[00:00:02] Introduction: Welcome to All Cats Considered, a podcast from the Feline Veterinary Medical Association.
Here we interview professionals from across the veterinary world and take deep dives into the latest evidence based research, developments, studies and guidelines that improve feline health and well being.
We are the home for veterinary professionals seeking to enhance the care of cats through high standards of practice, continuing education and evidence based medicine. In each episode you'll hear interviews with a variety of experts in our field covering a wide range of topics and the latest developments in feline health. We'll share the key points you need to know to improve your patients' care.
Let's dive in and listen to this week's experts.
[00:00:45] St. Denis: Hi, I'm Dr. Kelly St. Denis. I am co-editor of the Journal of Feline Medicine and Surgery and I am here for our podcast to talk to Mary Ellen Goldberg about her article Physical Rehabilitation of Cats Part 2, Treatment Therapies and Exercises.
And you may remember that we had a discussion earlier in the summertime on part one, Common Conditions Benefiting from Physiotherapy. Welcome Mary Ellen. It's so exciting to talk to you again.
[00:01:14] Goldberg: Thank you so much Dr. Kelly. I appreciate you all having me tremendously.
[00:01:19] St. Denis: These articles have been such a tremendous work of our labor of love, I guess we can call it based on we talked about in our last podcast about your history and everything that's brought you to where you are today and all the amazing things that you have contributed to veterinary medicine. And I'm really excited that today we're going to be talking about the treatment therapies and exercises.
So I know you've covered a lot of different topics in here and so we're going to hopefully touch on some of these a little bit more than we did in the last interview.
When we're talking about physical rehabilitation in our cats. I wondered like, is this something that any veterinary team member can do? Do we have to take a special course and earn certificates or licensing before, say we're allowed to do this? That might vary geographically.
[00:02:06] Goldberg: There are things that are definitely set aside for people that are certified or have specialties in physical rehabilitation.
And in that instance, some of those people, you know, for instance, if you would have a veterinary technician specialty in physical rehabilitation, they would most likely be at a rehab practice somewhere.
There are absolutely techniques and things that if you have someone that whether it's a surgeon, the veterinary surgeon, or someone that is certified 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, you can teach people and there are physical rehabilitation techniques. And I say this because that's what they would fall under, the auspices they would fall under.
So massage or things like therapeutic laser or PEMF, you know, the assisi loop, that kind of thing.
And passive and active, passive range of motion. Animals and that have things like surgeries, whether it's orthopedic surgery or something on their particular limb. These therapies can be taught to assistants, to anyone. When they're waking up from anesthesia and they're starting to wake up. You can put their limbs through range of motion.
You can do things like massage the muscles and help them. You can do things like a big one that helps with pain, cryotherapy, cold therapies that can help. And what is the rule of thumb is the first 72 hours post operative, they like to use a cold or a cryotherapy, something cold. After the 72 hours, they like to switch it to a heat, like, you know, something warm.
I will give a tip with cats.
Cats aren't always overjoyed with cold. 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 going to lay there and let you put ice packs on a specific limb or something if they're mobile. Now, you also have to be very concerned if they're on things like opioids. Postoperatively, you don't. They're not going to 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, you know, 10 to 15 minutes and no more because you don't want them to have any problems that occur because of this, like frostbite, you know, or something like that.
[00:05:46] St. Denis: But yeah, the same rules would apply as when we're trying to keep patients warm, is that we have to be very careful. Right. Not to burn them, but.
[00:05:52] Goldberg: Absolutely. Yes. So but what I'm saying is these things, if you have a post anesthetic care unit, so they call that a pacu in human medicine, it's postoperative for our terminology.
If you have an area where animals are recovering from surgery, anybody can do this with some coaching, training, that kind of thing, and having someone within hearing range that they can say, could you look at this or come see this?
Those are the kinds of things that honestly, anybody can do, especially the recovery from surgery.
