I actually read this just last night! We will definitely try this. For now the vets are still trying what they can there. If nothing works and he ends up back here we will have to try this again.CarolC wrote:I have a feeling this might not make a big difference with your cat, but am quoting it anyway because it is such a simple thing to try, almost ridiculously simple. Then when that does not work, you have ruled one more thing out.
Jean in http://handicappedpet.net/helppets/viewtopic.php?f=5&t=11105&p=56225&hilit=heater#p56225 wrote: make sure that your baby is warm. Jaime my cat with posterior paresis needs her enviroment kept at 78 to 80 degrees or she shakes and is nearly impossible to express. I use a radiator heater with a temp control on it. I couldn't adequately express her if she wasn't warm.
Expressing a large atonic bladder
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Re: Expressing a large atonic bladder
Re: Expressing a large atonic bladder
The surgery was done today - the findings were:
* The apex of his bladder is contracting a little, but the rest of the bladder is totally flaccid
* They are waiting for results from bladder biopsy to get more details about what is wrong with it exactly
* They tried to put a catheter in from the bladder through the penis (so inside out) and were unable to
* They then tried to go in from the outside in and it was very difficult. After this they then WERE able to put it through the inside out. However, there seems to be some fold there and a very thin part of the urethra that is making exit difficult.
* So this thin area of the urethra is another problem in addition to his bladder being distended and unresponsive
* They will get biopsy results back next week (this is an agricultural university hospital with its own lab, so they are asking the technicians to rush this through as soon as they can but it won't be over the weekend) they will consider next options, and a urethrostomy will be one of the things they may consider.
* I asked whether this urethral difficulty may also be why nobody's been able to express him so far, and then even IF the bladder has longer term damage maybe the urethrostomy would help us to express him ourselves over the long term. She said it's a possibility, but they want to have all of the biopsy results back and review all the information before committing to a decision.
* He had a bit of bleeding in the bladder, they suspect due to being drained with a needle. The most immediate danger is him ripping out his catheter this weekend (which he's done in the past at the previous place that was treating him), because getting it back in would be very difficult and would mean another stressful emergency procedure for him. They hope that if it can stay in at least through the weekend it would let his bladder rest from the needle until they figure out next steps.
She talked to the internal medicine specialist about the ethics of the situation. They agreed that it is ok for them to keep trying because he is otherwise happy and doesn't even seem to know he's sick. She said we should keep in mind that the prognosis is still grim and that we shouldn't get our hopes up, but they will continue to try to find some solution.
* The apex of his bladder is contracting a little, but the rest of the bladder is totally flaccid
* They are waiting for results from bladder biopsy to get more details about what is wrong with it exactly
* They tried to put a catheter in from the bladder through the penis (so inside out) and were unable to
* They then tried to go in from the outside in and it was very difficult. After this they then WERE able to put it through the inside out. However, there seems to be some fold there and a very thin part of the urethra that is making exit difficult.
* So this thin area of the urethra is another problem in addition to his bladder being distended and unresponsive
* They will get biopsy results back next week (this is an agricultural university hospital with its own lab, so they are asking the technicians to rush this through as soon as they can but it won't be over the weekend) they will consider next options, and a urethrostomy will be one of the things they may consider.
* I asked whether this urethral difficulty may also be why nobody's been able to express him so far, and then even IF the bladder has longer term damage maybe the urethrostomy would help us to express him ourselves over the long term. She said it's a possibility, but they want to have all of the biopsy results back and review all the information before committing to a decision.
* He had a bit of bleeding in the bladder, they suspect due to being drained with a needle. The most immediate danger is him ripping out his catheter this weekend (which he's done in the past at the previous place that was treating him), because getting it back in would be very difficult and would mean another stressful emergency procedure for him. They hope that if it can stay in at least through the weekend it would let his bladder rest from the needle until they figure out next steps.
