Crutiate ligament recovery question

crunchie

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Hello, my 10-year-old Manx cat is going in for a cruciate ligament repair surgery (left rear leg) in a couple of days.  I've read a lot about the recovery for this surgery and I'm I'm looking for opinions on which would be best for her recovery.

I know that she will need crate/restricted recovery area and I have two choices.  Would it be better for me to set her up in the bedroom, where she will have fewer distractions and it would be a little quieter, but where she might be lonelier? Or would it better for her to be out in the main living area of the apartment where she can see what's going on but there would be more noise, distractions etc. but I would be better able to keep an eye on her.

Would also like to hear about anyone's past experience with the recovery of this surgery.

Thanks.
 

white shadow

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Hi Crunchie and welcome to the forum !

I've dealt with a partially torn ligament in a front leg.

Because of the surgery, I would suggest that you use a large dog crate, large enough to accommodate food, water and a low-wall litterbox. You'll need a large crate so that the litterbox can be distanced from the food/water. Perhaps you could 'wall off'  the litterbox with a partially cut cardboard box.

A quiet, separate room is best for her....don't worry at all about her being 'lonely'. Cats are naturally solitary, the quiet solitude will ease her hard-wired sense of vulnerability during recovery and the lack of stimulation will not excite her and stimulate activity.

You must be patient about her recovery period.....this will take (if I remember correctly) months. If you rush it, there could be re-injury which could even result in permanent disability. It is better to allow for the longest period rather than risk shortening it.

If I think of more, I'll post back.
 
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crunchie

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Hi White Shadow,

Thanks for the reply.  After I posted I decided that the bedroom would be the best choice and I already have the large crate.  The bedroom was also the best because over the next few weeks I can easily keep expanding her confinement area and remove all jump temptations as her leg improves.

Do you remember what your cat had for medications after the surgery?
 

white shadow

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I'm glad you replied, because afterwards I did have a few thoughts - but, short on time, thought I'd wait to see if you might be a one-time poster


Medications was one of those points.....but, Sam (the White Shadow avitar) did not undergo surgery.....

The second point related to the qualifications of the Veterinarian who would perform the surgery.

[Before those, I'll return to Sam's case. Sam was believed to have a partially-torn CL - and, it was a hind leg. During the previous year and then concurrently, he showed a weakness in a front leg. The front weakness continues which is why I suggested, from memory, that the CL injury was a front limb issue. I kept Sam confined in one room for about three months. I used simple ramps so that he could get up on (realistically unmovable) furniture and have access to a window view. His lameness slowly diminished and eventually resolved.]

You asked about medications. Modern pain relief in cats targets pain from different 'directions' and can employ up to three different types of drugs. This is known as "multi-modal" drug therapy. While this concept uses/suggests non-steroidal anti-inflammatories (NDAIDs), these drugs are acknowledged to have a very narrow margin of safety in the cat - because cats have not evolved with the necessary liver enzymes to metabolize those compounds. Some are definitively toxic to the kidneys which is where they are filtered out and excreted. I would advise politely refusing NSAIDs.

Here's an article on all of that - the chart doesn't show nutraceuticals, those are described near the end of the article: http://todaysveterinarypractice.navc.com/focus-on-pharmacology-management-of-chronic-pain-in-cats/

With another of my cats where inflammation and pain were issues, instead of NSAIDs, we used a low dose of Prednisolone to deal with inflammation.....if there's any danger of infection, then an antibiotic would be needed as a result of using the pred.

I'd suggest that you have a discussion with the Vet about the meds 'they' are considering....that article could offer a place to start the discussion.

......

I'd better post this much to you now and the rest later - otherwise, it may not happen at all. (sorry that I can't just get to this and finish it off)
 
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crunchie

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Hey White Shadow thanks for the info. Thought I'd give you a little update:

She went in yesterday morning for her surgery and is now home.  Last night wasn't great, I guess it was the effects of coming off of the anesthesia.  She kept growling all night until about 5 am (including some howling at around 3).  She could barely move, couldn't stand and mostly stumbled if she tired. Didn't (and still doesn't) like her pen and kept pushing at the bars trying to get out.  She was nice and quiet from 5 am until 9 when I gave her her "breakfast" and meds. 

