Long shot- Any Veterinary Orthopaedic Specialists here?

[SugaryBits]

Who would be willing to give an opinion and possibly look at X-rays for me?

My cat was hit by a car last night and has fractured his pelvis, dislocated his femur and fractured his left ilium. I have been offered a couple of options, including orthopaedic surgery but have been told this will cost a minimum of £3000. I really cannot afford this, 2K I might have been able to borrow but not 3+.

The other option seems to be to wait until pelvis heals slightly, put the right leg back into place, then amputate the left.

Would really appreciate any advice. Thanks

Hopeful bump

Well I'm not an orthopaedic specialist by any means but I am a vet - is it his left femur which has dislocated? It's very hard to give much of a comment without seeing the films. Has your own vet been in consultation with an orthopaedic surgeon? I quite frequently trace x-rays and fax the picture to referral surgeons for them to look at, and find they're often able to give helpful suggestions if I explain that the owners have financial constraints.

Sorry you're having to deal with this - poor cat

Thank you so much for taking the time to answer.

No sorry it's his right femur which is dislocated- which is why they can't do the amputation straight away. He needs to have a "good" leg before they can do anything as I understand it. The vet said she could send the specialist the Xrays (which are on disc), which would cost £45 but I don't know whether it would be best to not do that, as I already know I cannot afford even the minimum amount. Really don't know what to do. Absolutely heart broken.

So why does the left leg need to be amputated? It may be because there is a fracture through the socket of the hip joint, do you know if this is the case?

Have you made your financial position absolutely clear to the vet? This will help them to work out what treatment options are best.

To be honest I don't know, I presumed because the fracture is quite bad and I can't afford the surgery option which would be to pin it. I am just so upset at the moment, I didn't really ask the vet many questions.

I have told the vet that I absolutely cannot afford 3000. (As an aside if I was on my own I would just take a loan and pay whatever necessary but my husband does not agree) She said it is possible he could recover in 4-6 months with the treatment they can offer which will cost around 1000.

Could you give me some pointers on things I need to ask the vet? I am going to visit Jasper tomorrow so may get a chance to speak to her.

Thanks again.

I've just looked at what I wrote down last night when I spoke to the emergency vet and he said the left ilium joint is fractured.

Are you still around IAR?

Sorry, ill baby!

I'm really limited without seeing the films but the critical things which your vet should explain to you are the following:

He needs to be able to pass urine and faeces - sometimes nerves can be damaged when the pelvis is traumatised.

He needs to be able to bear weight through his hip, which is a ball and socket joint, so a fracture which involves the acetabulum (the hip 'socket') requires surgical repair, or alternatively amputation of the limb.

Severely displaced fractures may need surgery but often pelvic fractures will heal adequately with strict cage rest, painkillers (obviously!) and nursing.

In some cases, femoral head excision (removing the 'ball' part of the hip joint) can allow reasonable function of a hindlimb when the pelvis has been badly damaged.

There are too many variables for me to give you my advice but you should be absolutely clear on your financial limitations because then the vets can try to plan treatment accordingly. Most expensive is not always what's best for the animal, so don't feel guilty. Ask why surgery is necessary, ask why an amputation is necessary, and ask about whether the injury would have a chance of healing without surgical intervention. Your vet should take time to explain all of the above to you so that you understand exactly what your options are and why.

Sorry I'm not more help - I'm more than happy to look at films if you can get hold of them but as I said, I'm certainly not a specialist!

My cat was hit by a car and dislocated her hip. Vet tried to put it back but it kept dislocating. She had the head of the femur removed and you would never know now. Climbs trees etc. no probs. This surgery cost us about £300 pounds in total with all the other treatments and xrays etc and including an emergency call out for vet as she was run over at night.

Thank you so much for your time IAR, sorry you baby is ill. I will take a list of questions with me tomorrow. The emergency vets put the xrays on disc so I will ask if I can have them and if you wouldn't mind, see if I can E-mail them to you... Not sure if thats possible or if they need a special program to open.

Shouldbeworking, glad to hear you cat is well. My grandmother has a cat whose leg was aputated and he lived a very happy life to the grand old age of 22!
I think we are looking at a significantly bigger bill unfortunately. The treatment (Xrays, drip, catheter, methadone)last night cost £300 and as he will be staying until tuesday (at least) I expect another bill for around £200 for his stay and meds before anything more is actually done.

Why do they always manage to hurt themselves on bank holidays?!

I hope Jasper's feeling better soon, and if you get hold of the pics email them to me at turquoiseelephant at sky dot com.

Thank you IAR. Think they call it Sod's Law don't they?! Hope baby is better soon, will E-mail you if they will give me the disc back!

I'm also a vet - not an orthopaedic specialist though.
Is your cat with your own vet or still at the emergency vets? Are these figures ones the emergency vet has quoted or your own vet?

Fractures through a joint such as you describe are very hard to deal with yes. Cat's do heal well, but this sort of thing is less likely to heal without some sort of internal fixation in most cases.

Dislocated hips in cats are most commonly treated by the removal of the head of the femur = the ball of the ball and socket joint that makes the hip. They then walk based entirely upon their muscles supporting their weight and keeping the bones in a reasonable alignment. The vast majority do really well with this.