She talked to the internal medicine specialist about the ethics of the situation. They agreed that it is ok for them to keep trying because he is otherwise happy and doesn't even seem to know he's sick. She said we should keep in mind that the prognosis is still grim and that we shouldn't get our hopes up, but they will continue to try to find some solution.
Re: Expressing a large atonic bladder
It sounds like you're getting good information and good care, and that's a good start!
Re: Expressing a large atonic bladder
Yes - I guess the third vet's the "charm". They suspect that the second vet treating him (after the first vet, who gave him the infection) may have let his bladder fill for too long, causing the distension and damaging the bladder. I've only heard this in passing - nobody's "blaming" anyone, but this is what it's sounding like.critters wrote:It sounds like you're getting good information and good care, and that's a good start!
I wish we hadn't been so stupid and that we took him to the agricultural university hospital straight away. We don't know what will happen, but at least they are trying different things and not overfilling his bladder hoping that would make him pee. I'm still dreading a day when a phone call will come that they're ready to give up and pray that this won't happen.
I'm now checking my phone every 5 seconds to make sure I haven't missed today's update phone call. It's Saturday so his regular veterinarian won't be there and the call will be from the emergency vet on duty. I'm hoping with all my heart that the call won't entail them telling me that he's ripped out his catheter - that is the most immediate danger right now. His bladder needs to rest from the draining and he needs a break from the daily sedation, if he rips it out I'll be devastated. I'm thinking about asking if I can come stay there with him to watch him to make sure he doesn't start messing with the catheter. I doubt this sort of thing is allowed, but it seems like if they did let me just sit there next to him 24/7 we'd at least be able to make sure he leaves it in. I could bring a sleeping bag or something. Problem is we have another kitten at home and my partner will be out of the country starting with Monday night, so I may need to come up with a quick free-feeding solution for a few days while I'm over there if they do say yes, and maybe find someone who can stop by and check on her while I'm away at short notice. But I have a feeling the hospital won't go for letting a strange lady camp out there next to a cat for days at a time anyway - we will see, it's worth asking at least.
I have also gotten a loan approved because I think his insurance may be running out. I may not need it, but just in case my savings don't last me through this I want to have the money lined up. The contract papers were meant to come last week but not here yet, I will call the provider first thing on Monday. I refuse to let him die for financial reasons and right now I'm so glad I had savings, and still have some stock to sell if needed.
Re: Expressing a large atonic bladder
I SO know the feeling! It seems to me it's worth asking, too. There aren't any easy answers that I know of in cases like this, and I've been there.
Re: Expressing a large atonic bladder
Got an update from the emergency vet on duty. She basically said there's no change (not that we expected any). He hasn't ripped out his catheter at this stage (thankfully). I brought up the idea of going over there to watch him 24/7 but she said there should be no need because the catheter they're now using is different from the kind he ripped out at the previous vet. Instead of having a tube with a bag attached, which he could easily get tangled in and dislodge as he's very active, they put in a short catheter that doesn't attach to any sort of tube. They then drain it with a syringe. I asked if we should worry about him ripping it out (since that's what we've been mostly freaking out about), and she said there should be no need to worry - he doesn't seem bothered by it and it gives him more freedom of safe movement than the other kind. I was so busy listening and trying to understand everything that I forgot to ask if they have to sedate him for this syringe-catheter-draining. I suspect not, especially since he tends to be a big gentle giant and doesn't struggle much when you hold him, but don't know for sure.
The vet didn't sound overly happy or positive, but then - the only 'positive' news has been that he hasn't ripped out his catheter, everything else is exactly the same. I'm really glad the catheter is still in, but also still very worried about his prognosis and can't bring myself to be too happy about the news, especially hearing the lack of enthusiasm in the vet's voice. But of course she would also no doubt be tired at the end of a Saturday caring for sick animals, so you could hardly draw any conclusions. Still, it's something I can't help but be influenced by.
