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Please help, advice needed - cat with paralysis

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.
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Niloda
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Please help, advice needed - cat with paralysis

Post by Niloda » Sun Jun 28, 2020 8:41 pm

Hi,

I would very much appreciate any advice on the care for my recently paralysed cat, Summer. The problem started about 4 weeks ago with some lameness/wobbly walking for 1 week, and then total rear leg paralysis 3 weeks ago. As soon as we noticed the lameness we visited a neurologist who advised an MRI to be able to diagnose exactly what was going on but suspected some sort of disc problem or tumour pressing on the spine. They were reluctant to recommend the MRI because Summer is 18 and does have some other health issues (kidney disease and heart murmur - although both well controlled). We were given three options: 1. Try pain relief and rest and see if it resolved itself; 2. Steroids (which is risky with an existing heart issue); 3. MRI with possible subsequent surgery. We went with option 1, but it quickly became clear that wasn't working when she became unable to use her rear legs at all. I spoke with the nuerologist again, and the anesthetist, who were both very pessimistic about the chance of surviving even just doing the MRI, and said even if they did manage to get through an MRI and then surgery, it was very unlikely she would recover the use of her legs.

After an agonising couple of days trying to make a decision, we decided not to go the MRI route, and try and find another way of coping (or at least make the most of the time we have left). That was 2 weeks ago, and since then we started cold laser therapy and I've been trying to do some physiotherapy exercises with her. Unexpectedly, there have been small improvements in her leg movements, but I don't know if they really mean anything in terms of overall prognosis. She now responds when I flex her back feet by grabbing on with her claws, but if I pinch her toes there is still no reaction. She moves her tail if I pinch it, but otherwise doesn't move it (I've seen a flick a few times, but nothing consistent). She very occasionally stretches her back legs out, or has what appears to be an involuntary movement of her leg moving rigidly (when lying). However, when 'walking' (I support her rear end) she doesn't try to move her rear legs at all.

I guess my questions are:
1. Do any of the changes I've seen mean anything? I've read that reflexes can occur but that it's pain perception that makes the difference to recovery. Is it likely pain perception would improve after this kind of time frame?
2. If there is any hope, is there anything else I can do? I've thought about acupuncture but with the Covid-19 situation the vets who offer than in my area are not able to at the moment.
3. If there isn't any chance of recovery, is there anything I can do to provide better care for her? I've tried to create a 'walker' for her, but she isn't really keen on using it. I'm concered she needs to keep her front leg strength up too.

I should say, all throughout Summer is generally happy and eating and drinking well, and she doesn't appear to be in any pain. I know my vet thinks I'm insane and should have her put to sleep but I just can't give up on her when I can see she still wants to keep going. As well as the fact her life really hasn't changed that much (she's always been a Garfield-type cat!), I just have to help her around now, which I can do since I work from home and I'm with her 24/7 anyway.

Many thanks for reading this and I would be very grateful for any advice,
Niloda

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CarolC
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Re: Please help, advice needed - cat with paralysis

Post by CarolC » Mon Jun 29, 2020 10:33 am

Hi Niloda,

I have never had a paralyzed cat. I've had 2 paralyzed small dogs and a paralyzed rabbit. Someone with cat experience will be along soon so please keep checking back. Will reply in blue below...


:group:
Niloda wrote:
Sun Jun 28, 2020 8:41 pm
Hi,

I would very much appreciate any advice on the care for my recently paralysed cat, Summer. The problem started about 4 weeks ago with some lameness/wobbly walking for 1 week, and then total rear leg paralysis 3 weeks ago. As soon as we noticed the lameness we visited a neurologist who advised an MRI to be able to diagnose exactly what was going on but suspected some sort of disc problem or tumour pressing on the spine. They were reluctant to recommend the MRI because Summer is 18 and does have some other health issues (kidney disease and heart murmur - although both well controlled). We were given three options: 1. Try pain relief and rest and see if it resolved itself; 2. Steroids (which is risky with an existing heart issue); 3. MRI with possible subsequent surgery. We went with option 1, but it quickly became clear that wasn't working when she became unable to use her rear legs at all. I spoke with the nuerologist again, and the anesthetist, who were both very pessimistic about the chance of surviving even just doing the MRI, and said even if they did manage to get through an MRI and then surgery, it was very unlikely she would recover the use of her legs.

