Week 12: Thu.June.09: I was up all last night reading about Urine Retention and didn't get to bed till 6am (I really must get a life one of these days), so poor Raz didn't get expressed till 13:30 (guilt, guilt). I sat down to express him with a heavy heart, fully expecting failure - but it actually went pretty well, and we were all done under 30 mins.
It's clear when he starts to help: he sortof lengthens himself, and straightens his back, and then the pee comes in a proper 'stream' (albeit a small one) rather than dribs and drabs. I wish I knew why he decides to help at some points but not at others. He got very annoyed towards the end, I think I make a bit of a painful mess out of getting him properly empty.
However, the evening expressing was truly bad: after 45 mins the towel was still as dry as a bone, Raz was very fed up indeed, and so were Julian and I. In desperation, Julian held all four paws tight and I squeezed Raz really hard, and finally got about half out, at which point we gave up.
Not a good day - I kept feeling like I was about to burst into tears all day.
Week 12: Fri.June.10: Expressing Raz this morning was definitely an all-time low to date. He was very full because I hadn't emptied him last night. Every single time I got a drop of pee to drip out, the little #### would squirm and wriggle and growl, and I would lose his bladder and have to reposition my hands. I do not believe he was in pain, but I am mystified why he should object so much. After 90 minutes of him cursing and swearing and generally making life as difficult as possible, I had only managed to get him 3/4 empty, but neither Julian nor I could stand any more crap from him, so we called it a day - at which point Raz leapt off the bed and into the litterbox, squatted and did a tiny pee all by himself.
We went outside into the garden for coffee and to discuss where we go from here. Julian said that he had had enough and couldn't go on like this any more. I must confess I too am getting pretty fed up and desperate. We decided to leave things as they are until Monday morning, and then talk to the vet about a possible Cystostomy, preferably one with a cap.
To cheer myself up I decided to spend the day gardening and ignore the mammoth amount of work on my desk. The weather was warmish, and all three cats came outside and helped sow grass seed. I saw Raz twice (!!) squat and do a pee - WFT is going on?? He caught himself a mid-afternoon mouse-snack, climbed the neighbour's scarily high tree, and generally had a good time<br />
Surprise, surprise - at the evening expressing he was almost empty. He lay down and purred and purred, and I got about 8ml out of him with no trouble at all - we were all done in 15 mins flat, which is a bit more like it! Pray God this marks a turning of some sort.
Week 12: Sat.June.11: Something is definitely changing, although we shall see whether it is temporary or permanent. Again this morning in the garden I saw Raz squat and do a decent-sized pee, and at morning expressing time Raz was again almost empty: I got about 10ml out of him.
Same thing in the evening: again, less than 10 ml.
It is very odd: when we sit down for expressing and I start to massage Raz's tummy, his bladder is pretty firm and easy to find. But after 5 mins of tummy massage he relaxes, and his bladder goes all floppy, which does make expressing him a lot more difficult. I would have thought that the Bethanochol would force his bladder to be in a firm state. I don't understand.
Raz spent the evening asleep on the small sofa, and dribbled pee - I haven't seen him dribbling for a couple of weeks, so why now?
Week 12: Sun.June.12: It's unbelievable - Raz was again almost empty both this morning and this evening. But the very best part is that it took less than 10 mins to express the remainder. Yahoo!!
Week 12: Mon.June.13: This morning was again a breeze - Raz only had about 10ml in his bladder, and we were all done in 7 mins flat.
This evening it was hard to get him going. He had about 20ml in his bladder, and I think I got about half of it out, but he wasn't happy and wriggled and growled quite a bit, so we gave up after 30 mins. We shall see what the situation is in the morning. He dozed on the sofa beside me all evening, and again dribbled a bit.
Week 12: Tue.June.14: I saw Raz trying to pee early this morning, but without success. I presume his being extra-full due to not being emptied properly last night was motivating him to try. Expressing him took about 20 mins, and wasn't too bed.
At the evening expressing he wasn't nearly as full as I had expected, which makes me hope that he is doing some amount of peeing by himself. However, he did have a lump of poo just before his anal sphincter, which I haven't seen for some time, so I popped it out for him (he wasn't impressed). But what's interesting about this is that we haven't thought about his pooing for ages, but clearly he is not 100% back to normal.
Week 12: Wed.June.15: A really yucky present beside my pillow this morning - a small poo! Raz must have come into the bed at some point last night, and he usually crawls under the duvet and makes bread like fury - which of course gets his tummy muscles going, with this icky result. I guess we are taking a backwards step at the moment (in the style of "two steps forward, one step back".
