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Urgent help needed to EXPRESS a cat...

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Urgent help needed to EXPRESS a cat...

Postby 100%humanunlikesome » Mon Oct 16, 2006 4:54 pm

Dear Forum Friends

I am a new member and like many posters here, found this wonderful site in my search for urgent information.

Here we go..sorry its a longish post but I thought it would be a good idea to give the full info.

I have a male cat 7 years old (neutered). He has some spinal problems and does not have full use of his hindlegs. He lives indoors but goes outside and enjoys all normal cat activities for much of the day, weather permitting. I have 5 cats +2 permanent visitors!, these live outdoors much of the time and he enjoys the female company! We have a very safe large garden and I keep an eye on him of course bringing him in if we go out etc. The vets have described the problem as neurological, although having examined much veterinary material he fits the Diabetic Type II picture.

1. He has a tendency to become somewhat constipated, particularly if the weather is warm, its difficult to get him to drink sufficient fluid at times. Generally though, although he sometimes has trouble passing hard stools, sometimes large ones, up to now he has not had a serious problem with this. I am taking many precautions with wet food etc..(I've read up on mega colon but the vet never mentioned it.)

2. About ten days ago he had a problem urinating, straining and passed a little blood. At first I thought it was constipation but on close inspection realised it was not so we went to a vet. (Its difficult in France to describe the attitude of some of these people!!!) Anyway, this visit was OK. The vet took urine samples and reported stuvite crystals in the urine causing inflammation in the bladder etc. There was no blockage or anything. We had an anti-spasmodic injection and tablets+antibiotics and he stopped straining right away. The next day the urine was normal and we continued the course of treatment for the 7 days. He has not had an acute cystitis attack before although he pee's large amounts quite often.

3.Last week, Wednesday he was straining a little , he looked constipated, but because of the acute cystitis attack I took him back to the vets to be safe. The vet said his bladder was empty, and that he could feel a large stool, and that he WAS constipated. He gave him a Microlax enema, and I had another one to give the following day, also Laxatone (petroleum jelly/oil oral 3 times a day). Of course the aim was also to get him to drink as much as possible. However, the following day, THURSDAY, still constipated, and I had not seen him pass any urine! So I took him back as an 'emergency' in case his urethra had become blocked. His bladder was very full and the vet expressed him. They said he had a large stool still and needed to be washed out. They actually put a cathetar in and said his bladder tone was reduced (nerves) so he could not empty his bladder himself at the moment. THIS WAS A NEW DEVELOPMENT he had had no trouble urinating up to this point.

4.He stayed at the vets and I went to see him on Friday. He looked very dehydrated and I could not see any sign of a drip to hydrate him. I asked the vet about it, he said it was not necessary because he was drinking water!. I had an alarm bell..VERY LOUD. He also smelled digusting which suggested other problems. So..to cut a long story short..I went home feeling totally unsettled. Particularly as the vet had said in not so many words that if he was constipated he was inoperable should it come to that!! because he was disabled a little and that with the bladder being unable to empty there was not a lot they could do. They did not explain that expressing was an option or possible, they did not really want to take on his constipation.

Since both these problems were new..I turned to the internet..

I Collected him on Saturday and his bladder was empty, he was also dehydrated somewhat..I have been using a water enema on him which gave him a new lease of life, and his constipation seems to have eased..no poop yet but no straining and he is eating and there is no vomiting.

So my emergency problem is to EXPRESS him..he passed a little on Sunday and I managed to get a little dribble out..his bladder was not full yesterday but today since his drinking has now improved it is fullish..I need to express urgently..but I think he is holding himself against my efforts.

Any words of wisdom, given his lack of use of hind legs, which makes it impossible to stand him up to express him in the normal way, would be helpful. I have read many of the posts on this board and the guides but having actually located the bladder I think perhaps I am afraid to put on sufficient pressure in case I bruise or damage it..so any guide with regards to pressure or experiences would be much appreciated.

This cat is really large on personality and I cannot give up..at this new hurdle. He may still be constipated but I am working on this (very careful in the way I feed +lactulose+enema)..any tips again would be useful.

