Thursday, May 21, 2015

Paralyzed Cats. When Happy Endings Meet Reality of Care

Happy endings are not as elusive as the fairy tales lead us to believe. 

Happy endings are what you make of the misfortunes that life throws you.

Faith
This is the story of Faith. She was found hit by a car unable to move from the waist down. When she was brought to me she had an obvious craggy projection from her spine and was emaciated, grateful, calm, and oh, yes, pregnant.


Faith had been rescued by a couple who wanted to make a happy ending for her happen. I am a sucker for optimism in veterinary medicine more so than any other human on the planet. It is my attempt to live in a world of real atrocities created by real people and still know that miracles exist in the small often overlooked corners of everyday life.


But, every story on its way to a happy ending has to have some bumps along the way. Faith was a list of unknowns in a list of seriously life challenging problems.

Here is how I start assessing paralysis in pets;

Breathing.
Every pet needs to be able to breathe to move oxygen throughout muscles and organs. Every accident victim needs to be calm, comfortable, and able to breathe. This is why seeing a veterinarian immediately after an accident is imperative. Pets with spinal cord damage high in the spine will die quickly as the brain can't communicate with the lungs.

Pain.
Trauma patients deserve to be managed with the plethora of pain management tools art our disposal.

Spinal cord injuries below the level of the ribs can involve the following and must be assessed;
  • Deep pain. Your veterinarian will pinch the toe hard enough to try to elicit a "deep pain response." This is often difficult to assess and should only be done by a veterinarian. Loss of deep pain is a very poor prognosis to return to function. It in most cases implies a total loss of nerve function to the limb.
  • Anal tone. A pinch with hemostats to the anus should elicit a "wink" implying that the anal sphincters are still functional and anal tone is in place. This is used to assess basic fecal continence.
  • Urinary continence is best assessed by the ability to urinate voluntarily. We monitor closely for when, how and if the pet pees without hesitation. The abdomen and bladder are gently palpated every few hours to assess that the bladder is still intact. 
  • Ambulation. A pet needs to be able to get up on four feet and walk, or a discussion about managing the paralysis needs to be had. There are pet focused carts and braces available from 
  • Quality of Life. I feel this needs to be added although the longer I practice medicine the more I realize that this is an incredibly personal heavily biased opinion. I have found that almost every pet who is beyond the point of imminent and obvious death has a strong, primal, undeniable will to live. My measure of quality of life is different than others, therefore, my perception of quality of life also varies. My pets are a lifelong obligation independent of amount of care required. As a veterinarian I know that there are options available for every ailment, every condition, and every situation. It really is merely a matter of resources and will. Quality of life is about their quality, your obligation to keep them pain free and function and their basic life's needs. 


Faith's initial needs were to allow  her time to heal from the accident. She was calm, happy, comfortable, eating, drinking and grateful for a warm bed and three square meals. Unless there is impending emergent medical treatment needed I prefer to watch and wait. A cat that is eating, drinking should be peeing within a day, and defecating within three. There should be ease in breathing and good mucous membrane color. Faith had great reluctance, trouble, and weakness in getting up, but, if you picked her up and supported her at the sternum (where the ribs end on the abdomen) her back left leg would paddle in a forward direction. She had a small glimpse of response from her brain to her back legs. She was, as so many cats are, down one life in a list of at least nine.

After my primary concerns of surviving a trauma were assuaged it was time to discuss Faith's pregnancy. She was not able to stand on her own. Her pelvis was broken  and she would likely not be able to deliver babies who may, or may not have been damaged in the trauma. I had to advise spaying her as soon as possible. It was the most harrowing feline spay I have ever done. Faith woke up having to carry half less of her morning weight.

Faith left the hospital four days later. Within weeks she could get herself up and walk a short distance.



Within six months is was apparent that her ability to urinate on her own was very unlikely. She needed to have her urine expressed at least twice daily. The long term problem with this need is that the bladder fails to empty completely with each manual palpation. This residual urine in the bladder allows for the fertilizer for urinary tract infections.

Faith also left a trail of feces without any knowledge, intent, or remorse.

She gained  considerable strength back, and was an active happy cat.



Faith's family found that her care required almost around the clock care. She went to live out her life at a cat sanctuary dedicated to providing intensive care for the most needy.

Faith's treatment plan included;

  • FeLV/FIV test $45
  • Exam $50
  • Vaccines $80
  • Spay $80
  • Intestinal parasite check $30
  • Radiograph $100 (is not always required). 


I was inspired to talk about Faith based on a recent question I received from Tracey on Pawbly.

My rescue cat is 3 yrs old, has nerve damage in tail from tiny kitten, has no control over bladder & bowels. Continuously soils himself. Lately he vomits foul vomitus, from faeces he swallows while grooming. Is it kindest to euthanise him?

