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 this month is focused on physical
rehabilitation in cats.
Dr Kelly St. Dennis will be interviewing Mary Ellen Goldberg on one of two JFMS
articles on feline pain management through physical rehabilitation.
In this first part, she will be discussing common reasons for
physical rehabilitation in cats.
We will share a second part of this interview later on this summer, but
first, I will interview Dr Ann Hohenhaus about some of the many things she has
published, including a JFMS article that covers feline non regenerative
anaemia, which as you know, can be challenging from a diagnostic point of
view.
Dr Ann Hohenhaus, double board certified in oncology and
small animal internal medicine.
She works as a senior veterinarian specialist in oncology and director
of pet health information at the Animal Medical Center in New York,
where she also hosts a podcast.
Anne has contributed widely to research articles of books, lectures
internationally, has won prestigious awards in veterinary medicine and
journalism and chairs the oncology working group at the World Small
Animal Veterinarian Association.
And she was just telling me that she also works as a foster.
So Anne cowrote an article about non regenerative anaemia with Sarah
Winzelberg Olson and the Journal of Feline Medicine and Surgery, which is actually
one of the most read JFMS review papers.
Which is the practical relevance of this article, why do so
many vets want to read it?
I was stunned when Journal of Feline Medicine and Surgery sent
me an email that said this article had been downloaded 29,000 times.
That number of downloads reflects that pretty much
every sick cat becomes anaemic.
Cat red blood cells are not very sturdy and don't last long, when cats are sick
they last even shorter period of time.
And so I think that's one of the reasons that this article was popular is that
it was hopeful to the veterinarian for a really common problem that they face on
an everyday basis and that that is, is the anaemia the primary problem this cat has
or is it secondary to some other disease?
This article's been published a couple of years now, and there are more and new
treatments available for anaemia in cats.
Even though this is a popular article it's going to be out of date very
soon because there's new stuff coming along, which is great because
we need new treatments for cats.
Someone is gonna call me and ask me to revise this article.
One thing I noticed was the abstract clearly states the evidence, the review
is based on, something not always present in this type of publications.
In which ways do you think including this information in peer reviewed
veterinary literature benefits the clinical decision making of
practitioners working in primary care?
Peer review means Dr Winzelberg Olson and I wrote this article, then it
got sent to experts in anaemia who reviewed it and made suggestions
on how we could make it better.
And that's what peer review is, is your academic peers look at your
work and help you make it better.
This article is held to a higher standard than a non-peer reviewed publication.
It ups everyone's game.
When we wrote about non regenerative anaemia, we wanted it to be visual and
reader friendly, which I think it is.
I attribute that to the Journal of Feline Medicine and Surgery staff who helped
turn our concept into a beautiful reality.
It's a really pretty article to look at with great pictures, and that
was a in a lot due to the staff.
Thank you very much for such a kind compliment on behalf of of the JFMS team.
They will be pleased.
All veterinarians face the diagnostic and therapeutic challenges
describing the article that will benefit from reading this review.
What contextual factors of non regenerative anaemia
are relevant to primary care?
There are lots of contextual factors veterinarians don't really articulate.
Journal of Feline Medicine and Surgery published an article about
how many times people were bitten trying to medicate their cats, and
it, I think the number was like 75%.
It's a really big number.
That's a huge factor in managing cats.
It's not about the disease.
Contextual factors are not about the illness you're managing.
They're about the patient and owner and how those impact management of disease.
So one contextual factor is how hard is the cat to medicate?
And so that caused us last week to make a decision not to treat a cat with pills
because the owner could not pill the cat, but the owner was able to give injections.
And so we decided to treat the cat with injections at home because that
was something that the owner could manage because the cat was just
a tyrant when it came to pilling.
So that's an example of how to work around a contextual factor.
The other thing is to think about these wonderful little old ladies with
cats and the cat is their everything because maybe they're, they live alone.
But bringing that cat to the veterinarian frequently for
multiple treatments is a challenge.
You need to understand what their transportation issues are, what
you can do to help mitigate those.
Some things we do, find a veterinary nurse near their home that could go
and help them medicate or give subq fluids, or maybe we collaborate with
the primary care veterinarian who's just down the block and they can go
there for some of the treatments and come to us for some of the treatments.
So those are kinds of things that one needs to think about.
In rural areas, you have to think about veterinary deserts,
meaning no veterinarians close by.
In New York City, we don't have that problem.
There are lots of veterinarians, and the other thing is we have
pretty good transportation.
Even if you don't have a car, you can get around with your cat and
a carrier on the subway or bus.
If you live in a rural area, you might have to drive two hours to find
someone to take care of your cat.
All those are things you need to build into the treatment plan for
the patient that you're seeing.
I was thinking some owners tend to think sometimes a sleeping cat is normal and
when they are anaemic, they sleep more.
It's very easy to miss signs like lethargy and sometimes
owners realise the cat is anaemic when the cat is very anaemic.
Cats are masters of disguise, and so it's very easy for cats to hide the fact
that they're very ill until they cross that threshold of illness to crisis.
And so things that might give you clues to a cat being anaemic would be a cat
eating something that's strange, which is called pica, non eating non-food items.
And I've had anaemic cats who eat cat litter.
The other thing that I've seen is cats licking the grout between the
tiles in the bathroom, tub, or shower.
