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Hello, and welcome to
Chattering With iCatCare.

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I'm Yaiza Gomez Mejias, iCatCare
veterinary community coordinator

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and host of this month's podcast.

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Our clinical spotlight this
month is focused on physical

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rehabilitation in cats.

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Dr Kelly St. Dennis will be interviewing
Mary Ellen Goldberg on one of two JFMS

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articles on feline pain management
through physical rehabilitation.

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In this first part, she will be
discussing common reasons for

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physical rehabilitation in cats.

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We will share a second part of this
interview later on this summer, but

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first, I will interview Dr Ann Hohenhaus
about some of the many things she has

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published, including a JFMS article
that covers feline non regenerative

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anaemia, which as you know, can be
challenging from a diagnostic point of

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view.

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Dr Ann Hohenhaus, double board
certified in oncology and

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small animal internal medicine.

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She works as a senior veterinarian
specialist in oncology and director

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of pet health information at the
Animal Medical Center in New York,

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where she also hosts a podcast.

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Anne has contributed widely to
research articles of books, lectures

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internationally, has won prestigious
awards in veterinary medicine and

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journalism and chairs the oncology
working group at the World Small

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Animal Veterinarian Association.

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And she was just telling me
that she also works as a foster.

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So Anne cowrote an article about
non regenerative  anaemia with Sarah

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Winzelberg Olson and the Journal of Feline
Medicine and Surgery, which is actually

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one of the most read JFMS review papers.

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Which is the practical relevance
of this article, why do so

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many vets want to read it?

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I was stunned when Journal of
Feline Medicine and Surgery sent

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me an email that said this article
had been downloaded 29,000 times.

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That  number of downloads
reflects that pretty much

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every sick cat becomes anaemic.

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Cat red blood cells are not very sturdy
and don't last long, when cats are sick

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they last even shorter period of time.

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And so I think that's one of the reasons
that this article was popular is that

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it was hopeful to the veterinarian for a
really common problem that they face on

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an everyday basis and that that is, is the
anaemia the primary problem this cat has

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or is it secondary to some other disease?

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This article's been published a couple
of years now, and there are more and new

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treatments available for  anaemia in cats.

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Even though this is a popular article
it's going to be out of date very

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soon because there's new stuff
coming along, which is great because

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we need new treatments for cats.

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Someone is gonna call me and
ask me to revise this article.

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One thing I noticed was the abstract
clearly states the evidence, the review

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is based on, something not always
present in this type of publications.

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In which ways do you think including
this information in peer reviewed

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veterinary literature benefits
the clinical decision making of

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practitioners working in primary care?

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Peer review means Dr Winzelberg Olson
and I wrote this article, then it

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got sent to experts in anaemia who
reviewed it and made suggestions

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on how we could make it better.

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And that's what peer review is, is
your academic peers look at your

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work and help you make it better.

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This article is held to a higher standard
than a non-peer reviewed publication.

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It ups everyone's game.

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When we wrote about non regenerative
anaemia, we wanted it to be visual and

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reader friendly, which I think it is.

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I attribute that to the Journal of Feline
Medicine and Surgery staff who helped

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turn our concept into a beautiful reality.

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It's a really pretty article to look
at with great pictures, and that

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was a in a lot due to the staff.

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Thank you very much for such a kind
compliment on behalf of of the JFMS team.

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They will be pleased.

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All veterinarians face the
diagnostic and therapeutic challenges

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describing the article that will
benefit from reading this review.

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What contextual factors of
non regenerative  anaemia

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are relevant to primary care?

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There are lots of contextual factors
veterinarians don't really articulate.

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Journal of Feline Medicine and
Surgery published an article about

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how many times people were bitten
trying to medicate their cats, and

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it, I think the number was like 75%.

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It's a really big number.

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That's a huge factor in managing cats.

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It's not about the disease.

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Contextual factors are not about
the illness you're managing.

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They're about the patient and owner and
how those impact management of disease.

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So  one contextual factor is
how hard is the cat to medicate?

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And so that caused us last week to make
a decision not to treat a cat with pills

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because the owner could not pill the cat,
but the owner was able to give injections.

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And so we decided to treat the cat
with injections at home because that

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was something that the owner could
manage because the cat was just

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a tyrant when it came to pilling.

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So that's an example of how to
work around a contextual factor.

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The other thing is to think about
these wonderful little old ladies with

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cats and the cat is their everything
because maybe they're, they live alone.

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But bringing that cat to the
veterinarian frequently for

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multiple treatments is a challenge.

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You need to understand what their
transportation issues are, what

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you can do to help mitigate those.

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Some things we do, find a veterinary
nurse near their home that could go

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and help them medicate or give subq
fluids, or maybe we collaborate with

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the primary care veterinarian who's
just down the block and they can go

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there for some of the treatments and
come to us for some of the treatments.

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So those are kinds of things
that one needs to think about.

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In rural areas, you have to
think about veterinary deserts,

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meaning no veterinarians close by.

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In New York City, we
don't have that problem.

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There are lots of veterinarians,
and the other thing is we have

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pretty good transportation.

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Even if you don't have a car, you
can get around with your cat and

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a carrier on the subway or bus.

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If you live in a rural area, you
might have to drive two hours to find

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someone to take care of your cat.

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All those are things you need to
build into the treatment plan for

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the patient that you're seeing.

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I was thinking some owners tend to think
sometimes a sleeping cat is normal and

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when they are anaemic, they sleep more.

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It's very easy to  miss signs
like lethargy and sometimes

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owners realise the cat is anaemic
when the cat is very anaemic.

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Cats are masters of disguise, and so
it's very easy for cats to hide the fact

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that they're very ill until they cross
that threshold of illness to crisis.