Her coordination is much better this morning, she could actually get up and move around and used her litter. Now she is sleeping again, after a big meow/cry session about the pen.

If anyone else is reading this and has gone through this procedure with your cat I'd love to hear about your experiences.
 

white shadow

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I had come back last night to offer my other thoughts, but quickly realized they would be too late as you had mentioned the surgery date.

The 'biggie' had been about the surgical skills and qualifications of the Vet - well, that's water under the bridge now


It sounds very much as a normal recovery does - and, you've done the right things.

If it turns out that she's really resisting the crate, consider whether you might want to install a soft lining on the walls of the crate. I've seen cats who have been live-trapped for rescue purposes, injure their heads/faces in an effort to get out....now, I know there are many differences between the two situations, but I'd rather point out the possibility than not and something adverse occur. I attached pieces of cardboard boxes on the insides of the trap after seeing that - which also removed visual stimuli from the equation.

I had something else to pass along. It's a handout from a Vet who does these procedures and lays out a recovery timeline, some physical therapy and has some recommended supplements you might want to discuss with your Vet
 Start Dasuquin, Cosequin, or Glycoflex (joint supplement) ASAP
Start essential fatty acid supplement, ie. Derm Caps to reduce joint inflammation ASAP
Here's that handout: http://www.mobilevetsurgeon.com/images/CruciateRehabCat72.pdf

An excellent fatty acid supplement is Krill oil - if not now, I'd recommend its use down the road.

So, keep us posted!

.......any pics?
 
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crunchie

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Thanks, WS,  she has adapted well to the pen once the anesthesia wore off. She has been doing quite well all day. I suspect that a lot of the pushing at the bars had to do with the comedown and the fact that she really couldn't move very much. I had also covered up the pen to have her stop pushing on it.  As for the cosiquin, my vet put her on that right away so she has been on it for 3 weeks already. I'll look into the fatty acid supplement, good suggestion.  The handout I have already read, I've been all over the internet reading up on this for the past 3 weeks, that one was great for getting a good idea of what was to expect for her recovery.

She is already putting some weight on it when she walks and the surgeon was very happy to hear that.

Here are a couple of pics for you.





The last one also has a wall in front of the door to the pen as well.
 

white shadow

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WOW !

Talk about 5-star accommodations ! Looks like you copied those from Feline Airbnb !

Thanks for the pics.
 I'll look into the fatty acid supplement, good suggestion.
OK........There's a member here with a great deal of knowledge in the realm of supplements - and, that also comes with a tonne of her own experience - she is "LDG" (Laurie). I've bookmarked one of her posts that speaks to the use of Krill oil in combination with some others and I'll post it. First, though, an excerpt from there to highlight a tidbit that could easily be overlooked:
I put her on the curcumin - she was already on the krill oil - and....her mobility from the hip arthritis improved. Turns out, using one of the standardized curcumin products WITH a fat - and for our cats, this is best in a krill oil, though salmon oil would help, too - improves the uptake into the blood stream as it slows it down even further from zipping right through our / their systems.
 
Here is that post: http://www.thecatsite.com/t/314240/bro-and-advanced-arthritis-and-prognosis#post_3937467

You'll see more than the curcumin referenced there.

My own goal (were I in your position) would be to reduce inflammation in the short term (post-op) and prevent/mitigate (the probable) long/longer term arthritic effects.'Hope something in there will help.

Keep us updated, please.....this thread may also help other kitties down the road.
 
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crunchie

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Haha, thanks, I'll have to read over the thread.

Question about the Robert jones bandage, do you know how long they should stay on?  Ulla started doing a thing with her leg where she shakes it very quickly, like when you get something stuck on your foot.  I figured that she just didn't like the bandage.  I sent a short video to her surgeon so he could see how she was walking and he just replied with "let's take the bandage off".  It hasn't been a full 2 days yet so I don't want to take it off too soon, but I don't want it bothering her either.

