Prostheses for pets - anywhere in Thailand?

[Sheryl]

Does anyone know of a place that can fit small animals (in this case a cat/kitten) with prostheses devices?

Neighbors brought a tiny 4 week old kitten to me today whose foot has been completely crushed and was already gangrenous. I took him to the Animal Hospital on Ramkamheng (the one under Royal Patronage), X rays and exam --> the foot cannot be salvaged as too much tissue death has already occurred, also several of the digits have completely separated off. The rest of the leg on Xray is OK though I am not completely sure there isn't some tendon damage as he does not more the leg at all, but vet said that might just be due to pain on movement.

I was told there were 2 alternatives: amputation, which they would do all the way up near the hip, or conservative approach with just antibiotics and daily dressing changes and wait for the dead tissue to slough off (the kitten shows no sign of systemic infection - no fever, eating well). I opted for the second as to my understanding the poor thing stands a chance of keeping the leg (though not most of the foot) which I figured would give him better balance than to be completely 3 legged. Also he is severely malnourished at weighs only 300 grams so I feared he wasn't a good surgical risk.

I asked about prosthetics but they do not have them there (though they do have wheelchair type devices for dogs and cats who are double amputees or have spinal cord damage). In the US they do make prosthetic braces and such that would enable a cat like this to walk reasonably well.

Does anyone know of a place in Thailand that makes these?

I am going to seek a second opinion from a vetinary orthopedic specialist anyhow as in the short term the poor fellow seems unable to move without great pain, want to see if there is anything that can be done or devised so that at least he can limp about while healing. Any suggestions for that will be appreciated. Should be an actual vetinary ortho preferrably with some rehab expertise.

The little kitten is a real fighter and despite his injuries and malnutrition, is very alert and affectionate. So "putting him down" is not under consideration.

[wayned]

If the daily cleaning and changing of dressings does not work, I would have the leg amputated at the hip joint and not bother with any prosthetics. I have an 8 year old mutt that I picked up on the side of the road when she was about a month old with a damaged foot. We nursed her back to health and she learn to hop along fine on three legs with the damaged one in athorpy close to her chest. She got in a fight and we had to have the damaged leg amputated at the shoulder. She runs, "hops", faster than the 9 other dogs that we have and enjoys her place on the bed beside me at night which she earned when she was little and sick. They can adapt very well with 3 legs.

[harrry]

I would agree with wayned about this. I do nto think a prosthetic would really help. They manage well in a home environment with 3 legs though if you let it go out amoung the soi dogs it may get outnumbered. Better to spend the money on getting it fixed and then letting it be an inside friend.

Hope the furry one gets better soon,.

Edited October 13, 2013 by harrry

[Sheryl]

Both of you refer to digs, does anyone have experience with 3 legged cats? This is a 4 week old kitten.

[harrry]

Both of you refer to digs, does anyone have experience with 3 legged cats? This is a 4 week old kitten.

Actually do not know too much about digs...I think you meant dogs but I was not refering to them either. I do pretty well without my prothesis too considering.

I have had friends who had cats with one leg and the seem to adapt.

http://www.youtube.com/watch?v=xC7F0dx31b0

and the other cats on the page seem to be happy.

Of course they will need a caring owner.

[Sheryl]

Yes, the owner is an issue as I cannot keep the kitten long term due to the cat I already own being extremely jealous. But I will keep him long enough to nurse him back to reasonable health as at this point his stomach is swollen from malnutrition and he has to be fed small amounts every few hours.

Concern about the difficulty of placing a 3 legged cat was part of my thinking re pros and cons of amputation in this instance. It's sad but true that not many people would be willing to take a 3 legged cat, even one as very affectionate and sweet and outgoing as this one. (Just in case anyone reading this would, I attach his pix)

I'm bringing him to Thonglor Pet Hospital tomorrow to get a consult from an ortho specialist, doc who saw him Saturday was a general vet. If nothing else I am hoping this doc will speak more English and do a better job of outlining options and pros and cons, the vet on Saturday was sweet but communication very limited and she would not indicate which course of action she thought was best for the cat. Just "If you want to we can cut off his leg or if you don't want to cut off his leg then we can do X", no response when I asked which was best for the cat. Will update after.

