Our Cat Has a Phantom Limb.

In the never anticipated sequel to ‘My dog has unilateral neglect’ I am here today to tell you ‘Our cat has a phantom limb’ *!

*I feel it’s important to clarify right now we are capable of raising animals who don’t develop neurological conditions, currently we also have a relatively normal Labrador in our care and a large black cat!

This is Seres.

Seres the three legged Bengal

Let me give you some background.

Seres is technically my boyfriends cat. She was bought just before he went to university in 2008. She is a 8 year old Bengal, and she is beautiful and I have decided she is now my cat too!

Shortly after Jake started at university, in the Autumn of 2008, Seres was involved in a RTA (road traffic accident), his parents went to the trouble and great expense of having her rear left leg surgically reconstructed with metal pins and plates put in to try to ‘save her leg’. The same surgery that I myself was to have the human version of just 7 years later, following a ski related accident, also in my left leg (at a much cheaper cost I might add!).

For 6 years Seres lived with her ‘rebuilt leg’, she never placed it on the ground when she ran and she could not bend it properly, so it would always stick out on strange and uncomfortable looking angles when she sat or lay down.
She went on to become a mother during this time, having a small litter in the summer of 2011, all beautiful, healthy and slightly mad bundles of fur and in 2015 she was neutered.

Seres before her amputation – Click for video

Despite the hormonal changes pregnancy and neutering might have brought about, I would describe her as a relatively ‘unfriendly cat’, not necessarily mean, or vicious but not the most welcoming of attention or giving. Compared to Esme, the overly friendly, tending towards needy, domestic black cat of Jake’s sister, Seres appeared cold and uncaring. Which, to be fair to me seemed like a ‘typical cat’, having grown up in a household of dogs. She would swipe out and hiss at Hector, the lumbering and aged yellow Labrador, if he just walked near her and she did not care to sit on anyone’s lap, ever.

Demonstrating the way she’d sit pre amputation, ‘bad leg’ hanging off the edge.

Four legs, but not happy. You can tell by the state of her fur to be honest.

Fast forward to January 2016. I was awaiting a second operation on my broken leg a year post my skiing holiday disaster, to decompress the sural nerve, as I’d been left with serious nerve damage which led to hypersensitivity and unpleasant sensations in my calf.
The day before I was due to travel to London for this operation I came home from work to find Seres standing by her food bowl with her ‘bad leg’ raised up not touching the ground and twice the size it should have been!

I rushed her to the vet (despite her protests at being touched) and made them take an X-Ray. Their initial advice had been to prescribe her pain killers and bring her back in two days if it hadn’t improved (thankfully, I could not have done this because of my own impending operation, hence asking them to X-Ray it right away). The vet returned from X-Ray looking shocked, Seres had shattered her tibia and had a spiral fracture running up her fibular! Best guess was another RTA.

We had two options, the X-Rays could be sent to ‘specialists’ who without insurance would charge up to £3000 or more to try to ‘rebuild’ the already once before ‘rebuilt leg’ if it was even possible, or she could have it amputated for a lot less (quoted £500, ended up more like £1000- but still better than upwards of £3000!) .

Now, I don’t want you thinking the cost was the main reason we opted for amputation. My boyfriend was quite prepared to call the bank and see how much he could borrow to try to ‘save her leg’. What swayed the decision in the end was my sudden realisation that for the past 7 years Seres might have been in the same kind of pain, or worse that I had been in the last year from my accident and nerve damage. I asked the vet if it was possible that she too had permanent nerve damage and was told it was highly likely. And that was it. Decision made. We both went into surgery on the same day. We picked Seres up a day later and she and I convalesced together in my bedroom for the following two weeks.

Taking care of each other. Seres with her stump and stitches, my leg bandaged and raised after the decompression.

Cats are amazing. By the end of those two weeks she was cleared to go back outside. She showed no signs of infection, she’d healed and had her stitches out 7 days earlier than I managed and the hair on her stump was even beginning to regrow.

She has adjusted to her amputation better than we could have ever imagined, I suppose it was a relief really after 7 years dragging a useless and possibly painful leg around.

She has become a totally different cat. I don’t know if it was in part down to the two weeks in a bedroom together in recovery, where she was bribed with Dreamies for cuddles and sat watching “youtube videos for cats” and episodes of Archer with me, or maybe it’s entirely due to the absence of the pain she’d been in previously, or maybe it’s a bit of both. Either way, she is much kinder to Hector, only swiping at him now if he does something more deserving than just walking past her. She runs, boy does she run, she runs so fast it’s amazing to see! She enjoys cuddles (as much as any cat really can) and she willingly comes over to sit on our laps and fall asleep, she is the cutest, sweetest little killing machine alive.

