Orthopedic problems in cats

Treating arthritis in cats

Question: I subscribe to your newsletter. Our oldest cat (15 years old) limps slightly. It seems that her hips bother her and also a front leg that was broken when she was young. Is there a medication that`s effective for arthritis in cats. She also suffers from and takes medication (Tapazole) for hyperthyroidism.

Jan

Answer: Jan;

Unfortunately, we are still pretty limited in our choices for medications for arthritis in cats.

Some cats will respond to glucosamine and chondroitin products, such as Cosequin (tm). These must be given on a continuous daily basis for best effect and it may take several weeks to notice benefits. We have also used Adequan (Rx), an injectable glycosamine product, with good success in some cats. We have not had consistently effective results from either product, though.

Aspirin can be used in cats if it is used very carefully. It is best to have your vet examine your cat and help you determine an appropriate dosage, although the standard dosage is 10mg/lb of body weight, given every 48 to 72 hours. It is very important to stick to these long dosing intervals because aspirin has a long half-life in cats and can accumulate, leading to toxicity, if it is given daily. Do not use acetaminophen (Tylenol tm) or ibuprofen (Motrin tm) in cats.

Corticosteroids are sometimes necessary for older cats with severe arthritis signs, due to the lack of good alternatives. We try not to use these medications for arthritis unless it is really necessary, due to the potential for side effects. However, when a cat is in a lot of discomfort, the benefits outweigh the risks, in my opinion. I would wait a little longer in a cat with hyperthyroidism to use these medications because they can make it harder to control the thyroid level in some cases.

Acupuncture might be worth considering for arthritis, as well.

If a new medication becomes available that is useful in cats, I know that we will include it in the first possible issue of the VetInfo Digest.

Mike Richards, DVM

FHO - femoral head ostectomy

Question: Dear Dr. Mike:

I am a subscriber to your site and I have used it extensively when I have questions about my cats` health. Thanks for providing this service.

I have two Tonkinese cats, 13 months old, brother and sister of the same litter, strictly indoor cats. The male, Kusha, who is the sweetest boy imaginable, broke his leg last week -- he pushed a chair over and either it fell on him, or he landed badly. He broke the femur at the neck and the surgeon recommended a femoral head ostectomy, rather than trying to pin it back together. He had surgery six days ago and is now home. The surgeon prescribed strict rest for 4-6 weeks. The problem, of course, is keeping him from doing anything strenuous. We have allowed him to walk around, but we are trying to keep him from running, jumping, and climbing. We have arranged our bedroom so that there is almost nothing to climb on -- we even took our bed apart and put the mattress on the floor. We also have a large cage (24 x 42 x 28) that we keep him in for short periods when he`s a bit too frisky. His sister, Lila, is a problem, wanting to play with him, but they are very attached to each other, and both of them would be unbearable if we tried to keep them apart. I am able to be at home with him continuously for the first two weeks of his recovery, and my husband can be with him most of the time for the third week. My question is about how much activity we can safely allow him, what are the possible consequences of too much activity during this period, and whether it will really take 4-6 weeks to heal. I have searched the web for information on FHO in cats, and have found very little. At one site I found, a person described her cat`s FHO and said her surgeon recommended two weeks rest, with physical therapy (manipulation of the leg). What is your recommendation?

Any information or advice would be appreciated. Jane

Answer: Jane;

We have done a number of femoral head ostectomies in cats and all of them have worked well. I think that cats are light enough and flexible enough that they do not have much problem recovering from this surgery. We recommend keeping outside cats confined until we remove the sutures and check to see that healing is progressing satisfactorily. We do not make any special recommendations for inside the house cats. We recommend flexing the leg several times a day (usually three sets of four or five repeats of flexing and extending the leg) as long as the cat is reasonable about this procedure and doing this until the cat is using the leg well. Most cats are comfortable walking within a week or two and have full use of the leg within two to three months. It would be very surprising to me if Kusha does not have a good recovery from this problem. If you wish to be cautious, your vet is giving you the standard advice for femoral head ostectomy surgery, although this is based on dogs, who need more physical therapy and more time confined to leash walking rather than running hard. Our experience with cats suggests this is probably more caution than is necessary for cats and we tend to agree with the plan from the other web site you found.

