CCL Rupture in "Senior" Cat

My twelve-year-old boy (one of two indoor-only cats I adopted from shelters around one year of age) has ruptured his cruciate ligament in a hind leg in the worst way possible: I stepped on him in the dark when he followed me to the bathroom because he loves me THAT much...  The guilt is killing me...

Because he seemed okay at first, I didn't immediately take him in, but a day or so later he seemed to be limping, and then seemed to be in extreme pain when putting any weight on it; it also visible collapses.  Sure enough, it's the cat equivalent of an ACL tear so common in dogs today.  I was given the options of a) immediate surgery to the tune of thousands of dollars or b) waiting and watching because in a very few cases, it improves on its own.  This vet doesn't prescribe NSAIDS for cats because he believes they don't metabolize it adequately and it doesn't significantly help?  So I was given a morphine derivative in pill form (needless to say, it's nearly impossible to pill him) to get him through a two-week conservative treatment period.  He already basically just lies around and doesn't jump, so it doesn't seem necessary to crate him, which would further traumatize him, as do vet visits....

His pain, after a week, seems to be less (he cries out only with certain sudden movements), but he's clearly not happy.  Do these ever just resolve?

The complicating factor, besides his age and the cost, is his chronic condition, which is feline megacolon.  After a year of emergency vet visits for evacuation of impacted stool and ineffective and pricey treatments, I learned about Miralax on a message board, and that's been a lifesaver for us.  Because he REFUSES to eat anything but dry kibble -- always has -- I administer it dissolved in water with an eyedropper every night (yes, for eleven years, haha).  Despite this treatment, he still occasionally has "lare-ups which are painful for both of us (always accompanied by what I call "explosions" out both ends, with vomiting and diarrhea before the offending turd is expelled).  For the most part, however, we're stable with that.

However: opioids are notorious for causing constipation, so. won't that worsen his condition?  If that's all that works to relieve pain, how would I even get him through the post-operative period?  He's also inexplicably losing weight; the vet recommends blood tests first (naturally).  I won't say I can't afford it, but that's a lot of money if the outcome isn't going to be a good one.  :'(  Given his age and medical conditions, what would you recommend?

To the crating, I know what you mean with you don't know if crating is worth it and the trauma. My boy broke his leg and is a hyperactive 2.5 year old Siamese. I thought a crate would be hard on him and went the route of surgery/supervision. I wish now I had crated from the start. My boy jumped more than we realized and ending up causing complications in the healing which lead to removing the pins put in and forced crate rest anyways. He took to the crate remarkably well and healed up much better on forced rest. I would urge you to reconsider the crate. My boy adapted much better then I thought he would and settled into it well. 

I can't speak to the complications with the bowel issues and mixed medicines. I am sure your vet knows what they are talking about with the drugs though. Cats systems are vastly different from dogs but often they are given the same treatments, from my reading it seems like researchers are just now starting to understand the differences in how drugs affect the two. Personally, knowing how my boy reacts to pain medications in general we don't use them at home unless he is showing obvious pain. Even with the broken leg we didn't use pain medications while he was on crate rest. He was in the crate not moving at all and not aggravating it any. He mostly slept through it. We would move him from the crate to a carrier when we cleaned and often would just cart him around the house in the carrier until he let us know he was ready to use the litter box or eat. He was walking better in the days after getting off crate rest than he does now a few weeks later which has made me think we should have kept him in it longer even. As to long term reaction, it has been 2 months and he is actually more loving and spends more time around the family than he did before the crate rest. 

To the pills, have you ever tried mixing it in with human meat baby food (no onion or garlic)? I know it has worked for me when I have a hard to pill cat. The flavor of the food covers the medicine and they lick it right up. I know you said yours is a kibble lover but it is worth a try if you haven't before. I do applaud the efforts you have been taking for all this time with the dropper. 

To your final question. Only you can really make the decision. If I was in your place I would do the crate rest. He might complain before he adjusts but the true limited movement will help ultimately. If you don't want to crate then confinement to a closet or bathroom would even help. Link ate more when he was on crate rest (I think boredom) so you might see the same and a halt to the weight loss. I can fully understand not eating as much because of pain so I wouldn't do further blood work for the weight loss until the leg is healed. One thing at a time. I would also look into switching to a more calorie dense food for the time being at least so he has to eat less to maintain his weight. Once he is feeling better with the leg I would check his weight and see if it has increase or at least stabilized. Given his age and other condition, if the weight loss isn't due to this specific situation then you would have to make the decision on how aggressive you want to pursue it. 