Oh, and for her 5-star accommodation, I don't' think she is too impressed with it.  Today she started with the "meowing, I want out of here".  :(
 

white shadow

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No idea how long the bandage should stay on....on the handout, under "Follow Up Instructions" it (only) reads: "Support/pressure bandage placed post-operatively to be removed in ____ hours".

I wouldn't want it removed too soon, either.

I'd be 'comfortable' with the surgeon's decision so long as I knew he understood I was simply describing her behaviour, that it is "shaking reminiscent of shaking something foreign off  a foot" - and, not biting/licking/tearing at the bandage/site......I think those actions could indicate pain, which then would need to be assessed for cause (such as circulation loss etc. (to me, it does sound like she's 'just'  trying to unload it!).

Oh, I'm sure you'll get the "Let-me-OUT's" - really a good sign, I think - I wonder if one of those Felliway products ( https://www.drugs.com/vet/feliway-diffuser-can.html ) might help. I have one, a spray bottle, and I know that my guys really take notice when I've used it. Maybe presenting her with a new small diversion once in a while (catnip mouse etc) could change her focus. I'd suggest not leaving that kind of thing in there, but rotating for variety sake.....unless it's her all-time-favourite.
 

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Hi Crunchie and welcome to the forum !

I've dealt with a partially torn ligament in a front leg.

Because of the surgery, I would suggest that you use a large dog crate, large enough to accommodate food, water and a low-wall litterbox. You'll need a large crate so that the litterbox can be distanced from the food/water. Perhaps you could 'wall off'  the litterbox with a partially cut cardboard box.

A quiet, separate room is best for her....don't worry at all about her being 'lonely'. Cats are naturally solitary, the quiet solitude will ease her hard-wired sense of vulnerability during recovery and the lack of stimulation will not excite her and stimulate activity.

You must be patient about her recovery period.....this will take (if I remember correctly) months. If you rush it, there could be re-injury which could even result in permanent disability. It is better to allow for the longest period rather than risk shortening it.

If I think of more, I'll post back.
Yes, months,

The collagen and similar substances in ligaments have a turn over measured in months. In humans, a safe bet may be 12 months.

The additional problem is that such tissues do not have blood vessels, so anything you want must pass various transport mechanisms that take longer than transportation by the blood,

Perhaps your vet can be more accurate in such estimations, because he/she knows the case.
 
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crunchie

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Hey, I finally did hear back from the surgeon.  I described the shaking just as I did in my post, but he also had the benefit of seeing it in the video.  When he replied with "let's take the bandage off" I asked "when" the only reply back was "today".  Now I know that a lot of surgeons don't have the best bedside manner but come on.  That just made me think of the worst.  Had to email him again with a few more questions as I was told by my vet that she needed to be sedated, needed to fast before etc. So his reply after that was a little bit better "There is individual variation in cats. Most of the cats do not tolerate bandage and some do. As she's is kind of in the middle so we will remove the bandage and see if it make her more comfortable". Still, not a lot of info but better than the one-word answers.  I think I did read somewhere (but I can't find it) that they can come off anywhere from 3-7 days.  She was scheduled to have it off on Monday anyway.  I'll have to trust that he knows what he's talking about.  :)

As for the Feliway, I thought of that this morning because I already have the diffuser, and found that there still is some left in the bottle. So, while she is away I will rig up her spa with the Feliway diffuser.
 
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crunchie

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Hi Solomonar,  I've read lots about the recovery so I was well prepared for the length of time (months).  Not expecting it to be quick but like anyone else going through this any information/past experiences help  :)   Thanks.
 

