Case Report: Cessna - His tail's not all it's cracked up to be...

Cessna

This handsome 8 year old came to see us for the first time in May, this year, with a particular tale to tell. His owners had found him on April 18^th, with an injured tail and a trail of blood through the house, leading back to their daughter’s bedroom and under her bed, where he loved to sleep. His owners had no idea what could have happened to his tail.

Cessna's damaged tail bone

They rushed him to a veterinary hospital on emergency basis and they repaired the injury by amputating the injured tip of his tail. About a month later, he returned to the hospital, having traumatized it again. He had been wearing an Elizabethan collar all the time and still managed to injure himself.  In addition, he was hiding, no longer social and good natured. It was recommended that the rest of his tail be amputated. Cessna’s family was uncertain that was what they wanted to do, so they brought him to Exclusively Cats Veterinary Hospital for a second opinion.



On May 24^th, there was no sign of infection, and the tail tip seemed to be healing well, so we re-bandaged it and attempted to manage his apparent chronic pain with a prescription for Tramadol. At this visit (and previously, at the other veterinary hospital), Cessna was notably quite grumpy and intolerant of much handling.

Cessna's new, short tail

Cessna’s hind end was very sensitive and his owners were not able to look at his tail at home, and was also very difficult to medicate. On May 30th he managed to remove his bandage and get at his tail, again. On June 16^th, Cessna’s family found a tick on him and wanted to have us look at him. He had been doing well on the Tramadol, but still seemed bothered by his tail. At least, however, he was not attacking it anymore. On the ride into the hospital, he started attacking his tail again, and urinated and defecated on himself. His family was distraught because they felt that he was miserable and could not live with this issue. They wondered if he needed his entire tail amputated. We took x-rays of the tip of his tail, and it appeared that due to his attacks, he had either exposed a sliver of bone, or some nerve tissue or tendons. At this time, his owners opted to pursue another tail amputation, and another 2 inches of tail needed to be removed. The concern about amputating completely was that if the entire tail was removed and he was still painful, he might start attacking his hindquarters and cause irreparable damage to himself. We applied a pain patch, gave him a mild sedative, an epidural, and a cocktail of other pain medications. He recovered from surgery well, and we sent him home on phenobarbital for pain control, sedation, and suppression of hyperesthesia-like symptoms.

Abnormal bone-like material in one of the tail joints

He went home again, but went into hiding. He started attacking his tail again on the 18^th. His appetite decreased and started trying to bite his mom when she medicated him. He hid under the bed and defecated on himself when his family members tried to get him out from under the bed.

Cessna was a little embarrassed by his Thundershirt, at first...

His family was beginning to lose hope. Cessna was miserable, and they wondered if it wouldn’t be kinder to euthanize him. He was no longer the loving cat they had known, and he seemed to be in constant pain and distress for no known reason. We examined his tail again and reviewed the x-rays from the previous hosptal and discovered an abnormal joint much closer to the base of the tail that did not flex as nicely as the rest. We x-rayed the area and discovered a very small round mineralized object located in the joint space between two tail vertebrae. This is likely abnormal bony growth due to arthritis. Because it is located between two vertebrae, it likely sends shooting pain down the length of the spine whenever he moves his tail. Since the pain was radiating down the length of the tail, Cessna was attacking the part of his tail that he could easily reach, and not the area that was causing the pain.



We amputated the tail behind the affected joint, leaving about 3-4 inches of tail for him to wave, and crossed our fingers. He received another pain patch, a local nerve block and was started on a medication regimen of gabapentin for neuropathic pain, phenobarbital again, and Onsior for inflammation. In addition, Cessna started wearing a Thundershirt. He stayed with us at the hospital for 18 days as we balanced his pain medications – little enough that he could walk around, eat, and use the litterbox, but enough that he would ignore his tail. Over the time that he was here, he grew continually more affectionate and well-mannered. He began asking for attention, rather than hiding. He was allowed some exercise time to sit in the office with the doctors while they worked on paperwork, and he sat on the cat tree with Mr. A.

