Desperate - still struggling to express cat bladder

[plap17]

I can't believe so much time has gone by. Posted last April.

I don't think I can do this any longer. I am the one with an almost 3 yr old male cat (Zula) who got tail under car! He lost control of tail - but pelvic injury mended. Still, no bladder progress. Since my son moved away, I have been the sole expresser (275 days to be precise). It is more than 1year and 4 months since the accident. He is otherwise normal: eats, plays. Hates it when the absorbent pad comes out, runs, cowers. But it's over in 5-7 minutes.

But I'm worn out. There are some nights I am literally exhausted after a day of work and commitments, and suddenly remember I have to do him. He's only 3, so we're talking another 12 + yrs.

I have never put a pet down. I didn't think it would come to this; always had hope that the nerve repair would occur. Vet said as long as a year.

This is not meant to be a 'woe is me'. I found this group to be very helpful. I guess I just needed to express myself (no pun intended) to people like many of you: passionate and loving, and always seeking the best.

Open to any thoughts. Is it ever ok to say 'enough''? Talk me out of it. Tell me it's ok. Either/both?

[CarolC]

I'm not trying to be funny at all when I say this, I am surprised it has taken this long to hit you. There is a kind of "burnout" or fatigue that we say (in general, based on experience of people on this board) usually happens around 6 months, maybe a little sooner or later, but you have gone 9 months and it's only now hitting you I guess. With me, my dog was paralyzed in September and it hit me in April. Here is something I wrote about that time. I don't know if the complete exhaustion of it comes through in my description.

I was pretty worn down, putting a lot of effort into helping my dog's quality of life but seeing no sign of walking or standing or bladder control. My dog was injured on 9/23/03. I saved a message from 4/5/04 that was written to me by a friend in Sweden who was going to have replacement of the descending and abdominal aortic artery, after already having had replacement of the ascending and arch. This is huge major surgery, a percentage of patients die from it. He wrote saying he was going to have surgery, and I knew I should write back to him, and I just absolutely couldn't. He needed support, and all I had to do was write to him, but I was so drained dry that I couldn't make myself do it. I was totally exhausted. Fortunately he survived the surgery and is still alive, and later I wrote explaining the situation. Unfortunately, being tired from dog care is not the kind of excuse people can readily relate to. If I'd been tired from caring for a sick child or a parent with Alzheimer's they would understand better.

Here was another description I posted. The description "beyond dead" only half covers it, I was a sinkhole of exhaustion. Then, as other people have experienced, without anything I did, when I wasn't aware anything was changing, it turned itself around. A transition takes place, and I think it is darkest before the dawn when that happens.

My dog's injury was September 23, and I cared for her all winter. The biggest adjustment was expressing because of the time it took and because I had to get up to do it no matter how tired I was, so I never got 8 hours of sleep. By April I was beyond dead, I didn't have anything left to give to anyone. Others here have observed the same thing. Somehow you go to the limit of physical and emotional exhaustion, and then somehow right when it is at its worst, for reasons that are hard to understand you begin coming out of it and it is never that bad again. Don't know why, but it's true. You may be about there, now. You've been doing this for 5 months. It's scheduling, and money, and appointments, and hopes and disappointments and delays, and the physical lifting, endless figuring out how to do things better, just all of it. And even if people around you are nice (there have been some amazing stories here of how sometimes they can be just the opposite) they can't really understand what you're going through. All I can say is, hang in there.

Here is the original post describing what we have come to call the "6-month wonder", or in your case it seems to be a 9-month wonder, whatever time it is when you get to the "can I keep doing this" point.

by Anita » Thu Aug 25, 2005 3:19 pm

I can't say more than has been said about the 6 Month Wonder.

I wonder if I am doing the right thing?
I wonder if she/he is happy?
I wonder what people think?
I wonder if it is all worth it?
I wonder is he/she will ever walk again?
I wonder where I will get more money for treatment?
I wonder how long I can do this?

Wonder, wonder, wonder. We have all done it and know exactly where you are. I think what is missing is acceptance. Once you accept that this is they way it is going to be, then it becomes so much easier. I know that it is hard and you are tired but you have gone this far, why give up now? The hard part is over!!! It will all become a way of life and you won't think anything about. I promise you.