I have always tried to keep him clean, bathed him etc. He has about 20 blankets which get changed continuously so he does not have to lie in his waste. But lately, he won't allow me near him to clean him and if I do get close to him he attacks me. One of my Great Danes always used to clean him, but now she doesn't seem too interested. I have tried everything, but it breaks my heart to see him trying clean himself and not succeeding especially when his stools are runny and he ingests his own faeces. Otherwise he is healthy, eats and drinks relatively well. I hoped that the nerves would regenerate and he would get some feeling back in his tail, but this never happened. He is a fighter and a survivor. He was found at about 10 days old being tossed between 2 dogs. We hand reared him. He had 2 hernias which were repaired but he nearly died during the procedure. But now I feel so sorry for him as we have other cats which climb on the bed at night, but we have to chase him off because its very difficult waking up at night with our bedding covered in faeces. I do have towels on the bed, but he chooses to lie where he wants to. It would also be impossible to use diapers as he has this really wild streak in him and will not allow us to fit it. My heart is breaking with this decision, but no matter how much it hurts me, I need to do right by him.

He was taken back at about 7 months when he was sterilized and the vet fixed 2 hernias at the same time. He nearly bled to death during the procedure, but he is a fighter and survived. I live in a rural area, so only have 1 vet close by. I haven't taken him back since then as I know they will tell me to euthanize him, but I am not sure if their reason would be for the cat's sake or mine. And all the decisions should be for the cat's sake. My vet told me when he was a kitten to euthanize him. I refused at that time

My reply;
Hello,
This is always a tough one to answer because it is based on personal opinion.
Therefore I can only answer for myself and my beliefs.
A living being in this condition requires a great deal of work, diligence and responsibility. He MUST be kept clean. Even he knows this. Allowing him to be covered in his own waste is not healthy or acceptable.
If he was kept clean it sounds to me as if you find his handicap as acceptable. I applaud this. We all have disabilities but they do not have to define us, nor do they have to be reasons to deny a chance at a life. He appears to have a strong will to live. This is how I decide when to euthanize to alleviate suffering. I do not euthanize because a living soul requires more work and effort to maintain an acceptable quality of life.
I do however agree that this kitten deserves to live a life and that at minimum someone needs to provide additional personal hygiene assistance.
This is my personal opinion. I know others would disagree.
My job as a vet is to be an advocate for the animal. That's how I define my role as a veterinarian. I am also an advocate and guardian for my pets in spite of the challenges life presents us with. If they want to live I will help them however I can for as long as I can. Compassion and kindness always come first.
Very best of luck.


Tracey's reply back;
Life is not perfect, therefore we cannot expect our pets and children to be perfect. Besides Dixie, my poor cat, we have a deaf, almost blind Great Dane and another Dane with a tail that had to be docked as it was also partially paralysed. None of these are in distress at all and have adapted to their differences. However the problem arises when the animals are suffering or perceived to be suffering by us, as how can we be sure that they are suffering. For instance, my deaf Dane does not suffer because he does not know he is different to the other dogs, but we tend to feel sorry for him and make allowances for this. The other dogs, however, do not feel sorry for him at all and therefore, do not treat him any differently as they treat each other. The same applies to Dixie, the cat. The other cats and dogs do not treat him any differently. But I can see that he does behave differently to the others, which I think is a direct result of his handicap.

My parting words;
It sounds as if you are an amazing parent. Only you know what's right based on your pet and the circumstances. It's not easy. I understand that. You can only do the best with what life hands you and try to not make selfish decisions. After that allow time to provide acceptance and forgiveness.

I write a blog about the pets and people I meet along the way of being a vet. Could I share this story? I had another patient with similar story and circumstances. I would like to write about you both. It raises important points to ponder when considering caring for a handicapped pet. I will hit use your name. I'm thinking about you and your kitty.

And PS. Vets are all too quick to recommend and provide euthanasia. We get so used to it that we forget to see each patient as an individual with their own desire to live in spite of the many obstacles they face.

Please do. Hopefully what I am going facing could help someone else in similar circumstances. Kindly send me a link to the blog once you have written it. Thank you

There are happy endings everywhere. There are also people doing amazing things for others far less fortunate with real-life challenges. This is one of the many reasons I love being able to spend everyday with animals. They will surprise, inspire, and impress you every single day.

Link to the original question can be found here at Pawbly.com

Photo courtesy of Eddie's Wheels

My favorite place for finding help for your handicapped pets is Eddie's Wheels. They make carts and equipment along with incredibly inspiring stories of animals who all have happy endings.

Photo courtesy of Eddie's Wheels
If you would like to ask, or answer a question and help an animal in need, please join  us on Pawbly.com. Pawbly is a free place dedicated to helping pets and their people.

For a personal appointment with me call me at the clinic Jarrettsville Vet in Harford County, or look me up on Twitter @FreePetAdvice

6 comments:

  1. Thank you so much for addressing all of the components paralyzed pets and their owners face. I'm glad Faith was given a second chance because in my experience veterinarians too often only see the physical condition of a pet and overlook the relationship people have with their pets and their willingness to care for them, even when they are disabled. Taking care of a handicapped pet is challenging and very rewarding. Unless the animal is in pain, second chances can lead to a new normal way of life that is appreciated by the entire family.

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    1. Thank you for reading, and most importantly, for being such an incredible resource for so many pet parents. You all inspire me every single day! Love knows no handicap..
      Much love to all you touch and help..

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  2. Such an uplifting and encouraging post. There might not be anything cuter than a Dachshund in a drag bag. But a bunny in a wheelchaor? Thanks for this.
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    1. Hello!
      Thank you for reading and taking the time to add a note.. My best to you and here's a big high five from a fellow vet in the trenches.. ;-)

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