Mike Richards, DVM

Paralysis of tail and leg in cat

Question: Dear Dr. Mike,

Once again I am hoping you can give me some help with my cats. I seem to run into the strangest problems.

Last night, Lily, my 5 yr old calico developed what can only be described as intantaneous paralysis of her tail and left rear leg. Five minutes before this she was playing. She went into the bedroom and laid down on the floor next to the computer chair ( a favorite spot of hers). I went into the next room and soon afterwards hear one loud painful yowl. Lily was laying in the same spot, all six of my other cats had come to investigate the scream too. She looked fine until she tried to get up to walk to me and her left leg was just hanging there limp. There was nothing out of place in the room, nothing had fallen etc. At first she did not seem to be in any obvious pain, for about the first 20 minutes. I put a call into my vet immediately and then checked Lily for obvious breaks or dislocations. My vet returned my call and I got Lily up there about 45 minutes after the incident occured. She was examined and showed no reflexes at all in her left rear leg. She did scream quite loudly when my vet pinched her toes, but I don`t know if this was a deep pain response or just the fact that she always screams very loudly at the vet`s. ( Lily has a reputation up there).

We took an xray and there were no broken bones in her leg or pelvis, no dislocations and no spinal fractures visable. She was given an injection of prednesone and a painkiller last night. I brought her back home and kept her isolated with me during the night and then back up to the vet this morning to be examined again. She was given another injection of prednisone and pain killer ( not sure what) and also penicillin. We had to catheterize her to empty her bladder. She is showing no signs of tone in her leg or tail. She did have some small signs of tone to her urethral area when we inserted the catheter.

Lily has had a history of adverse reaction to anethetic. she stopped breathing after a routine teeth cleaning. She also had a bout of elevated liver enzymes of unknown origin. (I wrote to you about that one as I had three cats ill with liver problems). To make matters worse, Lily is also what we affectionately call a "porker". I know the dangers of Hepatic Lipidosis as Fletcher passed away from this last November, even with early stomach tube placement. Lily is already refusing to eat which has me extremely worried.

Ok now finally to the questions. What in the world could possibly have happened to cause this? I am wondering if she herniated a disc in her spine. My only possible senerio is that something spooked her and she might have gotten her leg caught under the leg of the computer chair then wrenched her spine in the process. She obviously has some sort of nerve damage, but my vet and I just don`t know where to go with this, other than pain control and steroidal treatment.

Lily has not had a bowel movement in 36 hours and with her tail paralyzed I don`t know if she is capable of even having one. She has always had healthy bowel habits. Is there something I can do to help her with this?

I have read that nerve regeneration can take months to occur if it does at all. I am worried though that Lily will not make it this far due to the risk of hepatic lipidosis. I don`t want to have her suffer but at the same time I don`t want to give up on her. I am disabled and at home all the time so I can give constant care, so that is not a problem. It is just that I am at a loss as to what to do for her without a definitive diagnosis. I live pretty much out in the middle of nowhere and there is no access to an MRI scanner ( there is one mobile unit for humans in the entire southern half of the state of New Mexico).

I don`t know if I should be trying to "exercise" the limb to keep some muscle tone of if this would be detrimental. Would alternating ice and heat help?

I know it is nearly impossible for you to help when you can`t examne her in person, but any information you might be able to provide would be greatly appreciated.

Sincerely, Denise

Answer: Denise;

The three disorders that come to mind with this clinical history are aortic thromboembolism, fibrocartilagenous infarct and a condition referred to as "tail jerk".

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The most common problem is tail jerk, but it is a traumatic condition in which the tail is held still while a cat is moving -- or the tail is pulled while the cat doesn`t move. This happens from dog attacks, getting the tail caught in doors, under rocking chairs and under car tires -- or anything else that can lead to the tail being pulled away from the body with some force. Usually both rear limbs are affected equally, though. In many instance there is a visible separation of vertebrae in the tail, as well. So even though this is the more common condition, it doesn`t seem as likely in this case.