[Sheryl]

Well I took the little darling to Thonglor Pet Hospital today and met with an orthopedic specialist who spoke excellent English and was emphatic that amputation was the best option in this case. Based on this as well as prior consultation at Ramkhamheng, with a very heavy heart, I consented and it will be done tomorrow if all the labs come back OK today. He'll be a night in the hospital and I'll take him home Wednesday and they have promised me they will provide decent pain killers for the immediate post op period (one reason, in addition to the high risk due to young age, that I went ahead to have the surgery there rather than back at Ramkhamheng where it would have cost much less).

The doctor said the post-op pain won't last long and that he would be able to start walking within as little as 3 days. As he currently can't walk at all (due to need to keep the painful limb out straight) and has great pain at every dressing change or whenever the leg is touched, this if true will be a vast improvement over the current situation, in terms of the kitten's quality of life.

Hopefully I have made the right choice. I felt horrible leaving the poor thing at the hospital.

[harrry]

Sheryl, you are a nurse and I know cared for your patients but sometimes I know you had to step back a bit and just do what is best for them. The amputation cannot of course replace the limb. It does give the cat a chance to make the most of the other 3. Think of the cat as you did a patient. Do your best always thinking of the cats needs and you will have done all you can.

Sometimes it is up to the patient whether he can adapt to a new life. You cannot do anything about that just hope.

I know you care and think that is great but think of yourself a little too.

[Sheryl]

Well fate intervened -- the blood test came back with very high white count (40,000, which means there is sepsis) and serious anemia (that may be from blood loss at the time of the initial trauma). This makes surgery too much of a risk so the hospital called me to bring him back home for a course of antibiotics and iron and then we'll repeat the labs in about 2 weeks.

It's no surprise given such an extensive and completely untreated wound over a long time that he is septic, what is amazing is how well his little body is fighting it....still eating well, no fever and in fact looks much better now than just 2 days back, very alert, even amazed me just now by for the first time getting up and walking a short distance (on 3 legs, the bad leg stuck out to the side). (And to my great joy, once up he made a beeline for the litter pan....had been having to use nappies till now). And he has gained 100 gm since Saturday.

Unfortunately this means 2 weeks of the very painful dressing changes. Human patients can understand the reason for things, an animal has no idea why the otherwise nice human is hurting him so. But no choice.

Meanwhile my cat has learned of his existence and is parked outside the room he's in menacingly yowling. I know from past attempts that no amount of time will lead her to accept him so life will be somewhat less than peaceful for a while.

Please all, do let me know of anyone who would give a loving permanent home to a fabulous (but 3 legged) little kitten. Not immediately of course, but once he's at normal weight , has had the surgery and recovered from it, which fingers crossed will be in say 4 weeks time.

[Sheryl]

Sheryl, you are a nurse and I know cared for your patients but sometimes I know you had to step back a bit and just do what is best for them. The amputation cannot of course replace the limb. It does give the cat a chance to make the most of the other 3. Think of the cat as you did a patient. Do your best always thinking of the cats needs and you will have done all you can.

Sometimes it is up to the patient whether he can adapt to a new life. You cannot do anything about that just hope.

I know you care and think that is great but think of yourself a little too.

Harry,

As a nurse I act from a basis of knowledge i.e. I know what is best or necessary in a given situation (most of the time, at least).

I do not, however, have any training in vetinary medicine much less vetinary orthopedics and I do not know what is best. That's the problem here...having to make a major decision when I am not sure what the right decision is.

As it happens, fate has taken it out of my hands for now since surgery is not possible until the infection is under control and the anemia improved, so for now nothing to decide but 2 weeks or so hence I'll be back with the same dilemma.

[wayned]

As fate has taken it out of your hands most likely what will happen over the next two weeks will be that your other cat and the young one will have learned to coexist and the young one will have a fine person to care for it and a loving home. You will just have to wait and she how she responds to the treatment and whether she will be able to use the leg or not. Mine is a dog with a damaged front foot and she was not able to use it so I had to eventually have it amputated. She is 8 years old and coexists with my other 9 dogs but you would never known that she only had three legs until you saw her hopping like a rabbit through the fields. good luck!

