Cat with potential gangrene :(

[catsrmylife]

Hi I have a cat with hind limb paralysis who suffers with urine scald (she is doubly incontinent)

Luna is expressed regularly to try and stop dribbles of urine from making the scald worse. Luna has been on various antibiotics but all gave her diarrhea which made the scald worse. I have never been able to get on top of the wound for it to heal,despite regular washing and gentle drying of the area.

I have been away for a few days during which time the wound has started to bleed. The wound isn't so bad underneath but it has spread up all of her tail and is veey sore. Luna was taken to the vets again who now think the woynd could be gangrene and spreading up hee spine

Luna has been put on different antibiotics and given a different shampoo to wash her with. The advice was not to wet the wound so often.

I am on my way back now and taking Luna to the vets in a few hours time for a check up.

I have asked the vet before about amputating Luna's tail as she doesn't use it and it is almost impossible to keep dry.

Luna is otherwise a very happy little girl,playful and full of life but I am very concerned about the prospect of gangrene.

I have looked into so many different things to try and heal the urine scald but nothing has worked thus far.

I urgently need advice please on what I can do to help heal the wound and remove the necrotic skin. I don't want to lose my little girl.

Thank you.

Susie

[CarolC]

Hi, I am sorry for the problem you are having. Does she wear diapers? Normally a combination of diapers along with a barrier cream, will be enough to protect the skin. Diapers nowadays have a gel lock filling that locks moisture in, and a cover over the filler that keeps the skin dry. With any good brand of diapers today, the diaper can be wet but if you run your fingertips over the surface it is barely damp.

As for a barrier cream you can use right now while she has an open sore, you might ask the vet if you can get Barri-Care, unless your vet knows of something better.

Here is a link to look at it:
http://www.caretechlabs.com/ctl-veterin ... tions.html

The following things work for normal skin but I do not think you can use them with an open sore.

The best over-the-counter barrier cream seems to be Desitin ointment. You can only use it if you pet does not lick it, because it contains zinc oxide and zinc is toxic to pets. Other options include traditional A&D ointment or even plain Vaseline, but they have to be reapplied frequently. There is a spray on barrier called Cavilon spray, which is also sold as NexCare No Sting Liquid Bandage. The area has to be shaved or the spray will just gum up the fur.

[BendyMom]

What you are describing sounds similar to what my boy Legume had. it is very hard to get on top of. I am attaching a pict.
he developed a thick scab which spread and spread and ultimately needed surgery to remove all the necrotic tissue and then stitch him back together.
I have often thought about what I would do differently in the same situation now, as then I did not have much experience.

It would help if you coudl post some picts.

Firstly YES, amputate that tail, if it has no function to it then it is just getting in the way making a huge mess.
Second, do you have any kind of debriding agent? this is something that removes dead tissues. the most common is hydrogen peroxide.

what i am going to suggest is going to sound extreme, but you are in extreme territory.

Get some Betadine solution (available at any pharmacy), and peroxide.
Put enough water in the sink (or a bucket or whatever) to submerse the lower third of your girl.
Add enough Betadine to make it look like dark ice tea.
Add peroxide (it will change the color, make it lighter, don't worry about that) about a half cup, more is ok. I am not exact with my measurements.

SOAK your girl's lower third for about 15 minutes.

This is a mixture I use all the time for cleaning and disinfecting wounds, it is esp good for puncture wounds and anything stubborn.

pat kitty dry.

the peroxide works as a debriding agent removing dead tissue - this is very important to get things to heal.
betadine is a wonderful antiseptic agent and does not sting.

Do this twice a day, pat dry each time and allow to be open to air.
Expressing is definitely needed!
the diarrhea is a huge problem, I would get some canned pumpkin (just plain pumpkin, not pie mix) and add that to her food, it provides fiber and many cats eat it just fine, often mixing it with a little canned helps make it tastier if needed. Do you have anything like bene-bac? it is helpful gut bacteria, you can find it in most pet stores or ask your vet for it.

A barrier spray is a good idea, it lets the skin breathe while protecting it, and allows it to dry. "no sting barrier spray" is now sold in most pharmacies.

you definitely need to let those wound air out and be as dry as possible.

For cleaning in between soaks, I would pat her with a paper towel, I would also try to express her several times a day (i9 don't know how often you are currently).

What antibiotic is she on? Antirobe is usually what my guys get for anything like this. Has your vet mentioned a Convenia injection? I love Convenia - long acting antibiotic that has cleared up many an infection here.

