Showing posts with label Paw Project-Utah. Show all posts
Showing posts with label Paw Project-Utah. Show all posts

Thursday 17 July 2014

Paw Project-Utah Reconstructive Paw Surgery Demystified

By Kirsten Doub - Paw Project-Utah

The Paw Project-Utah reconstructive paw surgery demystified!! There have been questions as to what exactly we do for these cats. This should answer all your questions! Truth be told: Medicine is an art!

The goal of Paw Project-Utah surgery, under the care of Dr Kirsten Doub, DVM and several DACVSs who she consults with, is to help shelter declawed cats achieve an improved quality of life, so that they can live pain free lives and use their declawed paws for ambulation.

This is in the hopes of finding PAWMAZING permanent homes who will keep them and love them FOREVER. PPU’s study data has shown that 70% of declawed cats in Utah shelters have P3 fragments left over from a botched declaw. Most of these cats have fragments which are >5mm and include the ungual crest; because the ungual crest was not removed during the initial declaw, these cats have pieces of nail regrowing under the skin, abscesses on many toes, and deformed painful toes. The majority of these cats have a monocytosis on lab work. They also have toes that are painful on palpation; because of this pain, some of these cats do not want to move or play, are aggressive, or do not want to use their litter box.

PPU takes a very holistic approach to these cats.... and we aren’t talking about shaking the shaman stick here! We are talking about evaluating the WHOLE cat. Before surgery is even considered, we run a comprehensive lab panel on each cat, including a 5 way differential CBC with reticulocyte count, full chemistry panel, T4, urinalysis, feline leukemia test, FIV test, and stool analysis with giardia.

We look at the declawed paws and examine the paw pads for callouses, abscesses, swelling, and difficulty moving toes. We observe these cats ambulating to see how they use their paws. We evaluate for referred nerve pain in the lumbar spine. We also radiograph all declawed paws and non declawed paws with 2 orthogonal views. With this information, we come up with an individualized detailed plan to fix the cat 100%, in order to make them an amazing pet!

A PPU reconstructive surgery candidate is a cat who is metabolically stable, and who has P3 fragments which are causing a stress to the animal, either psychologically or physically. These cats have moveable toes (albeit some are not 100%), but have toes that are misshapen and infected from surgery that was performed so haphazardly that extensive damage was done to the remaining anatomy.

Dr. Doub likes to call this reconstructive surgery, because we are reconstructing these cat’s lives. We are taking mutilated shelter cats with little hope of escaping the UT shelter system alive, and transforming their lives in a very progressive loving way.

PPU finds loving foster homes for these cats BEFORE we start the surgery process. These cats learn to receive affection and learn to become well-loved family members, so that they are emotionally ready to start their paw rehabilitation. Foster parents are counselled extensively on the issues each cat faces overall and with paw health. Foster parents administer daily medication to improve joint health and improve post-operative success rates.

Surgery for these cats is “reconstructive” in that it involves taking someone else’s “bomb field” of a declaw surgery site, which in no way resembles a paw, and removing all the “shrapnel” left behind (P3 fragments, hematomas, bacterial contamination, necrosis surrounding glue, and abscesses), also debriding the dead and diseased tissue, to leave a declawed paw that is bacteria and scar tissue free. An infected, painful, scarred, and misshapen toe is reconstructed into a healthy one that is missing P3. Dr. Doub also will reposition all the paw pads permanently, so that it will cushion P2 and prevent paw pad abscesses and callouses for the remainder of the cat’s life. While it is impossible to reconstruct a half mutilated P3, surgery with PPU will reconstruct the cat’s declawed paw so that it is as functional as possible given that P3 is no longer part of the toe.

What about tendon contracture? Based on a study by Cooper, Laverty, and Soiderer: “Bilateral flexor tendon contracture following onychectomy in 2 cats, it is hypothesized that the etiology of the flexor tendon contracture was postoperative inflammation. Suboptimal surgical technique when performing onychectomy may result in excessive tissue trauma. Errors in surgical technique may include excessive or rough tissue manipulation, use of a dull scalpel blade, improper use of tissue adhesives, or poor aseptic technique. The combination of bacterial contamination and tissue trauma may then incite an intense inflammatory response. This may result in flexor tendonitis, fibrosis, adhesion formation, and flexor tendon contracture.

Tendonitis results in fibrosis, vascular hyperplasia, and infiltration of inflammatory cells around the tendon and tendon sheath. Other less commonly observed histopathological findings include ischemic necrosis, edema, cartilaginous or osseous metaplasia, and vascular dilation. Histopathologic examination of the deep digital flexor tendon from the 2nd case was consistent with granulation tissue, explaining the adhesions seen intraoperatively.” Surgery with PPU does address this possible, but very rare tendon contracture, by removing the inflamed tissue and breaking down adhesions around the tendons and carefully examining the entire remainder of the paw for any other pathology.

PPU has no need to cut tendons like some other salvage declaw surgeons advocate, because we have a fancy laser. Not the laser you think of when you hear about laser declaw. This is a therapeutic laser, and this is the face of cutting edge human orthopedic and sports medicine programs applied to veterinary medicine. This deep penetrating infrared laser addresses bacteria, inflammation, and infection deep in the tissues. Over time, with frequent laser therapy, we can see contracted tendons begin to relax so there is no need to drastically change anatomy by cutting tendons. You might remember PPU cat Angel? Her toes were so contracted initially that her wrists were completely curled in to compensate….she was walking on the tops of her knuckles with the few steps that she would walk. Angel had big P3 fragments and very abscessed toes, but was a poor surgery candidate due to failing kidneys due to lymphoma. After 3 laser treatments and aggressive oral joint support, Angel was able to extend and contract her toes to make little muffins. Angels little muffins were her gift to Dr. Doub one week before lymphoma claimed her life.

We hope this will give our followers a better understanding about what we do for our PPU cats! If you still have questions, you are welcome to message us, and we will be more than happy to clarify anything for you.

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