The next most common problem is aortic thromboembolism, usually due to dilated cardiomyopathy. This is a heart condition in which the heart chambers increase in size, leading to blood sludging and clotting. When a clot is released into the aorta, it may block blood flow to one leg or both legs, leading to sudden loss of function in the leg. The leg is usually colder to the touch than the other leg and other signs of poor circulation. There may be swelling of the leg or legs and this condition is often painful. I am not aware of a really effective treatment for this condition. Many cats will recover from the immediate problem but the cardiomyopathy is still present, so the long term prognosis is still grave. There may be a heart murmur or other signs of heart problems when cardiomyopathy is present. The best way to diagnose this condition is ultrasound examination.

Fibrocartilagenous infarcts occur when disc material makes it into blood vessels around the spinal cord, damaging the cord. This condition is rare in cats but it can cause really discrete damage, such as the loss of function in one leg and the tail, as you are seeing. This condition is extremely hard to diagnose with certainty. Usually, there is a partial to complete recovery of function within a few weeks, if deep pain is present on the initial exam -- so hopefully Lily was feeling the toe pinch if this condition is the cause of her problems. There is no treatment for this condition that I am aware of but most vets do try corticosteroids like prednisone. It is important to make sure that she does have bowel movements, is urinating and is taking in food and water. Nursing care is the key to recovery. You do have to worry about secondary hepatic lipidosis, so enticing Lily with special foods or going to tube feeding if she isn`t eating soon would be good things to do.

Those are the things I can think of.

Mike Richards, DVM

Stiff joints in Birman - treating pain in cats

Question: I have a 17 year old Birman male cat, who is starting to suffer from stiff joints. Can you recommend anything to ease these symptoms. Also he seems to have occasional sudden jerking movements (similar to a small electric shock) that makes him jump suddenly (its not fleas), and I wonder if there might be any neurological issues associated with this. It only lasts a second, and seems to recover quickly, but it definitely upsets him. Thank you for your assistance. Regards Jane

Answer: Jane;

Pain is a frustrating thing to treat in cats. They do not tolerate non-steroidal anti-inflammatory medications (NSAIDs) very well. This is particularly true for cats who have any kidney damage.

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Acetaminophen (Tylenol Rx) should never be given to a cat. Aspirin may be used carefully, and under a veterinarian`s supervision, but must be given no more frequently than every 48 hours (every other day) and the dosage has to be calculated correctly for the individual cat. We use 10mg/lb of body weight or 1 of the 81mg adult chewable aspirin tablets, whichever is less medication. We worry about these cats but there are times when pain control is worth a small amount of risk taking. Piroxicam (Feldene Rx) can also be used in cats, as long as there are no pre-existing kidney problems, at a dose of 0.15mg/lb every 48 to 72 hours, when taking some risk is worthwhile. These are the only NSAIDS that I know of that can be used with any safety in cats.

Glucosamine and chondroitin can be used in cats. The veterinary product that I know of, containing both of these ingredients, is Cosequin (tm). It seems to help. We use Adequan (Rx), an injectable glycosaminoglycan product that sometimes seems to work when oral medications do not.

Corticosteroids are the remaining choice in cats with pain from arthritic or neurologic pain or inflammation. These can be very helpful but there are a lot of side effects associated with corticosteroids, such as increased drinking and urinating, decrease in immune system function and sometimes even weakening of the cartilage in the joints that you are trying to protect. Despite the drawbacks these are potent anti-inflammatory products and the reduction in inflammation that they can provide is very important to the quality of life of some patients.

Your vet might be able to help you tell if there is degenerative joint disease or a neurologic problem, although it could take some effort. These is a small chance that this could be a seizure condition, as well.

Since the major problem is stiffness at this time, the best solution might be to consider using the safest medications first, which would be the glucosamine/chondroitin or Adequan (Rx). It would be worth talking this over with your vet.

