Mobility Problems in a 13-Year-Old Cat
by Dr. Lan Xiao
Abstract
A senior cat with coxofemoral osteoarthritis had very limited mobility and confined herself to one room of the house, spending most of her time under the bed. Her family’s main concerns were the patient’s discomfort and the decline in her quality of life due to these mobility limitations. We treated the patient with gabapentin, acupuncture, and laser therapy. The combined therapeutic approach provided improved comfort, mobility, and social interactions with the family.
History of Present Illness and Chief Complaints
Kayla is a 13-year-old female spayed domestic shorthair cat. Family members reported that for the past two years, Kayla’s mobility has steadily declined. Initially it started with difficulty getting up after lying down for long periods of time, which prompted owner to start glucosamine supplements. About a year ago owner noticed Kayla’s overall gait became very stiff and she stopped using the stairs. Gradually Kayla started to spend more time in just one room of the house, and eventually spent most of her time hiding under the bed. At that time, radiographs were taken and Kayla was diagnosed with osteoarthritis of the coxofemoral joint bilaterally and the lumbosacral junction. Caregivers had tried tramadol initially but it made Kayla restless. Gabapentin was prescribed to help manage her osteoarthritis, at 50 mg twice daily. Kayla’s mobility and overall happiness improved. She became more active and social with the family. However, whenever a dose of gabapentin was missed, or delayed, owner noticed change in her behavior, as she would go hide under the bed again. The caregiver had to increase gabapentin to 75 mg twice daily few months ago, as she was noticing more hiding behavior even with consistent 50 mg twice daily dose.
Physical examination and clinical assessments
Kayla was bright, alert, responsive and well hydrated. She was very nervous but tolerated the exam well. Abnormal exam findings included nuclear sclerosis of eyes, severe dental tartar and gingivitis, and a grade II-III/VI heart murmur grade. She was only willing to take a few steps in the exam room, with very cautious movements. Sacral region was notably kyphotic when standing and ambulating.
Hair coat observation: Overall coat is slightly unkempt. Hairs between shoulder blades and in the thoracolumbar regions in dorsal view appear to be standing up. Hairs lay completely flat against the body around shoulders, sacral to tail region and around the hamstrings. In quadriceps and lateral abdominal regions, the coat appears wavy with hair laying about in different directions, suggestive of uneven tension.
Myofascial evaluation: Ropy bands were present in dorsal cervical region. Warmth noted around cervical and sacral midline, which extends to the hip region on both sides. Triceps were tight bilaterally. Small ropey bands also noted in epaxial muscles at level of 5th and 6th lumbar vertebrae. Hamstring muscle group had significant muscular atrophy bilaterally.
Neurologic assessment: Intact cranial nerves. Intact patellar reflex bilaterally. Normal withdrawal reflex bilaterally. Normal proprioceptive placement of all four limbs.
Laboratory findings
Complete blood cell count panel was unremarkable. Chemistry panel showed glucose of 363 mg/dL, with remainder of values within normal limits. T4 level was 3.4 ug/dL. Urinalysis showed urine specific gravity of 1.045, with 3+ glucose in the urine. CARDIOPET proBNP was 447 pmol/L.
Problem List
- Decreased mobility
- Hyperglycemia with glucosuria
- Heart murmur with elevated proBNP
- Periodontal disease
- Overweight
Differential diagnosis for decreased mobility
- Vascular – ischemic neuropathy, fibrocartilaginous embolism
- Infectious/inflammatory – osteoarthritis, osteomyelitis, tick born polyarthritis
- Neoplastic – CNS lymphoma, osteosarcoma, synovial cell sarcoma, chrondrosarcoma
- Degenerative – osteoarthritis, hip dysplasia
- Iatrogenic/intoxication – disuse atrophy, nutritional osteopathy
- Congenital – hip dysplasia, neuromuscular disease
- Autoimmune – immune-mediated polyarthritis
- Traumatic – injury secondary to rough play or handling
- Endocrine/Metabolic – diabetic neuropathy, hypokalemia, hyperaldosteronism
- Myofascia – compensatory changes secondary to chronic osteoarthritic pain
Differential diagnosis for hyperglycemia with glucosuria
- Vascular – ischemia induced pain
- Infectious/inflammatory – acute pancreatitis, acute sepsis
- Neoplastic – pheochromocytoma, exocrine pancreatic neoplasia
- Degenerative – none
- Iatrogenic/intoxication – stress hyperglycemia, medication administration (corticosteroids, megesterol acetate)
- Congenital – none
- Autoimmune – none
- Traumatic – head trauma
- Endocrine/Metabolic – diabetes mellitus, hyperadrenocorticism, acromegaly
- Myofascia – strain pattern secondary to diabetic neuropathy
Definitive diagnosis
- Decreased mobility: bilateral coxofemoral osteoarthritis, with compensatory myofascial strain pattern in cervical, thoracic limbs, and lumbosacral regions
- Hyperglycemia: fructosamine level can help to further differentiate between diabetes mellitus and stress hyperglycemia. The caregiver declined fructosamine at this time and elected to monitor spot check glucose at home.