[Sheryl]

As fate has taken it out of your hands most likely what will happen over the next two weeks will be that your other cat and the young one will have learned to coexist and the young one will have a fine person to care for it and a loving home. You will just have to wait and she how she responds to the treatment and whether she will be able to use the leg or not. Mine is a dog with a damaged front foot and she was not able to use it so I had to eventually have it amputated. She is 8 years old and coexists with my other 9 dogs but you would never known that she only had three legs until you saw her hopping like a rabbit through the fields. good luck!

Alas, repeated experience is that my cat never comes to accept other cats. Believe me, I have tried many times as I am a virtual magnet for stray cats, they come out of the woodwork to find me, so this problem has arisen more than 10 times over the years (though never before with a handicapped cat). I have given it as much 6 months to no avail and it was like living in the Gaza strip. So I have very, very little hope of that.

Re your dog, when they amputated did they do so at the hip or lower down? As like your dog, the kitten's injury is the foot. He will clearly not be able to use it but the rest of the leg may be viable. So I am interested to know how it worked out exactly, thanks!

Some pix of the little darling today:

[wayned]

My dog's problem was "drop paw" in the front leg, not the back. At first she tried to walk on the wrist but eventually she held it to her chest and atrophy set in and it was permanently there. She got in a fight with her "nemesis", one of ours, and the leg, which was weakened, was broken and infection set in. The first attempt by the local vet was to amputate at the elbow but it got infected and I took her to another vet who amputated it at the shoulder. She has been fine ever since. If you do amputate, I would suggest that you have it done at the hip as the leg is basically useless. I had a Golden Retriever in the USA that was hit by a car and had his back leg amputated. After his recovery he ran and played just like the rest of them.

Her recovery was fairly fast after the last operation and she was hopping around when she woke up from the sedative, but she knew how to do it since she had been doing it for a long time with a useless leg. The biggest chore was keeping the incision clean, but you as a nurse shouldn't have any problem with that. There's a 4 or 6 inch wide gauze tape that really makes it easy.

Good luck and if you can't work it out with your other one I hope that you find here a good home.

[Sheryl]

Thanks, Wayned, that was very helpful.

Can you be more specific re the gauze tape you mean? Is it the sort of elastic type that sticks to itself?

As I am having a very hard time now keeping dressing on the leg (even if it will be amputated, need to keep it clean to control infection). Have tried a variety of approaches none of which deterred the kitten from getting the dressing off in short order....

[bina]

sheryl there are special wrappings to put on dressings that are like self stick, usually someone who keeps (expensive) horses would have that, usually its colourful also.

http://www.amazon.com/Bramton-Company-Wrap-Self-Adhering-Bandage/dp/B0009YYNV4

tis the best invention since penicillin let me tell you for goats horses wahtever thai vets dont have? have them order over the net, no?

[bina]

its called self adhering vet bandage and there is a bitter/no chew version as well, and also one for cats

[wayned]

I've used the roll of self sticking gauze, elastic, tape that comes in rolls and looks like gauze but is sticky on both sides. I think that it would be good for your application where you can wrap it around her leg if you can keep her from chewing it off. Not available everywhere but it is available as I have a roll in my medical kit.You might have to put one of those cone shaped anti chew/scratch collars on her to cure that.

The tape that I was talking about comes in 5cm and 10 cm widths.. It is a breathable surgical tape that is only sticky on one side and can be used to cover the entire incision The vet used it when I had the leg amputated the second time and It was used to cover my large incision when I had my femur head replaced. It is good to cover a large area and sticks very well. The stuff that I currently have is a BSN medical product, it is called BSN Medical Hypafix fixation tape I don't think that it would be good for wrapping around a leg but great for a large clean relatively flay surface after surgery. Most likely you will have to get it at a large pharmacy or a pharmacy in a hospital - that's where I buy it.

Edited October 15, 2013 by wayned

[Cuban]

Two points:

- The bandage issue I understand completely from my own time in a Thai hospital - I trained them on using a water misting spray to release the bandage gauze from the healing wound to lessen the "pull my clucking skin off" experience. I did the same with our pup when she was recovering from a broken leg, not ideal but better.

- I recall seeing a documentary (Discovery Channel?) about an English Vet that is leading the world in this area - IIRC he does international consultation and so probably has staff that handle such enquiries - if nothing else he will be a source of guidance about process and what's viable.

http://en.wikipedia.org/wiki/Noel_Fitzpatrick

http://www.fitzpatrickreferrals.co.uk/

He has published/contributed to many books in this area.