PushPurrCatPaws

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Hey, I finally did hear back from the surgeon.  I described the shaking just as I did in my post, but he also had the benefit of seeing it in the video.  When he replied with "let's take the bandage off" I asked "when" the only reply back was "today".  Now I know that a lot of surgeons don't have the best bedside manner but come on.  That just made me think of the worst.  Had to email him again with a few more questions as I was told by my vet that she needed to be sedated, needed to fast before etc. So his reply after that was a little bit better "There is individual variation in cats. Most of the cats do not tolerate bandage and some do. As she's is kind of in the middle so we will remove the bandage and see if it make her more comfortable". Still, not a lot of info but better than the one-word answers.  I think I did read somewhere (but I can't find it) that they can come off anywhere from 3-7 days.  She was scheduled to have it off on Monday anyway.  I'll have to trust that he knows what he's talking about.  :)

As for the Feliway, I thought of that this morning because I already have the diffuser, and found that there still is some left in the bottle. So, while she is away I will rig up her spa with the Feliway diffuser.
Hi Crunchie! I saw your thread the other day and have been keeping an eye on it. My young cat had a complicated knee surgery in August 2016 for a luxated patella, which seemed a bit of a different scenario than your older cat had with "just" a cruciate ligament surgery... so I wasn't sure if I have help to offer. But I will say that her (very good) surgeon was adamant about NOT using a cast or bandage, so try not to feel weird about your own vet's opinion on this. She's likely to do fine, with monitoring and care.

The main goal was to prevent my cat Milly from licking at and biting at her seven stitches. For several days, we had to use a soft Elizabethan collar, but I was lucky with Milly - she was a "good girl" and did not bother her stitches very much at all. This would vary from cat to cat, I'm sure.

I'm sure your vet/surgeon has informed you of what the site on her leg could look like, with swelling and some bruising being normal, etc.
 

PushPurrCatPaws

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One more note: you make have to cut down the height of the sides of her cat litter box, if she is unable to easily get in and out of it. The sides look a bit high for this kind of surgery. But maybe she'll be fine!
 
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crunchie

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Thanks PushPurr, I'm sure your "luxated patella" recovery was not that far off from my cat's run-of-mill cruciate ligament recovery ;)  I would like to think that the surgeon wouldn't recommend taking it off if it was not ok.  I was only a little concerned with her "leg shake" because she was doing it more often and if she was laying next to something she would hit her leg on it (ie the litter box, side of the pen and even the floor) so was a little worried that she might cause more damage doing that.

I've looked around for the soft E-collar and unfortunately, I can't find one where I live.  She HATES  the hard plastic ones and I tried the inflatable one the other night but she had no problem pulling that off of her head. Luckily she isn't one to really lick at wounds/bandages any other time that she has had surgery. So my fingers are crossed that it won't be a problem this time. That included an abscess that needed to be drained from her front leg a number of years ago.  She had restricted movement then, no jumping as well, so it's not her first rodeo. However, this rodeo is much bigger than the last one. ;)

As for the litter box, that was a concern as well but with the Robert Jones bandage, she was able to get into it fairly well.  Will see what happens with her now.  I figured if I had to I could just put an old cookie sheet or baking pan on the floor.  But that would be the last time that got used for cookies.  :)  But cutting down the sides of the litter pan is a good idea, didn't think of that. Thanks.
 

PushPurrCatPaws

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Our surgeon (by "Our", I mean, my husband and me and our cat, Milly, lol) -- our surgeon gave us two collars, for "free" (again, LOL, "free" meaning, included with the expensive surgery!)

One a hard plastic one, but also THIS one, which is the one that worked for Milly:


She's a young cat, so eventually she found a way to slide that soft e-collar off of her neck... but it worked for the time that we needed it to work! She is only 8-9 lbs, so we got the "X-SMALL" one.

--
Here's another link, which shows that this (abovementioned) soft e-collar has a sliding tightener for the neck:
 
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crunchie

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Well ulla's return from the vet was a far better experience than it was the other night. No hellish comedown from anesthesia, just a little tired from the sedative.
Her leg looks much better than I thought it would and she can still put weight on it and move around. She even allowed me to put on her inflatable collar and even purred while it happened. I think they may have given me the wrong cat.
Fingers crossed for a smooth recovery from this point on.
 

white shadow

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Consider using a plain ol' cardboard box and cut a low door into the 'front side'.................plastic bags make great liners......and, the whole contraption can be changed up in a flash.
 
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