It will be 2 years Labor Day weekend that my Sydney went down. Looking back, it was tough. But now, it is no big deal. Yeah we have been through alot because of the UTI but it all worked out and through my bad experience I have been able to teach others. We can't do everything right all the time. I wouldn't trade this experience for anything in this world. I have met some of the nicest and kindest people-many on this board-that have helped me out and in turn I have helped out others. I look back now and wonder what I use to do with all my free time?? Now it is spent expressing, pooping, exercising, giving butt baths, Chiro treatments, accu treatments, and the list goes on. I must have had a lot of free time on my hands!!!!

I can't speak for you, I can only speak for me, we're all different. With me it was partly emotional exhaustion, feeling let down more and more the longer my dog did not walk again (she actually finally did but I had long since given up hope) and partly just physical because of not getting enough sleep because of having to express every 8 hours. I worked full time and my work schedule consisted of irregular day and swing shifts back and forth, back and forth, so on days I was supposed to transition to a swing shift I could not sleep late because I had to get up early to express, and on days I was supposed to go to bed early so I could get up for a day shift I had to stay up late because I needed to express. I was just physically exhausted. If you say you're exhausted, I believe you. I do.

The thing is, it doesn't exactly change, but you change somehow. It is not just my experience, others have had the same thing happen. But I do believe there are families or people who really can't do it and probably shouldn't push themselves. For example, if you have a heart condition and not getting enough sleep, or too much stress, is not good for you, that is not your fault, and nobody with a "healthy" heart should judge you if you are forced to make a difficult decision. There are people caring for large dogs that are down. We are not all physically equipped to care for a 90-lb down dog, we are not all the same. So I don't believe anyone can tell anyone else what to do. In this case, all I can say is, there seems to be a phenomenon where "it gets better", you turn a corner, somehow it switches from chore to routine, and people who are long term expressers have experienced this.

Have you considered boarding him for 24 hours once in a while to give yourself a free day?

There is an article written for pet caregivers, which talks about burnout. Here is the link.

http://www.specialneedspets.org/caregvrs.htm

I hope you can keep going, but either way, you will know that you gave it your best and that's all any of us can do.

[Jackybear]

Hello I am the mom of a 9 year old male cat who has recently slowly started to lose control of his back legs and is now not able to pee and poo on his own. It started middle of March with back pain and after examining him and an x-ray the vet diagnosed a lumbar syndrome. But the pain medication and cortisol didn't help for his pain and he started getting more and more wobbly on his legs and now is just dragging himself along on his front legs. On the plus side I noticed that he doesn't show signs of pain anymore and the vet has confirmed that he is not in pain anymore.

About a week ago our Jacky stopped being able to pee on his own and also got constipated. He is still trying to go to the box, bless him but can't get anything out. Otherwise he is a happy, purry cat that happily eats and plays. He has since had enemas from the vet and has been taken to the vet to be expressed twice a day since I still cannot do it despite my honest efforts. The vet has said that he is very difficult to express as Jacky has apparently very strong stomach muscles which he tenses and it is almost impossible to squeeze and find the bladder. He also actively resists letting pee out when being expressed so it is very difficult for the vet and painful for Jacky. The vet has had more and more difficulty getting pee out of him and yesterday said that he couldn't do it anymore and would rather put a catheter each time which he admitted bears the risk of UTIs. Jacky has already been given Phenoxybenzamine the past 2 days but his stomach muscles and holding back his pee just seemed to get stronger since then and the vet could only express little lately.

Now I stumbled upon this post and read that some cats cannot be expressed without being on proper combination of medication and it was such a relief since I was already so worried about what would happen if I couldn't learn to express him. I am in Austria and unfortunately it seems to not be very common here to care for and express handicapped pets for years and our vet wasn't very helpful when I mentioned that I read about other meds that can help for cats that need expressing.