That's a clue that cat might be anaemic.
Other subtle things owners will say, he used to jump on the counter
and refrigerator, but he's not now.
Maybe he's too weak.
Is this cat anaemic?
Does this cat have arthritis?
Listen to the owners.
The most important thing in a veterinarian's office is for the
owner to talk about what their cat is doing, and for the veterinarian
to listen, I ask questions like tell me why you're here today?
Tell me what's different about your cat?
If I get the owner to talk about those things, then they will give me a lot
of clues, not only about the health of their cat, but also about the contextual
factors involved in managing it that I'm going to have in managing their cat.
And now Dr Kelly St. Dennis will speak with Mary Ellen Goldberg about
her JFMS article on Feline pain management and common reasons for
physical rehabilitation in cats.
Welcome, Mary Ellen.
Thank you very much, Dr Kelly.
This article is amazing because it focuses on our feline species.
Maybe we could start with the basics.
What is physiotherapy and what are its potential benefits to cats?
Why are our clinicians interested in these publications?
First of all in addressing the first publication, it helps to outline
conditions cats can develop or have where physiotherapy would be helpful.
Physiotherapy or physical rehabilitation as they call it in the United States, that
is helping the animals’ quality of life.
So as they're aging, it helps them to be able to move.
It tremendously helps with pain and helps them to move, help them to get back to
a normal way of life, helps them not have pain and as they age, have more
mobility, a happier quality of life.
Also, I compare my thoughts of human patients with my thoughts
of animal patients because yes, there are differences.
Absolutely.
The more you study and read, the more you realise how closely connected we
are, and I believe that's why one of the definitions for pain that the
International Association for the Study of Pain developed is that, pain is not
just limited to patients that can speak, but they now include non-speaking.
Whether that's patients that are unconscious, whether it's patients that
are babies that you know, paediatric.
But it includes all our none human animals.
The fact that, that they cannot speak does not negate the necessity for
our knowledge of pain management.
And one thing back to the physiotherapy is that, I find that we need to look at it
as part of complete veterinary medicine.
There are gonna be people that say, I can't do that.
And that's understandable, but if you want to offer the complete
package, more people are looking at their pets as their fur babies.
And so when you have this, you think, if my child couldn't walk,
would I just go I can't do this?
And there are ways, there's so many ways that we'll do this in the second part of
the article, there's so many ways that you can help the clients to do things at home.
So even if they can't bring them in all the time and often, they can
have an exercise program at home.
So I wondered if we could talk a little bit about that and where cat
friendly interactions and handling come in to dispelling the myths
behind cats and physiotherapy?
If you do physiotherapy, it's not imperative necessarily, but
with the Fear-Free approach, it's getting more and more that way.
But it's imperative if you're gonna be trying to do physiotherapy with
cats, that you want to have excellent behavioural knowledge and handling skills.
The saying less is more it, it could not be more true, and we need to
think of it in terms of, sometimes you can have your dog in physical
rehabilitation or physiotherapy.
With dogs, sometimes we can prod them along, help them, if you're doing
specific exercises that you have hands on them and you want to move something.
The one thing that is absolutely true is if you've got a cat that's having pain.
Whether it's from osteoarthritis or from an injury, a trauma, or neurological
pain and you want them to do something, they're not going to do it if they hurt.
They're just not.
one of my mentors, Dr Robin Downing, she taught me years ago, you're not gonna get
them to do anything if they are hurting.
And if you try to make them do it and they're hurting, it's, it, that's
the last time they're gonna do it.
That's it.
If it's a younger animal, you can give them a dose of gabapentin or
have pheromones in your practice to help them not be upset.
Techniques in physiotherapy can help with pain management and I am
the big believer in acupuncture.
So you can have an elderly cat that has kidney disease and liver disease,
they can't take drugs, and you can bring them in, give them acupuncture.
You can use laser photobiomodulation on them.
So you can use therapy, laser therapy, you can send home pulsed electromagnetic
field therapy to lessen their pain prior to starting any physical exercise.
And that kind of helps with minimising the pharmaceuticals you
might need to use for analgesics if the patient has contraindications.
Absolutely.
If you start them young enough and their lab values are good, you can
start them on a multimodal pain approach and then when they come for
physical rehab, they're more relaxed.
Dogs tend to want to please, cats don't care whether they please or not.
You have to be willing to change up your program.
You have it all planned out that you're gonna do a specific thing and if that
day they happen to be in a bad mood, maybe do some massage, maybe you can
do some of the therapeutic laser.
But I mean, you have to be willing to change up your plan.
And I think a lot of us are learning cat friendly handling
and understanding feline emotions.
We also do that in our physical exam.
A complete physical examination will vary from cat to cat, depending
on their emotions and responses.
You can't push them, right?
You have to adapt to the cat's emotions.
Thank you for listening.
If you are an iCatCare Veterinary Society member don’t forget you can access the
full version of the podcast and all the other member benefits including
congress recordings, monthly webinars and clinical clubs, the discussion forum
and much more at portal.icatcare.org
If you are looking for more free CPD from International Cat Care, on the
20th of August, Dr Christine Pye will host a CFC open access webinar on
Feline Ageing and age-related diseases.
We’ll be back again next month with more from the world of feline medicine and JFMS