She might need surgery to remove dead/dying tissue.

Zinc Oxide is good, but is 100% toxic, and right now this mess needs to be open. When you get to the point of just severe skin irritation with a little scabbing, instead of open oozing, we can talk about how to use zinc oxide and prevent the cat from licking it.

if you can take picts every day to show me how things are going, i can help better.

hang in there. this is tough, but we can get her healed up!!!

[CarolC]

Here is a picture of a cat before BendyMom adopted him, and his skin is much better now.

viewtopic.php?f=16&t=16075&hilit=butterbean#p85473

[BendyMom]

thanks Carol.
Butterbean was bad, but Legume's skin was much worse. Butterbean never developed the thick scabs that spread. He had some scabbing but it acted normally!
I cleaned him with chlorhex, covered the area in zinc oxide cream, wrapped him in a diaper and that did the trick. i hope never to see skin like Legume had ever again. I still feel awful for him that I didn't know anything else to do for him at the time, but neither did the vet. I remember showing my vet how the scabbing was getting worse despite the antibiotics despite the cleaning and asking her...isn't there anything else we can do? she did not have any suggestions this place was still tiny then, standard urine scald techniques didn't work for him. having never seen regular urine scald at that point i didn't know what else to call it.

[catsrmylife]

Thank you all for the responses.

It turns out my vet said it could lead to gangrene, not that it probably was (my sister must have misconstrued what the vet said).

I will get photos and post, the urine scald is very bad on Luna's tail.

We went back to the vets on Friday and he said it had improved but that we are 'peeing on a bonfire' with our efforts at the moment. Luna is booked in for tomorrow to be anaesthetised so that they can cut out the infected tissue and if the infection is too far ingrained, that they will amputate her tail.

They have put Luna back on Novamox antibiotics and have given me a shampoo (Malaseb - also used for ringworm) to use which contains chlorhexidine.

The wound looks less sore but the skin just never heals

We did try baby diapers before but the vet said not to use them and instead, to let air get to the wound. I also bought some Fancypants from Glendarcy which you could put panty liners in as the pants were washable. Luna hates having any of them on.

The vet also suggested confining Luna to a dog cage as she's been having free range of the lounge which although has laminate flooring, she was picking up any dust off the floor.

I have also used Dermisol solution to debride and the cream to debride and help heal the skin but nothing has really worked effectively enough.

I am very confused; I've read somewhere that you can't wash the affected area enough but my Vet seems to think I shouldn't wash Luna so often and keep the area completely dry instead. He has also told me not to use a hairdryer on a low setting to dry the area after bathing but this is the only effective method I've found to get Luna completely dry.

I'll post photos later and you can see how bad the wound is

[BendyMom]

its a balance between keeping them clean and not having them moist all the time.
i have used a hair dryer, your vet might be concerned about potentially burning the skin. i would ask him specifically WHY.
don't be afraid to ask a zillion questions of your vet, you need to understand why he says what he does, why he says not to do some things. if he tells you not to do something, make sure you understand an alternative solution before you leave. and i would talk to him direclty, its too easy to get answers confused when they go through a second party, even if that party is very well meaning. just human nature. that person also doesn't know all of your questions.

confining helps keep them clean but also means they are limited to the area they have soiled. if you can keep her in one room and keep that floor very clean, i think that would be a good midpoint.

the surgery sounds like a good idea. i personnaly would amputate the tail even if it is healthy, just because it is easier to keep a tailless cat clean. definitely need to get all that infected and dying tissue out of there so she can heal!

Malaseb is OK, but honeslty I think straight chlorhex is better, the surgical scrub or shampoo.
here is a good link, it isn't expensive. http://www.jefferspet.com/davis-chlorhe ... p/0034227/

you'll find that you can save a lot of $ by getting supplies online, getting stuff from the vet is convenient but gets costly fast. They are generally the most expensive source. She is going to be an expensive kitty with all the care she needs, so I would hope that they will help you keep the costs down.

oh, about the diarrhea. have you tried pumpkin? the pulp adds fiber and gives the stool form. i have had many cat swith assorted gut issues (IBD, incontinence leading to motility problems...) and pumpkin helps tons. they usually like it esp if mixed with a little canned food. and it is much cheaper to feed a high fiber diet that way than by buying the prescription high fiber food.

is she on anything for pain? I am a believer in pain meds, even though I know cats don't always complain much, I look at somethign and say "that has GOT to hurt" you might ask about Tramadol or see if there is somethign they recommend. I woudl DEFINTELY get pain meds for post op!!

