Should we amputate?

[SMX]

My beloved kitten Dude is a 10 month old dsh tabby boy. I've had him since he was 3 days old and bottle raised him along with the help of a kind fosterer. A week ago tragedy struck when he somehow got out on the road and was hit by a car. He is suffering from a tail pull injury, his tail is completely paralysed, he has a loss of anal tone and is also suffering fro bladde paralysis for which he has an indwelling catheter for the moment. Radiographs showed nothing obvious apart from a break far down on his tail which would have these effects which leads us to believe it is nerve damage. He can still walk perfectly, in fact he can run, jump and get up to all the mischief he was getting up to pre accident. We went to the vet this morning thinking we would get the catheter out but as there's no signs of infection we can leave it in a bit longer, he is very very hard to manually express as he still has feeling in his abdominal nerves so it's painful for him, so syringing the catheter is the least traumatic way to do it. He protests a bit, but he doesn't seem to be in pain and doesn't resent me for doing this, as once I'm done he turns around and starts kneading me and sucking on my clothes! We were given the option of having him put to sleep but as he is so full of life, eating and drinking normally and generally being himself I do not want to do this without exhausting every option available to us. Which is where my query comes in, the vet said that by amputating his tail it would get rid of a dead weight pulling on the nerves. There is absolutely no guarantee that it will help, and if it doesn't we are only delaying the inevitable. Is it worth putting him through another anaesthetic and a surgery when he may not ever recover? Money isn't an issue here either so if it's worth it will will do it. But at the moment that is the only option which gives him a chance of life so I am leaning towards it, but is it the right thing to do? Have other people gone through this? Thanks for reading!

[critters]

All of my tail pull boys (2) turned out pretty high-functioning in the end. Both still have/had their tails. I would disagree that putting them down is inevitable, at least for the forseeable future; they can have a decent life, regardless.

[SMX]

Hi, just an update on this. The night after I posted he regained control of his bowel which is great, he will go into the tray and poop 95% of the time, and doesn't pass any while he is asleep anymore. He did develop an infection somewhere, we presume the bladder, last night so we brought him over to the vets. They gave him antibiotics and pain relief and today he had surgery to remove his tail, and he is now in recovery and will be staying in again tonight. They took the catheter out yesterday, but he still didn't pass anything over night so they expressed him while he was out for surgery. So seriously hoping that the tail removal will mean less pull on the nerves and that he may be encouraged to pee. If he doesn't pass anything tonight he will be getting another catheter in tomorrow so we can have him home through Christmas, and when that one comes out he will be given a chance to see if he passes anything, and if he doesn't, we are out of options because he just can't be manually expressed while conscious, it's agonizing for him. He never growled in his entire little life but he growls and screams while it's being done so I couldn't put him through that several times a day, which makes me feel terrible but I don't want him to suffer. So at the moment I am just praying so hard that he will pee over night. I'm taking the fact that his anal tone has recovered is a good sign that the nerves aren't severed, and that the tail was just pulling on the nerves that control the bladder but I'm not an expert so I really don't know. All I can do is hope and pray!

[CarolC]

I think you will be able to relate to this thread:

viewtopic.php?f=5&t=15599

She also made a website about her cat, with helpful information, which is listed at the end of the thread.

[SMX]

Thanks so much for the link, read through it all and it really gives me hope! The last week and a half have been so stressful, I've lost so much weight from worry and am barely sleeping as I stay up all night with him to make sure he's okay and somehow didn't damage the catheter while in my care (he did burst one stitch but we coped). While he's been in the vets last night and today I haven't known what to do with myself as 24/7 my life has been revolving around him and his little bladder. It was so easy to manage with the catheter in, 2-3 times a day when he was asleep on the couch I would slip an incontinence sheet under him, open the cath and let him flow for as long as he would stay asleep (a few times he woke and I had to clean pee off the walls ) and while the E collar didn't bother him TOO much, he would still have prefered to be able to groom himself. He was still eating and drinking like a champ until the infection hit, which is what prompted the vets to take his tail, and apparently since he has gotten antibiotics and pain relief he is bright as a button and flirting with the nurses! (He's a ladies man ). All I can do is wait, see and pray pray pray that he pees tonight and doesn't have to get the cath back in, but if he does we will cope. Also hoping to start electro pulse therapy with him when his amputation recovers to see will that help with nerve function. According to a vet, just because his anal tone has come back it isn't an indication that the bladder is returning, but to me anyway it seems that there is some healing going on, hopefully it will continue! I love my little man so much, and am so sad that he had to go through all this. Here is a pic of the man himself!