Mike Richards, DVM

Amputation for radial nerve paralysis

Q: Dear Dr. Mike: A good friend of mine has adopted an 8 week old kitten that was found wondering in a parking lot. The kitten, had sustained an injury (unknown as to how) to his front left paw. The paw has damage to the radial nerve, but seems to have good circulation. The kitten has full use of the limb other than the paw. (In human terms, from the "wrist joint" forward the paw just dangles.) The kitten gets around okay and bats at toys with the injured paw. The vet who has cared for the kitten so far recommends amputation at the shoulder joint. My question is why amputate the whole limb when only the paw is effected? I appreciate any information that you might be able to offer. Sincerely, Andrea

A: Andrea;

The standard recommendation for amputation involving a front limb is to amputate at the shoulder. The reason for this is that cats will persistently walk on the leg if there is any portion beyond the elbow remaining. Walking on the scarred end leads to infection and to continued problems with the leg. In most cases, if amputation is necessary, it is better to amputate at the shoulder.

I do think that it would be worthwhile to get a second opinion about this case, though. Radial nerve paralysis normally causes the foot to turn inward and for the pads of the feet to turn in enough that they actually point upwards (think of it as the position your had is in when you are eating soup and are moving the spoon between the bowl and your mouth). In some cases radial nerve paralysis will correct itself over time and if the leg muscles have been exercised the foot will be useful. We have splinted several patients to try to prevent the foot from turning and this seems to have worked at times.

If the radial nerve paralysis is permanent, most cats will walk on the top edge of their carpus (wrist) and eventually develop chronic infections -- which is why there is a recommendation to amputate the leg.

I have a very hard time reading radiographs in kittens this young and evaluating damage to areas like the carpus that have a lot of small bones in close proximity. We send young patients to an orthopedic specialist when we are not sure what the best course of action is. If that is possible in your area, and within your friend`s means, it may be worth considering.

If the foot is damaged due to blood clotting in the foot from an injury or if the nerves are damaged farther down the leg than radial nerve damage typically occurs (usually everything past the elbow is affected), then it the foot might flop as you describe even though there isn`t a fracture or dislocation. Your friend`s vet has had the advantage of being able to see this injury and it is very likely that the advice given is based on sure signs of a significant problems -- but if there is any question consider a second opinion.

Mike Richards, DVM

Tail amputation

Q: Dr. Mike,

I specifically subscribed to your site and newsletter so I could get an answer to my question, so the sooner you reply, the better. I have an 8 month old cat who recently(2 months ago) got his tail caught in a garage door and as a result of the injury had to have his tail amputated. Also as a result of the injury, he has lost all of his control over his bladder and his bowels. The tail was seperated from the spinal cord and the nerves were damaged and/or torn. Is there a way to tell wether or not the nerves will ever heal or do I have to wait for 6 months like my vet said. Is a CAT scan an option? The cat is very healthy besides the obvious and is very happy. He had temp. paralysis after the accident, but after 2-3 weeks he was able to walk and now can jump and climb. He also stretches his hind legs, which I believe is a good sign of his nerves repairing. He can not feel his rectum and it bleeds quite often from the constant running of the bowels. The vet put him on steriods after the surgery and they helped the walking, and we have him on Flagyl for the diarrehea. We tried a drug called clavamox, but it gave him diarrehea. Isnt clavamox an antibiotic? Do you know of any drugs I could give this animal to help repair his nerves. I hate the idea of putting this happy animal down, but unless I can get this problem resolved I will have to resort to that. Please offer some advice or some names of a specialist in the Atlanta area that could possibly help me. Do you know anything about acupuncture on animals, I had a vet recommend that for the nerves. If you could offer any advice, it would be greatly appreciated.

Thank you, Jamie McD

A: Jamie

I`ll try to answer all the questions in your note. If I miss one, just write back.

Clavamox (Rx) is an antibiotic. It is a combination of amoxicillin and clavulonic acid. Flagyl (Rx) is also an antibiotic, metronidazole. It is always tempting to use antibiotics when diarrhea is present but I think that the diarrheas associated with "tail jerk" injuries are more likely to be physiologic due to irritation from retained stool. For some reason, once these start, they can be very hard to get rid of. We have the best success using higher fiber diets. Feline w/d or r/d diets sometimes help and it is OK to add Metamucil (TM) or canned pumpkin to the cats regular food to increase fiber, too. Sometimes we resort to Immodium AD (TM) or Lomotil (Rx) when we get desperate. Controlling the diarrhea makes the whole situation a lot more livable. The stool still comes out when it wants to but it is easier to clean up when it is solid and is far less irritating to the cat.

