Pls help - cat w/use of all 4 legs & bladder nerve dmg

For those seeking advice on caring for incontinent pets and animals with kidney-related problems.
amyestes
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Pls help - cat w/use of all 4 legs & bladder nerve dmg

Post by amyestes »

This forum is a godsend! Already I have read so much that has given me cause for hope and determination to succeed in being able to express the bladder of Miss Kitty, the sweet girl I have taken on this week, 3 or 4 times every day so that she can stay comfortable and enjoy life.

Miss Kitty has been my mother's cat for several years. She is an indoor/outdoor cat (only indoor now!), obese spayed female, about nine years old. She never spent much time outside, but my mom lives on a dead-end street in an animal-friendly neighborhood, so Miss Kitty was able to enjoy going out occasionally. About two weeks ago, my mom was pulling into her driveway. She always does this very carefully, checking the position of each cat. All was well, but then something caught MIss Kitty's eye, and she moved quickly. The car hit her. My mom called her vet immediately; he met her at the clinic and performed surgery on one of her rear legs, which was badly broken, but otherwise he believed she was OK.

After a few days at home, Miss Kitty's tail (which had not been functioning normally since the accident) went completely limp, and it was clear she was having trouble peeing and pooping. My mom took her back to the vet's office. The vet who did the surgery was on vacation, so a different vet checked her and said she had nerve damage that was preventing her from being able to pee or poop on her own. She said the injury occurred from the car accident and that she may have exacerbated it by doing too much when she went home with my mom. The vertebrae which had been slightly separated on the initial X-rays (although the original vet didn't catch this) showed more separation when my mom took her back in.

My mom -- who can no longer work due to a spinal injury and suffers with osteoporosis, fibromyalgia, and COPD -- was devastated. Her relationships with her cats are such an important source of joy and purpose in her life. She is overcome with guilt and could not stop sobbing. Because of my mom's condition, the vet knew that she would not be able to care for Miss Kitty, and encouraged her to consider euthanasia.

The last of my own three cats died a year and a half ago at a grand old age. I have purposefully not adopted another cat so that I could care for my mother's if she needed me to. I did a lot of research online and discovered this site, which gave me so much hope. I am not trained at all in any veterinary profession, but I am not afraid to do what needs to be done for people or for animals in need, and I have always had good luck working through my own cats' injuries and health problems, so I felt sure I could do this. Miss Kitty is a wonderful, sweet girl. I take her to the vet's office and she purrs through every visit. She tries to make other animals she meets at the vet's feel more at ease. She has all of her claws, but she believes in velvet paws. Just a wonderful, wonderful girl.

I live in New York and went to my mom's in Tennessee last Tuesday. I brought Miss Kitty home from the vet's, where she had been staying Wednesday morning, and from that point took her back twice daily to learn how to express her bladder and bowels. I got the bowels right away and have had no problem with that. Each night, I tried to express her bladder myself with no luck. Finally I had to leave. We started the drive on Saturday late afternoon after Miss Kitty had been to the vet twice. I planned our route around visits to vets on our way. Saturday night a terrific vet tech at the Knoxville emergency clinic helped me. Sunday morning I was prepared to go to another emergency clinic, but I was able to get her to pee! I was so thrilled and relieved - I believed once I got it this once, I would be able to do it forever. And I did express her again on Sunday afternoon. Sunday night, though, I could only get a few drops, and same thing Monday morning. By Monday morning, I was fairly certain from the look and smell of the urine I expressed she had a bladder infection. We stopped at a vet's office on the way to confirm, get antibiotics, and get her bladder completely empty.

Again last night and this morning, just a few drops of urine. She is fighting me more and more. Miss Kitty of the velvet paws has shown me her claws. She practically begs me not to make her use them. She twists and turns and fights so hard while I am trying to express her, I am afraid I could injure further.

This afternoon, we had our first appointment with her new vet in New York, whose practice includes acupuncture and Chinese herbs in addition to traditional Western medicine. The leg is healing, and he changed her splint and treated places on her belly that were practically raw from chafing the splint. I am sure this is another reason she is fighting so hard - it must really hurt for me to be squeezing so close to those sore places!

The vet took X-rays and said he was not ready to give up on her recovering use of her tail yet. He showed me that her spine otherwise looks healthy. The Tennessee vet said some of the vertebrae were significantly separated, causing the nerve damage responsible for her loss of bladder and bowel function, but he said all of the vertebrae appeared to have a similar amount of separation - none too much. I wonder if this may mean improvement?

