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Hind leg neuropathy/knuckling in cat-need advice (complicated case)

Neurological Disorders Resources. Treatment and care for pets having pain or trouble walking or standing due to spinal injuries or neurological disorders like IVDD, FCE and DM.
Sienna's mom
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Re: Systemic Toxicity Associated With Doxorubicin Administration in Cats

Post by Sienna's mom »

FYI wrote: Sat May 21, 2022 9:44 pm https://onlinelibrary.wiley.com/doi/pdf ... .tb01024.x
Cats 3 and 6 developed muscular weakness, particularly in the rear legs during treatment cycles 9 and 10. Examination of the sciatic nerve in four cats (cats 1, 2, 4, and 6) showed moderate myelin degeneration (Fig. 5).
The myelin degeneration of the sciatic nerve found in four cats was unexpected. Therefore, sciatic nerves had not been sampled at necropsy in all cats, and additional nerves were not sampled in any cats. Two cats did develop muscular weakness that may have been related to peripheral nerve dysfunction. We could find no reference to myelin degeneration associated with doxorubicin administration in any other species. The incidence, distribution, and pathophysiology of this myelin degeneration in cats treated with doxorubicin deserves further study.
I also came across this article during my research. It was pretty much the only thing I could find that supported the neurologist's theory of doxo being the cause of all of this. Interesting to say the least.
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CarolC
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Re: Hind leg neuropathy/knuckling in cat-need advice (complicated case)

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Sienna's mom wrote: Sun May 22, 2022 11:32 am They didn't use sedation for her chemotherapy appointments, including the times she received doxorubicin.

OK, then that eliminates that possibility.

BUT, and this is the interesting part, they did have to give her a mild sedative (for the first time) at her last appointment because she was being "difficult". We noticed her leg was a little wonky the second we got her home and it continued to get worse from there.
I'm not blaming anyone as I appreciate restraint is necessary and would have more than fine in any other situation. But I do wonder if the restraint/positioning caused something to flare up or be re-injured in the process due to her existing condition?

Ohhh. Yes, you very much would wonder. It sure sounds like it. I'm picturing a senior kitty, active and young for her age, but she has some calcification and arthritis. She accidentally falls off a speaker and "twinges" something in her lower back/hip area. A laminectomy helps, but she's still a senior kitty with some age-related changes, and in the future she needs to be more careful. She shouldn't be struggling with her hind legs trying to fight vet techs, sinking her claws into clothing trying to climb over somebody's shoulder. If someone lets go of her, she shouldn't be jumping off of tables right now. If someone carries her in a carrier, they should use both hands and keep her level.

I guess I just don't know what to do about it now and it's a helpless position to be in. The neurologist says to give things more time but it's already been weeks with no improvement.

Totally agree with the neurologist. Recovery from nerve injury tends to be slow or very slow. That doesn't mean it's not happening. It only means it takes time till you see results. As the saying goes here, if you are only at a few weeks with nerve recovery, you are "still in early days". This is only an example, because your kitty is not paralyzed, but my first paralyzed dog took 9 months before she could walk a little bit. During those first months, recovery seemed slow and I could *maybe* think she was improving ever so slightly every 6 to 8 weeks if I really stretched my imagination. The dog I have now took about 11 months to be able to walk without support (he was quadriplegic). The point isn't that it takes 9 or 11 months for improvement, but that slow improvement takes place over many weeks and months. Fortunately it doesn't stop at 2 weeks or 4 weeks. My dog was still doing something new at almost the 5-year point.

And how do we know how much time to give if they can't seem to figure out why this is happening? I worry about pain and her quality of life. I seem to have things well controlled and she is constantly looking for love and attention but she must be experiencing some degree of pain if she's limping.