I would please need advice which meds I should look into that could help a cat that has very strong stomach muscles and actively tenses them and the bladder to avoid being expressed and letting urine out. Any tipps would be more than welcome. I should maybe also mention that we have tried different positions to express him and also to support him when he goes to the box which he doesn't mind at all but unfortunately hasnt produced pee yet except sometimes a dribble. He is very patient and sweet-natured and just such a loving cozy boy.
Kaz

[CarolC]

I am not a vet but you might ask your vet about something like robaxin or diazepam to relax the sphincter. My understanding is the phenyoxybenzamine can take a few days to build up and become effective, at least in dogs.

You might try external stimulation in combination with the expressing, it can make all the difference for some cats. At this link, scroll to the bottom and there are a number of videos on expressing (I know you said you have tried several methods), and a couple of them show external stimulation. I will embed the video that might be especially helpful, you can see that they are simultaneously squeezing his abdomen and stimulating where the urine comes out. This method is being done by one person in a video on a female cat, which I will also include.

viewtopic.php?f=5&t=16027

[Jackybear]

Thank you very much for your reply. Our vet gave us diazepam now and I did notice a difference in the tone of Jacky's stomach. Unfortunately he still tenses up and struggles to move away as soon as I try to feel for the bladder. He kind of inflates his tummy - weird as it might sound - to press against the pressure of my fingers. I then cannot even fully get my hands around his tummy. This unfortunately has made it pretty much impossible for me to find his bladder. The vet says he has very strong stomach muscles and he actively works against expressing.

Knowing the phenoxybenzamine might start to work in a few days, gives me hope. At the moment when I manage to hold onto him and squeeze harder, I cannot get a single drop out of him, the vet says he closes his sphinkter purposely. I really hope I will manage to express him soon. I don't know what to try anymore. I have spent hours and days researching, watched the videos and have tried different ways of expressing over the past, have watched and practised (unsuccessfully) with the vet, but cannot get it. I feel like a failure. And poor Jacky is getting more and more frustrated with my attempts.

The vet said not to give him Bethanechol since his bladder tonus is already strong. I am a bit worried that this might change with giving him Diazepam and Phenoxybenzamine? Couldn't these meds change his bladder tonus?

A few days ago I saw the video with Ropa who needs stimulation to pee. We tried it with him over his litter box and it worked. Unfortunately it hasn't worked since. I can't stand seeing him be uncomfortable and struggle and so am trying to find a way where he will be comfortable and help with expressing him.

[critters]

Hmm. My Buddy, who had a spastic (tight) bladder did very well with PBZ, but he needed far bigger doses than the books thought he would. I don't know that they really know how much is necessary in such cases, but you may want to try more. Bethanechol made Buddy's bladder MUCH more spastic and even impossible to express, so your vet is right on that. Apparently understanding has come a long way since Buddy's day!

PBZ was all but instantaneous for Buddy.

[Jackybear]

Thank you so much for your reply and sharing Buddy's experience. I'm so grateful I found this forum. Every bit of information is so useful.

Jacky has been on 0.25 mg PBZ twice a day for the past 9 days now and for the past 6 days 2.5 mg diazepam 2 to 3 times a day. He weighs 5.5 kilos, so about 11 or 12 pounds. He gets incredibly sleepy from the meds and he has been severely constipated for the past 2 weeks, so I spoke to the vet about trying to give him methocarbamol instead of the diazepam, about which I read on this forum. Since methocarbamol is not licensed for animals in Germany or Austria, our vet could only find dosages for cramps from acute poisoning. We looked for dosages on American pet meds websites and she suggested to start with 180 mg twice a day, but recommended to get in touch with people who already give their cat methocarbamol to find out about dosages. It would help us greatly if someone could tell me their experience with methocarbamol and dosages that have helped their cats.

Jacky's problems are a tight spastic sphinkter,crampy legs and shakey shoulders. He hasn't been able to use his back legs for the past 2 weeks but has never stopped trying to go to the litter box. Unfortunately less and less pee came and then (about 2 weeks ago) nothing at all anymore (and of course it was the weekend and vets closed). But almost exactly 5 days after starting PBZ he suddenly was able to pee decent amounts again last Sunday evening. Hurray! He went to the litter box several times in a row for about an hour but in the end it made up a solid amount of pee.