In himself he is amazingly very bright and alert..but not surprisingly likes to rest at the moment. The vets episode shocked him I think, I don't think he had very good nursing type care..he is so happy to be home and yet I know that if I don't get this sorted I will have to find another vet FAST!! maybe there are some human ones in France..but it seems difficult to find them.

So I am sending out this SOS for your advice and support.
To make the world a better place let humanity flood around the world!
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Re: Urgent help needed to EXPRESS a cat...

Postby GabrielDeafBlindPupFamily » Mon Oct 16, 2006 6:19 pm

GO RIGHT NOW TO THE URINARY PAGE, PLEASE!
There are all sorts of help there, and a ton of folk here express...
Karen, Andy's ^i^ mom
Lethal White Aussies Rule!
INTERACTIVE RESCUE SITE!
http://www.s8.createphpbb.com/lethalwhiteauss/
http://groups.yahoo.com/group/LethalWhiteAussieRescue/
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Re: Urgent help needed to EXPRESS a cat...

Postby CarolC » Mon Oct 16, 2006 9:12 pm

Hi 100%human,

I am not a vet but I am really impressed with all the good things you're doing with that cat. I will give you some links. Here is a page on expressing the bladder:

http://handicappedpets.com/wiki/index.p ... dog_or_cat

Here is a page on handling (in some cases expressing) the bowel:

http://handicappedpets.com/wiki/index.p ... inent_pets

Here is an excellent message by Bill who expressed his male cat lying down.

http://www.handicappedpets.com/cgi-bin/ ... read=25481

Responding to some parts of your message:

They actually put a cathetar in and said his bladder tone was reduced (nerves) so he could not empty his bladder himself at the moment. THIS WAS A NEW DEVELOPMENT he had had no trouble urinating up to this point.


I am guessing that he has temporarily lost tone through having his bladder distended because it was overfull. Since you did not (to your great credit) allow him to remain that way for long, I am hopeful his bladder will regain tone if you keep it from being distended long term. Once the bladder is staying at its proper size again you can hope he will be able to use the muscles to contract it properly.

his bladder was not full yesterday but today since his drinking has now improved it is fullish..I need to express urgently..but I think he is holding himself against my efforts
.

Others have said this as well, that they think their pet is resisting being expressed. That may be the case. It is possible to overcome the sphincter with sustained firm pressure. My big male cat always resists being expressed by the vet when he takes a urine sample, and he grumbles and complains during the process, but the vet wins. Do not be surprised if your cat vocalizes during expressing.

You may have to use more pressure than you expected. With all the people here who have expressed animals, no one has ever reported rupturing a bladder, and some of us have animals with really tight sphincters, but I understand the concern because I used to worry about it, too. Do not try to express if you think he may have a urinary blockage.

One thing that helps me greatly is to dig around in the abdomen (palpate aggressively) and fish the bladder down farther toward the abdomen. It tends to ride rather high up toward the spine where is it hard to squeeze. The farther down toward the belly you relocate it, the easier it is to express. You do not have to express the bladder where you find it.

About the bowel. You can help your cat eliminate by actually popping the stools out of the rectum. There are instructions in the bowel management page I linked above. Feel around the anus and pinch and see if you can detect something firm in the rectum. If you detect firmness (stool) you can use your fingers in a grasping motion and pinch the soft tissue surrounding the anus while pressing in on the soft tissue, then do a really firm pinch, and you will be grasping the stool. Pinching makes it break and the leading end of stool pops out. With a little luck, more stool moves toward the exit and you can repeat, popping it out until there is no more. I do this with my dog once or twice a day as needed. Here is a picture of a cat with stool in the anus, showing where you would do the pushing in and pinching.
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Re: Urgent help needed to EXPRESS a cat...

Postby critters » Tue Oct 17, 2006 4:20 am

Carol's exactly right, which isn't surprising since she told me the same thing when I was learning to express Buddy! :lol: I always expressed Buddy when he was on his back; he was 100% paralyzed, and he, too, fought me when he'd improved enough. There are meds that can improve bladder tone, such as Bethanechol. http://www.handicappedpets.com/pics/buddy.htm
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Re: Urgent help needed to EXPRESS a cat...

Postby 100%humanunlikesome » Tue Oct 17, 2006 6:46 pm

Thanks for the information and help I really appreciate it, it was VERY useful.