You would know her best, and can see her. Cats are really bad about hiding and not eating when they don't feel good, so if she had any serious discomfort I think you would definitely know. She sounds happy. She's eating, toileting, and being sociable. Any discomfort she might have does not seem to be enough to affect her quality of life. Though I am sure you are both tired of medication. Hopefully she can get back to where you're not having to give her meds every day, unless she does something again someday in the future and has another episode, but by then you'll be used to this and know what to do. When my dog was on gabapentin, we had the liquid kind with a dropper, and I measured it into her canned food and she acted like she didn't even know it was there. Not sure if this would work for your kitty.

That doxorubicin article is indeed interesting. Then I realized, wait a minute, it's also 1993. It seems like if there really was a problem with myelin or peripheral neuropathy, they've had 30 years to confirm it. That's a very long time. That's a lot of doses of doxorubicin given to a lot of cats, in the day and age now with adverse event reporting online, and Internet access to information, and people willing to sue when things go wrong. The absence of any other reports to support those findings is pretty noticeable. Maybe there's information that's inaccessible due to subscription databases or paywalls.
:thinking:
I have been back and forth on whether this is something kind of orthopedic, with her skeleton/joints, as a result of the mild trauma of the fall, or something neurological, which could also be caused by trauma if it affected a disk or "pinched a nerve" so to speak. I'm about to the place where I think it's a little of both.

There can be more than one reason for a limp. One is because something hurts and you are trying to keep your weight off of it. Another is because there is weakness associated with a nerve condition and the leg isn't supporting you well, so you shift your weight to your other legs and it looks like you are limping. A human would use a cane or walking frame, a dog or cat uses the other legs.

With rear paralysis or weakness, weight is shifted to the front legs. My dog with central cord syndrome (an unusual case where the hind legs work better than the front legs) shifts his weight to the hind legs.

Some people worry if they see their pet losing muscle in the hindquarters or an affected leg, because they think it's gone forever. Fortunately, muscle comes back as the nerves improve. Recovery of nerve injury tends to be by baby steps. Recovery occurs in the background where you don't see it. Day after day it may look much the same and you think nothing is happening. After a while you may notice some little improvement, then a while later another, eventually another. All those little improvements add up. I really agree with the neurologist. Time is your friend.


I can take her in for another CT scan (which will require more sedation) but I don't know much more that will tell us at this point. And the thought of putting her through another surgery is something I would definitely struggle to get behind after everything she has has already been through. :cry:

I wouldn't want to do another CT either. She's been through a lot, and her family has, too. I think I'd be inclined to just let her rest and try to keep her from doing anything strenuous and give it time. Does she have a solid scratching post in her room where she's confined? That might be good to have, in case she wants to use it to carefully stretch her back. I'd probably trust her to use her judgment. I'm thinking it might help her rehab herself, just an idea.
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critters
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Re: Hind leg neuropathy/knuckling in cat-need advice (complicated case)

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Cats typically like to do stuff themselves, even in a different way, so a cat tree is a good idea to consider, I think.
Sienna's mom
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Re: Hind leg neuropathy/knuckling in cat-need advice (complicated case)

Post by Sienna's mom »

Thank you. It's very hard seeing her limp but it's reassuring to know that just because we aren't seeing major improvements each week, that this is normal. I'm trying to stay positive. I also think that because she has been confined for so long (the room is quite large; she just can't jump or use the stairs) that she's lost a lot of muscle and this is impacting how she walks as well. I can see it. Hopefully, with supervision and time, we can start to increase her activity.

She had big cat tree that we threw out when she had her surgery. It had seen better days and she also liked to jump on it and climb to the top. The neurologist asked us remove any toys and all scratching posts but I will consider reintroducing the smaller one to see what she does. I think it has been more than enough time now.
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CarolC
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Re: Hind leg neuropathy/knuckling in cat-need advice (complicated case)

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Sienna's mom wrote: Thu May 26, 2022 10:31 am I also think that because she has been confined for so long (the room is quite large; she just can't jump or use the stairs) that she's lost a lot of muscle and this is impacting how she walks as well. I can see it. Hopefully, with supervision and time, we can start to increase her activity.
It may sound surprising, but they do hydrotherapy for cats. You automatically think, "Cats hate water", but surprisingly not all of them do. Hydrotherapy is a gentle way to exercise without having to bear full weight, and without needing good balance. Here are examples.

viewtopic.php?p=103300#p103300

I suppose she is sleeping a lot, and there is no place to go in the room other than back and forth to the water bowl or litter box or a sunny spot on the floor.