The vet didn't sound overly happy or positive, but then - the only 'positive' news has been that he hasn't ripped out his catheter, everything else is exactly the same. I'm really glad the catheter is still in, but also still very worried about his prognosis and can't bring myself to be too happy about the news, especially hearing the lack of enthusiasm in the vet's voice. But of course she would also no doubt be tired at the end of a Saturday caring for sick animals, so you could hardly draw any conclusions. Still, it's something I can't help but be influenced by.
Re: Expressing a large atonic bladder
It's good news, I'd say, but you're right that it's a start. How smart of them to use that kind of cath! I've never heard of using one that way before.
My Buddy wasn't sedated even for needle cysto, but he was a very good boy.
My Buddy wasn't sedated even for needle cysto, but he was a very good boy.
Re: Expressing a large atonic bladder
So nice that Buddy didn't have to be sedated! Sounds much less stressful than what this guy is going through, at least on that frontcritters wrote:It's good news, I'd say, but you're right that it's a start. How smart of them to use that kind of cath! I've never heard of using one that way before.
My Buddy wasn't sedated even for needle cysto, but he was a very good boy.
They started off only using local anesthetic for our guy at the second vet but after the bladder became so distended and misshapen it had become too difficult for them to get the needle in without him being totally relaxed
It really shows how strong he is, recovering and still being happy and "not knowing he's sick" according to the vet after everything he's been through over the last three weeks. I know it's got to be wearing on him though; I really hope they find some solution soon, I know we're running on borrowed time.Here are some pictures from my last visit, and one a couple of months ago in his healthier days, when he'd just turned 5 months or so:
Our poor sick foofus:
http://i.imgur.com/NdUtlyG.jpg
http://i.imgur.com/XtQXdmR.jpg
Happier times:
http://i.imgur.com/lgAzjrG.jpg
Him with his "sister" - they bonded straight away and were inseparable. She misses him, too:
http://i.imgur.com/QCTnUwG.jpg
Re: Expressing a large atonic bladder
Well, Rigel is going into surgery for the urethrostomy now. The vet called about 40 minutes ago (a different one from the same place) to tell us he managed to rip out his catheter this morning. They were going to sedate him to put in another one, but she said his prognosis was not good at all. We're still waiting for biopsy results (which come tomorrow), but she said that at that point unless they find something great we should consider putting him to sleep.
I argued and said that right now even if they manage to fix his bladder peeing for him would still be very hard if not impossible with the urethra stricture they found. He definitely felt like he had to go about a day before we brought him to this vet, he just wasn't able to get anything out, so we know at least at that time he still had some sort of feeling in his bladder. And wasn't it at least worth giving him a chance? I told her that we'd be willing to manually express him for the rest of his life, and wouldn't this surgery potentially make that an even easier task rather than leaving the stricture there and just giving up unless they found some miracle in the biopsy?!
She said that at that point it would be a matter of ethics - that manually expressing an animal often makes their abdomen very sore. But it seems that plenty of animals here on this forum lead happy and long lives being expressed manually, I can't imagine killing him just because we're not willing to try!
The vet said she'd call me tomorrow with the biopsy results, but then she called about 30 minutes later saying that she spoke to the surgeon, who said that the urethrostomy MIGHT help him. We don't know for sure. It won't magically fix his bladder, but the surgeon said it may help the situation and it may help ONE of the two main issues hindering him right now. The vet asked the surgeon if it would be better to wait for the biopsy results before deciding to do this, but the surgeon said there isn't much point waiting, since the bladder biopsy results will likely be irrelevant to the stricture and may not tell them what the *main* of the two problems is - the bladder or the stricture.
So we decided it's worth a shot - they're going to do the urethrostomy, still put another catheter in, and wait for tomorrow's biopsy results (and hope that he doesn't rip the catheter out again).
This is such a long shot, I'm terrified that we are putting the poor guy through this for nothing. But if he makes it through this we will make sure he has the most amazing life, we just aren't ready to give up on him when we know there's more than can be done.