After much reading of ALL the advice given and a number of attempts to 'find' the bladder which was fairly full, I managed to express a little urine. It was NOT EASY and there were as some objections to the process, but in the end some success so a big thank you.

I made my way today to a new vet who confirmed that the bladder was pretty full. They were not able to express more than a dribble as the cat was resisting, so as the discomfort/stress factor needed to be minimised, a cathetar was inserted very easily and the bladder drained into a small tray. The cat look relieved!! so was I!!

I don't think this vet will be prepared to teach me to express so I shall try again tomorrow when the bladder is much smaller IF the cat is unable to urinate freely. The vet did confirm that the spincter muscles to the bladder were very strong, as suggested by someone here, so that seems to explain some of my difficulties. I am going to continue to learn how to express and try a couple of your excellent suggestions because when you have to learn in an emergency its a bit tricky and stressful. I am determined not to be caught cat-napping next time!

I thought I would give him some cranberry conc. tablets to make sure the bladder and kidney's do not get infected. I was reading about an American product yesterday called 'Carpon', has anyone tried these or got any opinions/thought on these?

On the constipation front _ after 2 days of warm water enema (3 times a day) + Microlax afterwards to lubricate the end of the tract to the anus..for ease of passage of the blockage/plug last night my cat produced, after a relatively small amount of straining, a very large plug..I cheered! I think there will a second smaller one (in diameter) but longer which will appear tomorrow night, that is his poop time. So fingers crossed that this will then end his current bout of constipation..I felt quite chuffed as the vets gave up. I shall keep the stool to show them!

Having read the information here I think that the constipation and hard large plugs in the colon have probably effected the bladder situation through pressure on the urethra, maybe this has been responsible for the lack of urine problem, it seems possible. Lots to think about I guess.

I am now going to do some more reading from all of your links, its a goldmine of information for me. Thank you all. I will have a little more time later in the week to give an update.
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Re: Urgent help needed to EXPRESS a cat...

Postby Dianne » Tue Oct 17, 2006 7:23 pm

Welcome. I am impressed by your desire to learn to help your kitty. You seem to have accomplished more than the vet.

Below is a link to show the location of a cat's bladder. The link is for cats with broken tails. I am not asserting that your cat's tail is broken, but included the link so you know where to press on the abdomen. The bladder is outlined in yellow. It takes a minute for the pic to load.

http://www.marvistavet.com/html/body_ca ... tails.html

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Re: Urgent help needed to EXPRESS a cat...

Postby critters » Wed Oct 18, 2006 4:32 am

Yay poop!!!! Only here are such things highly celebrated!! :lol: Buddy took, and loved, lactulose syrup to soften his poop. He'd poop, most of the time, when I went to express him, so you're right--that neighborhood is VERY small.

Bethanechol probably wouldn't be a good med for your kitty because it tightens the bladder, but I'm sure there's something out there to relax it. I'll tell Jean you're here; her paralyzed girl, Jaime, has an incredibly tight bladder or sphincter.
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Re: Urgent help needed to EXPRESS a cat...

Postby 100%humanunlikesome » Wed Oct 18, 2006 8:05 am

Thanks people.

Thinking about things I have a question perhaps a very important one..

In your experiences, yesterday when the vet inserted a cathetar (a very fine one they said) into the urethra they then used a syringe attached to the end of the cathetar to draw off the urine.
So my question is WHY DID THE URINE NOT IMMEDIATELY FLOW OUT OF THE FULLISH BLADDER BY ITS OWN ACCORD, under its own pressure?

Is this normal or more imporantly what does it indicate about the bladder system?

The cat is still in the process of eliminating his constipation so is this blocking the exit from the bladder? was this the reason for having to draw out the urine?

The urine was normal coloured, bit yellow concentrated (not surprising since the bladder was full) no sediment or deposits, no glucose elevated.

Any Thoughts..
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Re: Urgent help needed to EXPRESS a cat...

Postby CarolC » Wed Oct 18, 2006 11:24 am

There are several people here with vet tech experience, so hopefully someone will know the answer for sure. I am only guessing.

100%humanunlikesome wrote: they then used a syringe attached to the end of the cathetar to draw off the urine.
So my question is WHY DID THE URINE NOT IMMEDIATELY FLOW OUT OF THE FULLISH BLADDER BY ITS OWN ACCORD, under its own pressure?


