Rosebud is 6 year-old spayed indoor/outdoor (American long-hair former city street) cat who was AWOL for 13 days and made it home on her own yesterday morning. Vet who has reputation of being excellent says surgery is option as well as letting things heal naturally, but in either case the recommendation is that ideally she'd be restricted (by cage or medium sized dog pen) in movement to allow for full healing. Minimum bed-rest time would be 4 - 5 weeks - that will be a huge challenge.
She lost 2.5# and is down to 5# 4.5 ozs and was quite dehydrated. Early signs are very promising, and her pelvic fracture and sacral area mis-alignment are present but not terribly severe. Biggest concern is that the shift of pelvic girdle might be impinging on the colon and thus make BM more difficult, however no BM in 1st 24-hours makes sense as food is just starting down the digestive track journey. She is urinating and with each several hours this is increasing in qty; eating and drinking from water dish are getting better. I have confined her to my small office and moved a mattress in so I could sleep nearby. Already today she is unhappy that office door is closed and it is the only time she calls out to complain.
Most often she holds her right rear leg in the air but today occasionally tries to put a little weight on it. She is grooming herself. She is not on pain meds as these can cause constipation, and if she has some pain which is likely given the fractures on one side then this will encourage her to stay more quiet and not overdo thing - it is natural feedback mechanism and I expect that after the injury probably 10 days ago she chose to lay low and nurse herself and begin to heal rather than attempt to get home and deal with the pain of moving. Seems to me that her body has a natural wisdom that has served her well even with the weight loss and some dehydration.
Per vet, it is unlikely that there is kidney/bladder injury, or liver/spleen injury as she probably would be dead rather than getting home. Personally and for cats in this home a natural approach is preferred and I am using homeopathy, and nutritional supplements e.g. Probiotics to support the healing. She will have acupuncture tomorrow from a home visiting vet who will also look at the xrays but that isn't her area of expertise.
Surgery or not?
Will try to post image of the xrays.
If BM is not coming or is not plentiful in a few days then surgery seems like a better option.
I had read a few articles with some anecdotal reports that cats with surgery and pins were more likely to have arthritis issues later in life at that location, but this is hard to evaluate Any opinion on this?
Of course the large expense of surgery is a factor but not insurmountable and not the driving decision making factor.
Both my vet and several articles by vets indicate that the fibrous tissue and scar tissue at the fracture site which are part of the healing process make it more challenging to do surgery as little as a weak after the injury. For Rosebud it will have been nearly 2 weeks. My vet said that he has to move or cut some of this to do his pinning and moving of pelvis into better alignment and that once out of surgery this tissue and its nerve endings will be complaining. It is almost like surgery would be over riding what had naturally taken place to move things into better text-book alignment and while the latter is good to accomplish it you are interfering with what was naturally evolving. Tough choice for me and it seems that several months of increased discomfort for Rosebud might make for better movement for the rest of her life. It also seems that the natural process will not lead to a limp or terribly odd movement, but just something that is a bit unique to her own movement style.
So my inclination is that if BM is OK then no surgery.
Cage and bed-rest - the big challenge
My joke is that I hope I can get her addicted to cat TV and she gets hooked on some soap opera with a multi-year series so she has some entertainment for at least the next 6 weeks. I can work at home and telecommute to office computer; nonetheless, forcing her into an area of about 10 square feet is going to be very tough. I have read on prior forum thread that one orthopedic specialist had wanted only 7 days of cage rest in that situation and length of time varies by case but even for the same case it seems that internet experts have fairly wide differences in what they recommend. Perhaps they all have the same idea of what is best, but some simply know that it is impractical for most to enforce 2-3 months of very limited activity so they don't even try to suggest as it might be too discouraging or counter productive. I guess I could have her xrayed again after 5 weeks to see how things are filling in and healing and decide based on that how much more time makes sense. I do plan to enforce very limited movement to start and then each week allow a bit more activity so that both she and I feel that there is a progression.
Any experience and tips on enforcing bed-rest? Tomorrow 8 panel dog enclosure will arrive so I can start with a 4 panel area and then add to it over time.