I do know there have been several reports of cats with rear amputations (not exactly the same as a nerve issue) here who had a real learning curve trying to figure out how to walk afterwards. They would flop or walk backwards. The title of one of the posts was "Flip Flopping on 3 legs". You don't generally see that with dogs. Maybe it's because dogs have stiffer backs?

So having one weak leg for the moment may really be throwing her off her game. I should hasten to say that all the cats with amputations that never had any trouble walking simply wouldn't get posted here, because they have no issue, so seeing a few with problems should not reflect on the majority. But seeing the difficulty some of them have at first, I think I'd be pleased she is managing at this stage, however it looks. Here are some examples.

viewtopic.php?p=106425#p106425

There was also the wonderful story of Susiecat. Again, it's a rear amputation, not exactly what you are dealing with, but Susiecat was 15 when she had it. She had a hard time for a couple of weeks, especially using the litterbox. Here is a post where she was finally able to do it.

viewtopic.php?f=10&t=2591

I know your kitty is using the box OK. It almost makes me wonder if she has a little use of the left leg? If you think she would do better with a low entry litter box, I've got one I could send you (free present for your kitty, let me know).

Here are examples of boxes that are easier to get into, not such a big step to climb in.

viewtopic.php?f=5&t=20875

I don't know any timeline for your cat, but Critters had a cat with a nerve injury in the front leg, and it took several months. Here are 2 posts by Critters about her kitty.
https://handicappedpet.net/helppets/viewtopic.php?p=101778#p101778 wrote: I had a little girl with radial (arm) nerve damage from being hit by a car, and she got better in several months.
https://handicappedpet.net/helppets/viewtopic.php?p=98976#p98976 wrote: My Tristalyn was hit by a car and had radial nerve (arm) damage, but I wouldn't let them amputate. Months later she still had her arm, and it was totally normal!
:angel:
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critters
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Re: Hind leg neuropathy/knuckling in cat-need advice (complicated case)

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I didn't think about hydrotherapy, but it's worth a shot. None of mine have ever been very accepting of it, but I made Baby, who had a triple dose of cerebral palsy (cerebellar hypoplasia) do it once in awhile.
Sienna's mom
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Re: Hind leg neuropathy/knuckling in cat-need advice (complicated case)

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CarolC wrote: Fri May 27, 2022 11:31 am It may sound surprising, but they do hydrotherapy for cats. You automatically think, "Cats hate water", but surprisingly not all of them do. Hydrotherapy is a gentle way to exercise without having to bear full weight, and without needing good balance. Here are examples.
The emergency clinic has a rehab facility attached to it that offers hydrotherapy. I mentioned it to the neurologist after she had surgery and he didn't seem to think she would be to keen on doing it but it's definitely worth looking into at this point.
CarolC wrote: Fri May 27, 2022 11:31 am I know your kitty is using the box OK. It almost makes me wonder if she has a little use of the left leg? If you think she would do better with a low entry litter box, I've got one I could send you (free present for your kitty, let me know).
Thank you for the offer; you're too kind. :) We did purchase a low entry litter box after Sienna's surgery (although the ones in the pictures you sent seem lower) and although she may stumble every now and then, she is able to get in and out of it on her own. Once she's in, we notice her knuckling at times. She does have some use of that leg but the the limp is obvious and she doesn't want to put much weight on it. For example, when she's eating, you can tell her weight in the back end is mainly on the right leg as she's lifting the left leg ever so slightly off the ground. She has feeling in her toes, but it is minimal.
CarolC wrote: Fri May 27, 2022 11:31 am I don't know any timeline for your cat, but Critters had a cat with a nerve injury in the front leg, and it took several months. Here are 2 posts by Critters about her kitty.
This gives me hope.