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And so things that might give you clues
to a cat being anaemic would be a cat

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eating something that's strange, which is
called pica, non eating non-food items.

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And I've had anaemic
cats who eat cat litter.

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The other thing that I've seen is
cats licking the grout between the

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tiles in the bathroom, tub, or shower.

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That's a clue that cat might be anaemic.

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Other subtle things owners will
say, he used to jump on the  counter

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and refrigerator, but he's not now.

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Maybe he's too weak.

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Is this cat anaemic?

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Does this cat have arthritis?

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Listen to the owners.

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The most important thing in a
veterinarian's office is for the

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owner to talk about what their cat
is doing, and for the veterinarian

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to listen, I ask questions like
tell me why you're here today?

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Tell me what's different about your cat?

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If I get the owner to talk about those
things, then they will give me a lot

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of clues, not only about the health of
their cat, but also about the contextual

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factors involved in managing it that
I'm going to have in managing their cat.

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And now Dr Kelly St. Dennis will
speak with Mary Ellen Goldberg about

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her JFMS article on Feline pain
management and common reasons for

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physical rehabilitation in cats.

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Welcome, Mary Ellen.

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Thank you very much, Dr Kelly.

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This article is amazing because
it focuses on our feline species.

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Maybe we could start with the basics.

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What is physiotherapy and what are
its potential benefits to cats?

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Why are our clinicians
interested in these publications?

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First of all in addressing the first
publication, it helps to outline

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conditions cats can develop or have
where physiotherapy would be helpful.

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Physiotherapy or physical rehabilitation
as they call it in the United States, that

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is helping the animals’ quality of life.

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So as they're aging, it helps
them to be able to move.

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It tremendously helps with pain and helps
them to move, help them to get back to

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a normal way of life, helps them not
have pain and as they age, have more

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mobility, a happier quality of life.

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Also, I compare my thoughts of
human patients with my thoughts

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of animal patients because
yes, there are differences.

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Absolutely.

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The more you study and read, the more
you realise how closely connected we

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are, and I  believe that's why one
of the definitions for pain that the

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International Association for the Study
of Pain developed is that, pain is not

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just limited to patients that can speak,
but they now include non-speaking.

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Whether that's patients that are
unconscious, whether it's patients that

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are babies that you know, paediatric.

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But it includes all
our none human animals.

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The fact that, that they cannot speak
does not negate the necessity for

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our knowledge of pain management.

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And one thing back to the physiotherapy
is that, I find that we need to look at it

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as part of complete veterinary medicine.

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There are gonna be people
that say, I can't do that.

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And that's understandable, but
if you want to offer the complete

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package, more people are looking
at their pets as their fur babies.

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And so when you have this, you
think, if my child couldn't walk,

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would I just go I can't do this?

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And there are ways, there's so many ways
that we'll do this in the second part of

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the article, there's so many ways that you
can help the clients to do things at home.

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So even if they can't bring them
in all the time and often, they can

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have an exercise program at home.

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So I wondered if we could talk a
little bit about that and where cat

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friendly interactions and handling
come in to dispelling the myths

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behind cats and physiotherapy?

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If you do physiotherapy, it's
not imperative necessarily, but

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with the Fear-Free approach, it's
getting more and more that way.

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But it's imperative if you're gonna
be trying to do physiotherapy with

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cats, that you want to have excellent
behavioural knowledge and handling skills.

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The saying less is more it, it could
not be more true, and we need to

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think of it in terms of, sometimes
you can  have your dog in physical

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rehabilitation or physiotherapy.

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With dogs, sometimes we can prod them
along, help them, if you're doing

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specific exercises that you have hands
on them and you want to move something.

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The one thing that is absolutely true is
if you've got a cat that's having pain.

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Whether it's from osteoarthritis or from
an injury, a trauma, or neurological

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pain and you want them to do something,
they're not going to do it if they hurt.

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They're just not.

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one of my mentors, Dr Robin Downing, she
taught me years ago, you're not gonna get

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them to do anything if they are hurting.

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And if you try to make them do it
and they're hurting, it's, it, that's

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the last time they're gonna do it.

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That's it.

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If it's a younger animal, you can
give them a dose of gabapentin or

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have pheromones in your practice
to help them not be upset.

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Techniques in physiotherapy can
help with pain management and I am

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the big believer in acupuncture.

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So you can have an elderly cat that
has kidney disease and liver disease,

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they can't take drugs, and you can
bring them in, give them acupuncture.

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You can use  laser
photobiomodulation on them.

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So you can use therapy, laser therapy,
you can send home pulsed electromagnetic

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field therapy to lessen their pain
prior to starting any physical exercise.

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And that kind of helps with
minimising the pharmaceuticals you

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might need to use for analgesics if
the patient has contraindications.

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Absolutely.

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If you start them young enough and
their lab values are good, you can

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start them on a multimodal pain
approach and then when they come for

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physical rehab, they're more relaxed.

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Dogs tend to want to please, cats
don't care whether they please or not.

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You have to be willing to
change up your program.

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You have it all planned out that you're
gonna do a specific thing and if that

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day they happen to be in a bad mood,
maybe do some massage, maybe you can

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do some of the therapeutic laser.

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But I mean, you have to be
willing to change up your plan.

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And I think a lot of us are
learning cat friendly handling

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and understanding feline emotions.

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We also do that in our physical exam.

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A complete physical examination
will vary from cat to cat, depending

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on their emotions and responses.

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You can't push them, right?

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You have to adapt to the cat's emotions.

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Thank you for listening.

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20th of August, Dr Christine Pye will
host a CFC open access webinar on

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Feline Ageing and age-related diseases.

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We’ll be back again next month with more
from the world of feline medicine and JFMS