After an agonising couple of days trying to make a decision, we decided not to go the MRI route, I would not do anesthesia on an 18-yo cat either. and try and find another way of coping (or at least make the most of the time we have left). That was 2 weeks ago, and since then we started cold laser therapy this sounds like a good idea and I've been trying to do some physiotherapy exercises with her. Unexpectedly, there have been small improvements in her leg movements, but I don't know if they really mean anything in terms of overall prognosis. She now responds when I flex her back feet by grabbing on with her claws, but if I pinch her toes there is still no reaction. She moves her tail if I pinch it, but otherwise doesn't move it (I've seen a flick a few times, but nothing consistent). She very occasionally stretches her back legs out, or has what appears to be an involuntary movement of her leg moving rigidly (when lying). However, when 'walking' (I support her rear end) she doesn't try to move her rear legs at all.

I guess my questions are:
1. Do any of the changes I've seen mean anything? I've read that reflexes can occur but that it's pain perception that makes the difference to recovery. Is it likely pain perception would improve after this kind of time frame? I have no experience with this in cats, but in dogs deep pain perception can return weeks or months later, even over a year.
2. If there is any hope, is there anything else I can do? I've thought about acupuncture but with the Covid-19 situation the vets who offer than in my area are not able to at the moment.
3. If there isn't any chance of recovery, is there anything I can do to provide better care for her? I've tried to create a 'walker' for her, but she isn't really keen on using it. I'm concered she needs to keep her front leg strength up too. Does she attempt to drag herself? If she does, that will be exercise for her front legs. I would keep an eye on her hips and legs, because some pets will develop rug burns or sores if they drag a lot. This is also an issue if the hindquarters are thin due to loss of muscle mass or old age, where the hip bones stick out more and there isn't as much padding on the hindquarters. Also, the skin on elderly cats is fragile.

I should say, all throughout Summer is generally happy and eating and drinking well, and she doesn't appear to be in any pain. This is great! I know my vet thinks I'm insane and should have her put to sleep but I just can't give up on her when I can see she still wants to keep going. As well as the fact her life really hasn't changed that much (she's always been a Garfield-type cat!), I just have to help her around now, which I can do since I work from home and I'm with her 24/7 anyway. That's good!

Many thanks for reading this and I would be very grateful for any advice,

My personal feeling would be to just keep her comfortable. As long as she is happy, that is what matters, I would not try anything too strenuous with PT because of her age and heart condition. If she is not grooming, she may need extra help grooming. It is obvious to groom the fur, but I never thought about feet. My very senior cat quit cleaning her paws and had to have her paws cleaned with cotton pads and cleanser every 3 or 4 weeks. They get a build-up of secretions in between the paw pads that needs to be removed if they are not licking them. (My vet called it toe goo.)

It will be important that she continues to drink enough if she is less mobile now. If you start to notice dehydration, you can administer sub-Q fluids at home. The vet can give you the equipment and instructions on how much is safe to give her considering she has a heart condition, it is easy to do. You can monitor her hydration by pulling up the skin over her shoulders. It should snap back into place is she is not dehydrated. If it stays tented up, she is dehydrated. In my experience, you can also notice a kind of hollow eyed look if they begin to get dehydrated. There are videos on youtube showing how to do the skin test. I once heard that being dehydrated can cause a headache, so giving fluids makes them feel much better.

You did not mention whether she is toileting OK. When pets have rear end paralysis, they usually lose control of their bladder and bowel, and may need manual expressing or diapering (or both). If you need any information or videos on this, do not hesitate to ask! She needs to be fully emptying her bladder every 8 hours to avoid infection or crystals/stones. Also, constipation is something to watch for and treat promptly. Here is a wonderful video about a cat named Pookie.



Niloda

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critters
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Re: Please help, advice needed - cat with paralysis

Post by critters » Mon Jun 29, 2020 11:57 am

:whale:

Hmm. My first thought was to use prednisone, but I don't know anything about it in relation to her heart. Is she taking an NSAID? That might be almost as good. I, too, would be highly reluctant to mess with such a fragile old girl.

It's not unusual for movement to be inconsistent, especially at first. It tends to become more predictable as time passes. Any movement is good, if you ask me.

You might consider hydrotherapy (swimming) if you don't think it would upset her too much. Of course, I'm well aware that most cats go ape when it comes to water! Some, however, tolerate it fairly well. I've never personally had a cat who LOVED water. :haha:

Niloda
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Re: Please help, advice needed - cat with paralysis

Post by Niloda » Mon Jun 29, 2020 12:03 pm

Hi Carol,

Thank you for the welcome and for your reply - I'm so pleased I found this group. :thankyou:

Summer doesn't try to drag herself very much. She did in the first couple of days but either she lost strength to do it, or she realised I was always there to help, or both!

I hadn't thought about grooming feet either, I'll keep an eye on that. She is grooming the rest of herself but don't think she would reach her back feet now.