Yes, ‘killing machine’, the only serious downside to this is that she now regularly chases and kills voles, mice, birds and rabbits in the garden, sometimes the rabbits are the same size as her!

I suppose another negative is that she also appears to have developed a phantom limb. Thankfully, this is evident only in the way she will try to scratch her face with her missing leg. She shows no signs of pain in her stump, or discomfort at any other times, which is reassuring. I do my best to massage her hind quarters as she is putting so much additional pressure on her remaining leg and massage was recommended for my nerve recovery also.

I have managed to capture her phantom limb scratching on video a few times now. What I find most interesting is that she leans her whole head and body into each other as if she can actually “feel” something, and often she’ll stand up when she’s done and shake her head in a way that suggests she’s managed to satisfy the itch!

Seres demonstrates her phantom limb- Click for video

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So we now are the proud owners of a cat who has one of the most expensive missing limbs imaginable, and she imagines it!

For more pictures and regular updates please follow Seres’ future adventures on instagram @three_quarter_kitty and twitter @3quarterkitkat Instagram- Click here

Misophonia and Me

Misophonia is a term (first coined in 2003 by Pawel J. Jastreboff, Margaret M. Jastreboff ¹) given to describe a relatively unexplored condition that causes a person to experience an involuntary fight of flight reaction to innocuous repetitive, unpredictable, sounds and in some cases small repetitive movements. This immediate autonomic arousal is described by those with the condition as being akin to intense anger, panic and anxiety. Often it affects their ability to complete every day tasks and stops them from engaging in normal and healthy social interactions. (Edelstein et al. 2013²) The types of sound that most typically ‘trigger’ this reaction in misophonic patients are eating sounds, breathing sounds, nasal and sniffing sounds, coughing, tapping, clicking and whistling or humming.

Due to the nature of these ‘trigger’ sounds, it is extremely difficult for a person with misophonia to avoid coming in to contact with them in their every day life. As such they might withdraw from social activities, eat in isolation, avoid public transport and face difficulties in their work place.

It is not conjecture to suppose that people who suffer with this condition over a number of years may begin to develop other psychological issues ranging from social anxiety disorder to depression, although further research would be needed to verify this suggestion.

There currently exist only two peer reviewed papers that focus on this condition. The first was published in January this year by a group of Dutch researchers who’s area of expertise was OCD and other psychiatric disorders. They outline the condition based on 42 participants who were referred to or got in contact with their clinic. (Schro, Vulink & Denys, 2013 ³.)

They propose that the condition be treated as a discrete psychiatric disorder as it has unique qualities, which mean that none of the symptoms of misophonia can be classified in the current DSM-IV (DSM-V) or ICD-10 systems. In their paper they also outline a diagnostic criteria that might be implemented in the future to help with diagnosis and encourage further research.

Whilst we welcome this study and it’s identification of Misophonia as a separate condition that does not share it’s qualities with other more readily diagnosed disorders, it should be noted that the focus on the condition being psychiatric does not mean that it has not got a neurological cause.

The more recent study by Edelstein et al. 2013², which I refer too most often as ‘San Diego’ paper, can be seen to be a more neurological and physiological investigation. In this study they looked at misophonia with comparisons to another neurological phenomena called ‘synethesia’, which is a condition where a certain stimulus, either visual or auditory causes an incongruent sensory reaction from what is normally expected from such inputs. For a basic example synesthetes might see a color when they hear a particular word or see a certain number.  The suggestion being that the sensory misdirection present in synethesia might be comparable to that in misophonia. They were able to identify statistically significant differences in stress responses (measured by SCR, skin conductivity response, a bit like a lie detector test)  between misophonic patients, synesthetes and ‘normal’ control subjects in their physiological reaction to trigger sounds and visual triggers. Importantly this means that they have provided the first evidence to support the severity of the condition beyond the anecdotal evidence that already exists. (For more details please find a link to their study at the end of this post).

Whilst it is very important to aknowledge how great it is that this work is being conducted and that misophonia is slowing gaining recognition in the scientific community, what remains a concern to me is that the anecdotal evidence suggests that this condition is not very responsive to popular treatment methods such as CBT, and in some cases the has caused peoples reactions to become more intense and even increases the number of ‘trigger’ sounds. Often people are being prescribed anti anxiety drugs to help combat the response to triggers but these also seem to be having limited success amongst patients who have sought help. The only methods of ‘treating’ the condition that seem to offer relief come from avoidance techniques, or using headphones to block out the sounds, which ultimately might lead to more damage than good. Internet forums are a buzz with information and reports of less well known therapies being of some help to them, such as neuro-feedback and schema retraining. Time and greater levels of research will be needed to verify or find suitable treatment options.

