What is S.W.I.M Cats? SWIM Cats Coast to Coast is a Canadian Feline Weight Loss & Improved Mobility initiative providing physical rehabilitation and weight loss programs.
S = Safe
W = Weight loss
I = Improved
M = Mobility

The SWIM Cats Program was created by Dr. Anne Watson, DVM, CCRP of the O’Sullivan Animal Hospital in Barrie, Ontario and Jenn Panko, RVT/CCRP, OCMC, CAPMC of The SPAW Pet Rehabilitation and Fitness in Aldergrove, British Columbia.

Our Program

The Metabolic Prescription Diet “Meow and Purr Plan” for Feline Weight Loss and Improved Mobility

M = Morphometric measurements
E = Exercise
O = Osteoarthritis management
W = Weight loss
P = Pain management
U = Underwater treadmill
R = Rehabilitation therapy
R = Regular body fat index and ideal weight calculations

Rockin’ Rhonda: A Story of Team Work to Achieve Feline Weight Loss and Pain Management, and Improve Mobility

Subjective Assessment

Rockin’ Rhonda (Surrey Animal Resource Centre) fostered by Jenn Panko (SPAW) and Dr. Jeff Bowra (Aldergrove Animal Hospital) 13-year-old female spayed calico domestic shorthair found as a 10-kg stray in August 2016. Began weight loss program in shelter at 8.1 kg November 10, 2016. Assessed using Hill’s Body Mass Index and Nutrition Plan formulated and re-evaluated using Healthy Weight Protocol as weight loss occurred. Target Weight is 3.8 kg. Blood work consistently within normal limits. Had dental prophy and extractions (208, 307) at local veterinary technology school October 15, 2015.

Objective Assessment

1.  Painful all signs except 18, 24, 25 observed from 25 signs considered to indicate pain in cats (Merola, Mills 2016).

2.  Morbidly obese.

3.  Radiographs: osteoarthritis, left stifle worse than right (both show severe DJD), suspected previous bilateral cruciate ligament tears.

4.  Fully plantigrade stance bilaterally in hindlimbs, marked weight shift to front limbs. Takes maximum of 5 steps before sitting down. Suspected diabetic neuropathy. Bloodwork and urinalysis within normal limits.

5.  Attributed to excessive weight, loss of core strength, and degenerative joint disease.

6.  Activities of daily living: Cannot fit in cat sized kennel. Cannot step up into litter box. Requires soft padded bedding. Cannot groom self. Requires regular nail trims to improve mobility. Shelter reports ‘picky eater’. Physical rehabilitation, pain management and weight loss plan set in collaboration and under the direct supervision of Dr. Jeff Bowra, DVM, CCRP.

Pain Management and Joint Health Plan

1.  Onsior 6 mg PO SID, evaluating efficacy daily and reducing dose in correlation with weight loss.

2.  Therapeutic laser.

3.  Glycoflex chews (loading dose of 3 chews per day for 6 weeks) then 2 chews daily, reducing dose in correlation with weight loss.

4.  Cartrophen injections (0.33 cc subcutaneously every 7 days for 4 doses, then one dose every 30 days reducing dose volume according to weight loss).

Nutrition Plan

1.  Assess body fat index and create a safe weight loss and management plan using The Hill’s Healthy Weight Protocol.

2.  Monthly weigh-ins. Recalculate nutrition plan monthly.

3.  Measured and Controlled Hill’s Metabolic Wet and Dry + Glycoflex Chews.

Physical Rehabilitation Plan

1.  Low impact exercise sessions 2–3 times daily for up to 5 minutes increasing length of sessions and reducing buoyancy as tolerated.

2.  Swimming in pool to improve cardiovascular fitness and assist with weight loss.

3.  Environmental modifications: Low litter box with 1” step in. Padding bedding, medium sized dog kennel, as hind-end strength improves raise feed bowls to promote weight shifting to hind end and engagement of core muscles while eating and return to normal litter box use to promote flexion of stifles and hips.

4.  K-Laser stifles, elbows, and shoulders, 3 watts, 1 cycle each joint, twice weekly for 3 weeks, then re-evaluate.

5.  Move to weekly laser sessions when mobility improves.

6.  As pain and weight diminish incorporate therapeutic exercise program to increase core strength, build hind limb muscle mass, improve hind limb strength and plantigrade stance, overall mobility, and ability to complete activities of daily living.

