Geriatric, crippled and coping

Edward at 18, taking over the bed.

Edward was born in 1995. On Friday afternoon in September 2001, Edward was hit by a car on a West Vancouver side street. He was brought to a veterinary clinic in West Vancouver by a good samaritan. I was the veterinarian on duty, and it was just after 5pm, into the last hour of my shift. Edward was stunned, in shock, and also very handsome. Radiographs showed a very bad complex fracture of his right front leg. His owners did come in, and wanted to try save his leg, so he was transferred to the emergency clinic for ongoing care until a board-certified surgeon could be found to comment. He spent the weekend on heavy duty pain drugs, including a ketamine CRI. Monday a surgeon deemed his fracture unfixable, and amputation was recommended. The thought of managing a three-legged cat was hard to his owners, and they signed Edward over to me. With help and guidance of another veterinarian, I amputated Edward’s leg, including his shoulder blade. The next day, he came home – a new home, filled with cats, and feeling vulnerable and painful. Our pain management learning curve on amputees and what happens to them over a lifetime began.

On day three he was intensely grumpy but trying to jump. His back muscles were stiff and sore for the next few weeks, as he adapted his posture and walking to the single front leg. As a young cat (6), he healed and adapted rapidly. But he always snapped if I inadvertently touched his surgery site, and his back was often stiff and sore. Although he could do leaps up high, getting down was a problem, so we provided downward routes he could manage from his favorite spots.
Into his teens, he started experiencing severe back spasm and pain. His entire back eventually fused into one stiff inflexible system, and although the bouts of severe pain ended, there are still days when he really seems to ache.
I think his sensitvity to touching his amp site has lessened, and I no longer appreciate phantom pain in him. As a geriatric cat, now with no teeth, deaf, and having gone through radioiodine therapy for hyperthyroidism, and now dealing with progressive kidney disease, his absolute favourite thing is the memory foam bed.
Cats are more secure at about the height of a bed. Edward has steps that allow him access to different heights. He also has a secure padded downfilled grass basket in the closet, and he loves to sleep in boxes, again very well padded. He has heating pads, raised food dishes and several water bowls with the water level at just the right height. His litterboxes are open, low and big.
Many cats are amputees. They achieve a great quality of life, adapt to their disability with grace and aplomb, and age as any other cat. The difference is in the phantom pain, the sense of vulnerability some cats have to deal with (after all, if you were a street-fighter before, you stay a street-fighter), and the painful severity of the joint changes these cats experience early on in their ageing process.
Proactive and ongoing pain management makes a huge difference, from day of injury (before surgery) right through the entire lifetime. Simple lifestyle changes can make the most difference, especially in an older cat. As for drugs, be prepared to use acute pain management drugs as well as chronic pain management drugs. Each cat is different, and so there is no one recipe that fits all cats – I had to get to know the character, and then close observation with paying attention to details helps me decide when he is painful, and where. Edward has some mild cognitive dysfunction now, and we found one of the drugs made this worse. Since withdrawing that, he has been much more stable. Edward’s demonstration of pain or hunger is to get grumpy. I actively feed him through the night, on his memory foam bed. If I find him howling or stalking another cat, I will distract him with food.
He is well beyond the stage of metacam, and throughout the time I have known him, metacam was absolutely inadequate in providing pain relief. Opioids on demand have been his mainstay. I saw little response to amantidine or gabapentin (conversely, some of my patients cannot live without these); and understandably, since cartilage problems are not the cause of his joint pain, glucosamine did not appear to have effect. He still likes his glucosamine treats, but then he loves pill-pockets, Temptations and Greenies. Not a great one for stinky fish oil supplements, he will lap on the fluid in a can of salmon.
The dose of the drug varies according to the pain level – and chronic pain is never the same day to day and within the day itself. Being aware of the neuropathic effect of pain, and what will intensify it, and what seems to level it out, helps. Cats have imagination (so can anticipate pain), memory (so can remember and associate pain with space, time, smell, sight, sound, taste, touch and person), and emotion. Paying attention to the details, removing pain triggers, and redirecting emotions make a big difference.
Giving oral medication by opening the mouth and popping a tablet can cause pain in older cats. Explore other delivery options, and always be willing to adapt your technique to the cat. Forcing Edward’s head back, and his body into an unbalanced insecure position is not an option. He gets his meds as transdermal formulations (and yes, they DO work, in cats and humans!), hidden in treats, or given with his daily subcutaneous fluids.
Medicating him is on a routine, predictable and takes under five minutes. There is no fight. If he objects, is unwilling, we do not battle him down. We think and find a gentle, easy way. Some days are very different from others, and with cats like Edward, who are old, with limited mobility, and dealing with many concurrent conditions, no currently acceptable published veterinary standard and approach applies.
Providing quality of life to our older and disabled cats is possible. Caring for cats like Edward makes us think about it.

(Edward is still with us – 19 years old now)