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Old 12-25-2012, 06:24 AM   #1 (permalink)
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Default Poorly Kitty - Broken Femur

Hi,

Merry Christmas.

I'm a newbie here and I was hoping somebody could offer me some advice on one of my kitties.

He was bitten by a dog 2 weeks ago which led to him having a broken femur. The vet has repaired the leg using pins etc and an external fiaxtor. He's also been prescribed cage rest for 6-8 weeks.

Sharkie, is never a happy kitty in his cage, he had mad spells where he runs (well in a confined space) performs somersaults and generally attacks the carboard I've put round the cage to protect and calm him. Has anybody any experience how I can help to make his enforced rest any easier for him, or things to do to brighten his day?

I've also noticed this morning one of the pins (the one the vet said is usually the problematic one as it goes through the most tissue) is looking as if its been weeping. Also he appears to be loosing the fur around the pin site. Is this usual, as I don't recall seeing it yesterday.

Thanks for reading and for any advice and tips given.
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Old 12-25-2012, 09:45 AM   #2 (permalink)
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Maybe you could try putting a big blanket or sheet over the cage. It seemed to help when I got Oliver my youngest Kitty when I had to get him used to being around people because he was scared of everything. Good luck with your little man
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Old 12-25-2012, 10:01 AM   #3 (permalink)
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you asked me how to post a pic on another post you go to the top where it says User CP and click on that and on the left side of the screen click on avatar and then click on custom avatar and you can browse your pics and upload one. If you need help just send me a message and Merry Christmas
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Old 12-25-2012, 01:12 PM   #4 (permalink)
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Hi Sharkie&Sparx Mum! Welcome to the forum, and Merry Christmas to you too!!!

I think the heavy blanket is a great idea...apart from eliminating visual stimulation, it should muffle those of the auditory variety.

I would also place the cage as far away from the busy areas of my residence as well.

There are calming agents suitable for cats...products like Feliway and Rescue Remedy....but, I'd be cautious about the RR as it might add to the effects of any pain meds...best to check with the Vet on that one.

And...is he on pain medication - and, which one?

I'll add a caution in here. Should the pain medication be "Metacam", you should be aware of the potential for some serious side effects from it. More about this later if needed.

Now, if the wound is "weeping", then it's time for the Vet to see him again. And, losing fur around there...perhaps he's licking/chewing the area? (and, perhaps because pain control is insufficient?)

All-in-all, it's a difficult situation but, one that a competent feline Vet should be able to manage.

Ideas:
- mild sedation/pain med with sedative side effect
- e-collar
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Old 12-25-2012, 01:59 PM   #5 (permalink)
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Hi,

Thanks for your help.

He is in a large dog cage which is enclosed on all sides, roof included, by cardboard. The only open area he has is the door by which I take him in and out of.

He is on Metacam and it's been 2 weeks today since he had the op to pin his leg. What are the side effects I should be worried about? The vet did say that even before he had his leg pinned he would try to drag himself out the cage for fuss and attention.

When I get him out the cage for a controlled stretch of his legs or a sit on the settee he doesn't touch his pin entry points at all. Could it be that since he had the stitches removed (Friday evening) some of the scab has fallen away and I just never noticed before? I touched the pin (gently) and its fixed firmly so I don't think he's damaged it at all. He also walks on it fine, he even had a quick romp and play in the kids empty wrapping paper this morning.

Thanks x
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Old 12-25-2012, 02:42 PM   #6 (permalink)
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For the Metacam:

1. Are you in the UK?

2. What is his body weight?

3. Please read from the Metacam bottle and post: the strength of the preparation (e.g. 5mg/ml, 1.5mg/ml etc)

4. Also from the bottle: How much is to be given...and, how often?


You may have cardboard all around the cage, but, that won't do much to muffle ambient noise/sounds.....these are stimulants...if you want him to "relax", eliminate them.