7.  Monthly re-evaluations with Dr. Jeff Bowra, DVM, CCRP or as concerns arise, progress stops, or plan needs modification. Approximate 1 lb/month weight loss program recommended.

8.  Breaks from rehab at Jenn’s house. Provide opportunities to be a ‘normal cat’ and have a break from hospital environment.

Clinical Outcome

Pain: Moving with ease around clinic and at Jenn’s house. Jenn noted maximum of five steps, fully plantigrade stance at intake, November 2015. Now able to run around house, jump on sofa, beds, and shelves, able to go up and down stairs, and stand on hind limbs supported by front limbs on screen door to watch horses and dogs at the farm Jenn lives at. Still challenged by uneven surface activity and hill work. Enjoys laser therapy and hydrotherapy sessions. Signs 1, 3, and 5 intermittently present from Signs Considered to Indicate Pain in Cats (Merola, Mills 2016). Increase in signs determines use of Onsior 5 mg PO PRN and re-evaluation with Dr. Jeff Bowra, DVM, CCRP.

Mobility

November 10–18, 2015: Able to complete 3–4-minute underwater treadmill sessions twice daily.
November 19–26, 2015: Able to compete 5–7-minute underwater treadmill sessions three times daily. Introduced swimming laps in pool.
November 26–December 3, 2015: Able to complete 10–15-minute underwater treadmill sessions 2–3 times daily combined with swimming in pool. Plantigrade stance began to improve.

Began therapeutic exercise program:

1.  Weight shifting with front limbs on balance pad, progressing to front limbs on balance disc.

2.  Raised feed bowls to promote weight shifting to hind end. Progressed to having front limbs on yoga block while eating to increase challenge of hind end weight shift.

3.  Introduced cavalettis with poles flat on ground progressing to 2” then 3” off ground to promote front and hind limb weight shifting, flexion, and extension.

4.  Gradually increased depth of litter box until able to use normal litter box.

December 4–11, 2015: Able to compete 15–20-minute underwater treadmill sessions 2–3 times daily combined with assisted swimming in pool. Holding head up in treadmill and appearing stronger.

December 11, 2015–Present: Able to complete up to 30 minutes on underwater treadmill combined with swimming 4–5 times weekly combined with unassisted supervised swimming in pool. Enjoys working out and shows enthusiasm for underwater treadmill workouts. Achieved weight of 4.1 kg (9 lbs) September 2016. Added slight incline to underwater treadmill for 2-minute intervals.

Therapeutic Exercise Program Modifications

1.  Supervised outdoors time on a variety of surfaces including grass, sand, uneven terrain, and hills.

2.  Time spent a Jenn’s home just ‘being a cat.’

3.  Free time to be mobile around clinic when hospitalized for rehabilitation program.

Long-Term Lifestyle and Mobility Plan

Ongoing pain management, weight management, joint health management and physical rehabilitation with Jenn Panko, RVT/CCRP, OCMC, CAPMC, under the supervision and direction of Dr. Jeff Bowra, DVM, CCRP. Bi-annual wellness visits (or more frequently as required) to monitor blood values due to off label use of Onsior.

Discussion and Summary

Teamwork

A team approach to Rhonda’s care has made success possible. The SPAW Physical Rehabilitation Team, Aldergrove Veterinary Hospital Medical, Client Care Teams, Cleaning Staff, and Surrey Animal Resource Centre all played critical roles helping Rockin’ Rhonda overcome her obesity, improve her mobility, reduce her pain, and improve her quality of life. Surrey Animal Resource Centre identified Rhonda’s condition and pain and provided her with an oversize kennel and started her on a weight loss program. They promoted her story via the local news. When Jenn saw the news segment on social media, she knew she had to help! Daily care, kennel cleaning, and exercise has been shared between The SPAW and Aldergrove Animal Hospital staff. She is a favorite at the hospital and has many client fans that check in on her progress. We have a poster in the SPAW, in the hospital entrance, and at Surrey Animal Resource Centre that documents her progress. The use of social media to share Rockin’ Rhonda’s story has been a great way to raise awareness of the importance of a multi-modal approach to treat feline pain and obesity concurrently to improve mobility.