I think that the most major concern here is what happens with the ileum fracture. I think you need to get an opinion from your own vet and find out what they are able to do within their skills range and at what costs to you. The ileal fracture repair may or not be within the capabilities of a non-specialist depending upon their experience - however it will only be a minority of non-specialists that would do this I think. That is for them to be able to advise you.

If you came to me with this and money is a huge issue here, referral not an option, finding any financial help is not forthcoming, and you do not qualify for subsidised treatment at the PDSA or RSPCA then although not the most ideal approach, I would be tempted to remove both femoral heads (the ball part of the femur) which is a more relatively common procedure than the ileal repair in general practice (again though your vet would have to be comfortable to do this) and then treat the other fractures within the pelvis with conservative treatment - ie cage rest for 6-12 weeks depending. By removing the femoral head on the fractured ileum side you would put less force onto the pelvis and there is a better chance that the fracture would heal without further intervention surgically. Yes it is a bit of a gamble and still may not work, and yes the cat would have both hindlimbs pretty sore for a while, but it may just be an option. Please though do remember that I am saying this all without the benefit of the x-rays or cat to see and the full extent of the injuries could be different to those you recall being told. It also depends on how well your cat is in himself. If he can take any weight that is a more positive sign. Does his tail move? Does he have bladder control. There is a lot to be checked and monitored first to ensure that doing anything is in his best interests.

Well, there is a lot to think about in all that. I do hope your little cat does ok with all this, and that hopefully a good solution can be made given the financial situation. It is worth talking with your own vet if they will do the work if they allow any sort of standing order payments to help spread the cost. Sadly I know most specialists will not do this however for you so if he has to be referred there is a pretty low chance of that happening. You can but ask however. One final thought - if your own vet can't do these procedures, phone other local vets and see if there is anyone who is more interested in doing surgery like this in a non-specialist capacity. You may find that it is cheaper than specialists, though obviously you are not getting specialist care either. You are perfectly entitled to seek a second opinion on this, and should not feel bad if you wish to do this. Just let the new vet know your old vet details so they can seek the permission (a courtesy) and more importantly the full history through.

Good luck

Just breezily say you've a mate who's a vet who you said you'd show the films to but be warned, the images are property of the practice and they may say no. I don't see any reason why they would refuse though - our lovely ortho referral centre send us digital pics of their films with discharge reports so we can gasp in wonder at their surgical wizardry, I think they just like showing off!

I hope it all works out in the end, good luck

beautifulgirls has explained all this very much more clearly than than I ever could have

Took me forever to think it out though !

Thank you beautiful girls. Jasper is at my own Vets now. I picked him up from emergency vet this morning and took him to vet I am registered with.

The figures quoted are from my vet. They would need to refer to specialist ortho. My vet said in cases like this the minimum cost of this would be 3k, maximum around 5k. She can't give me a precise estimate unless she sends Xrays to specialist. I could have stretched to about 2k. As I am a SAHM I won't be able to get a loan and even if I could would have no means of paying it back. My husband will not agree to pay out 3+k. I would not qualify for any help with costs.

He was moving his tail last night and emerg vet said he could palpate (sp) bladder after he had been on the drip for a while. I'm not sure if he has passed urine, was on a catheter this morning. Vet said there is a future risk of constipation as something(sorry can't remember what, pelivc canal?) has narrowed.

The Xrays were actually done at emerg vets, and they gave me the disc so am hoping my vets will be prepared to give it back!

asked dp - top referral would be that price

he says diff without seeing it but

if you do not want to spend loads

1. leave pelvis to heal ( depends on degree of displacement)
2. do arthroplasty later on femur

this would amount to hundreds not thousands

But my cat was in the vets for several days, had drips, xrays, three anaesthetics, antibiotics, painkillers, an op to relocate femur plus another op when the femural head was removed and ALL this treatment was £300. I would expect you to have to pay more as your cat's injuries are worse but there is a long way between £300 and £3000. I hope everything works out for you.

beautiful girls agree re some vets tackle orthopaedics others just refer on to specialists

shouldbeworking....stick with your vet if they are that cheap Honestly I'm amazed they have covered their costs in any way with all that being done but glad for you and your cat that it was treated too. I know different parts of the country will charge differently too, but the differences are not so great usually.
It is really hard to comment on the money side of things for this poor little cat really without more detailed knowledge of the case.

SugaryB - press your own vet about the femoral head removal as to whether anyone in the practice would consider doing it, and if not ask if they know other local practices who would. You could also phone about and ask yourself without committing yourself. They may of course find it a bit odd and insist on more info but for now all you need to know is a yes or no, under the correct circumstances is there anyone there who could do that sort of surgery. If you get a yes, then work on the second opinion with your cat being seen and them having all the info to decide if it is really a fair option to try for your cat with this.

Butterfly & should be.. I am only going on what vet has told me price wise. I would obviously need to get the referral for a better estimate.

Shouldbe.. I think you got a very good deal! My bill just from last night was £303.62
emerg consult- £677.55
sedation fee £36.60
IV Cathether placement- £8.80
drim aquapharm 32.99
Xray cat 1-2 plates £111.25
hospital fee £24.24
methadone £ 13.05
synulox inj RTU 9.14

drip aquapharm not drim!

Quite..... I now realie how lucky I was. Because sadly at £3000, I would never have been able to afford it.