I have very little to add to Kieka 's very detailed post.

Regarding constipation and opioids - yes, they do make it worse, but that's easy enough to balance by adjusting the miralax to compensate (speaking as someone who's on both types of meds myself ).

Regarding the blood tests - I think that I'd always regret not doing them, personally. The results may well crystallise things for you, thereby make other decisions easier. I lost my old boy recently. His final blood results allowed me to make 'that decision' without a shred of doubt as to whether it was the right one. Yes, it was extra money, but the peace of mind and confidence the results gave me was worth it's weight in gold.

Maybe have a talk to you vet about possible causes for this weight loss, and what his instincts are about the possible cause(s). I would definitely do bloods before considering surgery. Firstly, surgery is far more expensive than blood tests, so it makes sense to know that you won't have any nasty surprises shortly after. More to the point, I know I'd feel just terrible if I put an animal through surgery, only to find shortly after that something else was wrong that meant I had to let him go.

My heart goes out to you and your boy [article="29662"][/article]

Hi All4Mom

I know exactly how you feel, I'm going through the same thing with my cat. My cat started limping back at the beginning of Jan so I took her in.  Had Xrays and blood work done and it came back as a torn cruciate ligament.  I was given the same options as you and was sent home with some pain meds and told to watch her for a couple of weeks. After which she was still limping so I decided to go ahead with the surgery.  I also searched all over the internet for advice and past experiences to make my decision.  Of course, there were arguments for and against so, in the end, it really just came down to my choice.  And yes, it was expensive.

  So I was given a morphine derivative in pill form (needless to say, it's nearly impossible to pill him) to get him through a two-week conservative treatment period.  

What was the morphine derivative pill that you were given?  I was given buprenorphine but in a liquid.  It's really easy to administer, all you have to do is squirt it into the cat's cheek pouch.  The mouth doesn't need to be open as it is absorbed through the lining of the cheek.

My cat is very difficult to pill, plus I hate doing it.  You can always ask your Vet if any medication can be compounded into a liquid form.  I find it easier.  It is a little more expensive but for me worth it.

However: opioids are notorious for causing constipation  I can't really speak to this as I didn't encounter any issues.  My cat does have a bit of an attitude and HATES! going to the vet.  So she does need to be sedated.  So I find that for a couple of days after that it does take her awhile to go poop.  But then she is normal after that.

My cat is also not a wet food eater, she loves her kibble.  I've tried many different brands and all she'll do is like it until the moisture is gone then walk away.  The only way I can get close to her eating wet food is if I make a "soup" out of it.  At that point, I don't think that it masks the smell or taste of the medicine.  Some pill just tastes awful so it doesn't alway work to crush and try and hide in food.

I have however found one type of wet food that she will eat and love.  It's called BFF (Best Feline Friend) brand and it is the one that comes in the pouches. It comes in a gravy with some chunks.  I only use about a tablespoon at a time so the pouch can last me about 2 days.  They are great for hiding the taste and smell of medication.

Another thing that you should look into is a joint supplement such as Cosequin.  It was recommended by my Vet (as well as others from the forum).  It`s basically glucosamine for cats. Plus it prompted me to start taking it again.  Cat get`s hers, I get mine. 

the vet recommends blood tests first (naturally).   Of course, they do and I would recommend as well.  This might come across as sounding a little insensitive, but it`s not.  The results of the blood test might make the decision for surgery for you.  At 12 years you never know when something else might be happening.  In my own experience, there were 2 things that needed to be investigated first before I decided to go ahead with the surgery.  First, the x-ray showed that one of her kidneys was a little enlarged but the blood work came back ok.  The 2nd was that the bloodwork showed an elevated T4?? count for hyperthyroid. But those results came back as high but normal.  But, that's good to know as we can now monitor her and catch it before it gets too bad.

Anyway, my girl had her surgery on Feb 1st and she is doing well. It is a long healing process but it is the only time.  I've had a couple of threads her about it if you want to take a look at them, you might get some more info and there are some pictures as well.

www.thecatsite.com/t/333556/crutiate-ligament-recovery-question

www.thecatsite.com/t/333997/how-tight-should-an-e-collar-cone-be

I hope this helps and feel free to message me if you would like to know anything else.

Good luck