The story: 15 to 30 minute appointments. Cat in carrier, cat stressed, cat hides at home or is viewed by the client as inactive or lazy. Weigh the cat in the carrier. Remove cat from carrier. Weigh carrier. Cursory physical examination because cat is challenging and requires minimal restraint, minimal handling.

Do we ever really, truly see our feline patients move? How often do we complete a detailed, accurate, and thorough mobility examination of our feline patients? The message we want to send our clients is: mobility matters. Every pet. Every time.

Recommendations

1.  Think outside the box (unless they are having difficulty using the litter box—add mobility and pain to your rule out list).

2.  Spacious feline only examination room with hiding spots, dim lights, and mobility assessment tools, feline friendly practice, feline appointments spaced out so cats have ample time to become comfortable in room before examination.

3.  Apply Fear Free approach to examination including prescriptions for fear, anxiety, and stress before travel to clinic.

4.  Have kitten socialization options in room.

5.  Option for clients to submit video of their pet moving. Provide example and set time limit 15–30 seconds.

6.  Mobility tracking chart for client to complete.

7.  Small land treadmill and cavalettis available to assess mobility.

8.  Promote mobility examinations—if you have concerns while having an examination for other issues let the client know you want to see their pet to discuss mobility.

9.  Choose pain assessment, grimace scales, fear, anxiety, and stress scales to be used consistently within your hospital. If everyone on the team is speaking the same language communication about patient needs becomes simple and effective.

10.  Set yourself and your patients up for success. Designate a feline strategy team and pet experience team in your hospital. Clients appreciate a game plan before an appointment. Explore fear free approaches.

Case Example

Seven-year-old male neutered domestic shorthair referred to rehabilitation service for osteoarthritis and/or potential soft tissue injury. Clients heard I swim cats and thought it would be a fun thing to try with their cat. History involved declining mobility and less activity. Cat typically hides in carrier during veterinary visit. Primary care clinician consents to hydrotherapy, therapeutic laser, and therapeutic exercise.

Cat booked for 45-minute sessions (half hour of treatment time, 15 minutes to get accustomed to my office and de-stress after car ride. Feliway spray and hiding spots available along with low litter box and reduced lighting.

Cat willing to explore office. Walking with crouched posture but curious. I am unsure if crouched posture is pain, osteoarthritis, fear, or combination. Underwater treadmill (in other room) set before cat arrives (approximate water depth selected and moving at selected speed) Make friends with cat, calmly put cat in underwater treadmill. Once cat was buoyant he began to take proper strides. Marked left proprioceptive deficit. Client frustrated the family veterinarian did not observe this. Discussed with client that cats are a challenge to exercise and in the physical rehabilitation setting I was able to observe the proprioceptive deficit because I was able to put his cat into a situation where his gait could be truly evaluated.

Discontinued treatment and reported finding to veterinarian and assisted client in scheduling recheck. Veterinarian completed neurologic examination, radiographs, and pain assessment. Began same rehabilitation program again with the understanding that if neoplasia was present therapeutic laser was contraindicated. Client and veterinarian agreed that the therapeutic laser could be effective in treating nerve damage and painful lumbar spine and compensatory pain in shoulder area.

Proprioceptive deficit was only ever observed consistently on underwater treadmill and on land treadmill and did improve. Cat gained muscle mass in hind end, improved hip extension, and spinal mobility. Original treatment plan was twice weekly for 6 weeks, weekly for 6 more weeks, biweekly thereafter. If he misses a week mobility does decline. Catch up with weekly sessions for two weeks in a row. Clients have invested in small land treadmill for daily exercise.

Therapeutic exercises consist of spinal extension and hind end contractions and extensions over a 30-cm Toto Fit Infinity, low cavalettis with socks on. Pain management includes gabapentin and an anti-inflammatory.

Lessons Learned from This Case

1.  Technicians—objective observations and physical examinations that vary from a veterinarian are not a diagnosis. Embrace a difference of opinion within your scope of practice. Objective and reportable findings can lead to a diagnosis, a more accurate and effective treatment plan, and better patient outcomes including reduced pain and improved mobility and quality of life.

2.  Collaboration within client ability or desire to obtain diagnostics. We do not have an MRI for this cat. We are treating based on clinical signs and response to treatment.

3.  Feline mobility matters. A physical rehabilitation professional can assist in making observations that can guide diagnosis and treatment plan.

4.  Set yourself and your patients up for success. Designate a feline strategy team and pet experience team in your hospital. Clients appreciate a game plan before an appointment. Explore Fear Free approaches.

5.  Choose pain assessment, grimace scales, fear, anxiety, and stress scales to be used consistently within your hospital. If everyone on the team is speaking the same language communication about patient needs becomes simple and effective.

6.  If you are a physical rehabilitation veterinary technician, objective observations and collaboration build trust with referring/consenting clinicians.

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.