[critters]

He's a handsome fella!

In my experience, it isn't all that uncommon for cats to raise a ruckus about expressing; they are, after all, stubborn critters. Just because he doesn't like it doesn't mean it's painful. Buddy was a sweet fella, but I had to develop a way of scruffing him and holding him on his back on a towel pad while expressing him into a diaper with the other hand. He just wanted no parts of it, but I was bigger, badder, and uglier than him, and it WAS going to happen!!

[SMX]

Well that's good to hear that it isn't causing him pain, I would hate to think I'm making things any worse for my poor baby! The vets rang me this morning, his amputation wound is healing quite nicely, and he has feeling in 50% of his bum, compared to 0% last week I think that's great progress! He didn't pass any urine overnight, a couple of patches but nothing significant, and again he was impossible to manually express, not even the struggling, the pee literally won't come out, so the cath was put back in which makes things a lot easier for us over Christmas. He was also given convenia which should cover him for infection for the next 2 weeks. So he's coming home tonight for a lot more intensive care and tlc! And covering me with pee when I express from the cath I'm so excited to have him home, I haven't known what to do with myself since Friday as all my time for the last week and a half was dedicated to him! The vet said he's doing well, and we are doing a good job so unless we run into any complications she wouldnt suggest giving up on him yet, so we will struggle on and keep him going! Thank you so much for the advice and support

[SMX]

Oh and the vet mentioned something like that he has upper neuron bladder which is why he is difficult to express because it makes it very rigid.

[critters]

Yes, Buddy had a spastic bladder, too. Phenoxybenzamine (PBZ) made a world of difference with expressing him!! Bethanechol, on the other hand, increased the spasticity until he was impossible to express.

Congrats on getting him home!

[SMX]

I haven't heard of that medication before, I'll mention it to my vet when I next meet her! He was on Valium but it wasn't making much of a difference apart from just getting him stoned, plus I would worry about it's long term uses as it's known to cause renal failure in cats, and one of the side effects in a false appetite so he kept trying to eat inanimate objects and was acting starved even though he was just fed. Also, one of the vet nurses in our clinic is a physio and uses an electro pulse machine, so he may benefit from that, the vet said that she didn't know if it would make a difference, but it wouldn't do any harm anyway so we may give that a try

[CarolC]

The phenoxybenzamine takes several days to build up an effective level in the bloodstream.

[critters]

Buddy didn't need any build-up; he was better almost instantly! That stuff made a WORLD of difference.

[SMX]

Hi just an update on this,
He got his catheter out yesterday after having it in for 3 weeks. He hasn't voluntarily passed urine yet and I still can't express him, but when he licks himself down there or when I stimulate him like a newborn kitten he will pass a little bit. I don't know if he is passing enough and am afraid of him getting sick but the vet said as long as he is passing something it's good. Has anyone had cats come back to using the litter tray from this stage? Thanks!

[CarolC]

Here are two videos about expressing with external stimulation, since you have found it works with your cat.

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

http://www.youtube.com/watch?v=CnFCwDp_fL0

That technique is something Jean used with Jaime when she first got her. She described it in this post:

viewtopic.php?f=10&t=5246&p=28660#p28660

It is also the technique Connie has used with Cricket for years:

viewtopic.php?f=10&t=4933&p=26404&hilit=+pat#p26404

[critters]

I've done that; I call it "baby style." I did it with Buddy until I learned to express. Buddy eventually regained control of poop and pee.