For the past 3 days he has been doing that 2 to 3 times a day, sometimes taking up to 3 hours. But he has started to lose more pee after getting off the litter boxes outside than in the litter box. He half sits half lies in the litter box for only a few seconds and then already gets out again. Also he has a lot of difficulty positioning himself in the litter box as he has no control over his lower half and he often doesn't manage to shift his butt and legs where he wants to and they sometimes falls out over the litter box. (We recently cut the sides lower to help him get in.) So sometimes he gives up before he has managed to settle himself. He pants and tries hard, it's heartbreaking. I try to help him and put him in a comfortable position in the litter box but he doesn't approve of that at all, because then he just gets right up and out of it.

We have also bought lots of rugs in the hope it would it make it easier for him to move than on our wooden floor but now the leaking has started. So as of yesterday he has also got his own towels.

At the moment he tries to go bathroom again but with very little success and it breaks my heart to see him so bravely struggling to climb in and out the litter boxes with no or little result.

The vet checked him today and expressed him which she said was easier with the PBZ and valium but Jacky still was howling in pain especially towards the end. Vet also said as long as he is peeing once or twice a day by himself I shouldn't try to express him. Which unfortunately I have never really been able to do anyway. I could just help him get little pee out by stimulating him.

Also this afternoon I have tried giving him his first dose of methocarbamol the same way I usually give him PBZ or valium, mixed with his favourite malty hairballpaste or a bit of yoghurt. But the methocarbamol is so bitter he started foaming from just a teeny tiny drop. I tasted it beforehand and it is absolutely awful, I have no idea how to get that in him, let alone twice a day!

I am also really trying to get his bowels moving, feeding him 3 to 4 times a day little portions because I read that it is closer to the cats natural eating habit and adding a bit of water, pumpkin, slippery elm, chia and ground linseed, all very little and soaked for at least half a day in plenty of water. Been adding that for the past 1 and a half weeks and hasn't helped so far. He has only had stool once since he has been given PBZ and diazepam. Because of that we or the vet have been giving him enemas (5ml tubes of microlax) every other day which isn't a long term solution the vet says. (And also terribly messy to do every other day.)

I just want to give him the right treatment and medicine to help him pee and poo, which he is trying so hard, but my nerves are wrecked because I constantly worry if he will manage and what I could do different or better to help him. I don't even remember what proper sleep is, constantly checking on him.

Thanks so much to everybody who takes the time to read this lengthy post. I would be so very grateful for any tipps or suggestions.

[amyestes]

Hi Kaz -- You are in far better hands with critters and CarolC than with me regarding meds (and probably everything else!). But I did want to let you know that I read your post and I admire you and your loving care for Jacky so much. It is very easy for me to recall how anxious I was about Miss Kitty, and I feel for you both. I did have a few thoughts, in case they might be helpful or encouraging to you. To this day, if Miss Kitty is having trouble pooping, I have a hard time expressing her bladder. It's been trial and error for me, and I find I still make tiny tweaks all the time, but I have worked out precisely the amount of Miralax to the amount of the kind of food she eats to keep everything moving along pretty smoothly. It sounds like Jacky's problems are different in many ways but I wonder if he might pee more easily if the poop were moving better. Have you tried Miralax or something similar? One thing I think Jacky does have in common with Miss Kitty -- he does have some feeling. I think at least at the beginning, that makes it more difficult, but in time it has gotten MUCH easier for us. I had this crazy idea when I adopted Miss Kitty that life before injury and life after injury were clearly distinct from each other, black and white. Looking back, I see that she was adjusting, her body and nerves and sensations were adjusting, and I was learning and adjusting all the time. Now we have a routine and it works so well. She knows just what to expect and reproaches me if I get us off schedule! She just had her blood work done, four years post-injury, and the vet said if he didn't know better he would assume she was a much younger cat in perfect health. But at first it was all so new. It takes time to work it all out. It sounds like Jacky is frustrated and troubled by what's happening, and of course, who could blame him??? Have you tried Rescue Remedy or any other appropriate flower essences to see if they help him calm down? I love them because they are so gentle. Miss Kitty really seems to appreciate the Rescue Remedy when she is stressed for travel or any other reason. Finally, I just want to encourage you and to say you are doing a wonderful thing. I know it is hard. I salute you and I truly hope things continue to improve for you and Jacky. All our best, Amy and Miss Kitty