After her surgery, the neurologist said that she could start doing stairs etc. again. This was roughly 6 weeks after the procedure was done and she was walking really well; almost back to normal. I'm wondering if I should I allow that again or continue to keep her confined? I feel like she's in the same place as she was before she had the procedure done, so allowing that kind of activity may cause things to flare up even more. On the other hand, I worry about muscle wasting at this point which could be contributing to her limp.
Sienna's mom
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Re: Hind leg neuropathy/knuckling in cat-need advice (complicated case)

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critters wrote: Sat May 28, 2022 8:04 am I didn't think about hydrotherapy, but it's worth a shot. None of mine have ever been very accepting of it, but I made Baby, who had a triple dose of cerebral palsy (cerebellar hypoplasia) do it once in awhile.
Did you take Baby anywhere or did you do it at home?
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Re: Hind leg neuropathy/knuckling in cat-need advice (complicated case)

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I am not a vet and not a rehab therapist. My best recommendation would be to check with the rehab place if you can afford professional rehab and if your schedule allows you to take her for rehab. There's so much that is not clear here, and I hope a rehab therapist can see what's really going on. When you say she is keeping her foot off the ground, I don't know if that means she has some discomfort, which a therapist could identify, or it's the beginning of a contracture, which a therapist would catch right away, or even something else.

Hydrotherapy is not the only modality available. For example there is cold laser, which is good for pain, and e-stim, which helps with nerve recovery. Nothing is required of the pet for either therapy except to just lie still. No exercises or weight bearing. Swimming would also be non-weight bearing. The underwater treadmill involves bearing some weight, but how much depends on the height of the water, and it's less than walking.

After a possible unknown mishap at the vet (when they sedated her and she came home limping) I was feeling cautious about recommending she be taken somewhere else and handled again, but that is a judgment call you can make when you decide how you feel about the rehab therapist and staff in that department. If I were in your shoes, at this point I'd been feeling overprotective and they'd have to assure me they can work with a sweet senior cat at her pace (but that's just me).

My experience with hydrotherapy is with 2 dogs. The sessions start out short. The first few times you go the pet is only in the water for a few minutes. You may even wonder if it was worth the trip. But they build up gradually as the pet gets used to it, to avoid stressing the pet. Hydrotherapy would let her preserve some muscle mass and overall conditioning without having to bear weight, when it sounds like she doesn't want to.

I don't know about your rehab clinic, but a lot of places have appointments where you can pay per appointment, or you can pay for a package which is a set number of appointments, and it is more affordable. The first appointment will likely cost more as it takes longer and they evaluate the pet.

I tried 5 sesssions of acupuncture with my newest paralyzed dog. I could not tell whether it was doing anything or not, so we quit. I ended up feeling about 55% maybe it helped a little and 45% it didn't help. The acupuncture vet wanted to add herbs and said my dog wouldn't get the full benefit without them, and I declined supplements because he has a swallowing problem. We were doing it for recovery from quadriplegia, not pain. There may be better results when used as a pain treatment.

You were talking about whether to let her loose in the house. That's another judgment call and I'm not sure there is a definite right answer. It seems like if she isn't wanting to bear weight on that leg, then she might be better off resting. Muscle does come back when the nerves improve, which can take time, but that is referring to the affected limb or limbs, whereas you are concerned about overall deconditioning, and I don't know the answer. If it's a disk problem she'd do better resting. If it's arthritis then she's better to keep moving, with low impact exercise. If it is arthritis, the heating pad might be worth a try. She will know whether it feels good to her or not. Heat is good for arthritis. It helped my Betsy loosen up and do her grooming.

