Crate rest and support her hind end (if you don’t have an appropriate harness, a rolled towel works in a pinch) when going up and down stairs.

Are you using cat attract litter?

How about dirt? I know that freshly turned dirt attracts cats, so why not try that? (Make sure it’s plain old organic topsoil with no additives.)

Unfortunately, amputation really needs to happen here. Please do this – your kitten is suffering otherwise.

Have you tried cat attract litter? Or moving the box? Or *changing* the box to a different style? He probably associates the litterbox with pain, so changing things up should be the next thing. Also make sure you use an enzymatic cleaner for the messes.

For what reason was this recommended?

I’d guess the low cost clinics don’t do pre-op bloodwork? Furthermore, costs of everything have gone WAY up, and shelters/rescues are funded with donations and fundraising efforts while veterinarians have businesses to run and employees to pay.

I find $400 to be quite fair. We paid around $700 for our Doberman’s spay about 6 years ago.

Couple of thoughts.
1 – how often do you clean the slow feeder?
2 – how often do you clean and refill his water?

My current dog is still very new to us, but I’ve learned if I don’t keep her water PRISTINE – meaning I wash the bowl twice daily – she’ll have a pukey day. My Doberman would get pukey if I didn’t wash her bowl daily.

I’m sorry, but this is an emergency. He WILL die if he doesn’t get immediate medical attention. Please try to get funds – gofundme, Care Credit, borrow from friends and family.

I’m sorry this wasn’t seen when you posted, but I hope you got him to the vet the same day you posted this.

Get her to the vet for a dental. She may need an extraction.