24,540 that may be a big consideration for some. 214 00:15:29,840 --> 00:15:31,150 Thank you so much for listening. 215 00:15:31,330 --> 00:15:34,800 If you want more CPD from iCatCare and you're a iCatCare Veterinary 216 00:15:34,800 --> 00:15:38,710 Society Member, on the 1st day of October you can start with our Monthly 217 00:15:38,710 --> 00:15:42,760 Member Webinar where Dr Katie Tolbert will discuss gastroprotectants. 218 00:15:43,500 --> 00:15:46,900 As always, a week later we will have an opportunity to join the speaker 219 00:15:46,900 --> 00:15:51,050 live at our Monthly Clinical Club, as well as the other panelists, so you 220 00:15:51,050 --> 00:15:55,550 can ask all your questions about the topic discussed and share any related 221 00:15:55,660 --> 00:15:57,370 clinical cases you may be dealing with. 222 00:15:58,300 --> 00:16:01,959 Don't forget that as an iCatCare Veterinary Society Member, you can 223 00:16:01,960 --> 00:16:05,540 access the full version of this podcast and all the other members benefits 224 00:16:05,870 --> 00:16:09,480 including recordings of the webinars, clinical clubs and congress lectures, 225 00:16:09,759 --> 00:16:14,630 the discussion forum and the resources library at portal.icatcare.org. 226 00:16:15,700 --> 00:16:19,339 If your interested in our open access content, we have several 227 00:16:19,340 --> 00:16:20,520 free access webinars coming. 228 00:16:20,870 --> 00:16:25,250 On the 30th of September, Dr Becky Mullis will discuss Caring For The 229 00:16:25,250 --> 00:16:28,319 Aging Cat - Managing Common Conditions and Maintaining Their Weight. 230 00:16:29,029 --> 00:16:32,800 On the 16th of October, Dr Bill Saxon, a renowned specialist in internal medicine 231 00:16:32,800 --> 00:16:37,320 and critical care, will discuss diagnosis and management of early feline cardiac 232 00:16:37,320 --> 00:16:39,230 diseases if you want an update on this. 233 00:16:39,860 --> 00:16:44,650 And a few days later on the 21st of October, Laura Watson, iCatCares Welfare 234 00:16:44,650 --> 00:16:48,289 Coordinator, will explain everything about cat friendly kitten clinics. 235 00:16:48,849 --> 00:16:52,760 So join us, spread the word and again thank you so much for joining us. 236 00:16:52,790 --> 00:16:56,799 We will be back again next month with more from the world of Feline Medicine and the 237 00:16:56,800 --> 00:16:58,449 Journal of Feline Medicine and Surgery.