So far as the wound is concerned, I can only tell you what I would do...and, that would be to have it looked at - a trained eye will immediately assess properly.

And, if he were here, he wouldn't be doing any "romping" for a very long time. I wouldn't risk the healing process.....I would not want to increase the risk for arthritis - which most of our cats will encounter as a matter of course.
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Old 12-25-2012, 03:07 PM   #7 (permalink)
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Hi,

Yes I'm in the UK, and I'm sorry but I can't remember what his body weight is. Per the bottle it says Metacam 0.5mg/ml, and he has to have a 2.7kg dose (on the syringe) once per day on food.

I will take him back to the vets when they reopen on Thursday, unless I see a deterioration in the meantime which warrants an emergency trip.

What I meant by romping, is that he laid down in the middle of the wrapping paper and we played with him and he used his front paws only. His back paws were not involved at all.

Is it likely he will suffer from arthritis, is that common as he's suffered a broken limb?

Thanks
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Old 12-25-2012, 06:07 PM   #8 (permalink)
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Quote:
Originally Posted by Sharkie&Sparx Mum View Post
...Is it likely he will suffer from arthritis, is that common as he's suffered a broken limb?
I think it's "common knowlege/experience" in humans that, when one has suffered certain types of injury in early life (broken bones, severe repetitive injury e.g. sports injuries) it can be expected that "arthritic-type pain" will be experienced later on down the road, and, often, earlier than the"age-related" arthritic pain of later years.

Similarly, the same holds true for cats. "Ordinary" arthritis, known as Degenerative Joint Disease is extremely common in cats
Quote:
In one of the first studies designed to determine the prevalence of DJD in cats, radiographs of 100 cats more than 12 years old (taken as part of a diagnostic work-up for multiple reasons) were retrospectively reviewed,2 and 90% of them showed radiographic evidence of DJD Osteoarthritis in cats: What we now know about recognition and treatment - Veterinary Medicine
Quote:
Arthritis is a broad term used to describe inflammation of a joint. We often use this term when referring to degenerative joint disease associated with wear and tear. It is not limited to ageing pets, but can also develop in young pets following injury to a joint. Arthritis in Dogs and Cats | Darwin Veterinary Centre
Quote:
Joint trauma can also lead to secondary DJD, including any fracture that involves a joint surface. Joint fractures need to be reduced and stabilized precisely to prevent the occurrence of DJD. Any incongruity during healing will result in degeneration. Hip and elbow fractures occur fairly frequently. A traumatic dislocation of a joint can produce severe DJD if not treated appropriately. Cats are susceptible to ligament injuries, in particular the cranial cruciate ligament (CCL) of the knee, which is the most common injury to the canine stifle. Cranial cruciate rupture causes variable amounts of DJD. Degenerative Arthritis in Cats - Page 2
Now, for the Metacam.

Metacam for oral dosing is licensed for use in cats in the UK. It is not so in the USA, where only a one-time injection is approved for felines. It was only last year that oral administration was approved in Canada.

Metacam is known to cause kidney damage. It destroysline kidney cells. That was proven in the manufacturer's own initial laboratory studies. Cats are one of the few mamals that cannot metabolize non-steroidal antiinflammatory drugs...so, the drug is absorbed in the blood where it travels through the kidneys - and it's there that the damage is done. The greater amount of the drug, the greater the damage. Now, those kidneys have millions of filtering cells, some of them working and some in reserve. When cells die off, others step up and take over. However, these cells cannot regenerate, so over time, there will be insufficient of these "nephrons" to do the filtration - that's when the symptoms of kidney failure begin to appear.

So, with Metacam, it really isn't a question of whether/not it's safe...the question really is "How much kidney tissue is to be sacrificed to eliminate pain?"

For me, any damage is too much. And, when there are other, safer pain relievers available? I say, hands down, none of that for my cats.