We do SubQ fluids for her kidney disease so I think she's staying hydrated for now. We did increase it a little bit because we've started giving her laxatives as she was really constipated (over a week without BMs!), which I should have mentioned before. About 10 days ago she lost bladder/bowel control, no leaking, she just doesn't empty her bladder herself, so we have been manually expressing it. I wasn't sure if we were doing it too often or not often enough so I am pleased around 8 hours is ok - it's usually 3-4 times a day. She's had two BMs in the past week (she was never particularly regular, but this is worse) but it's not voluntary, I don't think. A bit like Pookie in the video I guess (great video!!).

I had resigned myself to thinking the only thing we could do is make sure she's happy and not in pain, but then she started to improve a little and I don't know if that means anything, and whether I could be doing more. Just clutching at straws hoping it is something like an infection or injury that will get better over time. Although, unfortunately I don't think it could be an infection because she's been on antibiotics (clavaseptin) for the past 5 weeks now due to a UTI that was diagnosed a couple of weeks before any of the walking issues started. She's had blood work and urinalysis done, and apart from blood in her urine nothing looks too unusual. It's the not knowing that is really frustrating too.

Thanks again - much appreciated!

Niloda
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Re: Please help, advice needed - cat with paralysis

Post by Niloda » Mon Jun 29, 2020 12:17 pm

critters wrote:
Mon Jun 29, 2020 11:57 am
:whale:

Hmm. My first thought was to use prednisone, but I don't know anything about it in relation to her heart. Is she taking an NSAID? That might be almost as good. I, too, would be highly reluctant to mess with such a fragile old girl.

It's not unusual for movement to be inconsistent, especially at first. It tends to become more predictable as time passes. Any movement is good, if you ask me.

You might consider hydrotherapy (swimming) if you don't think it would upset her too much. Of course, I'm well aware that most cats go ape when it comes to water! Some, however, tolerate it fairly well. I've never personally had a cat who LOVED water. :haha:
Thank you for the welcome!!

I read a lot about pred - we got some from the vet but I decided against it in the end as it seems possible it can cause heart failure and didn't want to invite any new problems to the mix. The same with NSAIDs, she can't take them because of her kidney disease. Her CKD is really well managed, and the heart murmur has never bothered her (really low grade, hasn't changed for years), so I feel that puts her in a better position, but it is a more difficult balancing act.

We did have buprenorphine for a week or two, but stopped that when it didn't seem to do anything (she has never appeared to be in pain anyway). That's when we thought about the laser therapy, which does seem to have a positive effect. The problem with that is if it is a tumour it can cause it to grow quicker.. again, a balancing act! We thought that was worth the risk to try though.

Funnily enough the place we get laser therapy does hydrotherapy but Summer hates water.. I'm not sure she would forgive me! :thinking: :lol:

I'm pretty much obsessed with any movements she makes now. Today she was dreaming and moved her rear legs more than I've seen before (really, not a lot, like 3 or 4 times) but I know I need to be realistic as well. I think hope is a better coping strategy though!

Thanks for your reply!

Niloda
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Re: Please help, advice needed - cat with paralysis

Post by Niloda » Sat Jul 25, 2020 8:58 pm

Just wanted to post a little update in case anyone finds this useful in the future. With a few more questions too!

We have seen changes in the past month (I hesitate to say improvements) where moving her legs are pretty common events now, but still not so much I'm convinced she means it. I am sure she has feeling in her legs at times, but it's definitely not all of the time. There are occasions where I just tickle her foot lightly, and she pulls away, but other times I can squeeze her toes and she doesn't react at all. I don't really know what that means.

We went through a couple of days last week where she was kicking her legs a lot, probably muscle spasms, but that seems to be under control now. I don't really know if that is a good or bad thing. Part of me thought more spasms might be indicative of some communication getting through, and that eventually that might become controlled, but that hasn't happened.

She had started dribbling urine a bit whenever I lifted her etc. (like she did in the first couple of weeks that this started) but that seems to have stopped now. Seems odd to think I was happier when she couldn't hold her urine, but I was hoping the process was reversing in some way, and that was the start of it. She also started to have BMs independently - insomuch as after she had her bladder expressed, she would sometimes have a BM without being assisted in any way. That has also stopped in the last few days too. I feel like we were making progress, but now not so much. I don't know if progress would be linear or more likely there would be ups and downs?

