Cat with hip dysplasia - tips for post-op care?

OopsyDaisy

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I agree we probably worry too much. I was trying to think like that as I wept earlier today because he was meowing in discomfort - he's pooping less and straining, yes, because he's constipated, but it's unlikely he'd pass away over something like this when he's otherwise doing so well. I just panic tbh. I keep looking for things online that talk about this side effect of tramadol to console myself.

I barely even think about his legs these days because of how concerned I am about his bowels. Who would have thought...
I get it! I suppose as long as he doesn't have any sort of blockage, like the vet told me: If it's going in, it has to come out eventually. Would he eat some pumpkin or something? Maybe a little extra water would help. I was giving Lulu extra dropperfuls of water because she wasn't going to drink as much as I thought she should. Just a thought.
 
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gabicards

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I managed to get a video of Topaz climbing up to one of his favorite spots in the apartment (the seat on my bedroom's window), so I thought I'd share: Topaz-16DaysPostOp.mp4

You can see the amusing mess we've made to try and help him out - rugs that are taped to the floor to cover as much of the (quite slippery) tiles as possible, boxes to create some form of "stairs" so that he doesn't need to jump onto it. Most of the apartment looks like that now, to minimize the chances of him trying to reach a place he can't and hurting himself.

Today we reduced the dosage of the other pain med he was on besides Tramadol, which is dypirone. He was getting it twice a day, and now only once, at night, as per his physical therapist's request. Her reasoning is that by getting it at night he relaxes and recharges for the following day, but if we give it to him early in the day, he could move around more than he should and feel uncomfortable at night... on Tuesday she'll see him, try to do her massage and let us know if we keep giving it to him once a day for a bit, or if we can let go of it already.

So current meds are: 3/4 of a 5mg prednisolone pill per day (starting the very slow process of weaning him off of it) and 120mg of dypirone.

Today he threw up a hairball, which he's been doing once a month since December. In December - January it was probably due to shedding (which has decreased a lot in February) as well as the elevated level of inflammation in his intestines, since that's when I was trying to transition him out of kitten food. Now I figure it's because of his constipation. It's so frustrating that it's all happening at once... after this horrible situation post-surgery (and post-Tramadol, which has been completely traumatizing) I expect it will take me months to have any sort of idea of how his intestines are doing. I'm only praying the constipation won't worsen the inflammation, which the prednisolone should have helped lower, specially since switching the food solved the symptoms. It would suck horribly if this set us back completely. :(

I've resolved to just let him be and try to keep him comfortable for now, as I doubt he's in any form of life threatening situation. We've ruled out literally everything we could with the blood, stool, urine analysis and all the other pre-surgery exams (kidney, heart...). Everything is perfect and his legs are recovering well. Can you tell I'm trying to convince myself? 😭

I hate Tramadol.
 

fionasmom

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Topaz is walking very well and does not seem to be in pain, just careful, but I don't see flinching or hesitating. You have to alter your place for them when they have any mobility issues, so don't think twice about home design right now.

Is he still getting Lactulose or any similar product?
 
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gabicards

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Topaz is walking very well and does not seem to be in pain, just careful, but I don't see flinching or hesitating. You have to alter your place for them when they have any mobility issues, so don't think twice about home design right now.

Is he still getting Lactulose or any similar product?
He does get around very well! His physical therapist has seen videos of him moving around the apartment and seems to be very pleased with his recovery. He complained a bit when my dad touched him yesterday (petting his belly, then picking him up), but the therapist says it's normal, it will take some time for the soft tissue to heal completely. We'll see how he does tomorrow when she manoeuvres him during his final session!

He is on lactulose, but tbh I haven't found it to be helpful. I once again tried and failed to give him an enema this morning - I just poked him a bit and gave up, but he pooped right after just like on Saturday. So that's 3 poops in 4 days - with a nudge, but I'm hoping he's not as uncomfortable as he was before.

I gave him a tiny bit of pumpkin puree today (just unseasoned, cooked pumpkin), about 1/4 of a teaspoon, maybe? I set aside half a teaspoon, but he ate that much willingly off my finger, and I didn't want to push my luck. I'll try another 1/4 tonight and see if he'd like it as a treat.

He's also been eating the usual post-surgery amount of wet food - between 2 and 3 sachets per day - with a tiny bit of added water everytime. He actually seems to like it more soupy, so I'm taking advantage of it to get some extra water into him.
 

