4yo cat on bethanechol chloride need advice

[Jennmarie]

So my kitty Telos is a 4yo Balinese male neutered weighs about 12lbs. On the 30th of march I had to take him to the ER to remove a blockage in his urethra which turned out to be a stone. They did a catheter, flushed him out and sent him home. I ended up taking him back that same night about 10 hours later because I thought he was blocked again, they did another catheter and kept him overnight, but there wasn't another stone. I transferred him to my family vet in the morning and they kept him all day. I have taken him to my family vet every day since because he has been having trouble peeing still. The 3rd of April she gave him a steroid shot to help the inflammation and it worked great all day that day. Late that night we had some trouble again but I thought it was from him not drinking enough therefore having nothing to pee out. Early morning on the 4th he started having some bloody urine so I took him back to the vet and she made the decision to do yet ANOTHER catheter he came today about 11:00 am (after having ripping off his e collar and pulling out his IV and catheter this morning around 5 or 6am)

The vet said he is absolutely not blocked anymore because when she expresses him he is peeing out a nice clean stream but the problem is he cannot pee on his own, which she thinks is because his bladder is stretched out from holding in too much over the last few days. She prescribed Bethanechol Chloride (10mg pills cut into 1/8ths every 12hours) on top of his other meds (Clavamox, Prazosin, and Buprenex).

The 1st two are being given every 12 hours at about 8a/p and I'm giving him the Bethanechol at 2:30a/p. Does anyone know how long it usually takes for the new medicine to take effect? I gave it to him an hour and a half ago but he has yet to even try to pee, I also gave him the Buprenex around the same time though so he is kind of sluggish from that and maybe that's why he's not going?

I'm sorry if I'm all over the place this is the first furrbaby I've had whose been sick like this and unfortunately my vet is closed until Monday. I want to avoid taking him to the ER again if I can because they are beyond expensive and I don't feel like they give him very good care (they seem to care more about making money than actually solving problems).

[Bobbie]

Onset is 30 to 90 minutes. If it has been 90 and he hasn't peed, try expressing him- it should be easier than it was before. It only lasts six hours so after that time if he hasn't peed he probably won't.

[Bobbie]

Also, for a cat that is a low dose so if it doesn't work call the vet and ask if you can give 1/4 tablet.

[CarolC]

I am not a vet. I agree about the timing of bethanechol if that is an appropriate treatment right now....but...If it was my cat I would want firm proof there are no more stones, such as x-rays or ultrasound or whatever kind of imaging is appropriate.

What your vet said could be right, he could simply be having trouble urinating because he was stretched, or due to cystitis, or spasms due to irritation from the catheter. I would just want to know there are no stones before I proceed with bethanechol or expressing, to be safe. I agree the emergency vet can be expensive, and medical tests can be expensive. X-rays usually aren't too bad, and a bladder ultrasound is about $200 here where I live, which is cheaper than a human ultrasound.

This is what my Pill Book Guide to Medication for Your Dog and Cat says exactly:

"Bethanechol should only be used when the urethra is open, as when a catheter is in place, or with urethral relaxants because bethanechol can cause contraction of urethral smooth muscle as well. Theoretically, the bladder could rupture if bethanechol is given when the urethra is blocked, or in spasm."

Some more information about bethanechol is here
http://www.marvistavet.com/html/bethane ... oride.html

If the bills get too high, Care Credit is a loan for emergency veterinary care. The terms are good and they let you know right away if you are approved. You can ask for an application at the vet reception desk or go to http://www.carecredit.com

[Jennmarie]

Unfortunately I cannot reach his vet until Monday :/ as for expressing him I was never shown how and I'm hesitant to try on my own without knowing what to do.

He is very sleepy (not lethargic just tired) and isn't doing much other than that and cleaning himself.
He will drink water when I put him next to his bowl but he won't eat much (probably no appetite from the meds) and when I place him in his litter box he tries to go but only gets about a thimbleful out.
He is due for another dose of the bethanechol in 4 hours and I haven't given him anymore of the buprenex yet as he doesn't seem to be in pain or need it at the moment so I am hoping that taking the bethanechol without the painkiller will make it have more effect.