I don`t think that a CT or MRI scan is likely to be very helpful, based solely on the total lack of recommendation to use them in the literature concerning this problem. I can not be certain of this based on what I can find, though.

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The neurologic signs that are present are the best clue as to what is going on. With loss of use of the rear limbs for several weeks and continued lack of rectal tone and bladder control, the prognosis has to be guarded. These things indicate lower motor neuron damage with often means that the nerve roots were actually torn free from the spinal cord. If this happens they are not likely to heal. The progress you have seen so far is encouraging, though. Sometimes it is helpful to use urecholine (Bethanecol Rx) to stimulate bladder contraction but it is late in the game for this. I`d probably still consider trying it, though.

The longest we have ever had a client wait, unsuccessfully, for bladder function to return was one year. I think that this client would have kept on going but family problems led to a move to a situation in which caring for the cat was much more difficult (being around to express the cat`s bladder at least a couple of times a day is necessary for long term success in managing a cat without voluntary bladder function). The longest time we can remember a client waiting and having a successful outcome is 4 months. One of our own cats had this problem and took a little over three months to get a return of voluntary bladder control. It is difficult to wait for an answer but as far as I know, it is the only choice.

I don`t know a vet in Atlanta but you`re not that far from the veterinary college in Athens and I am almost certain they have a neurologist who could give you a better idea of the prognosis at this point if allowed to examine your cat, or possibly just from your vet`s description if he or she will call for a consultation.

I don`t know a whole lot about acupuncture but it isn`t likely to hurt so if you can find a veterinary acupuncturist I don`t see any reason not to try that. Several of the veterinary schools have acupuncturists associated with them now but I have no idea if the University of Georgia school does.

Sorry I can`t help more.

Mike Richards, DVM

Feline Arthritis - Glucosamine and Chondroitin dosage

Q: Dear Dr. Richards, You sent a note to me on 3/15 recommending that I might try glucosamines for my arthritic cat. I discussed this with my vet today and she said it wouldn`t hurt. She has never prescribed it and doesn`t know what dosage to recommend. My cat is currently taking 5 mg of Prednisone every other day. How much glucosamine should she take? Is this something I can find at a health store like GNC? Any particular brand? Can I combine it with the Prednisone or should I try it separately?

Thanks for helping, we very much appreciate it!

Nancy

A: Nancy;

There are several products on the market containing glucosamine or chondroitin (or both) for oral use and the injectable product (Adequan Rx) is also used in cats by many practitioners.

The dosage for the oral products that I can find a dose for:

Cosequin (TM): 1 regular strength capsule per cat per day

Glycoflex: 300mg/day per cat

Adequan: 1 to 2mg/lb. Dosing schedules vary widely. We use it weekly for 5 injections and then try to stretch out the interval to whatever we can without losing its effect. Usually this is somewhere between 2 and 4 weeks.

I have seen a recommendation for glucosamine of 150 to 300mg/day per cat using the generic products available.

To the best of my knowledge, none of these dosages is based on a controlled dosage study -- they are all just commonly used dosages. These products are pretty safe so complications from use aren`t likely despite the lack of controlled studies.

Good luck with this.

Mike Richards, DVM

Broken Tails

Q: Hello. My cat dislocated one vertebrae halfway down his tail. We had x-rays done, and he is on antibiotics to prevent bacterial growth. The vet said they do not set or fix their tails when this happens. Is this correct?

A: Tara;

Tails can be surgically repaired when the vertebrae are luxated (which is the most common cause of a "broken" tail) or even repaired if there is a fracture through one of the vertebrae that make up the tail. Most of the time this isn`t done, though. Tails seem to heal reasonably well without treatment and treatment tends to be expensive so most vets assume that treatment doesn`t have a good cost/benefit ratio. I have had several clients who were very concerned about the appearance of their pet`s tails, though. One put on a padded bandage to keep the tail straight during healing and it worked quite well. We referred one broken tail for surgical repair due to an owner request, as well. As long as you don`t mind a visible kink or bend in the tail leaving it alone is usually OK.