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Three poops in four days is really good, especially if they are anywhere near normal in output and appearance. I understand your frustration in how much this requires staying on top of his elimination. My Graycie who was a street rescue at five has been to the ER for constipation and I have to be vigilant every day that she eats the food that has the Miralax in it, eats some of her hairball food, and drinks water.
 
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gabicards

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Three poops in four days is really good, especially if they are anywhere near normal in output and appearance. I understand your frustration in how much this requires staying on top of his elimination. My Graycie who was a street rescue at five has been to the ER for constipation and I have to be vigilant every day that she eats the food that has the Miralax in it, eats some of her hairball food, and drinks water.
Aww so that's an ongoing issue for your Graycie? I can't imagine :( I'm glad she has a human that cares!

Topaz's stools are normal-ish in appearance. They're more on the dry side, and they're less in quantity when he goes - so I see smaller pieces, whereas his healthy stools were seemingly perfect, in the sense that there was enough moisture for the litter to get stuck to it and for him not to strain, but they were still well formed. I don't know what to expect since he's been eating less... and I haven't been able to find anything online about how long it should take for the bowel movements to return to normal after someone stops taking opioids. My guess, though, is that there probably aren't any pieces of stool in his intestines that are dry and stuck, since what's actually coming out is well formed and not liquid? (I've heard constipated cats can sometimes have liquid stools because that's the only way it will pass if there's a blockage...).

Also, to be clear, he wasn't going back and forth to the litterbox like he was when we tried to give him the enema on Saturday. My mom thought we should try the enema again because yesterday he didn't poop, but it was more of a "let's make sure it isn't uncomfortable when he does try to go" as opposed to "he seems to be uncomfortable because he's trying to poop and nothing's happening". When I realized he was in the litterbox, he was already done, so I don't know if he was straining or if there was any blood on it.
 

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Fecal impactions of hard, dry stool will sometimes allow for the passage of a much more liquid poop, for example, if the impaction were poked with an enema, that did not allow all the stool to pass. You would notice it this were happening. Eating less will produce less, and it could be drier if there is less moisture in what he is eating. Blood from straining will be visible on the outside of the stool, of course hard to determine if it were covered up already. If he is not going back and forth to the box, not hiding or exhibiting other different behaviors, he might feel okay.
 
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gabicards

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4 poops in 5 days! Still needs a nudge, though. He had been meowing all morning, but not going to the litter box, so we waited. I was sure that's what it was though, so we finally gave him an enema again (I think this time I actually did it properly, most of the solution seems to have come out) and he pooped. What was interesting to me is that he did it twice and they looked quite different - first time obviously very dry, normal color, and the 2nd time a slightly lighter shade of brown and softer (but formed) - with some liquid around it, but I think that was still from the enema. On the first time I could see blood on the outside, on the 2nd time no blood.

I think lactulose isn't helping (it's his 4th day on it), but I'm wondering if the bit of pumpkin that he was given yesterday might have helped already. The meowing stopped, so I guess the discomfort is gone. His physical therapist showed me how to do a soft massage to help stimulate his bowels, and also told me that if he needs some stimulation I can also try gently rubbing a bit of ice to his butt, which would cause him to contract the muscles and might induce a bowel movement.

He seems to be regulating his food intake. On Sunday he ate 2 sachets, yesterday he ate quite well, 3,5 sachets, and today we're off to a slow day again with barely 1 sachet at 1pm. Still hasn't lost weight - which I'm grateful for, but it does confuse me.

I'm sure you all know, but I really can't wait for things to go back to normal so that I can worry less.
 
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fionasmom

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He seems to be pooping enough that, if it keeps up and regulates itself, you should not have to worry. It is not uncommon to see drier stool first, followed by looser, and blood can be from straining and if it does not continue is probably going to disappear.

I have never used Lactulose, but Graycie has to have Miralax 4 times a day, at 4 specific times, and only has a movement every 2 days, once in a while 3 and then we get out the dreaded Laxatone. But they are formed and normal, so the vet is willing to accept that this is her normal. It does get stressful to continually worry about the poop!

Topaz is a very good boy to allow so much handling.
 
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gabicards

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He seems to be pooping enough that, if it keeps up and regulates itself, you should not have to worry. It is not uncommon to see drier stool first, followed by looser, and blood can be from straining and if it does not continue is probably going to disappear.