The pharmacist said there shouldn't be any issue giving him the bethanechol and buprenex at the same time but since one basically knocks him out and the other is meant to constrict his bladder I'm thinking that maybe the painkiller just took over since it is a stronger medicine?

As for the X-rays he did have those done and there are no more stones his urinalysis came back positive for crystals but we changed his diet to Royal Canin Urinary S/O right away to help dissolve and prevent those.

[CarolC]

OK, I'm glad about the x-rays. You could still be dealing with spasms or inflammation. It's encouraging that the steroid worked.

Here is what it says in Plumb's Veterinary Drug Handbook, 7th edition:

If urinary outflow resistance is increased due to enhanced urethral tone (not mechanical obstruction!), bethanechol should only be used in conjunction with another agent that will sufficiently reduce outflow resistance [e.g., diazepam, dantrolene (striated muscle) or phenoxybenzamine (smooth muscle).]

EDIT TO ADD: Under Client Information it says:

Give medication to animal with an empty stomach unless otherwise instructed by veterinarian

[Jennmarie]

Yep he's got that last one, the Prazosin is to relax the urethra and prevent spasms.

[Jennmarie]

So I ended up taking my baby to the ER last night because I couldn't tell if his bladder was full or not and he wasn't peeing much if at all. I got worried cause he was crying out when I touched his abdomen even though he was on his pain meds

I got there and the vet took him back and checked him, expressed his bladder and thankfully it wasn't full, he just didn't have enough in there to pee but she got a little out and it was clean, no blood or other issues so she sent him home and didn't charge me a thing which is beyond great since it's normally $100 just for an exam.

He's doing good this morning, very sleepy (not lethargic) but from everything he's been through I would say that's normal, I'm right there with him in the exhaustion.

Does anyone have any advice for getting him to eat wet food? I have Royal Canin U. S/O in both wet and dry but he's never been much of a fan for the mushy wet food (he does like wet food that is grilled or flaked but those have an ash content so I won't give him any) and he won't eat his dry if I sprinkle water on it like the vet said.

[CarolC]

Not advice exactly, but I think Science Diet also makes a couple of formulas for crystals, he might like one of those better, or at least perhaps you could try a can and find out. Maybe he will, or maybe he won't.

If you're really aiming to get more fluids in him, it might be easier to do sub-q fluids? It isn't as much fuss as it sounds like, you can do it with a hang bag and admin set, or simply with a couple of large syringes. Using syringes is a much quicker procedure. Then you know how much he got every day.

Wonderful about not being charged for the exam!

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[critters]

My experience was that Bethanechol made Buddy's bladder a lot more spastic; it set off so many spasms that he couldn't even be expressed. You might have better luck with phenoxybenzamine (PBZ) if he's having spasms.

The vet refused to believe that Beth. made such an enormous negative difference, so she took Buddy home one weekend and, unbeknownst to me, tried Beth. again. She found out I was right.

[Jennmarie]

Can you describe kind of how the spasms were? Like did he lay on his side with this leg up and sort of twitching while his genital area twitched with small drops of urine coming out? Because that's what happened to my baby this morning I rushed him into the vet since he was obviously in pain and his bladder was huge she couldn't express him and she had trouble expressing him yesterday as well. I'm taking him to an internal medicine (?) dr tomorrow to try and see if the issue is from scarring or if it's something we can fix without surgery but I will be bringing this up to my vet when I go pick my baby up in a few minutes.

[CarolC]

I sent critters an email to let her know about your question.

Here is a really good website you may find interesting in general, although I don't think it will answer your specific question. It has a lot on bethanechol and phenoxybenzamine, although the situation is different (the cat on the website had a tail injury).

http://www.kestrel.ws/erasmus.html

[critters]

He did the twitchy bit when he was about to pee, but the spasms were at the neck of his bladder and prevented the pee from getting out. He was blocked, but blocked by muscle spasms. He ended up having a urethrostomy (pee button) put in his belly.