It took quite a while this morning to get Raz going - about 20 mins, but after the first drop appeared the rest came fairly easily, and we were all done in 30 mins. I definitely got the feeling that he was helping, but I can't explain how or why.
This evening: Raz was very full, which I suppose means he didn't pee at all by himself today. But it went pretty well: it took 10 mins to get the first couple of drops of urine out, and then it came thick and fast. I still find it very difficult to get the last 5% out, which is when he gets fed up. About 30 mins all told.
Week 13: Thu.June.16: Expressing Raz this morning was another nightmare - 90 mins of pressing really hard, the pee would only come out drop by drop, he wouldn't stop wriggling and arguing - arrghghghg! And yet, and yet - we went outside for coffee and croissants and the little beggar dug a hole in my newly seeded grass and did a decent-sized pee. Go figure.
Raz's issues seem to have resolved into a single one of peeing. I have read so much literature it is coming out of my ears. I found an absolutely brilliant description of the urinary system in Fundamentals of physiology: a human perspective. I think that his problem is getting the internal urethral sphincter to open - but I'm still reading about the urethral sphincters, so we'll see.
We are going to have to do something about the castration problem. Raz is getting seriously stroppy, and is beating the other two cats up all the time, which is making them miserable.
The Vet phoned this evening to see how things were going, and was both disappointed and puzzled by my report of "Sometimes he pees and sometimes he doesn't." He says that just doesn't add up in a physiological sense. I offered up the idea that the healing nerves could be 'short-circuiting', so's to speak. He responded with a thoughtful "I wonder if there could be some tiny particle that sometimes goes into the urethra and partially blocks it, and other times doesn't." I also told him that Raz was becoming impossiblly stroppy, and beating up the other cats all the time. So, in short, Raz is to go in tomorrow morning to have his goolies chopped off, and at the same time he will be catheterized and back-washed, to ensure there are *no* particles or anything else in his urinary system.
The evening expressing wasn't too bed, only 30 mins (feels like a holiday after this morning). It still takes 10+ mins to get the first drop of pee out, but I didn't have to squeeze really hard, thank goodness. It is puzzling why the pee only comes in a sortof fast dribble, though. Either his urethral sphincter is only partially opening, or there is something partially blocking the urethra (sigh).
Week 13: Fri.June.17: We took Raz to the Vet this morning to be castrated, poor guy. The Vet called for a chat this afternoon: he said the castration went well, but he wanted to talk about the peeing problem. He said that they had catheterized him and drained his bladder completely, did an x-ray to check how his sacrum was healing + an ultrasound on his bladder + washed out the bladder + urinalysis + every test under the sun (you should have seen the size of his bill!). But he said they were alarmed to find complete bladder atony, ie. the bladder did not contract at all after being emptied. He said this was really, truly bad, and understood that expressing him was difficult and time-consuming, but that I really needed to be a lot more aggressive and keep him as empty as possible in an effort to reverse the problem. He said we should therefore continue with the bethanochol+phenoxybenzamine for the moment.
The trouble is, it's a bit of a circular problem. I have noticed that it has been getting harder and harder to empty Raz, the last 10+ml or so is almost impossible to get out, and the problem has been getting slowly worse. But I need to get everything out if we are to reverse this problem - how to manage this?
I am now raddled with guilt that in fact I have created the whole pee-problem or at least made it worse than it was. As I read more, I understand more about how the urinary system works. Good bladder tone is crucial for the correct operation of the internal urethral sphincter; is it possible that by only expressing him twice daily I have in fact been contributing to making matters worse, because the bladder spent too much time being full? Dear God, please no.
The Vet and I also talked again about Dantrolene. He said he only knew it as a people medication. I offered to email him various articles + the info CarolC sent me, he will look into it and we will talk again soon. The $64,000 question is whether it is Raz's external or internal urethral sphincter that's being the problem - or possibly both. The Vet said there's no way of telling short of surgery and then afterwards finding out that the wrong one got cut
We went to pick Raz up this evening, he was really, really glad to see us. But he can't talk properly, he is all croaky, and I can hear a weird sortof rattling sound when he breathes; but the worst thing is he's being really, really hyper. He won't settle down, he just paces and jumps up, then down, then walk around ... endlessly. He wolfed 40 grams when he first came home, then another 40 grams an hour ago, and he's making it clear that more food is a Really Good Idea. I am feeling extremely trepidant at the idea of trying to express him while he is in this state (gloom, gloom).
CarolC: sorry about the very brief earlier post, but I had just got off the phone with the vet and we were walking out the door to go get Raz, so tme was short. Hopefully you can now understand what was behind my previous post about irreversibility. Is it possible after such a long time (3 months)? I must confess to feeling rather low this evening about it all.