[00:06:44] St. Denis: Right. And they'd probably be using those kind of in conjunction with things like pain scales. So acute pain scales, like Feline Grimace Scale to kind of get a sense of.
[00:06:54] Goldberg: One of the things I've taught my students to do is I made from the Glasgow Pain Scale for dogs and cats, I made cage cards. And so an animal I've, you know, reduced the size, print them out and on the cage where the animal is, and especially in like the recovery room, 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, you know, 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 you know, the assistants can do that easily. You know, they can be taught how to assess and pain and then get somebody that can do something about it.
So I love the Feline Grimace Scale. Love, love, love it. And all the work that has gone into it from the Steagall lab. But I did make, and I'm sure other people have thought of the idea, but I made these cage cards so that it could be something that can be directly on the cage instead of if you don't have a clipboard that can hang on the cage, you know, something like that. So, so that's just a tip that, that I did. Yeah.
[00:08:40] St. Denis: And that just really helps you probably with applying these techniques postoperatively because I know in the, in the article you do talk, as you have just spoken about the things that you can do in that immediate post operative period and there's probably a list of things that you shouldn't be doing at a post operative period in those kinds of situations as well. So I know you cover that in the article, but that helps probably with the pain management scales there to know what you're, if you're doing things, if it's making a benefit for that patient or if you should adjust what you're doing.
[00:09:09] Goldberg: Absolutely. And when you think about.
So for instance, with passive range of motion exercises, you know, an animal that comes out of orthopedic surgery, you can.
Why do you want them to be able to move the limb, you know, 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 going to hurt worse. And so that's why in human medicine, to be quite honest, they do a hip replacement. They get you out of bed the same day for a human patient, for our animal patients, if they do a hip replacement or if they're doing an FHO, you know, femoral head ostectomy or whatever, they get the patient up. They don't want them just laying in the cage. Now, when I say they get them up, I don't mean the patient wakes up from surgery and 30 minutes after they're awake, they stand them up and make them run down the corridor. I'm not talking about that.
I'm talking about 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. And what it looks like, it looks like a big inflated ball.
And whether the cat or a dog has neurological problems or orthopedic 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, you know, it's. All of this is very important, especially with neurological patients, of stimulation and getting those nerve connections back and working normally.
So, yeah, I like, I like some.
[00:11:21] St. Denis: Of the stuff that you have in there. In terms of examples of different equipment that's available and sort of thinking about beyond post operative that you were talking about animals with neurological disease, I notice you have some really cool exercises for strengthening flexibility, balance, proprioception. Like the, the. I don't know if they're called the bones that the cats are standing on.
The PhysioBone.
[00:11:44] Goldberg: Yes, they're PhysioBone.
[00:11:45] St. Denis: I've never seen those before.
[00:11:46] Goldberg: Yeah, a PhysioBone. Yes. I guarantee you, you could Google it. I'm not positive, but I bet you could get them from Amazon somewhere. Seriously, you know, I mean, they have everything. So.
But I like also to think about, for these neurological cats, things that owners can do. Yeah. So, you know, one of the things that in a neurological cat, if you're trying to get, and it's any neurological patient, if you're trying to get sensation back into, down to a pad or something, you can take something like a brush or a toothbrush and rub it on the foot and you can tell that. Now, I don't mean they rub it so much that they draw blood on the foot. You know what I'm saying? Yeah, no, they take stimulation, yes, absolutely. To bring sensation back down into the foot. Those are the kinds of things that owners can be taught. Owners can be taught how to do passive range of motion.
Owners can be taught how to. So what's the difference between passive active range of motion? Active range of motion means the animal performs it themselves versus having a therapist move a limb. So if you have. One of the things I like to think about for cats, there are these things that, that they have for dogs, and you can use them at your rehab practice. They're called cavaletti rails. You can have them real low on the ground.
Well, an easy way for owners to do this is if you have a hose.
And you can snake your hose, you know, so that the hose can wind around.
