Age: 1-2 years
Hello again Dr. Marie
I had contacted you just awhile ago about my cat Linus and his ongoing trouble. I will, therefore, not restate everything from before as you could review it to refresh your memory ( still online in your Questions section).
The difficulties have continued. We have had multiple unproductive trips to the vet I tracked Linus through over a week very closely regarding his litter box activities ( I followed him quietly and stood unobtrusively to listen and watch, and I checked and cleaned the box every time he went in it; and kept a log. I discovered a 3 day cycle that always culminated in very painful defecation. I had been calling the vet and bringing him right at each cries point, but then by the time we got him there ( remote location; 2 hour drive to the nearest vet), he would have passed the stool ( normal stool) and appear as if nothing was wrong. We have been to the vet 7 times now since mid July. On this last visit, I was ready with my very detailed log, and also asked for more extensive diagnostics for Linus's pain when trying to poop. A barium study, full blood panel, and a UPC test for kidney function ( and he's had a urinalysis, and a test for pancreatitis all ok). All of these were normal; including the barium study all the way through so far. Last evening; the barium had just reached where Linus needs to defecate, but he has not gone ( typical of his pattern; he is still there at the vets in the hope they will see the most crucial part of the cycle).
So; the vet re-examined the xrays that showed the bone spur from that pelvic fracture from when Linus was a kitten. The vet now thinks, given the detaile information that clearly shows Linus is having significant pain defecating, (and ruling out other things now from the tests), that the likely problem is the bone spur. I wish I could have you see the xray;( it looked to me like a sharp, needle shaped projection, pointing downward on an angle, right at the back of the pelvis near the very back end tail area.) The vet has never seen symptoms like Linus's before he says ( ie: Linus seems fine, then displays of pain that increase and culminate with vomiting and gagging while trying to defecate. Then when he passes the stool; he begins the cycle again).
Now here is my question: it has been suggested that the bone spur is the likeliest problem. We can continue trying to soften stool in the hope it will help ( but we've been doing that with anyway with it making minimal effect on this cycle; also it means Linus, and our lives, will revolve around 4 medications a day; and I am not happy with this option as a solution because so far it hasn't worked well, and I'm afraid of dragging this out more and more for Linus and for us; it's already continued for so long ), or the vet can do surgery to remove the bone spur. That sounds more hopeful to me. We think we want to do this. Is this a good option in your opinion? Or is it a shot in the dark? Could such a procedure do more harm than good? Is removing a bone spur an option to treat if they cause pain and interfere with body functions in this way? Has this been done in other situations regarding bone spurs in animals? Your thoughts would help me sort out what is best. I know you can't see the xrays and you can't diagnose etc, or see the actual patient; I would just like your opinion on this situation, and these options, and any input that might help us sort through this.
I appreciate your thoughts. Most sincerely
Dr. Marie replied:
Gosh, this is a really tough situation! I really feel for you guys.
I can't say that I have ever heard of a bone spur causing issues like this, but then, if it happened as a result of an accident it's not likely something that is very common.
Here's something you could ask your vet about...When I have a difficult case like this and I am not sure whether I am seeing something significant on xrays I will sometimes send the xrays to a veterinary radiologist to get their opinion. These vets have dedicated their lives to looking at "strange things" on xrays and really should be able to give you an idea of how uncomfortable the bone spur is.
I can't remember...has the vet tried Linus on pain medication (such as Metacam)? If so, if this was a pain issue there really should have been some improvement on the medication.
You could also ask the vet if something called lumbosacral syndrome is a possibility. This is a condition that causes pain in the end of the spine. Often cats with this condition will have pain on defecation.
Regarding surgery, that's a tough question to answer as it really depends on the location of the bone spur. Usually pelvic surgery is difficult because it is often hard to get to the offending area. But if your vet feels comfortable with the surgery and feels it is a good option then it's worth a try.
Although this is a frustrating case it really does sound as if Linus is getting good veterinary care. I wish I could add more!
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Thank you Dr. Marie.
Your suggestions are good ones, and I will discuss these with my vet.
Your service online is so helpful. Just having this sort of access to ask questions from a veterinarian is wonderful. The internet certainly has some good things going for it!