I argued and said that right now even if they manage to fix his bladder peeing for him would still be very hard if not impossible with the urethra stricture they found. He definitely felt like he had to go about a day before we brought him to this vet, he just wasn't able to get anything out, so we know at least at that time he still had some sort of feeling in his bladder. And wasn't it at least worth giving him a chance? I told her that we'd be willing to manually express him for the rest of his life, and wouldn't this surgery potentially make that an even easier task rather than leaving the stricture there and just giving up unless they found some miracle in the biopsy?!
She said that at that point it would be a matter of ethics - that manually expressing an animal often makes their abdomen very sore. But it seems that plenty of animals here on this forum lead happy and long lives being expressed manually, I can't imagine killing him just because we're not willing to try!
The vet said she'd call me tomorrow with the biopsy results, but then she called about 30 minutes later saying that she spoke to the surgeon, who said that the urethrostomy MIGHT help him. We don't know for sure. It won't magically fix his bladder, but the surgeon said it may help the situation and it may help ONE of the two main issues hindering him right now. The vet asked the surgeon if it would be better to wait for the biopsy results before deciding to do this, but the surgeon said there isn't much point waiting, since the bladder biopsy results will likely be irrelevant to the stricture and may not tell them what the *main* of the two problems is - the bladder or the stricture.
So we decided it's worth a shot - they're going to do the urethrostomy, still put another catheter in, and wait for tomorrow's biopsy results (and hope that he doesn't rip the catheter out again).
This is such a long shot, I'm terrified that we are putting the poor guy through this for nothing. But if he makes it through this we will make sure he has the most amazing life, we just aren't ready to give up on him when we know there's more than can be done.
Re: Expressing a large atonic bladder
That's pretty much the situation Buddy was in, and I felt awful that I couldn't get vets to cooperate. PTS because they have to be expressed doesn't seem right to me either. The bladder and belly probably DO get sore at the beginning, but both the human and the critter eventually usually work it out.
BEST of luck with the urethrostomy!!!
BEST of luck with the urethrostomy!!!
Re: Expressing a large atonic bladder
What ended up happening with Buddy? Did you learn to express him? I'm worried about even trying now because they had to open up his bladder for the biopsy on Friday and I'm afraid that it won't have healed by then and that any pressure to express him could damage or rupture it.critters wrote:That's pretty much the situation Buddy was in, and I felt awful that I couldn't get vets to cooperate. PTS because they have to be expressed doesn't seem right to me either. The bladder and belly probably DO get sore at the beginning, but both the human and the critter eventually usually work it out.
BEST of luck with the urethrostomy!!!
Thanks for the well wishes.
Re: Expressing a large atonic bladder
Yes, I learned to express him, but he developed a spasm at the neck of his bladder after having had pee crystals. This was quite a few years ago (like 8 or 10?), and I took him 60 miles for a urethrostomy. The place was AWFUL and didn't put the right tube in his urethrostomy, it fell out, and they, and everybody else, refused to replace it, so I had to PTS him because he couldn't pee. That's the nut shell of it. He got his spinal cord injury from being hit by a car, but he eventually got ALL of his function back, only to lose it again. http://www.amazon.com/Buddy-Easy-Reader ... slow+buddy
Re: Expressing a large atonic bladder
Oh no I am so sorry this happened to Buddy and you, that sounds awful. It's shocking how many bad vets there are - I never even thought about it until this whole fiasco. I will be sure to buy the ebook after this whole thing is over - right now I'm saving every dollar for vet bills and refusing to spend money on anything else.critters wrote:Yes, I learned to express him, but he developed a spasm at the neck of his bladder after having had pee crystals. This was quite a few years ago (like 8 or 10?), and I took him 60 miles for a urethrostomy. The place was AWFUL and didn't put the right tube in his urethrostomy, it fell out, and they, and everybody else, refused to replace it, so I had to PTS him because he couldn't pee. That's the nut shell of it. He got his spinal cord injury from being hit by a car, but he eventually got ALL of his function back, only to lose it again. http://www.amazon.com/Buddy-Easy-Reader ... slow+buddy
Re: Expressing a large atonic bladder
The surgeon called after the urethrostomy and said it went smoothly. He was just waking up when she called. She says there's no way to know if this will save him, but it helps remove just one of the roadblocks - the stricture. He now has a catheter and she says it will be easier to replace it now after this surgery, but in reality this really seems like his last shot They said normally they would not put in a catheter after this surgery, but in this case they did because they don't expect his bladder to magically fix itself just because of the urethrostomy and they want to keep the bladder as empty as possible to give it a chance to heal. They want to keep the catheter in for at least a day, but if he rips it out they may just wait and see what happens with his urination, since eventually they would have to try it (she also said they will be able to try expressing him). I'm hoping with all my heart that he leaves it in for now and then can get it taken out properly and safely.