If the syringe was on the catheter when the catheter was inserted, the urine could not flow out because the catheter was full of air and the air could not escape because the syringe closed the other end. The purpose of the syringe would be to draw out as much urine as possible, rather than depend on shrinkage of the bladder and repositioning the catheter to get it all.

The cat is still in the process of eliminating his constipation so is this blocking the exit from the bladder? was this the reason for having to draw out the urine?


I don't think so, no. There is a condition in cats called megacolon where they become so constipated they are blocked. Feces continues to build up in the colon and it dries out as it remains in the colon, causing a large hard mass called a fecalith which is even more impossible to pass. The cat must be cleaned out manually, often anaesthesia is required. Sometimes getting the colon empty requires several cleaning sessions, and sometimes the colon cannot be cleaned out and a section of it is surgically removed. However, it is not urinary obstruction that sends these cats into surgery, it is the colon problem. I don't think a full colon causes urinary obstruction or they would mention it in the literature on megacolon and I haven't seen it.

I think I would be looking at other possibilities of why he didn't empty the bladder. You mentioned crystals. Here is a good website about lower urinary tract disease in cats.

http://courses.vetmed.wsu.edu/vm552/urogenital/fus.htm

I don't remember and no time to check, do you have your cat on a special diet for the crystals now?

Also you mentioned some spinal problems affecting the hind legs. Spinal problems can definitely cause urinary incontinence. There are 2 kinds of urinary incontinence, depending on the type/location of the spinal problem. In one kind, the pet had a loose urinary sphincter and dribbles urine. This is what most people think of as incontinence, a diaper pet. In the other kind, the pet has a very tight urinary sphincter and cannot void urine even if he knows he needs to. My dog is that way. She simply can't pee because she can't release the sphincter. Jean has a cat who is that way. Both of us have pets with very tight sphincters. It takes a surprising amount of pressure to overcome the tight sphincter, but you can do it. It takes Jean up to a half hour to express her cat. However, you must be sure your pet does not have an obstruction if you are going to do this.

Hopefully someone else will have a better answer, I am not a vet. Maybe this will give you some ideas to ask your vet about.
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Re: Urgent help needed to EXPRESS a cat...

Postby 100%humanunlikesome » Thu Oct 19, 2006 8:28 pm

Hi folks an update on my boy!

Today, I had to return to the vet because my cat was only able to produce a very small amount of urine when I expressed yesterday. Even though at the end of last week the vet (first one) was able to express him fully. The urine test had not shown crystals and neither the first vet or the second mentioned blockage and clearly there was no blockage. However, I went back today to the vet (second one) to empty the bladder, they didn't try and express him they immediately inserted a cathetar and could not pass it all the way up. Only a small way up in fact. They used a syringe of sterile water to flush up it, to try and clear it but that did not work!

so, they tranquilised him and emptied the bladder by needle directly into the bladder. No problem and took urine sample at the same time.

Then they tried the cathetar again. It looked thicker than the one they used last time, but they said not. Anyway, they passed it up a little way and then used a syringe of sterile water again to flush upwards and bingo up the cathetar went up.

They said the passage should now be clear..but I wondered why the urethra had suddenly become a little blocked? Any thoughts people?

Just to recap my cat simply does not visit the litter box or really try and urinate. The bladder fills and he does not try and go!

I must admit apart from the nerve/bladder tone possibilities I was reading about behavioural problems and I wondered whether there was a STRONG PAIN association for him with urinating. I wondered whether since he was still getting through a bad constipation session, whether he was avoiding more pain by urinating and so just didn't try. I also read that the administration of a pain killer sometimes gets over this problem.

any thoughts?

If he does not attempt to use the litter tray or pee when outside tomorrow, then the vet has suggested putting in a cathetar for a few days to make sure the bladder does not overextend and perhaps regains some control.

So I am praying he manages to pee in the morning..or before then.
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Re: Urgent help needed to EXPRESS a cat...

Postby CarolC » Thu Oct 19, 2006 10:07 pm

Hi 100%human,

This is not even my cat but I am feeling worried. I just sent an email to Debbie_Spain. She is from England but runs Kat's Club for disabled and chronically ill animals in Spain, and she has experience with idiopathic cystitis and other bladder ailments. She is also an expert at expressing. I am not sure if she will be here tomorrow or this weekend, so please keep checking this board.

