Traumatic Transdiaphragmatic Hernia for Male Cat

Hi,   Was wondering if you could help me out with some advice. I have a male cat ( approx 3 years of age ) that was ran over by a car about 2 years ago and has had issues breathing since. It wasn't that bad at the time as he did not show any signs of distress,  I took him to the vet and all, got a few shots and also his lower back was injured after he got run over, was paralyzed from waist down for about 2 weeks but then got up on his feet like nothing happened. Unfortunately the doctor at the time did not tell me anything about any ruptures inside his abdominal area and only advised that he had a leg fracture that was due to heal.   Unfortunately, for about 8-9 months, his breathing problems got worse as he is visibly breathing through his mouth, only sleeps in a few positions, tries to eat as little as possible but multiple times throughout the day, and tries to stay in an upwards position for as much as he can ( sometimes he even sleeps standing up, most likely because his intestines are slightly going back in his abdominal area and he feels comfortable ). His nose slightly turned purple alongside his tongue but he doesn't feel like he is in much pain, he just sometimes breaths awkwardly and has a few coughs every now and then with a bubbly, slightly foamy yellow-ish liquid coming out ( though as of late for the past 3 months, he did not cough at all and seems to be ok )   I couldn't take him to the vet sooner this year as he kept panicking as the car drive is really long to the veterinary clinic and he was barely able to breath, so I decided to wait a bit and take him when he feels better.   I finally took him today, he got an x-ray and the doctor diagnosed him with traumatic trans diaphragmatic hernia as his intestines shifted from the abdominal cavity to the thoracic cavity. Doctor said that this can be rectified by surgery but in his case there's about a 70% chance he'll make it due to that membrane being fractured ( which could pose a threat when the doctor attempts to close it ).   I really don't want to lose him but considering that there is a potential fatality risk when attempting the surgery, and as the doctor said he is not in any pain and can live many years with this diagnose, do you think are the chances worth it ? Could it be too late now since it's been 2 years since the accident and the complications can be fatal ? I will also attach a photo of the x-ray maybe you can make something out of it as I am not specialized at all. I am not based in the US so surgery costs here in my country are not a problem, the thing I think the most about are the risks due to him spending too much time with this problem and has been showing symptoms now for about 8 months.   P.S Do apologize for the hurried up writing and for the fact that English is not my first language but I am really curious for your thoughts on this.      

Hello and please don't apologize for your English - I would be very proud if I could write as coherently as that in a second language.  When I was newly qualified, we always used to repair diaphragmatic hernias using surgery.  Sometimes they did very well but other times they deteriorated and it wasn't easy to understand why.  Now-a-days, researchers understand that cats with an 'acute' (new / recent) hernia - usually from a car accident  - have the best results during surgery.  Cats that had had the hernia for a long time (so-called 'chronic' cases) are associated with much poorer surgical outcomes.  Often, with chronic cases, the edges of the hole in the diaphragm need to be removed and then the hole won't close properly. Diaphragms are muscle and this type of muscle doesn't easily stretch to cover a gap, so in cases where tissue is missing (or has healed badly and needs to be removed) a graft is often needed - and these come with their own problems.  In many cases, the patient copes much better with an existing chronic hernia than they would do with surgery.  Your vet and - if in doubt, referral specialists - are best to  review this on a case-by-case basis (I regret that not being your cats' vets, we cannot assess radiographs, but it sounds as though they may have explained their preference).  I hope that this helps.

Hi Liz. Many thanks for taking some of your time get back to me on this. I guess deep down I already made up my mind to not proceed with surgery for Prosopel ( which translates to "Little Towel" ) especially considering how long ago the car accident happened and the fact that he already created himself a habit of coping with this problem he s having. Vet wasn't too optimistic when she recommended the surgery and it felt like almost she knew it wasn t the best call and tried to convince me otherwise, especially since the cat technically feels better and learned to live with this illness by setting himself a few limits when it comes to doing certain cat "things" ( ex he is not that playful anymore as he always tries to conserve energy and also tries to not engage in fights with other cats as he is both an outdoor and an indoor cat)     I suppose all I have to do is to take care and try to make his life as easier as I can for his remaining time. Since he can not eat too much at a time due to the intestine problem he has right now, would you recommend I feed him any specific type of food or natural medication that can help with his digestive track to ease his digestion or speed it up ?  Or maybe what NOT to feed him to avoid slow digestion, because as I understood from the vet, the more he eats, the digestive system expands and it puts even more pressure on the lungs thus inducing heavy breathing. Would it also help if he sleeps on flat & hard surfaces as he seems to be preferring those instead of softer ones ? Also any tips you might have received with cats experiencing this problem before so I can raise his life quality and expectancy as much as I can ?