He gave me another bladder expressing lesson, which I believe will help. The problem is, Miss Kitty is so tired of me and I know she is sore and her bladder is irritated, and she just doesn't want me touching her at all. I have watched all of the videos online which are brilliant and very helpful, but I have not found one of someone expressing a cat who has use of her hind legs. Have I missed something? I am doing this solo, so I have to find a way that will work for Miss Kitty and me without a helper.

If anyone has any suggestions about helping her relax to allow me to learn to do this, please share them!!! I would be incredibly appreciative. Many, many thanks -

Amy
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Christine
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Re: Pls help - cat w/use of all 4 legs & bladder nerve dmg

Post by Christine »

Oh my goodness....your mother and Miss Kitty are so lucky to have you in their lives. Bless you for your determination and loyalty to both of them. I am so glad you found us. Our cat experts will be along with advice (I am not one of them).

:welcomepink:
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Re: Pls help - cat w/use of all 4 legs & bladder nerve dmg

Post by Sasha's Mom »

Amy,

Please check your private messages here. I think a phone call will be much easier to discuss the idiosyncrasies of helping you express Miss Kitty's bladder with a little less difficulty.

Leah
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amyestes
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Re: Pls help - cat w/use of all 4 legs & bladder nerve dmg

Post by amyestes »

Christine: Thank you so much for your kindness. I think I am the lucky one to have my mom and Miss Kitty in my life!

Leah: Thank you for everything! I am so looking forward to meeting you by phone!
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Re: Pls help - cat w/use of all 4 legs & bladder nerve dmg

Post by critters »

My Buddy was a little :twisted: when it came to expressing, too. I get ""Page Not Found on the red sticky post at the top of this board, with the expressing info on it. Buddy has a section because I had to do him so strangely because of his rotten expressing behavior. I'd scruff him and hold him on his back on a folded towel on the floor. I'd then express him with the other hand into a baby diaper. Our vet at the time swore up and down one person could NOT express him, and I finally had to show her. They had a low opinion of non-vet people expressing. :twisted:
amyestes
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Re: Pls help - cat w/use of all 4 legs & bladder nerve dmg

Post by amyestes »

Thank you so much for your post about Buddy! It really gives me confidence I can get it. I am having more success now...I cannot get her bladder completely empty, but more often than not, I am able to get a real stream, even if a short-lived one. Right now I am trying to work with her standing, as that is how I have had the best luck so far. I scruff her and try to position my forearm so it lines up with her spine since I don't have an extra hand to place on her back and then express with my other hand. Some of the vet techs tell me I am not applying firm enough pressure, and some tell me to be careful I don't rupture her bladder. It's confusing, and I definitely don't want to cause any new injuries! But I am going to keep working on it till I get it...I am hoping for sooner rather than later, as the money is definitely dwindling...thank you again for the encouragement. I am going to give your position a try! :thankyou:
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Re: Pls help - cat w/use of all 4 legs & bladder nerve dmg

Post by CarolC »

critters wrote:I get ""Page Not Found on the red sticky post at the top of this board, with the expressing info on it.
Fixed!

:thankyou:

This will probably not help you but I will mention it anyway. After my paralzyed chihuahua was spayed I had to express her bladder and she kept trying to run away. I ended up putting a barstool in the bathroom and a puppytraining pad on the floor. I expressed her with her front feet on the stool and she did not try to run away because there was no place to go. However a cat would probably see it differently, a kitty would probably just try to jump...

Some cats will hold still as if they are being scruffed, if you put clothespins (clothespegs) on the back of their neck, if you're lucky enough to have a cat that responds that way.

http://www.felinecrf.org/subcutaneous_f ... _peg_trick
amyestes
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Re: Pls help - cat w/use of all 4 legs & bladder nerve dmg

Post by amyestes »

Thank you Carol! I have been trying the clothes pin trick. I don't think it works as well with Miss Kitty as it would with other cats I have known. She was attacked by an Akita before she came to live with my mom and because the wounds were to her head and neck, I don't think she "scruffs" as well as other cats.

I am back to a point of utter frustration after a couple of good days. I have not been able to express her bladder at all by myself for the past few days. She fights me more and more. Last night she repeatedly went to the litter box and thrashed around to no avail. I could have cried. I feel so sorry for her.