I have never used Lactulose, but Graycie has to have Miralax 4 times a day, at 4 specific times, and only has a movement every 2 days, once in a while 3 and then we get out the dreaded Laxatone. But they are formed and normal, so the vet is willing to accept that this is her normal. It does get stressful to continually worry about the poop!

Topaz is a very good boy to allow so much handling.
Yeah, I think he's pooping enough too - and today it was also enough in quantity that I think he must be more comfortable. My concern was how he didn't even try to go to the litterbox today (I know because I put a camera right in front of it that notifies me of movement, it's how I've been able to keep track of his constipation issue in the past two weeks, and how I knew he was straining when we gave him the first enema), he was just meowing at us. Once he went the first time, he got out and about 5 minutes later went back on his own.

I really really hope that if we manage to soften his stools a bit with pumpkin, he can go back to just going without complaining to us or straining. His physical therapist saw him today and said that, because the stools are hard, he's also probably scared of going and straining, because his abdomen is still sore due to the surgery and it will surely hurt. We really need to find a way to soften them, hopefully the 2nd stool we saw today is an indication that pumpkin, or lactulose, or even the damn enema (no idea whether 5 minutes would have been enough to get it to the consistency that I saw) are helping with that. I wish we had Miralax here...
 

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Your PT is right...and it is too bad that animals can't talk and just tell us that they are still sore, still shy about the litterbox because it feels strange, or just feel that something is not right. His back and forth to the litter box does sound like what cats do once they have associated it with pain.

Have you tried the ice?
 
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gabicards

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Your PT is right...and it is too bad that animals can't talk and just tell us that they are still sore, still shy about the litterbox because it feels strange, or just feel that something is not right. His back and forth to the litter box does sound like what cats do once they have associated it with pain.

Have you tried the ice?
Not yet, but the next time we feel he might be feeling uncomfortable I definitely will do that instead of an enema. Should I try tomorrow, for instance, if it doesn't seem like he will pass stool? I don't know if I *should* be trying to stimulate bowel movements, given how the medication has slowed them down, or if they will slowly start working properly again.

And before the ice I will probably try and just put him in the litter box - it used to work when he was younger. He would run, my mom thought he was going to the litter box, and then he went near it and turned around. She would eventually pick him up, put him there and he'd do it. It happened a few times, I think.
 

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The ice won't hurt anything and won't interfere with anything, so it is a win/win. If it does not work, it is not like you introduced another medication into his system, so the worst is that it won't work and that will be the end of it. It sounds to me as if he has discomfort, not necessarily bad pain, and it makes him hesitate when he goes to the litter box, but then he tries, or maybe he tries if his humans are there to help him.

He can't stop having bowel movements, but sometimes if too many enemas are used, the intestines start to "wait" for the signal and it sort of backfires. You might ask your vet about this and see what they advise. It is like the use of laxatives in humans; the body starts to wait for that signal.
 
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gabicards

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The ice won't hurt anything and won't interfere with anything, so it is a win/win. If it does not work, it is not like you introduced another medication into his system, so the worst is that it won't work and that will be the end of it. It sounds to me as if he has discomfort, not necessarily bad pain, and it makes him hesitate when he goes to the litter box, but then he tries, or maybe he tries if his humans are there to help him.

He can't stop having bowel movements, but sometimes if too many enemas are used, the intestines start to "wait" for the signal and it sort of backfires. You might ask your vet about this and see what they advise. It is like the use of laxatives in humans; the body starts to wait for that signal.
I think that makes sense - for the ice and for the excess of enemas. Thank you!

He just pooped again 😆 no meowing, went on his own, and this time all soft and not much of it - which I suppose makes sense, since he passed well formed stools twice today already. I had never been so happy to see soft stool before.
 
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Alright, so we're at 48 hours with no stools again, but he did pass 3 times on Tuesday, so I'm still at peace with it.

On the plus side, appetite seems to be slightly better? He had been alternating between 2 and 3 sachets per day, always with some insistence, but yesterday he ate 3 and today he's at 3,5, eating mostly unprompted. We're still not following his usual mealtimes (3x a day), because following the surgery he wasn't necessarily eager to eat at those, so we offer food multiple times throughout each day - and today he seemed more excited when he noticed us getting it ready. We'll see how he does tomorrow.