She put down a note for the vets to say that I'm happy to go there and watch him 24/7, but said hopefully it shouldn't be needed tonight because he should still be tired after surgery.
Tomorrow they also expect to get the bladder biopsy results. I don't know what it can tell them, hopefully more details about what exactly is wrong in there. Hopefully something positive.
I now honestly feel that this vet has tried everything within their power unless I'm missing some other procedure that can be done for the atonic bladder (am I?). I just want them to get more information from the biopsy, maybe find some magical drug to "cure" him, and if not that to just try one last thing - expressing him manually and teaching us how to do so. If we could just give that a real shot they will be my heroes no matter what happens.
They said normally they would not put in a catheter after this surgery, but in this case they did because they don't expect his bladder to magically fix itself just because of the urethrostomy and they want to keep the bladder as empty as possible to give it a chance to heal. They want to keep the catheter in for at least a day, but if he rips it out they may just wait and see what happens with his urination, since eventually they would have to try it (she also said they will be able to try expressing him). I'm hoping with all my heart that he leaves it in for now and then can get it taken out properly and safely.She put down a note for the vets to say that I'm happy to go there and watch him 24/7, but said hopefully it shouldn't be needed tonight because he should still be tired after surgery.
Tomorrow they also expect to get the bladder biopsy results. I don't know what it can tell them, hopefully more details about what exactly is wrong in there. Hopefully something positive.
I now honestly feel that this vet has tried everything within their power unless I'm missing some other procedure that can be done for the atonic bladder (am I?). I just want them to get more information from the biopsy, maybe find some magical drug to "cure" him, and if not that to just try one last thing - expressing him manually and teaching us how to do so. If we could just give that a real shot they will be my heroes no matter what happens.
Re: Expressing a large atonic bladder
The biopsy showed nothing useful. Rigel ripped out his catheter again. They were able to put another one in temporarily fairly easily without having to put him under general anesthesia after the urethrostomy. They were not able to express him. They said they had to be very careful when expressing him because his bladder would be weak and risk rupture after the needles and the biopsy surgery, but they expected it might be easier after the urethrostomy. It wasn't. I don't know how I can even try it at home now without possibly rupturing the bladder myself. They are saying that if he doesn't pee on his own now we are out of options. She is going to get back to me tomorrow morning after talking to the specialist about how long is reasonable to wait for him to at least try to pee, considering his bladder is so stretched that it may take him longer to fill it. He may still pee, but with our luck and with the fact that they have seen zero change in his condition it just seems like wishful thinking.
I don't know what more I can do. I've contacted a mobile vet who can do at-home euthanasia because I don't want to him to die at the hospital. I can't think of anything else we can try to save him. Can anyone? My partner is out of the country until next week also so he won't even be here, it will just be me and our other kitten.
I don't know what more I can do. I've contacted a mobile vet who can do at-home euthanasia because I don't want to him to die at the hospital. I can't think of anything else we can try to save him. Can anyone? My partner is out of the country until next week also so he won't even be here, it will just be me and our other kitten.