[wayned]

Interesting video. The cat needed prosthetic legs because it had lost both legs and would have had to drag her hind quarters is she did not have the artificial legs. If she had lost only one leg she could get along fine without the artificial legs. Doubt that you could find them in Thailand any way.

The trick to not having a bandage stick to a wound is that after you clean it and put the bentadine one you should put a layer of vasoline impregnated gauze over the wound before you put the dry dressing on. Works very well and never "sticks" to the wound. The gauze is available with the vasoline in Thailand but can't find the name of the product right now.

[Sheryl]

Thanks all. I will see if local Vet has that tape as he is most efficient at removing everything I have tried - including similiar self-stick gauze tape but if there is one with bad taste that may help.

Oh to be in England, that is exactly what I had in mind. I will contact that doc but I too am doubtful anyplace in Thailand does this or anything like it.

[wayned]

The vet should have the cone shaped collar which will keep himfrom chewing the bandage off. He won't like the collar but it works and might keep him busy trying to get it off and he'll leave the bandage alone.

The non stick gauze dressing impregnated with Vaseline that I have is: J & J Xeroform Petrolatum Meas Pleated Gauze Dressing and is a large piece that you cut to the size as needed.

[richardjm65]

The collar is called 'an Elizabethan collar'. Almost all vets should stock them. They're pretty cheap but they do keep the cat from further damaging itself, though it may not like wearing it much. Sheryl should be able to find one easily in Bgk. If not, they can be quite easily made - there's probably instructions to be had from Mr Google. I've used them on our cats, not for paw damage, but to prevent scratching at infected head wounds. Essentially it's a cone shaped device, fastened around the animal's neck, that effectively prevents the cat's mouth reaching the parts it shouldn't. As long as the collar does not extend too far forward of the head, the cat should still be able to adjust itself to both eat and drink, but that should be monitored, especially for a small cat. If it cannot reach its food or water, simply cut off the wide end of the cone by stages until it can. This kitten should only need a small collar. Let observation and common sense be your guide. Continue the good work.

Further to the above, google 'Elizabethan collar for cats', if you can't find one commercially.

Edited October 16, 2013 by richardjm65

[Sheryl]

I'm familiar with the collar but really don't want to subject this poor kitten to that with all else he's got to bear, especially since this is likely to be a very long haul. Plus, it would also make it hard for him to clean himself.

What he doesn't like is anything bulky on the leg as it makes it all the harder for him to balance..now that he's put on some weight and the infection is improving he's gotten lively and frisky and wants to move about.

I've tried now with the clingy gauze tape but in very thin small strips so that the whole thing is less bulky, will see how that does. I think not easy for him to take off. (famous last words?)

[Sheryl]

Well the new bandage approach is working, so that problem solved. And the kitten continues to thrive.

I have had a prompt and encouraging response from the UK doc who does the foot prosthesis. It may be that this can be done provided I can find a receptive vet here who is willing to work with me and them (the UK vet) on it, which will include following their instructions re surgery and attachment of the device, which would be made there and shipped here. Due to the kitten's age will probably have to change the device at least once as he grows.

The vets I have seen so far would not be open to this. Can anyone suggest one -- preferrably an ortho specialist -- who might be ready to do something new and innovative in partnership with a UK specialist (via long distance communication)?

I imagine one of the govt hosps (Kasesart, Mahidol etc) would be most likely to have this but as I do not live in Bangkok it's a 2-3 day affair just to see one, so I would like to have a reasonable idea of who to see before I try.The vet needs to speak English very well, enough to understand my explanations and detailed instructions from the UK specialist.

I really appreciate the help I've gotten here. It will be wonderful if he can keep his leg and get a good foot prostehesis and who knows, may pave the way for this to be done on other pets in future in Thailand.

[Patsycat]

Sheryl

He looks like a mini me of jimmi in my av!!

I have known, but never owned, cats and dogs that live a full and happy life with only three legs. And as he is young,I would go the amputation road. He will soon get used to it and be bouncing around in no time.

I see where you are coming from with the prosthesis, but it will be a long and drawnout and expensive procedure. Including more pain and distress for "X" (please give the wee mite a name!!).