The manufacturer of Metacam has gone 'all-out' to market this drug. They've paid for numerous studies which (surprise, surprise) have concluded that the drug is "safe" for cats. There's even a study that purports that Metacam may even HELP kidney-failure kitties! The marketing of this drug is relentless - have a read here (where they're 'partnering' with well-known organizations)
Quote:
As part of the brief to promote Metacam, the agency has been given responsibility for launching a campaign aimed at educating owners about the signs of chronic and post-operative pain in their cats.
The Spot the Signs campaign will see Boehringer Ingelheim join forces with charity FAB Cats to raise awareness of the common signs of cat pain among owners, while promoting the importance among veterinary professionals of discussing pain relief with their clients. Pharmaceutical giant Boehringer Ingelheim hands Pegasus animal drug brief | PR & public relations news | PRWeek
The result: in the UK, it's now being given out like candy - as evidenced in posts on UK pet forums.

So far as the dosage you've been prescribed is concerned, because you're using the approved syringe (automatically doses by cat's weight), I can only presume that the amount is "standrd/approved" as per the NOAH guidelines. HOWEVER, those guidelines also specify for a maximum of four days - you can read that right here:
Quote:
Dosage and administration
Post-operative pain and inflammation following surgical procedures:
After initial treatment with Metacam 2 mg/ml solution for injection for cats, continue treatment 24 hours later with Metacam 0.5 mg/ml oral suspension for cats at a dosage of 0.05 mg meloxicam/kg body weight. The oral follow-up dose may be administered once daily (at 24-hour intervals) for up to four days.
NOAH Compendium of Animal Medicines: Metacam 0.5 mg/ml Oral Suspension for Cats - Dosage and administration
IF a cat has been on this drug regimen for two weeks, I would be very concerned. I would not be waiting until Thursday for this - I'd seek an alternative option as soon as I could.

The easiest pain control is available through the "pain patch" - an adhesive strip which transmits the pain med through the skin and lasts about four days. Next best in my book is Burpinex (buprenorphine) which is dropped into the mouth and simply absorbed by oral tissue. Both are very effective pain control in cats.

This repeated oral dosing of Metacam was "outlawed" by the US FDA - here's the notice about that: FDA Announces Addition of Boxed Warning to METACAM® (meloxicam) Labels
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Old 12-27-2012, 04:50 AM   #9 (permalink)
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There's one additional item on all this...

When people raise such concerns with their Veterinarians, they are usually "reassured" that all will be fine "because blood testing will be done to monitor kidney function".

Now, most people will take such assurances as one would in such circumstances....'don't worry, be happy, we're on top of it'.

What most people will not realize is that, by the time the blood test shows a problem.........the damage is already done!

The kidneys filter waste products from the bloodstream...those leave the body as urine.

Kidney function blood testing measures the amount of waste product in the bloodstream at the moment in time the blood was drawn...so, from that measurement it's easy to see whether the amount of waste is normal or higher than it should be. (this status is measured on a well-developed numeric scale)

To follow on....if the waste level is "normal", that means at the moment in time the blood was drawn the kidneys were able to filter the blood to a level that is considered acceptable ("normal")

What this blood testing will not disclose:
- how much healthy kidney filtering tissue remains in total
- how much kidney filtering tissue has been destroyed/lost
- how much healthy kidney filtering tissue remains "in reserve" (unused now, but 'waiting in the wings' to be called on later in life - in the normal ageing process)

So, when people are given such "reassurances"..........they really are meaningless in terms of identifying damage done or - and, most importantly, the life expectancy of those kidneys.

People who are members of the specialized online self-help groups which provide practical support to kidney-failure-kitties guardians are seeing more and more younger cats with CKD. In one group, when asked for recommendations to prevent CKD in future cats, the number one recommendation was "No Metacam". Period. End of story.
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Old 12-27-2012, 06:42 AM   #10 (permalink)
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Hi,

Thanks for the information.

I have an appointment at the vets later today to get them to check out the weeping from the topmost pin and also to change his pain medication from Metacam.
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