When the neurologist said she could do stairs again, the way I understand it, that was based on the assessment at the time that she was doing well. It seems like something has happened in the interim, and that advice might not apply now. Maybe you could get a recheck with the neurologist and see if it still holds. That would be another idea. Discuss what's going on, tell him she was doing better, you don't know what happened, and you're looking for any positive steps you can take to help her recovery. If appropriate, ask for a referral to try rehab. If he says again, "She may not like it," a good reply might be, "What can it hurt?" That is advice someone gave me once, and it was priceless.

EDIT TO ADD: The oncologist might need to approve e-stim or cold laser, I'm not sure.
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Re: Hind leg neuropathy/knuckling in cat-need advice (complicated case)

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You actually don't necessarily need anything fancy; you could try using a bathtub or the like for hydrotherapy. In fact, I'd try that first so you don't waste a lot of money if she refuses to do it.
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Re: Hind leg neuropathy/knuckling in cat-need advice (complicated case)

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We had to make the gut wrenching decision of putting Sienna down yesterday evening. I felt the limp was getting worse and could not stand to give it any more time, so we brought her back to the emergency clinic. The neurologist didn't feel there was much of a difference since the last time he examined her but agreed to do another CT scan. Although she was considered to be in remission, the CT scan and MRI revealed a new mass that was affecting her sciatic nerve. It was an incredibly hard decision but I could not put her through any more treatment in the hopes of another miracle. I loved her too much. She fought a hard battle and it was time for her to rest.

I felt the urge to let you know what happened since you were so kind in trying to help me navigate through this frustrating and heart wrenching situation. I am completely gutted and I feel lost without her. She truly was special and we shared an irreplaceable bond that I will hold dear to my heart forever.
Last edited by Sienna's mom on Fri Jun 03, 2022 10:37 am, edited 1 time in total.
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CarolC
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Re: Hind leg neuropathy/knuckling in cat-need advice (complicated case)

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Oh, no... :cry: I am so sorry. You did everything possible for her, and this was not what anyone would have hoped. Sometimes we are left with no good options in spite of every best effort, and I am sorry that was the situation you were left in. You knew her better than anybody, and you had a sense that something might be going on, and then after all that, someone finally figured it out. :(

I have been in the position where I did everything possible for my kitty and it still didn't work out. You're left with the loss, and wondering if you should have done something differently, or even done nothing at all. I look at the unpleasantness of surgery and treatment for my kitty, and the amount spent, and the disconnect with specialists at times, and the extra pain I was left with, only to have it end the same as if I had done nothing. It doesn't seem fair. But I always come back to, how could you not try, when it might have worked? We do the best we can with what we know at the time. Then you are left to wonder how much to trust doctors or medicine, after this. I try to tell myself that my cat had many years of good health and happiness, and technically only a month of illness and unpleasantness at the end, but it doesn't seem to sink in, because nothing less than a perfect life would be good enough for the pets we love.

You have my deepest condolences. I wish it had turned out differently. Sometimes we do everything right, but it's just out of our hands. I'm so very sorry...
:candle:
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critters
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Re: Hind leg neuropathy/knuckling in cat-need advice (complicated case)

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Aww, I'm sorry. I'd hoped she'd do well! :cry:
Sienna's mom
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Re: Hind leg neuropathy/knuckling in cat-need advice (complicated case)

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CarolC,

I'm reading this with tears streaming down my face. :( Thank you so much for taking the time to write such a thoughtful and kind message. It really means a lot to me. You were able to put into words everything that I am feeling. And I know that it unfortunately, comes with your own personal experience with overwhelming loss.

I have been here before and navigating through those losses was incredibly difficult. But this time, the pain seems to cut a little deeper. Not only because she was so special, but for all the reasons you listed above. My heart is absolutely broken right now but I'm hoping the memories I have of her will help piece it back together in time.

Take care and thank you again.
Sienna's mom
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Re: Hind leg neuropathy/knuckling in cat-need advice (complicated case)

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critters wrote: Fri Jun 03, 2022 6:36 am Aww, I'm sorry. I'd hoped she'd do well! :cry:
Thank you. Me too :(
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