Medical decision making
Treatment plan was formulated to with the goal to improve Kayla’s overall mobility and comfort. Kayla is challenging to bring into the clinic. Timing of treatments was based on owner’s travel plans as Kayla boarded in the clinic with us while owners were away. Treatment points were aimed at addressing all abnormal areas noted on myofascial palpation, as well as previous radiographic changes indicating coxofemoral osteoarthritis: cervical, caudal bladder points in the lumbar/sacral region, and the hip triad points. Distal points were attempted as she tolerated, but she preferred to stay in a sternal position with limbs tucked under her for her treatments and resented touching of the distal limbs.
Acupuncture treatments
7/17/21: Seirin 0.12 x 15 mm needles were used initially to see how she would tolerate needling. Kayla is a very nervous girl in the clinic and her stress level can escalade quickly. The first needle placed was GV 14 to see how she reacts to needling, as well as a central point to stimulate cervicothoracic nerve roots. GV 20 was used as a central calming point. BL 25 was selected to treat the ropey bands noted in this area on myofascial palpation. Bai Hui was selected for lumbosacral discomfort. BL 54, GB 29, and GB 30 were selected as the hip triad points to treat coxofemoral osteoarthritis. BL 60 left side was used as an autonomic point, and this was the only limb point she allowed me to access during treatment. She did surprisingly well with acupuncture treatment overall, and enjoyed her gentle massage after the treatment.
7/19/21: Seirin 0.16 x 30 mm needles. GV 20, GV 14, Bai Hui, BL 25, BL 54, GB 29, GB 30. Kalya did not tolerate needling of limb points this time.
Laser therapy (K-Laser) to hips and LS area: 10 J/cm^2, 505 J total, 5000 Hz, Peak power 5 W. Laser was also applied to BL 60 on each side for a few seconds since she didn’t allow needling.
7/21/21: Seirin 0.16 x 30 mm needles. GV 20, GV 14, bai hui, BL 25, BL 54, GB 29, GB 30.
Laser therapy repeated with same parameters.
Outcomes and discussion
After Kayla went home from the clinic on 7/21/21, the caregiver reported that she slept on the bed with the kids that night and seemed comfortable. Typically, when Kayla comes home from a clinic visit for any reason, she hides under the bed for the rest of the day. In the following few days, owner observed Kayla repeatedly went up and down the stairs on her own, which is something she has not done in over a year due to pain. Now, Kayla is more social and interactive with the family, which the kids are very thrilled about. Owner reduced Kayla’s gabapentin dose back down to 50 mg twice daily and did not observe any obvious changes in her mobility. Owner plans to repeat acupuncture treatments for Kayla whenever she comes into the clinic for boarding in the future.
Prior to starting her treatments, I was concerned about how well she would tolerate handling and how she would reactive to the acupuncture needles. Kayla is generally very reactive and resents most handling in clinic, and can become very upset just getting her out of her cage. I was pleasantly surprised at how well she tolerated her treatments. I would like to try the addition of electroacupuncture for future cases once I obtain the proper equipment.
References
- Curacore Integrative Medicine and Education Center. Medical Acupuncture for Veterinarians: Canine Point Mini-Manual.
- Witt, C.M., Jena, S., Brinkhaus, B., Liecker, B., Wegscheider, K. and Willich, S.N. (2006), Acupuncture in patients with osteoarthritis of the knee or hip: A randomized, controlled trial with an additional nonrandomized arm. Arthritis & Rheumatism, 54: 3485-3493.
- Bjordal, J.M., Couppé, C., Chow, R.T., Tunér, J., Ljunggren, E.A. (2003), A systematic review of low level laser therapy with location-specific doses for pain from chronic joint disorders. Australian Journal of Physiotherapy, Volume 49, Issue 2, Pages 107-116.