I've been trying to do this for two weeks straight now with very limited success. The people at the vet's office are very nice but I can tell they think I should "get it" by now. Has it taken anyone else this long? I have never not been able to do something like this before and I am getting scared that I just can't get it. :?
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Re: Pls help - cat w/use of all 4 legs & bladder nerve dmg

Post by cricketsmom »

Hi there,
My cat Cricket also has use of all four legs. I got her in September of 2009, and she requires daily expressing. I had a bit of an advantage because I am a vet tech, but what I was taught was pretty general. You don't really get good until you have to do it all the time. It took a while for Cricket and I to settle on a technique that worked in our situation. Believe me, there was a lot of frustration for us when we started this journey, too. It was especially tough during her healing period - which you are in now with your own cat. Her nerves did strange things and, when I tried to express, I would get various results. So keep your chin up. It gets easier! It's also possible your cat may gain her function back. Cricket could care less about a litter box, but it sounds like your cat is still interested.
Anyway, so in our routine, I take Cricket by the scruff and make her face me. Her body is pointed more at my left side than straight at me. I have to keep her front feet lifted off the ground to keep her from trying to duck from my hand and run off, and I keep her hind legs on the floor so she feels steady. Then I use my right hand to find the bladder between my thumb and fingers. Then I steady it and try to squeeze evenly on both sides until it feels empty. She usually squirms in the process, and I have to lift her up then put her back down to help settle her.
I don't know if that's any help, but it works for us. Good luck!
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Jean
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Re: Pls help - cat w/use of all 4 legs & bladder nerve dmg

Post by Jean »

Hi,
I just wanted to say what a big heart you have for caring so much.
You will get the hang of expressing. When I first pulled Jaime off of the highway 13 1/2 years ago I would get so frustrated. I'm surprised she even lived. But, she did and is doing great. Like Cricket's mom said you just have to do it for a while and then it becomes second nature. I now have 2 paralyzed doggies, 2 paralyzed cats and 3 Manx cats that I express. I could do it in my sleep. But, that wasn't always the case. I spent so much time having the Vet work with me. He was so patient. He would take my hand and literally help me to form my fingers around Jaime's bladder. Then, he would wrap his hand around my hand that was clutching her bladder and show me how to squeeze and push forward. He was such a Godsend.
Keep working with the Vet and techs. Spend every day with them if that is what it takes. One tech may have a little different way that might work for you. Some of my paralyzed guys I express lying down, standing up or to the side. Find the approach that works best for you and your kitty. Go to the vet at least 1x a day so that your kitties bladder gets expressed totally at least 1x a day. Don't worry about what the techs think. They will realize that you mean business and that will cause them to work even harder to help you.
So, you live in NYC? If my email wasn't down I would try to contact Celene with Hurricane rescue. She has a foster who expresses but I'm not sure where she is located. Guy doesn't MC live in NYC ? Maybe she could give a lesson or two since she expresses or at least direct her to a knowledgeable and patient vet ??
Don't give up. You will learn to express. It just takes time and practice !!!!/Jean
Carol I'm terrible with links. Could you send a PM to MC (Mary Christine) and include this link and see if she could help ??
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Re: Pls help - cat w/use of all 4 legs & bladder nerve dmg

Post by Christine »

Hi ladies,

I think Carol works on the weekends so I am pm'ing Mary Christine with the link just in case. Worst case scenario, she will get it twice.

There sure area lot of very caring cat ladies who live in New York - you all need to get together for coffee!
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Re: Pls help - cat w/use of all 4 legs & bladder nerve dmg

Post by Jean »

Hey thank you Christine.
You are right there are a lot of cat ladies in NYC. I wish we had that kind of support in the midwest.sigh
One of my paralyzed kitties Caramel Apple is from NYC. A lady named Nancy with one of the local rescue groups flew her down to me 3 years ago. She and other rescuers pooled their frequent flier miles and brought her down. /Jean
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Re: Pls help - cat w/use of all 4 legs & bladder nerve dmg

Post by CarolC »

There is medication to assist with expressing. Bethanechol plus phenoxybenzamine are frequently used together. Bethanechol helps the bladder contract while phenoxybenzamine relaxes the urethra. Do not use bethanechol alone without something to relax the urethra.
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Re: Pls help - cat w/use of all 4 legs & bladder nerve dmg

Post by amyestes »

Dear, kind ladies,

Thank you SO MUCH for the advice and support and encouragement! I can't say how much I appreciate it. Jean, I read your story about Jaime on the long post with different methods of bladder expression, and knowing you struggled but ultimately worked it out has definitely kept me going many days. Cricket's Mom, thanks for reminding me we are still at the beginning. It helps to be reminded I may just need more practice.

I typed a long post yesterday afternoon but apparently it didn't make it - boo. So I will try again, because I have some good news and some new questions!