I'm realistic and know she probably won't walk again, but I still want to try and do everything and anything that might help. We're still doing cold laser therapy, I think that is helping. I do some PT with her, but just based on watching videos, including massaging, stretching, and ROM activities. She's good with it, even seems to relax her sometimes (although perhaps a sign she can't feel it :thinking: ). I spoke to the vet about the increased movement, and she suggested I could take her for an examination 'if I wanted' but I don't really see the point since I know they're not going to do anything. I suggested taking her for proper PT at a specialist, and they agreed, but I haven't made the call yet because of the fact we still can't go into the practice due to Covid. I'd really rather be with her so I could try and do some of it myself.

One other thing, her urine has been really strong smelling for a few weeks now. I assumed a UTI but we took a urine sample to the vet and there was no sign of infection apparently. The vet suggested it might be because she isn't urinating as much, but we express her 3-4 times a day, and I think her bladder is empty each time. I'm almost certain she never went that often when she was going herself. Seems odd that it started a week after we stopped antibiotics too. But she is fine otherwise, so no other signs it would be an infection. Any experience of this?

On the bright side, she's eating really well and seems pretty happy, so we're just going to keep going and be thankful for the time we have.

Thanks for reading/listening :thankyou:

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Re: Please help, advice needed - cat with paralysis

Post by critters » Sun Jul 26, 2020 4:58 am

Niloda wrote:
Sat Jul 25, 2020 8:58 pm
Just wanted to post a little update in case anyone finds this useful in the future. With a few more questions too!

We have seen changes in the past month (I hesitate to say improvements) where moving her legs are pretty common events now, but still not so much I'm convinced she means it. I am sure she has feeling in her legs at times, but it's definitely not all of the time. There are occasions where I just tickle her foot lightly, and she pulls away, but other times I can squeeze her toes and she doesn't react at all. I don't really know what that means. In recovery responses aren't necessarily consistent. When it comes to paralysis, I consider ANY movement to be good.

We went through a couple of days last week where she was kicking her legs a lot, probably muscle spasms, but that seems to be under control now. I don't really know if that is a good or bad thing. Part of me thought more spasms might be indicative of some communication getting through, and that eventually that might become controlled, but that hasn't happened.

She had started dribbling urine a bit whenever I lifted her etc. (like she did in the first couple of weeks that this started) but that seems to have stopped now. Seems odd to think I was happier when she couldn't hold her urine, but I was hoping the process was reversing in some way, and that was the start of it. She also started to have BMs independently - insomuch as after she had her bladder expressed, she would sometimes have a BM without being assisted in any way. With Buddy poop and pee usually went together. I can't remember anymore which one came first. That has also stopped in the last few days too. I feel like we were making progress, but now not so much. I don't know if progress would be linear or more likely there would be ups and down.I don't know that it's ever entirely linear anymore than it is with people.

I'm realistic and know she probably won't walk again, but I still want to try and do everything and anything that might help. We're still doing cold laser therapy, I think that is helping. I do some PT with her, but just based on watching videos, including massaging, stretching, and ROM activities. She's good with it, even seems to relax her sometimes (although perhaps a sign she can't feel it :thinking: ). I spoke to the vet about the increased movement, and she suggested I could take her for an examination 'if I wanted' but I don't really see the point since I know they're not going to do anything. I suggested taking her for proper PT at a specialist, and they agreed, but I haven't made the call yet because of the fact we still can't go into the practice due to Covid. I'd really rather be with her so I could try and do some of it myself.

One other thing, her urine has been really strong smelling for a few weeks now. I assumed a UTI but we took a urine sample to the vet and there was no sign of infection apparently. The vet suggested it might be because she isn't urinating as much, but we express her 3-4 times a day, and I think her bladder is empty each time. I'm almost certain she never went that often when she was going herself. Seems odd that it started a week after we stopped antibiotics too. But she is fine otherwise, so no other signs it would be an infection. Any experience of this?Is she drinking enough?

On the bright side, she's eating really well and seems pretty happy, so we're just going to keep going and be thankful for the time we have.Sounds good!

Thanks for reading/listening :thankyou:

Niloda
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Re: Please help, advice needed - cat with paralysis

Post by Niloda » Tue Jul 28, 2020 6:06 pm

Hi critters,

Thanks for your reply. She is drinking a lot, probably more than usual, and she gets sub-q fluids every other day. That was another reason I suspected infection, but they said it came back negative. I just feel like I can't approach the vet anymore since I'm sure they think it's all a waste of time, which is quite frustrating! I will take another sample this week anyway.

We're back to some urine leaking for a couple of days, and today none. Some changes are going on but I can't quite figure it out. Yesterday she headed in the direction of room where the litter tray is for the first time in weeks, she got about 75% of the way there, and decided to turn around. Might not sound like much but it's definitely different!