Mike Richards, DVM

Kitten with funnel chest

Q: my female maine coon pedigreed cat had a litter on 4-4-97. Last week I noticed one of the kittens had a sunken in chest area just below the sternum. I took them all to the vet to be examined yesterday. And the vet took xrays of the kitten with the sunken in chest. He said the kitten had funnel chest which he said is extremely rare. I asked if there was a surgery to correct it and he said that this kitten had it to bad and would have to be put down. The kitten is extrememly healthy otherwise and now weighs in at 300g at only 2 weeks old. He weighed 100g at birth. he is a gorgeous show quality brown classic maine coon. I hate to put him down if there is something that can be done. he also had a mild case of upper respiratory infection which we are treating now and of course treating the mother cat and the rest of the kittens in the litter. But the kitten with the sunken in chest seems completely healthy otherwise. He has a slight habit of breathing harder than the other kittens in the litter. And he also had some fluid in his lungs in the xray. We are treating that also. The vet said I could try to manipulate the chest occasionallly to see if that helps the chest to redevelope correctly. Please help me some advice I dont want to have to put him to sleep he doesnt seem to be in any pain or even appear ill.

A: There is a corrective surgery for this condition, also known as pectus excavatum, if you would consider a surgical repair. That would make it unethical to show this kitten later, if that is a consideration in the decision. I have seen no references suggesting that this condition is more common in Maine coon cats than other cats but have noticed that they are often the breed of cat mentioned in clinical case reports on this problem.

There are several surgeries designed to help with this condition but the most commonly used one seems to be fixation of the sterum and/or ribs to an external splint -- pulling them into the correct position. The success rate is very high based on the clinical reports. If your vet is unfamiliar with how to do this or uncomfortable experimenting with surgery, as I would be, referral to a surgical specialist may be a good idea.

We see several cats in the practice with varying degrees of this condition in which no repair has been made. It does appear to hamper the activity level that some cats can sustain and we have seen severe respiratory disease in at least one cat affected with this that I can remember. We have found this condition on physical exam of a couple of cats whose owners were completely unaware of it, so it does seem that some cats also can live a fairly normal lifestyle with this condition.

I`d definitely consider a second opinion prior to euthanasia and surgical repair while the kitten is young, if that is an option you would consider.

Mike Richards, DVM

Patellar luxation (dislocation of the kneecaps)

Q: We have a 5 year old male that was captured as a feral kitten at about 6 weeks. He has been very healthy and active. He has significant Manx, with no tail and long rear legs. Recently, and suddenly, he has had problems with his rear knees popping out of joint, particularly one leg. Our regular vet seems to think it`s congenital, and there isn`t any thing to do. We are taking him (the cat) for another opinion this afternoon. Is there any appropriate surgery, or other treatment? Also, I would appreciate literature referances, web or print. Thanks.

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A: Patellar luxation (dislocation of the kneecaps) seems to be more common in cats now than it has in the past. Or at least it is being recognized with greater frequency.

There is some argument about when it is necessary to surgically repair this problem and when it is OK to leave it alone. If it is from trauma it is possible that less invasive surgery will be necessary to repair it than if it is a congenital problem that is now becoming worse with age.

In a Manx cat it is also a really good idea to rule out neurologic disease as an initiating cause of the condition through its effects on the musculoskeletal system.

There are a number of good orthopedic surgery books but my favorite is Slatter`s Small Animal Surgery. Your vet may have others. I`d just ask if you can read them. We let clients read our reference books as long as they are willing to do it at our practice. I don`t lend them out!

Mike Richards, DVM

Manx with Patellar luxation - part2

Q: Thank you. I`ve read the appropriate chapter in Slatter`s, particularly the section on patellar luxation. It seems mostly to be `how to`, which I am not going to do myself. Given that he`s a healthy 5 year old, the things I want to know are: 1. Surgery or not: how do we decide this? He can walk and jump, but seems to be unhappy and slugish about the situation. He does seem to be slightly `throwing` one leg, and sometimes shaking it several times. 2. Prognosis if no surgery? 3. How likely is the surgery to really work well? 4. How likely is the surgery to make things worse? 5. Are their statistics, or better, owner reports concerning results? The Vet says he does a lot of dogs, and some cats, and the result is usually good. But with all due respect, that`s not very comforting or reassuring. I`d much prefer owner reports.