You can have it so that the. The patient is able to step over the hose. And that is. And so, you know, the owner doesn't have to go out and spend a massive amount on, you know, cones and rails and things like that. If you have a couple of brooms or a couple of sticks from the yard.
Now, I'm not talking about a log that you have the animal have to climb, but, you know, I'm talking about sticks initially have to just pick their feet up over.
Other things that can be done at home are. This exercise is actually called lunging on the stairs.
And so for dogs, they might do more, but you can have like something that is small and have the cat put their front feet up on it.
And then you can let them just stand there. And that's like a stretch so that they can just stand. It extends their hips and it helps them. It can be a low one step, two steps, something like that, or it can be a low bench.
Things like that can be done.
And owners, I like to have a sheet that is typed out and it gives the instruction for what the exercise is.
And when I went through school for rehabilitation, I was told, and I do this routinely.
You have printed instructions.
You can have images or pictures of what it should look like.
These go to the owner.
And then you perform the exercise that you're teaching them with their pet so that it's not like, here I have a perfect trained pet, and I'm going to show you how to do this. You do it with their pet and help them.
Then you ask them to repeat it back to you, because that way you can understand that they know that or that they understand what you're trying to show them.
And what is the big advantage to having them do a home exercise program?
The big advantage is that an animal, or especially for a cat, let's say they're supposed to have 10, 20 physical rehab sessions if they're doing homework at home there's going to be advancement that is positively going to show up the next time they come for therapy.
If they're not doing anything, it is going to take longer to develop what the mobility that you want the patient to get back.
It will be that or it is going to require many more sessions at the rehab practice place.
And so, in essence, if people do their homework with their pet, it can help them save money for, you know, and I mean, that may be a big consideration for some.
[00:17:49] St. Denis: I imagine if done correctly or if things are going well, it may improve bonding as well.
[00:17:54] Goldberg: Exactly.
Absolutely.
[00:17:57] St. Denis: Well, sorry, one of the questions I had for you, like, I imagine that in those kinds of things, and I've had this happen with a patient that had a femoral head excision where you really want to be in touch with that person almost on a daily basis, because if that animal's. The cat's pain increases for whatever reason, they may not be able to do those exercises. And the analgesics may need adjustment.
So that might be something that is a consideration that you always have a contact person when you're sending patients home for home physiotherapy.
[00:18:27] Goldberg: Absolutely. And you know, one of the things that I mentioned in the article, another one of my mentors, I have many. Dr. Laurie McCauley taught this, taught me this in a geriatrics course at the Canine Rehabilitation Institute when I was going through my certification.
She said, and it's absolutely true. If you have a patient that comes in and goes through a day, a program for a specific day for rehabilitation physiotherapy, and the next day the patient doesn't want to move, is sore, doesn't want to interact with the owner, is not eating anything. If the next day, then that day that they came in, the day before, it was too much for that patient, the rehab has to be cut back because no patient should go through rehab on a specific day and be more painful, more unhappy and not eating. And the owner immediately, this is like a red flag. The owner immediately needs to call and say, you know, Fluffy is under the bed and won't come out and doesn't want to eat their breakfast and doesn't want to pet them.
And they were in yesterday. I thought it would be better today.
Well, that is okay. Maybe it needs an analgesic today. The program immediately. Also, the owner is probably talking to, like the veterinary technician or nurse.
They need to immediately go to the rehab veterinarian or to the veterinarian in charge, alert them, because the program needs to be adjusted from top rung on down to who's carrying it out, you know, and. And then this is an imperative thing that you should not have a patient that hurts more after having been through a program.
[00:20:51] St. Denis: And our caregiver should feel comfortable.
[00:20:54] Goldberg: And.
[00:20:54] St. Denis: And all I must is say something's not right.
[00:20:57] Goldberg: Yeah, I've had frozen shoulders and been through rehab, and during. When I went through the extensions, I thought I was going to die. It hurts so bad. I mean, you know, frozen shoulder is real painful, but anyway, it's called adhesive capsulitis, but I equate it and I know I can be laughed at now.
