It was just a freak accident. Fenster, a beautiful but shy Tabby-Siamese mix, somehow got one of her hind legs caught under a double-hung window. Her owner isn’t sure how it happened, but cats are notoriously curious and Fenster has always been an amazing gymnast. I imagine she was sitting, pressed against the screen of the open window, perusing the great outdoors, as cats are wont to do. Somehow something caused the lifted portion of the window to slam down, so fast Fenster’s leg got pinned between sash and sill. Then, while trying to extricate herself, Fenster fell. Or at least most of her fell. Her hind limb was still firmly trapped. When her owner found her she was literally dangling from the window. “It was a terrible sight, seeing her hanging there by one leg,” he later said. When he freed her, she ran and hid.
The next morning, Fenster came out, dragging the swollen leg behind her. Her owner quickly contacted the veterinarian on call, who examined her and said the leg was not broken, but there might be nerve damage. If things didn’t improve with more time, the cat should be rechecked.
Well, things didn’t improve. It was now my turn covering veterinary emergencies. Fenster’s dad called and told me the story. “I would feel better if you would take X-rays,” he said. “Let me look at her first,” I prevaricated. Cats are remarkably flexible and frequently emerge unscathed from all kinds of bizarre mishaps. Worried owners often request radiographs when often all that is really necessary to make a diagnosis is a thorough physical exam. Nonetheless, I asked my assistant Fawn to turn on our automatic film processor. I wish I had state-of-the-art digital X-ray like big practices (and younger vets) have these days, but I can’t afford to upgrade (unless I work until I’m 90 to pay off the equipment). So we still load cassettes with film and develop pictures with an antiquated machine full of chemicals that need to warm up. It’s old school, but it works . . . most days.
Fenster arrived, skittish but very sweet. I could see why her owner was concerned. Her leg was swollen to at least twice normal. “Put her on the floor so I can watch her walk,” I told Fawn. Watching how an animal moves can tell the educated observer a lot about the exact location and extent of an injury. In Fenster’s case, that leg just dragged behind her like a sack of potatoes.
Bringing her back to the table, it was time to palpate that leg inch by inch. When examining for the source of lameness, I typically start at the toes and work my way up. This is how I was taught. Following a routine helps avoid making assumptions or overlooking unexpected problems. I usually begin with “this little piggy went to market . . . “ In Fenster’s case, however, I deviated slightly. Based on that history of hanging by her leg, the full weight of her body pulling downward, I wanted to first rule out a dislocated hip, which I did quickly by rotating her leg in the socket. It moved smoothly in all directions without causing her any distress. So back to the piggies.
I pinched this little piggy to see if Fenster could feel her toes. No response. I pinched harder. Nada. I found the delicate webbing between the toes and pinched really, really hard. Finally, Fenster turned and glared at me. She didn’t pull her leg away, but was clearly peeved. This told me several things. Sensation in her leg was reduced but she still had what we call “deep pain.” At least some information was traveling from her toes to her brain. She knew I was pinching her piggies. She did not, however, have the normal “withdrawal” response of pulling her foot away from this highly annoying doctor. This deficit likely was partly the result of loss of circulation during the entrapment and the ensuing swelling, but there could also be damaged nerves, and only time would tell if there was permanent neurological impairment. What about fractures? I palpated each bone. Piggies, metatarsals, tarsus, tibia, fibula, femur. No obvious breaks. But something else was now apparent. Now that the swelling had subsided slightly, I was able to check the motion of each joint. Her hip was fine. So was her knee. But her hock? Not so much. I found I could rotate the lower part of the leg, at the area anatomically equivalent to a person’s ankle, side to side into a grossly abnormal position. Fenster had blown out the ligaments that hold the hock together.
We took X-rays, coaxing those old machines to keep working. As suspected, there were no fractures but Fenster would need that joint stabilized somehow, as well as time to see if the nerve damage resolved. I prescribed pain medication to use until the next day when her owner was able to take her to a specialist off-Island. The official diagnosis was “medial subluxation of the proximal intertarsal joint with lateral collateral ligament disruption in the tarsus, and neurologic changes that may be indicative of nerve damage.”
They sedated Fenster and splinted her leg. She will need strict confinement and regular splint changes for seven weeks. Perhaps Mother Nature will heal that hock enough to regain sufficient stability. If not, Fenster may need “arthrodesis” surgery — a difficult procedure which fuses the joint into a fixed position. The hock would not be able to bend or flex, but her leg would be stable and not painful. If that fails, she might lose the leg, but her owner is already educating himself about how well three-legged cats cope. One thing I know for sure. Her owner is making sure she gets the best possible care. Someday soon, maybe not this month, maybe not next, but one day, Fenster will be able to sit on the window sill again and peruse the great outdoors, as cats are wont to do.