A: I have to admit that I don`t have my Slatter`s book at home -- usually there is a good section on the pathogenosis of the problem and prognosis for good recovery but that does vary some throughout the book.

I wish that I could provide the information you are seeking but I can`t. We have a hard time in many instances advising clients about the desirability of surgery in their pets for this condition.

If the injury is traumatic or if the underlying changes in the bone are not severe, surgical repair may be as simple as tightening up the joint capsule and there is little post-surgical discomfort and good success. If the condition has progressed to the point that there are severe changes in the bone conformation and disability then the more invasive surgeries have a better long-term prognosis than not treating the condition and the relatively short duration of the post-surgical discomfort compared to lifelong problems is still worthwhile.

It`s all the cats and dogs in-between that make this a hard condition to make recommendations for. If you trusted the surgeon and the surgeon trusted you it would make the decision easier -- because this is one surgery in which it is easiest to determine the complexity of repair necessary after starting the procedure. If your vet feels that it is OK to make a good judgment of how far to go with repair and if you understand that a simple approach may require a second surgery later, I would feel pretty good about recommending repair.

The rate of success in treating medial patellar luxation in cats is reported to by high by the orthopedic surgeons we refer to but those are not owner reports. On the other hand, I do trust the surgeons.

I know that doesn`t fully answer your questions but it is the best I can do.

Mike Richards, DVM

Arthritis or hypokalemia (low blood potassium)

Q: I have an 18 year old Siamese who is a little bit creaky in the hind limbs. She is plainly athritic. Would a nsaid help? What would be an appropriate dose?

A: Before you chalk up the hind limb problems to arthritis in an older cat it is important to eliminate hypokalemia (low blood potassium) as a possible cause of the apparent pain or weakness. This is a common problem in older cats who have a decrease in kidney function. Cats may just appear to be weak or they may appear to be painful. When the condition is severe they may have problems holding their head up due to weakness of the neck muscles. It is also a good idea to consider confirming the arthritis through X-rays. Cats do not seem to develop arthritis as commonly as dogs or humans and it is worthwhile to confirm it.

DO NOT give any cat a non-steroidal anti-inflammatory medication without consulting with your vet first. Acetaminophen is toxic to cats, aspirin is extraordinarily easy to overdose in cats because the half-life of aspirin in a cat is 72 hours (3 days!) and other non-steroidal medications do not appear to have been studied much in cats, probably due to the problems with these two common ones. For arthritis, we do sometimes use aspirin but it must be used cautiously and it is important to know the patient`s medical condition well prior to its use.

Due to the above problems, we use corticosteroids more frequently for arthritis in cats than we do in dogs. There seem to be less side effects but it still wouldn`t be our first choice if there was a safe non-steroidal medication.

Mike Richards, DVM

Feline Arthritis

Q: Is there any treatment for feline arthritis?

A: Arthritis is a little harder to deal with in cats than it is in dogs because cats are sensitive to a number of the medications that are normally used for arthritis. With the cooperation and careful supervision of your vet, it is possible to use aspirin for arthritis in cats. Due to the potential for toxicity it is very very important to talk to your vet prior to using aspirin in a cat. The new medication for dogs, carprofen (Rimadyl Rx) appears to be safe for short term use in cats. This may provide a period of relief sufficient to last a little while beyond the use of the medication. We have used Adequan (Rx) in cats in our practice and feel that it was useful but I can`t be absolutely certain. The glycosamine products like Arthroflex (Rx) or Flexagan (Rx) may also be beneficial in cats but again, there is not a lot of supportive evidence for this. They do seem to be safe to use, however. Lastly, corticosteroids are useful in cats and less likely to cause side effects than in dogs.

Also, it is very easy to confuse hypokalemia (low blood potassium) and arthritis in older cats and polymyositis and arthritis in younger cats. It is important to be as sure as possible that arthritis actually is the problem.

Good luck with all of this!

Mike Richards, DVM

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