:thankyou:

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Re: Please help, advice needed - cat with paralysis

Post by CarolC » Wed Jul 29, 2020 12:19 am

Hi Niloda,

It sounds a lot like what this other member described. I recommend clicking the link and reading the rest of it, especially the reply from Jean, this is only a part of it:
https://handicappedpet.net/helppets/viewtopic.php?f=5&t=16353&p=86428#p86428 wrote:her urine had an incredibly strong smell (but not fishy like a UTI). She had a couple of urinalyses with no signs of infection, although we did start her on clavimox the first time just in case. This cleared up the smell and she began urinating in the box, although both returned over time. The vet feels the smell is from her inability to completely empty her bladder (but I think I do a pretty good job when I express her, with no change in smell). Now, after this round of antibiotics, we have similar results--no dribbling in the diaper, and a significant reduction in the odor of her urine.
Here is another one (about a dog but doesn't matter):
https://handicappedpet.net/helppets/viewtopic.php?f=20&t=15349&p=81806#p81806 wrote: I express him as needed, and deal with UTI's as I think he needs. So far I've sent out 2 UA's to the lab, and both came back negative, but we put him on antibiotics anyway because he was more dribbly and his urine had a strong odor, he's much better again now.
Her urine smells strong and the smell started a week after she finished her antibiotic. Also she has CKD so she is more susceptible to UTI. But they could not find anything, but she had blood in her urine a month ago. Did they say what caused it? Blood in the urine is one sign of a UTI, but it can be also be caused by stones/crystals (and probably other things, see below, I am not a vet). Yes, that does sound worth checking again, and if they can't be sure, maybe they will put her back on the antibiotic and see if the smell goes away.

Tanya's is my favorite CKD website, and tonight it is giving 404 errors when you try to click anything, but here is a statement from it:
https://felinecrf.org/diagnosis_urinalysis.htm wrote:Blood in Urine (Haematuria)
This is usually a sign of a urinary tract infection, or bladder or kidney stones. Obtaining a urine sample via cystocentesis (a needle into the bladder) may sometimes cause blood in the urine. Other possible causes include high blood pressure. or, occasionally, cancer.
When you are taking a urine specimen to the vet, I would call them before collecting it and be sure they will have time to check it as soon as you bring it in. Urine left to sit after it is collected will form crystals all by itself, I think it takes about 30 minutes but I'm not sure exactly how long. You might want to note the exact time you collected it and put it on the container with masking tape so they know how fresh it is, then take it straight to the vet and they can check it right away.
Niloda wrote:
Tue Jul 28, 2020 6:06 pm
I just feel like I can't approach the vet anymore since I'm sure they think it's all a waste of time, which is quite frustrating! I will take another sample this week anyway.
It is not helpful when you have a vet who makes you feel like s/he doesn't want to do anything, you are just bothering them. You are trying to get good care for your cat because you noticed there is definitely a strong odor to the urine that was not there before. If you are not getting the help you need and feel unwelcome, I would look for another vet. It might be best to call around to different vets and ask the person who answers the phone if that vet has experience with paralysis and senior kidney issues. Tell them you are looking for a vet who believes in continuing to give excellent care to patients of all ages including seniors.

I hope you can get to the bottom of it.

Niloda
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Re: Please help, advice needed - cat with paralysis

Post by Niloda » Thu Jul 30, 2020 6:19 am

Hi Carol,

Thanks for your thoughts and those links. I have read the posts and they do sound very similar. The vet told me she thought it could be because the bladder isn't fully emptied. I'll make sure I do it more often, and will try the 10 minutes later technique too and see if that makes a difference.

I'm going to take a sample to them tomorrow, and will make sure I get it there quickly. The last sample I took within 30 minutes, but they were so busy with two emergencies that day I have my doubts about when they got around to testing it. I'm not entirely convinced they didn't just report the results of the previous test (unintentionally) because they said it came back with antibiotic markers in it, and we'd stopped the antibiotics 10 days before then. The vet didn't say anything about blood that time, but really I should have asked.

I have thought about looking for another vet, but in the UK it's quite difficult to find a vet who is supportive of giving sub-q fluids (and it took a while to convince them as well), so I think we'll have to stick with them. In some ways they have been good, and perhaps it's my own interpretation/paranoia, which isn't helped by not being able to go into the practice during consultations because of coronavirus.
Not a good time to have poorly pets - not that there ever is!

Fingers crossed we can figure it out.

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Re: Please help, advice needed - cat with paralysis

Post by critters » Fri Jul 31, 2020 1:58 pm

Maybe a sample can last longer if refrigerated? I'd think so.

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