They do get used to being tripods (there's a name for him!!) and cats also balance with their tails.

It warms my heart that you are doing all this for him. Keep us informed.

Also, i don't think you could find a "lampshade" small enough for him!!

[Sheryl]

You are probably right Patsy. I have been getting advise from Vets in the US (one of those "online consult" services) and they seem to think prosthetics do not work well on cats (tend to pull them off). However they are advising amputation only above the gangrenous tissue rather than at the hip, I am not sure why and have requested clarification as the Thai vets say better at the hip since the leg will not be usable anyhow.

Meanwhile he needs to build up his blood count a bit before they will risk operating. I am about to disappear into a meditation retreat for 10 days during which time I have a reliable caretaker looking after him and my regular pets and house (in that order of priority!). As soon as I get out I'll get repeat labs and arrange for the surgery. Stay tuned till then.

[Cuban]

Also, i don't think you could find a "lampshade" small enough for him!!

I second the proposal for "Tripod".

Lampshades are easy to make to custom size from a coke bottle in true DIY fashion.

Just tape up the rough edge.

[bina]

sheryl, try horse stables. people with expensive horses always have this type of bandage cause its used for everyhting from wounds to wrapping legs when trailering them from place to place... or order thru internet, or a vet could order for you.... i used the stuff on donkeys and goats as well, its really great stuff. // and as for making softer edges from plastic, we use matches and 'burn' along the edge to make it smoother. (had to put one on a tortoise once.... )

[Sheryl]

Update:

another week and a half of daily dressing changes, antibiotics and continued intensive feeding worked miracles. All the dead tissue sloughed off (toe bones with them), the heel and ankle healed completely and then the middle part of the foot is now a clean pink wound that looks like it will heal well. In other words, the distal third of the foot is gone but the rest is still there.

Meanwhile the US vets (including an ortho specialist) came down on the side of amputation. Leaving me very torn as I wasn't sure that he wouldn't be able to have at least some use of the leg even though the foot is now shortened and toe-less. I decided to wait a few days more and to look clsely for any sign he could at least stand on the leg (since keepiong it if he couldn't use it would be pointless and actually harder for him than having 3 legs).

Well, last night -- he suddenly stood up on all four legs!!!

And today, he's running all over the house on all fours, playing like a normal kitten.

Thank goodness the amputation (recommended by vets at 2 different high quality animal hospitals as well as 2 US vets consulted) did not go through.

He's more than doubled his weight now at almost all of 1 kilogram. What a little survivor! Never seen anything like it. I learned some more details from the person who rescued him and brought him to me. His mother and all the littler were badly malnourished (mama cat had no breastmilk due to malnutrition) and then he got his foot stuck in something and lay there trapped and of course without food or water, for enough days for the tissue to die (so must have been at least a few days). Hecstruggled so hard to get free (or possibly the mother cat tried so desperately to free him, or both) that it pulled his toe bones off completely. The pain would have been unimaginable. When finally a neighbor heard him crying and investigated and found him, he was covered with his own feces and the wound completely festered and necrotic. By all norms this alone should have lead to prompt death from massive sepsis.

This is him today:

Another week and he'll likely be healed and ready for a home. So if anyone would give a loving home to this incredible little cat, let me know. (My cat simply can't accept having him here...and I've got more pets already than I can really manage given how much I travel).

Meanwhile I have supplied his former "owner" with a big bag of dried food for the mother cat and rest of the litter and in a few days will go on over to see how that's going. Hopefully that situation can be improved just by providing the food, I have successfully made arrangements like that with other neighborhood cats in the past and it works OK...they stay at their home and I see to the annual immunizations and once a month or so drop off a sack of dried food. Doing it for one more house won't be a big deal. If I can catch them, I'll get them neutered/spayed as well, though it sounds like they are quasi-feral as regards humans (unlike their sibling who at this point is totally attached to humans!).

[Sheryl]

P.S. I forgot to mention - reverting to the original inquery, for anyone ever needing the info this place in the US dose prosthetic devices for dogs and cats and will work with international clients:

http://www.orthopets.com/

The process is not simple from a distance but it is possible. I never did find anyplace doing this in Thailand.

Fortunately little "Amnat" won't need this, but it's a good resource for animals who do.