The extra water we've been adding to his food has resulted in more visits to the litter box to pee. I think he's getting more than he needs, so it's all just coming out. Nothing if not a well hydrated boy!

He moved well through the day, getting on and off couches, walking, playing and even running a bit. Tonight's his last dose of dypirone, so as of tomorrow he will be completely off of pain meds.

He's still getting a teaspoon of pumpkin and 2ml of lactulose everyday. I honestly feel like lactulose has been useless, but I'm afraid of removing it now. :(
 
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Okay, so he finally passed stool today and it still seems like it's really dry and difficult to pass - so once again there was bright blood on his fur once he was done (not on the actual stool).

I think I'll keep the pumpkin puree until Sunday, and starting on Monday I will swap it for psyllium husk and see how that goes. He's appetite is still good today, so that's 3 days in a row, and he's still getting extra water added to his wet food.
 

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There is a real pattern here and I agree that trying the pumpkin and psyllium is a good step forward. You are doing a great job if caring for him.

Miralax is polyethylene glycol 3350 and it is sold in other countries under other names. However, I don't know if it is identical, or if there might be flavorings or other ingredients. If you should find it, ask your vet first if it is okay to try, given his history and other medications.
 
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There is a real pattern here and I agree that trying the pumpkin and psyllium is a good step forward. You are doing a great job if caring for him.

Miralax is polyethylene glycol 3350 and it is sold in other countries under other names. However, I don't know if it is identical, or if there might be flavorings or other ingredients. If you should find it, ask your vet first if it is okay to try, given his history and other medications.
I've researched this multiple times, and it seems that in Brazil all they have is PEG 400 - seeing as there is no mention anywhere of this version of the chemical being used in animals, I'm assuming it isn't, so I haven't considered it.

We'll need to finally return home (France) about a month from now, and if we're unfortunate enough to still be dealing with this then, I might have better luck finding polyethylene glycol 3350 over there. It would be easier to import it, too, if it turns out they don't have it in France either. Who knows, I might find a vet that takes the issue seriously there, too, since the whole team we have over here have basically told me "it is what it is" and offered no alternative to the (seemingly useless, in this case) lactulose.

I haven't seen anything that indicates opioids can have a lasting damage on bowel movements, all I've read is that it's the type of symptom that doesn't go away with prolonged use. I think, beyond a side effect of the medication, we're likely dealing with Topaz being straight up scared of passing stool because it's painful - both due to the surgery, as the muscles that are probably still sore from the aggressive surgery are right in his pelvic area, and because the medication has increased his digestion time and the stool ends up losing moisture by the time he needs to pass it. I have no doubt every single time he's passed stool since the surgery has hurt a lot. With this in mind, I figure all I can do for now is try different fiber alternatives to see if anything helps soften it a bit, so that he slowly gains some confidence that he can go when he feels like it, and we can rule out the possibility of him holding it in out of fear.

I'm trying pumpkin and will soon be trying psyllium husk against vet advice. I'm tired of chasing them because of this, too, so unless something goes array with his recovery, I'm inclined to only see his clinical vet once we need the documents for the trip back home, and just try what I can on my own. I will take him to one or two more physical therapy sessions, and hopefully that will be it.

As for the soreness from the surgery, we'll need to wait. I think he's doing really well, but most resources say that an animal is usually considered fully recovered from this procedure after 6 weeks - I suppose by then we'll know if this has become a chronic problem or if it really was just a part of the recovery. :(
 

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Definitely don't try any alternative product on Topaz.When you get back to France you may have some luck in getting genuine Miralax. In Canada, it is Restoralax and a couple of other names, if that helps.

I have read the same thing; that symptoms will not go away if the opioid is continued, no matter what you do, including in humans.

Considering how cats avoid anything that can be associated with fear or pain, your poor little boy probably does have a potty complex by now.
 
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We got easy-to-pass-stool today!! No blood, seemingly comfortable and normal looking in quantity (when it's dry it always seems like it's too little in comparison to what he eats, specially considering he's only been going every few days, but I know the moisture adds volume to it so it's hard to judge).

He ate a little bit less today (2,5 sachets) but we were heavy handed with the extra water we added to it, which I figure might have made him feel full. Great day, though, we're all happy after his litter box visit lol
 
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