I think at this point it is import to be clear about exactly how severe these reactions are so that there is not the common misunderstanding that those with misophonia simply find these sounds ‘annoying’. I can not think of a feeling that is further removed from ‘annoyance’ as my reaction to these ‘trigger’ sounds is. It’s fair to say that everyone gets irritated to some degree with a ‘noisy’ eater or that person at the cinema who just won’t stop rustling their popcorn as they moronically shovel it into their mouths without taking their eyes off the screen ahead. Misophonia is not that feeling.

A misophonic reaction is so strong and so instantaneous that, honestly, the only other emotion I can compare it to is that moment when someone tells you that a person you love has died. That gut wrenching, heart stopping, shortness of breath feeling, that you can not possibly control or stop from occurring. This is how intense the reaction to hearing a trigger sound can be. However, instead of that hollow grief that comes from such news, it is instead a burning anger, a completely alien level of rage. I am not a violent person (if you exclude the tantrums I had as a very small child) and I would never dream of hitting a person or causing them harm, but a trigger will make me want to lash out, my cognitive processes go from perfectly normal to phrases such as ‘I wish you’d just die’ or ‘why the hell are you making that noise, I’ll make you stop’… along with some often very violent imagery. There is nothing normal about this at all, and I can’t express enough how this is not just ‘being annoyed’ at someone eating rudely or loudly. Quite often the way in which a person is eating or the volume level has no significant impact at all on whether a trigger is better or worse. Though I would never actually hit anyone, I have to employ ‘coping’ mechanisms to deal with hearing these noises. My first response is often to try to leave the room if I can (this can lead to some very annoying train journeys where I have been known to move carriages 7 times in a half hour journey, or being incredibly rude at family dinners – Christmas time being the worst of course). Or I have to mimic the person eating, pretending to chew when they do (but this often just makes me look a little crazy so over the years I have tried to stop doing this if I can help it). I have tried humming to myself, or clicking my fingers to try and distract myself from the noise. But inevitably the aftermath of any of these attempts to lessen my reaction of ‘fight or flight’ is of course immense feelings of shame, guilt and embarrassment.

The reactions individuals report tend to be more intense depending on their physical situation and emotional state. For example being in an enclosed space, such as on public transport or a lift where there is no easy escape heightens the reaction. (This makes sense if considering the reaction to be fight or flight). Unsurprisingly being stressed or tired also is reported to make the reactions worse, either more intense or more likely to happen.

What concerns me most of all is that it appears that over time trigger sounds spread. Looking at the hundreds of posts written on the facebook site people say their reactions typically starting between the ages of 8-13, and initially were isolated to one particular individual being a ‘trigger’ (usually a close family member) before becoming more widely applied to close friends, extended family, work colleagues and then strangers. They might also begin as being eating sounds or breathing sounds but overtime it appears many people find their triggers extend to noises such as keyboards typing, pens clicking, packets rustling, dogs barking and whistling. There are people who have had misophonia for over 40 years and yet no one has ever been able to help them with their condition.

What is clear is that this is a condition that affects hundreds of people, social media sites and support groups are seen to have over 1000 members and the UK misophonia website has had over 100,000 hits. Little is understood about it’s origin, prognosis or treatment options and there is essentially a whole condition waiting to be uncovered.

It is my ambition to be the person to study this condition, to uncover it’s secrets and hopefully work towards finding a successful treatment plan for those who have suffered with it for longer than I have. If the doctors can’t help me, I will help myself and all the others too.

 

1.Pawel J. Jastreboff, Margaret M. Jastreboff (April 2003). “Tinnitis retraining therapy for patients with tinnitus and decreased sound tolerance”. Otolaryngol Clin. 36(2): 321–36.

2. Misophonia:physiological investigations and case descriptions Miren Edelstein, David Brang, Romke Rouw and Vilayanur S.Ramachandran Frontiers in Human Neuroscience June 2013 | Volume 7 | Article 296

3. Misophonia: Diagnostic Criteria for a New Psychiatric Disorder. Arjan Schroder, Nienke Vulink and Damiaan Deny* PLOS ONE | January 2013 | Volume 8 | Issue 1 | e54706

If you are a researcher who is particularly interested in this topic I would be very keen to hear from you. I have a background in Psychology and a MSc in Neuroscience and want to study misophonia as part of a PhD project, preferably starting in 2014 and based in the UK. I am currently actively seeking a potential supervisor for such a project and can be contacted at oggie114@hotmail.com