Here is her website:

http://groups.msn.com/ElClubdeKat
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Re: Urgent help needed to EXPRESS a cat...

Postby 100%humanunlikesome » Thu Oct 19, 2006 11:53 pm

Question

When they tranquilise cats for a short time WHERE do they normally inject them?

My cat was tranquilised for the insertion of the cathetar. He was injected in his SPINE half way down (just above the bladder!) and woken up by another injection in the left thigh muscle. He was only snoozing for about 15 minutes.
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Re: Urgent help needed to EXPRESS a cat...

Postby critters » Fri Oct 20, 2006 4:22 am

Just a guess here, but I wonder if they put the medicine in a back muscle that looked like his spine? I've never heard of spinal anesthesia in critters.
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Re: Urgent help needed to EXPRESS a cat...

Postby 100%humanunlikesome » Fri Oct 20, 2006 7:16 am

Thanks critters.

No I was sat the other side of the vets table. The spine was checked for vertebrae position (approximately half was along the back spine, just above the position of the front of the bladder) and then the anesthetic was administered into the spinal space. It was the only administration of any substance apart from the injection in the thigh to wake him. I sat with him all the time.

Thoughts..

Since he has weak muscles anyway, since he had a problem constipation and only suddenly developed lack of bladder function following a previous anesthesia last week to the first vet, who pronounced loss of bladder and bowel nerve function and a hopeless constipation.

Having checked up, one of the most common things to watch out for following anesthesia is urine retention due to low acetyl choline levels. His may have already been low, because his muscle weakness has been there a long time..DOUBLE ALARM BELL..

Normally following anesthetic vet/doctors, according to medical papers they are careful to provide a specific boost to keep the choline levles up..to prevent loss of bladder function..its what the medical profession do.

This second visit with administration of an anesthetic into the spine region and NO medication afterwards for the acetyl choline situation prevention, for where we already have LOST BLADDER FUNCTION...seems to be guaranteeing continued loss of Bladder function. I think he urgently needs administration to get his acetyl choline levels up.

(This is urgent people. Loss of Bladder function and bowel function due to low acetyl choline levels particualry after anesthetic. If you have any human vet friends please could you please ask them urgently. What is the best way if this is the problem to raise acetyl choline levels to restor lost bladder function. As I said all had been fine prior to his visit last week to the first vet).

Is expressing safe, I don't think he had a blockage, anyway its been flushed!)
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Re: Urgent help needed to EXPRESS a cat...

Postby CarolC » Fri Oct 20, 2006 7:53 am

100%humanunlikesome wrote:Having checked up, one of the most common things to watch out for following anesthesia is urine retention due to low acetyl choline levels. His may have already been low, because his muscle weakness has been there a long time..DOUBLE ALARM BELL..

Normally following anesthetic vet/doctors, according to medical papers they are careful to provide a specific boost to keep the choline levles up..to prevent loss of bladder function..its what the medical profession do.


Would you please provide a link for the source of this information. I have access to IVIS.org if that's where it is. Nearly every pet I've ever owned has had anaesthesia for surgery or dental work and acetyl choline has never been so much as mentioned. Here in the United States it is not "what the medical profession do."

Is expressing safe, I don't think he had a blockage, anyway its been flushed!)


I would be careful about that. I thought the offer of a fixed catheter for a few days sounded like a good option.

It seems to me that you have been getting good vet care there. Did you say you are in France? Is your French (including medical vocabulary) adequate to discuss this with the vet? Can you ask the vet about the anaesthetic? Like Critters, I have never heard of a spinal block for a cat, and I have never heard of a second intramuscular injection to wake him up. It seems more likely the second injection was an antibiotic. Getting a pet to come out of anaesthesia is not a pushbutton affair, they come out of it naturally through action of the kidneys and liver clearing the anaesthesia out of the system, not as a result of a stimulant. I'm sorry, I'm not trying to be contrary, I am only trying to say what my experience is, which differs from this.

Please be sure you know where you can take him for care this weekend if he needs an appointment and your regular vet is closed.
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