Hydrotherapy Rationale and Indications

Underwater treadmill was used to provide buoyancy reducing the impact on the joints while increasing the stance phase of the gait and increasing range of motion in the hindlimbs while building strength to reduce plantigrade stance and promote correct gait patterning and core strength.

When plantigrade stance began to improve underwater treadmill put on incline to increase weight bearing on hind end and increased hip extension. Water height adjusted in intervals to shoulder level to provide resistance and build muscle mass and reduced to stifle level to improve strength and endurance. Swimming was used to promote cardiovascular endurance and core strength. Assisted until hind end and core strength improved, then unassisted and supervised.

Therapeutic Exercise Rationale and Indications

Therapeutic exercise goals included:

1.  Develop core strength.

2.  Correction of posture (plantigrade stance).

3.  Improve ability to weight shift to hind end.

4.  Increase hip extension.

5.  Increase ability to complete activities of daily living.

Therapeutic Exercises Used

1.  Crunches: Reaching for food from lateral recumbency (left and right and forward) progressing to doing so on a TotoFit Infinity Inflatable.

2.  Transitions from lateral to sternal, from sternal to sit, and sit to stand supported from behind.

3.  Raising food bowls on 3 “yoga block improved weight shift to hind end. Progressed to standing on 3” yoga block while food bowl placed on two 3” yoga block to simulate exercise of standing on stairs. Incorporated reaching.

4.  Cavalettis: Starting at 1” height 9” apart progressing gradually to 3” height 4” apart to increase stifle and hip flexion and promote weight shifting alternating back to 1” height and 7” apart to promote hind limb and front limb extension.

TotoFit Kore Exercise Work

1.  Walking up Kore Wedge and weight shifting with front limbs on Kore Roller.

2.  Weight shifting and crunches on Infinity Inflatables. Practices reaching for ground and flexing hind limbs and pulling self onto Infinity Inflatable.

3.  Supervised outdoors time on a variety of surfaces including grass, sand, uneven terrain, and hills.

References

1.  Edwards T. A Pernicious Triad: Arthritis, Obesity and Chronic Pain, DVM 360. http://veterinarymedicine.dvm360.com/pernicious-triad-arthritis-obesity-and-chronic-pain. February 2018.

2.  Panko J, Goldberg ME. How does feline physical rehabilitation incorporate pain management for the veterinary technician/nurse? NAVTA Journal. 2017;December/January:16–20.

3.  Goldberg ME. Feline Physical Rehabilitation, Today’s Veterinary Nurse. https://todaysveterinarynurse.com/articles/feline-physical-rehabilitation/. 2016:1(6).

4.  Goldberg ME. Feline physical rehab: 7 tips to reduce stress to boost success. Yes, you can rehab a cat. Really! It’s all about getting them comfortable in the environment. DVM 360. http://veterinaryteam.dvm360.com/feline-physical-rehab-7-tips-reducestress-boost-success. August 2017.

5.  Bockstahler B, Levine D. Physical therapy and rehabilitation. In: Norsworthy GD, ed. The Feline Patient. 4th ed. Ames, IA: John Wiley & Sons; 2011:687–690.

6.  Bockstahler B, Levine D. Physical therapy and rehabilitation. In: Schmeltzer LE, Norsworthy GD, eds. Nursing the Feline Patient. Ames, IA: John Wiley & Sons; 2012:138–144.

7.  Drum MG, Bockstahler B, Levine D. Feline rehabilitation. Vet Clin North Am Small Anim Pract. 2015;45:185–201.

8.  Medina C, Robertson S. Non-pharmacological pain management in cats. Feline Focus. 2015;1(6):195–199.

9.  Sharp B. Feline physiotherapy and rehabilitation. 1. Principles and potential. J Feline Med Surg. 2012;14:622–632.

10.  Sharp B. Feline physiotherapy and rehabilitation. 2. Clinical application. J Feline Med Surg. 2012;14:633–645.

11.  Merola I, Mills DS. Behavioural Signs of Pain in Cats: An Expert Consensus. PLOS One. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0150040. February 24, 2016.