I've been waiting for your reply and thinking about you, paws crossed for things to improve.

after the stitches are out I woudl do the soak I talked about earlier. it really is fantastic.

[catsrmylife]

Hi again.

Luna is now under anesthetic. The vet has called to say that they are going to remove the dead skin and clean the wound.

As Luna does defecate by herself ( she will defecate if I express her bladder and she has a lot of stool in her bowels) the vet says she must have some feeling and muscle tone in her sphincter so to go into her spine and amputate the whole tail, would cut into the nerves and make her incontinent.

Depending how bad the wound is, he may amputate part of the tail.

I really don't think the skin has much chance of healing without something drastic

I have Chlorhexidine solution already but the vet said to use Malaseb. Maybe I will get more answers later when I collect Luna.

Photos are attached of Luna's wound, taken this morning after bathing (but before she was dried). The photos are blurry and not great quality but you can see how raw and sore the wounds are. I think they are really bad

[catsrmylife]

Just got off the phone with the vet, they have partially amputated the tail.

Recommending Intracite to put over the wound to keep it moist?

I will update when I know more.

[BendyMom]

Thank you for the picts. you are waaaaay beyond vaseline and barrier spray, which is what i figured.
i am not familiar with the product your vet is recommending, but i certainly don't know everything.

i hope the surgery goes well and that you can get her stools firmed up - that will help tons in keeping her clean. i have constant poo issues with my 2 incontinent ones, it seems either too runny or they get consitpated. sometimes we have a few good weeks. paws crossed you can get her issue under control.

i'm semifrantic here with a sick kitty of my own so if i take a little while to reply, that is why.

[critters]

OUCH!! That looks so painful!!

You know, some people have used sugar mixed with Betadine to heal sores, even cancer sores.

I would also add that vets frequently don't know what's going on, especially with regard to disabilities. I'm often better off finding my own way, especially with weird disability stuff. Hardly ever has a vet lived with and observed disabled critters up close.

[Mimi the cat]

How is Luna doing now ? I hope she gets well soon

[BendyMom]

I have been wondering too.
purrs she is recovering from the surgery well

[catsrmylife]

Thank you both, Luna is doing really well

We went for a check up on Friday and the vet was very pleased with the wound; he admitted he changed his mind back and forth about 5 times about whether to amputate or not. I told him I felt he had made the right decision. Gone is all the malodorous tissue and the lifeless tail!

The vet said Luna did have a good blood supply to the area so definitely not gangrene!

As it was down to raw tissue, he has tried to pull some of the muscle over the open wound and put a couple of dissolvable stitches in it.

I am washing Luna regularly with the Chlorhexidine solution (as opposed to the malaseb) as the last thing I want is infection in the open wound. I am applying Intrasite gel to the wound which acts as a barrier and keeps the wound moist so the skin can heal. The vet did say KY jelly works too but that the Intrasite gel is better. I am taking photos every few days with the digital camera to try and see if there is much improvement. Luna is also back on Nisamox antibiotics.

Luna is so bright you would not know she's just had major surgery! She is still 'chasing' the other cats and diving off the sofa (though obviously I am trying to supervise and prevent the latter as I don't think it will do her much good).

I did mention one concern to the vet; Luna's stools are very dark - black almost and tarry. She has some semi-firm stools but mainly come out like 'ribbons'. The vet didn't seem overly concerned at this stage, he said Luna has been on a lot of meds (she has, mainly antiobiotics), suggesting that is the cause. Her urine is also very dark no matter how many times I seem to express her bladder. The antibiotics are also to try and prevent a UTI.

The only pumpkin I can get in the UK is the tinned pie stuff (now that Halloween has been and gone); excuse my ignornace, but is butternut squash the same as pumpkin or as good as?

We have prokolin but of course, kitties hate it as it's like chalk. I am going to buy some Forti-flora to try and put the good bacteria back into her gut.

Any further advice you can give me would be much appreciated.

Luna is such a fighter, she's been through so much already in her short life. I hope this amputation is the turning point now and I can get her as healthy as possible.

I also have another special needs kitty called Liza. I will post about her in separate thread and see what advice you good folks can give me to get and keep her in tip-top condition.

Susie

[catsrmylife]

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

Here is Luna, prior to her amputation.