I am so happy that she is home, and her two adult cat kids are glad as well but I have severely limited any contact as Rosebud can't take too much stimulation at this point as it makes her want to get up and explore and interact. I do have quiet soothing music that plays continuously which helps make the office a real refuge for her.
Thanks for any of your thoughts and advice. The prognosis is very positive.
She lost 2.5# and is down to 5# 4.5 ozs and was quite dehydrated. Early signs are very promising, and her pelvic fracture and sacral area mis-alignment are present but not terribly severe. Biggest concern is that the shift of pelvic girdle might be impinging on the colon and thus make BM more difficult, however no BM in 1st 24-hours makes sense as food is just starting down the digestive track journey. She is urinating and with each several hours this is increasing in qty; eating and drinking from water dish are getting better. I have confined her to my small office and moved a mattress in so I could sleep nearby. Already today she is unhappy that office door is closed and it is the only time she calls out to complain.
Most often she holds her right rear leg in the air but today occasionally tries to put a little weight on it. She is grooming herself. She is not on pain meds as these can cause constipation, and if she has some pain which is likely given the fractures on one side then this will encourage her to stay more quiet and not overdo thing - it is natural feedback mechanism and I expect that after the injury probably 10 days ago she chose to lay low and nurse herself and begin to heal rather than attempt to get home and deal with the pain of moving. Seems to me that her body has a natural wisdom that has served her well even with the weight loss and some dehydration.
Per vet, it is unlikely that there is kidney/bladder injury, or liver/spleen injury as she probably would be dead rather than getting home. Personally and for cats in this home a natural approach is preferred and I am using homeopathy, and nutritional supplements e.g. Probiotics to support the healing. She will have acupuncture tomorrow from a home visiting vet who will also look at the xrays but that isn't her area of expertise.
Surgery or not?
Will try to post image of the xrays.
If BM is not coming or is not plentiful in a few days then surgery seems like a better option.
I had read a few articles with some anecdotal reports that cats with surgery and pins were more likely to have arthritis issues later in life at that location, but this is hard to evaluate Any opinion on this?
Of course the large expense of surgery is a factor but not insurmountable and not the driving decision making factor.
Both my vet and several articles by vets indicate that the fibrous tissue and scar tissue at the fracture site which are part of the healing process make it more challenging to do surgery as little as a weak after the injury. For Rosebud it will have been nearly 2 weeks. My vet said that he has to move or cut some of this to do his pinning and moving of pelvis into better alignment and that once out of surgery this tissue and its nerve endings will be complaining. It is almost like surgery would be over riding what had naturally taken place to move things into better text-book alignment and while the latter is good to accomplish it you are interfering with what was naturally evolving. Tough choice for me and it seems that several months of increased discomfort for Rosebud might make for better movement for the rest of her life. It also seems that the natural process will not lead to a limp or terribly odd movement, but just something that is a bit unique to her own movement style.
So my inclination is that if BM is OK then no surgery.
Cage and bed-rest - the big challenge
My joke is that I hope I can get her addicted to cat TV and she gets hooked on some soap opera with a multi-year series so she has some entertainment for at least the next 6 weeks. I can work at home and telecommute to office computer; nonetheless, forcing her into an area of about 10 square feet is going to be very tough. I have read on prior forum thread that one orthopedic specialist had wanted only 7 days of cage rest in that situation and length of time varies by case but even for the same case it seems that internet experts have fairly wide differences in what they recommend. Perhaps they all have the same idea of what is best, but some simply know that it is impractical for most to enforce 2-3 months of very limited activity so they don't even try to suggest as it might be too discouraging or counter productive. I guess I could have her xrayed again after 5 weeks to see how things are filling in and healing and decide based on that how much more time makes sense. I do plan to enforce very limited movement to start and then each week allow a bit more activity so that both she and I feel that there is a progression.
Any experience and tips on enforcing bed-rest? Tomorrow 8 panel dog enclosure will arrive so I can start with a 4 panel area and then add to it over time.
I am so happy that she is home, and her two adult cat kids are glad as well but I have severely limited any contact as Rosebud can't take too much stimulation at this point as it makes her want to get up and explore and interact. I do have quiet soothing music that plays continuously which helps make the office a real refuge for her.
Thanks for any of your thoughts and advice. The prognosis is very positive.