First the good (GREAT) news: two days ago, we saw a different vet in our same office who seemed excited by how much time I reported Miss Kitty had been spending in the litter box. He recommended diazepam to go along with the Bethanecol she was already taking (Carol, you were clearly already several steps ahead of the vet!). It was late so I filled the prescription yesterday morning, added it to her food, and almost immediately she started scratching in the litter box. She wasn't able to produce anything on her own though, but I thought maybe if those muscles were more relaxed she would let me help her more easily. Sure enough, she did! This is the first time ever I could really feel her bladder, got a good stream, could feel it getting smaller. When she had enough, I stopped, she covered up her own mess (I think I was forgetting how much this must mean to her - how crazy of me not to be thinking how awful every instinct she has tells her it is to have witnesses to her peeing and pooping and not to be able to cover it up!), walked away, groomed, relaxed a bit, and then went back to the box. I knew her bladder wasn't empty, so I helped again, and this time I do think we really got it empty. I could have just cried I was so happy! She is also feeling GREAT. More and more the past few days, she wants to run, jump, play. I have to really struggle to keep her from jumping all over the place for fear she will hurt herself again. She certainly doesn't seem to feel like an invalid, and being able to use the box seemed to give her one more boost of pride and confidence.

Here is my first question - when I went to the vet two days ago, he said that her bladder wasn't that large. It didn't seem possible to me because I had not been able to express her at all for 24 hours, but he said that based on how I am feeding her now (all wet food, high-quality grain free diet, no dry food, just feeding twice a day), she may not need to be expressed more than every 24 hours, and that his own cat only pees a small quantity once every 24 hours. This scared me, because I had in mind that I needed to express her 3x/day, no matter what. Now I am thinking, she clearly knows when she needs to go, and if she will let me help her while she is in the litter box, I should just follow her cues (based on the past couple of days, I think this would likely be twice a day). Does this sound like a good strategy? I don't want to endanger her by not expressing her frequently enough, but I also don't want to be so rigid about the schedule that she ends up feeling like she is being tortured when she doesn't even need to pee.

The other thing that has really been worrying me more and more is her poop. The first thing that the vet in Tennessee taught me was to manually express her bowels by gently inserting a gloved and well-lubricated finger. I didn't have any trouble with that initially, and she didn't seem to mind too much (although even the Tennessee vet noted she was minding more and more). Since we have been in New York (so since we started the Bethanecol), expressing her bowels has become increasingly difficult for me. Often, she will not allow me to do it, so she has ended up only having her bowels expressed every other day. When it seemed it was getting worse still so that we were essentially going two days with no bowel movements at all, I talked to the vet and said I needed help. Often, I was told that she didn't have much stool, the stool was soft enough but well-formed, not too worry about it so much.

Question 1: Is it possible she is just not producing that much fecal matter? How often should she need her bowels expressed? It is true she is eating much less than at my mom's (my mom free-fed dry food). But it is also true that she has a healthy appetite and she is eating two good meals a day! I don't want her to get backed up/to leave her feeling so uncomfortable.

Question 2: We have just run out of Lactulose. Do I need to refill it? Is this a maintenance medicine she needs to be on as long as she is unable to empty her bowels herself? Or do I not need to give it to her unless her stool becomes very hard?

Question 3: It seems really possible to me she may be getting bowel function back, but slowly. All morning she has been in and out of the litter box, clearly trying to poop, not able to succeed, unwilling for me to help. This morning on my bed, there was a little spot of poo. Last round in the litter box, there was a little poo outside her bottom. She did let me try to help then, and I can feel that there is feces right there waiting to come out. But she can't do it, and I haven't been able to do it for her, so we are going to the vet in an hour to get her cleaned up. Is there anything more I can do to help her? I am afraid she is going to hurt herself trying so hard. Clearly her back end was a little weak and fatigued just now. She doesn't like it but I put her in her crate so she would rest.

Ladies, I can't say thank you enough for all of your help. I am so hopeful right now we may be on the brink of finding a strategy that will keep us going long-term! THANK YOU!

Amy
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Re: Pls help - cat w/use of all 4 legs & bladder nerve dmg

Post by Christine »

I will defer to the true experts on expressing, but one thing I can suggest is to give her a tablespoon of pumpkin (no spices) mixed in with her food to help with the stools. Also, have you tried the ice cube method of getting her to poop? I used a little squirt of cool water on my dog and it worked like a charm. Just a quick squirt on the anus can get things started, however if they are hard to come out, you might have to help her by pinching on either side, but I am getting outside my realm of expertise! So glad to hear things are slowly falling into place. You will soon have your own system down pat and she will help you help her! Great job, so far :trophy: :wub:
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