Friday, October 10, 2008

decisions, decisions.

i have an 11 year old kitty. he is a bit on the "fluffy/big-boned" side. ok. he weighs about 14lbs. and he should weigh about 8lbs. in my defense, when i obtained this cat, i was all of 19 years old and didn't really know any better about free feeding pets. now that i DO know better, my cats are all too old to bend to big rule changes like structured feedings. that - and i currently have 5 cats and 1.5 jobs. it's not possible to feed them all individually. it's a bad, lame excuse - because it would be better for them if they were i have no excuse.

at any rate, my fat white kitty (fat man) started vomiting about 4 years ago - and it developed into a somewhat chronic problem. otherwise, he's stunningly healthy for being 11. bloodwork looks great, chest and abdominal xrays are normal. when he started vomiting, i took him into my vet at the time to xray his abdomen. as an aside, while telling me his guts looked normal, she pointed out his horribly arthritic hips. i promptly forgot about it.

fast forward to 3rd year of vet school when a clinical trial starts at my CVM. it was a clinical trial for a new NSAID for arthritic cats. i enrolled my fat man in the study. at his first check-up, the orthopedist - who has seen thousands of hips - turns to me and says, "your cat has the worst feline hips i've EVER seen."

fast forward to now - my beloved fat white kitty is limping a great deal on the back left leg. he's always been reluctant to jump, but he's never limped so noticeably. he's also started grooming all of the hair off his belly and rear legs. i think -given the lack of external/internal parasites (fleas, etc), any known internal disease, and a basic lack of any other cause, that he's overgrooming because he's so painful in the rear limb.

what sucks is that there are no good drugs for cat chronic pain. dogs - yeah. we've got rimadyl and deramaxx and previcox and aspirin and ketoprofen and metacam and cosequin...and on and on. so much. there are no real good options. none of the NSAIDs are approved or really safe for cats- prone as they already are to renal failure (NSAIDs decrease blood flow to the kidneys and can precipitate renal failure). other medications i might try include opioids - which are expensive and leave my kitty doped up a lot of the time. gabapentin is promising - it's an anti-seizure medication that also has interesting pain control in dogs and cats. there isn't much research, so the pain control is theoretical.

the short answer for chronic pain control in cats? there is none.

i've considered these options, as well as adding an injectable polysulfated glycosaminoglycan (PSGAG - a joint supplement) to his control. but it's a lifetime (hopefully many more years) of medication. medicating cats sucks. even one as amazingly well-behaved and easy to pill as fat man (he used to take the clinical trial out of my hand).

and so i've decided. in 2 weeks, fat man will undergo a femoral head osteotomy bilaterally. what that means is that a surgeon will go into his legs and cut the head and neck off of the femur. he won't have a hip joint on either side anymore. yes. it works. i know. i can remember how i responded in ortho during 3rd year when they described the procedure.

WTF?? you can cut the head off the femur? you can destroy the hip joint?

yes. you can. it will eliminate the source of fat man's pain (the bone on bone contact between the femur and his pelvis). and yes, he'll be able to walk normally - if all goes well operatively and post-operatively. he'll be a little jacked up in the rear (as in - his rear legs will be a little taller than they were). but he'll be pain-free finally and hopefully have many more years of a pain-free existence.

it scares me a litte - despite the fact that i know anesthesia is safe. despite knowing that the majority of orthopedic surgeries are without complication. i just don't want to put my fat man under anesthesia.

but i want him to be comfortable and happy - and i can't stand to see him limp. and i don't want to force pills and liquid into him and give him once weekly intra-muscular injections for the rest of his life.

so there you have it.

No comments: