Cat FLUTD/FHS/POST-OP Complications

by Jess Abston
(Woodstock, VT)

QUESTION

I'm hoping you might be able to help me with my cat Oliver. Oliver is a three-year-old maine coon mix that I adopted from the upper valley humane society when he was about six months old.

He has had a really rough year; in January, Oliver broke his left hind leg (a spiral fracture of his tibia). My vet recommended surgery to repair the leg and referred me to Burlington Veterinary Specialists in Williston, VT. What was supposed to be a very routine surgery turned very complicated as within days of installing steel surgical plate into Oliver's leg the plate dislodged entirely. They performed a repair surgery a week later, in which they installed a larger plate over the smaller plate that had come loose.

Then began a very long, frustrating, and stressful recovery process, in which Oliver had to be confined to a crate or room for months at a time; he wore a splint for the first couple of months of recovery that the vet changed every week/week and a half. For some reason, Oliver was not healing well. So the months of confinement and isolation dragged on; at some point it was decided that his leg was strong enough to try supporting his weight without the splint. But after a couple weeks of this, I noticed that he was holding his leg at an increasingly odd angle, as if he was almost walking on the inside of his ankle hock. So, I brought him in for x-rays, at which point the vet determined that Oliver, over time, had somehow bent the double steel plate. No one could explain to me how or why this happened. The consensus was that it was basically impossible, yet it happened. My vet thought yet another surgery would be required to correct this, but I consulted with the surgeon, and he felt that another surgery for Oliver at this point would do more harm than good because it would disrupt the healing that had already occurred. He assured me that Oliver's leg would heal as is, and while he may walk a little funny, he would not be in pain and would experience a full recovery. I came to terms with this being an acceptable end result to an epic ordeal.

I brought Oliver in for regular checkups to monitor his healing progress; he was healing so slowly, but he was showing signs for healing, so that at least was encouraging. Around mid-May it was finally decided that the could be left unconfined unlimitedly and without supervision. He seemed OK; he did walk with a limp, but he also ran, jumped (not as well), and played. I could not tell if he was in pain or not, and though I constantly worried that he was, the vets assured me that the signs of healing were good and he did not seem to be pain.

So, that's the back story! More recently, in July, Oliver started exhibiting signs that he may have a urinary tract infection (lots of licking in that area, straining, inappropriate elimination). I brought him into the vet to get it checked out, and they determined he had FLUTD (Feline Lower Urinary Tract Disease). They suggested that I change his diet immediately from the Purina One Sensitive Systems dry food that I had been feeding him to a prescription wet food diet specifically designed for this condition. Oliver loved the wet food initially, but not long after I switched him over, he started exhibiting a strange behavior that I'd never seen him do before--he would try to bite, scratch at, and chase his tail obsessively. When I informed the vet of this behavior, she thought it might be related to the pain he was experiencing from his bladder issues, so she upped his prescription food dosage, but the behavior got worse instead of better to the point that we had to put an e-collar on him to prevent him from hurting himself. Oliver stopped eating the prescription wet food, so we switched him to the prescription dry food for FLUTD.

At this point, the vet suggested that Oliver might have another, rare neurological disorder called FHS (Feline Hyperesthia Syndrome). She recommended that we start treating him with a combination of Fluoxetine and Gabapentin immediately. I had read about this disorder on the internet and how it could only be diagnosed through a process of elimination, so I asked her to run some tests, take some x-rays to make sure there wasn't something else going on. In the meantime, we started him on the prozac and gabapentin because she told me those would take up to six weeks to start having any kind of ameliorative effect on his condition. Blood work and x-rays came back normal, except she expressed concern at fracture site again, saying that Oliver may be experiencing chronic pain, but they'd need more x-rays and to consult with Oliver's surgeon to be sure. I agreed to this, and NOW the surgeon and my vet are saying that it looks like Oliver has delayed healing or a possible "non-union" at his fracture site and that he could be experiencing chronic pain because of this and that this could be the underlying cause for his current onslaught of stress-related disorders.

Now they want Oliver to have yet another surgery, in which the surgeon will go in and re-fracture his leg and try to heal it correctly this time. As you can imagine, after all Oliver and I have been through, I have grave reservations about this. Questions and fears abound--how can they be sure Oliver will heal any better this time around? What if he doesn't heal at all? How will the immense stress of going through yet another surgical procedure affect his mental well-being and his current stress-related disorders? I have very little confidence in surgery as the best option, but both my vet and surgeon are presenting it as the ONLY option.

I'm sorry I am writing so much about this to you, but if you have any advice whatsoever for me, I really would appreciate it. I feel so lost; I want to do the best thing for Oliver, and I thought I was doing that with the surgery the first time around, but it's just snowballed into a whole mess of problems for him, and I've gone almost broke trying to treat them all. I just want my happy-go-lucky, sweet, bestest kitty back!

Specifically, the question I was hoping you might be able to help me with is whether there are any non-surgical treatments/things I can do to alleviate any pain/stress Oliver is experiencing.

I look forward to hearing from you. Thank you so much in advance for any help you are able to provide.

All the best,

Jessica Abston
Woodstock, VT


It appears that your question and my answer are too long for this particular form. Please see my answer under the Surgery Section. It will have Oliver's name on it in some way. Thanks! Dr. Neely