Well, if I hurt from something like this, what about my patients?
Something that I do that a stretch may be too far for them?
What if they're worse off the next day? Or if they severely object to how far I'm trying to stretch their limb or something?
Then you immediately cut back because that hurts. And like I said, with cats, less is more. You make them have a lot of pain and they're not going to want to have anything to do with you.
[00:21:58] St. Denis: And that just ties up so nicely with everything that we talked about in the first interview. Just talking about feline emotions, feline pain, and really thinking cat, as you like to say.
And so these exercises are all here in this publication that's come out in September. And if you want to look at the common conditions benefiting from physiotherapy, you can find that also at the Journal of Feline Medicine and Surgery. All of the articles under Journal of Feline Medicine Surgery are now open access, and so anybody can go and look at them. And that part one was in July with Mary Ellen Goldberg as the author as well. And we are talking today about physical rehabilitation of cats, treatment therapies and exercises published in September.
[00:22:40] Goldberg: I'll give a few hints about introducing a cat to, say, hydrotherapy, because that's in this article. So you're not going to just take your cat and plop them in a tub of water and say, swim, you know, or you're not going to just take a cat and put them in an underwater treadmill and go have at it, honey. There's an introduction. I like to start out with the treadmill to put the cat in a dry. It's a underwater treadmill, but I like to put them on the belt and just very, very slowly start to move the belt. And the big thing that hydrotherapy can help with is you can have cats that are obese cats and that don't want to do anything. They don't want to exercise. They don't want to walk, they don't want to do it. You know, they just don't want to do anything. And by having them in water, it helps to take the weight off, you know, some of the weight. But you got to get them in the water first. So how can you do that and not have them, as I think of spaz out on you, you know, I mean, yeah. Oh, my God, what are you doing to me? So I like to put them in a dry treadmill and start them walking slowly on the treadmill. And they may not be crazy about it because they may be, you know, obese, and they may think, well, I don't really want to do.
Well, you can slowly add little tiny bits of water, and they may at first think, I don't want to have anything to do with this.
But the other thing that you can do, even if they get. They don't feel like walking on an underwater treadmill, you can put it up high enough and almost make it like a little swimming pool. You put a life vest on them. A lot of times I like to have a life vest on anything that's in water.
And I'm in the treadmill with them, but I'm there. You can have it almost be like a little pool.
And at first, what you can do is hang on to that vest that they have on because there's generally a handle on it, you know, of some kind of.
And you can move them through the water.
And they may not like it the water at first, but if you're in there with them, that helps a tremendous amount. I mean, it really. The other thing, you get a cat that completely wants to freak out about the water, well, then you only do it for a minute. Now, I know somebody said, well, that's ridiculous. One minute, no less is more.
So you do it slowly and incrementally. If you have them in there and they don't want to do walking at first, they'll start moving their legs and they normally don't just hang in the water, you know. They'll start moving their legs and this is all range of motion, moving little bits.
[00:26:01] St. Denis: Really appreciate those. Those tips because, yeah, anybody who's working with hydrotherapy is going to need to think cat and take it slow, obviously. So I really appreciate having those extra tips for everyone.
So, again, everyone, check out these articles. Thank you so much for joining us for this podcast. And Mary Ellen, I want to thank you again, both for contributing these articles to the Journal and for joining me today in this podcast. Thank you so much.
[00:26:29] Goldberg: Thank you. Because I could go on and on talking about.
[00:26:32] St. Denis: I love chatting with you.
Thanks so much.
[00:26:36] Conclusion: Thank you for listening to this episode of All Cats Considered. We hope you enjoyed this interview. For more information on the topics discussed in this episode, please head over to catvets.com/podcasts and explore the links in the show notes. Don't forget to subscribe to this podcast on your platform of choice so you won't miss any episodes as we release them. Have thoughts or ideas about the interview you heard today?
Share them with us by leaving a comment on our Facebook page or shoot us an email
[email protected] thank you again for joining us today.