Cessna became more outgoing after a while

At first, the Thundershirt was hard for him, because he wanted to curl up in a ball and not move with it on, but by the time he was discharged, he was jumping up into laps for cuddle time. Our entire staff enjoyed his antics as he became more adventurous and learned how to steal tuna fish from Dr. Demos, or snuck through the door to visit the receptionists. On July 6 ^th, we took his sutures out and for the rest of the morning, he was angry at his tail again, so we gave him an injection of Simbadol, which is a long-acting pain medication. We suspect that his tail was a little painful again, because we meddled with the tail and scrubbed it to clean the incision area.



On July 7, he went home to his family, and the purrs that rumbled out of his chest were so loud they could be heard across the room! We are hoping that he continues to improve over the next few weeks so that we can stop his medications and continue with just the Thundershirt. We’ll have him wear the Thundershirt for another couple weeks after that before we have his family try to take it off. At that time, we hope that his life can get back to normal – his long tale cut short for good reason!

Environmental enrichment (tuna in a cup) becomes Cessna's preferred method of keeping his tail safe

Feline Arthritis Part 2: 7 Things That You Can Do at Home to Help

Arthritis changes to an elbow joint

 How exactly do you diagnose your cat with arthritis? Your veterinarian may feel differences between the joints on one side of the body versus the other, or may feel abnormalities within the joints. The cat may display the same signs that you are witnessing at home, or adrenaline may take over and mask the problem. Patience and a calm, cat-friendly environment may allow the cat to relax and allow us to see the problem or, if not, our doctors have a few tricks up their sleeves to investigate further. However, the most effective diagnostic tool for arthritis is often an x-ray. Usually two views of the limbs are taken and analyzed for narrowing in the joint space, thickening of the bone, or formation of new, irregular bony projections in or around the affected joint. It doesn't matter whether there are many joints that are affected or just one - arthritis changes to the bones means pain with movement - a lack of joint cushioning so that bone grinds on bone. Ouch!

One arthritic pair of vertebrae in the lumbar spine

Multiple thoracic (upper back) vertebrae with arthritis changes

In our previous post about feline arthritis, we discussed medical treatments that are available for cats with arthritis to help rebuild and protect joints and decrease pain. However, there are things that you can do at home to help your arthritic cat, as well. Most of the home care options include environmental changes.

1. Make or buy pet stairs to allow your cat access to favorite spots in the house like beds or couches. This can be as simple as moving a footstool next to a favorite armchair to make one big jump into a set of small jumps.
   
   
2. Make sure that you have a litterbox on every level of your house so that your cat does not have to go far or up and down a lot of stairs to visit one. This will prevent inappropriate urination or defecation around the house. If it is too much work to get to the litterbox, you can bet that many cats will make their own box somewhere else. Also make sure that the edges of the box are not too high, so that it is easy for your elderly cat to get in and out of the box. It may be a good idea to cut down the side of the litterbox a little to help them out. 
3. Providing extra soft beds at floor level, or even heated beds will help your cat rest more peacefully and wake with less soreness. 

   

   Thickened toenail that is traumatizing a toe pad.

4. Make sure that food and water are easily accessible, not up high on a counter, and possibly elevated a little for cats with cervical (neck) pain. 
5. Cats with arthritis may need extra grooming assistance, and should have their claws checked and trimmed frequently. If they are wearing their nails unevenly, a nail could get caught and torn, or could grow into a toe pad and become painful and infected.
6. Weight control. Another change that helps arthritic cats is to make sure that they are not carrying around a lot of extra weight. Extra pounds put extra pressure on already complaining joints, so put your pudgy oldster on a diet to ease the burden on his aching joints. Work with your veterinarian to determine a good weight loss plan – you don’t want your cat to crash-diet, because that can cause other health problems.   
7. Getting your cat up and moving more can help with weight loss and flexibility. With adequate pain control, your cat should show a renewed interest in play, and you should use that to your advantage. For cats with a reluctance to play, you may try offering meals in a food ball, such as the Eggcercizer, which you can find in our office. Ask our hospital kitties for a demonstration!