[amyestes]

Kaz, just one other thought - will Jacky allow you to move his back legs for him, or does he play in any way that would stimulate some of those muscles? It's such a part of our routine that I forgot to mention that at some point it became apparent to me that the amount of play Miss Kitty got in everyday, especially play that stimulated her lower spine and abdominals (she has control of her back legs though one is injured, and she still likes to capture things, roll over on her back, and hold her "prey" with her front paws while ripping it apart with her back claws) made a huge difference in keeping her bowels moving regularly. I realize Jacky probably isn't playing too much but perhaps there is a way you could stimulate his back legs, like a kind of physical therapy? Just a thought. Best wishes.

[Danee6cats]

Kaz, I can only add that the people here were a huge help to me and my husband when our Baby Kitty needed to be expressed after a car accident. 4 years after and she's back to her old self doing her thing (sans tail). They talked us through everything more clearly than our emergency vet did.

You're in good hands here.

To the rest of you thank you so much for all your help, our Baby only made it through because of your help!

[critters]

Is he taking a poop softener? It's hard to keep up with what's equivalent to what across countries. Laculose is a thick, clear, yummy (sweet) liquid stool softener that is not only easy to dose either alone or in food but is also easy to change the dose as needed because it's liquid. Lactulose reminds me of corn syrup, so it shouldn't be as objectionable as some.

For the nothing it's worth, there's a lot of controversy over methocarb for bladder relaxation because many vets think it only relaxes skeletal muscles. Buddy never took it for that reason, but it's good to know about the foul taste. The over-the-counter docusate-type stool softeners are said to taste bad, too, which may make laculose a better option if you can get it.

[CarolC]

Howling during expressing is common for cats, it usually means he is telling you he is highly indignant about the whole annoying thing. "Let me go! Why are you squeezing me like that? Did I say you could do that? Stop it!" Then when you are done expressing they will turn around and love you afterward like it never happened. Please do not assume he is howling from pain. Unless he has an actual pelvic injury or a bladder infection, it is likely he is just feeling grumpy about the whole thing. He says, "Stop messing with me" and you say, "Hold still, we're almost done". You might try treats and praise after every session. Sometimes it really is more a case of drama.

You will notice in the expressing tutorial, it mentions this characteristic of cats.

Kitties may protest being expressed

We've been expressing Mimosa for almost three years now, she STILL complains loudly. RRRRROOOOWWWWLLL!!!!!! She no longer thrashes like she used to. Legume complained with growls & scratching, but his bladder was painful. Mimosa's bladder isn't.

[Jackybear]

Thank you all so much for your replies. I don't know where we would be without having found this helpful site, since different vets are constantly telling us how it's not sustainable for the owners to manually express a pet for years and talking about considering Jacky's quality of life. His quality of life is actually fine, he is purry, playing, enjoying sunbaths, eating and doesn't even seem to notice his back legs are not working like they used to. If I let him, he would dive of the sofa fearless as a cliffdiver. All he needs is a little (or at the moment again, a lot) help peeing, so we are trying to find our routine. Pooing we have managed pretty well every day in the past week with the help of lactulose (called Laevolac over here) and little (5 ml) handwarm water enemas which worked like a charm and the vet says are ok to be given daily. I did get the Macrogol (=Miralax) as well, thank you very much for the tipp, but have only used the lactulose so far and plan to switch him at a later time to the Miralax.

Our problem with peeing though has been varying. He seems to be fine some days. He now gets only the phenoxybenzamine, using his cat toilets (some days only trying) and admittedly mostly leaking when moving away afterwards. I would love nothing more than to be able to express him every 8 hours to save him the hassle of often trying unsuccessfully on the litter boxes and taking a couple of hours until he feels relieved, but when I try his belly turns into an armour and I cannot find his bladder for the life of me (and him, excuse the pun) and so I just "express" into the blue and therefore unsuccesfully.

After the vet put him on phenoxybenzamine, he managed to pee on his own again almost exactly 5 days later. The med is called Dibenzyran here and it is phenoxybenzamine hydrocloride. He gets 0.5 mg per kilo a day in two doses 12 hours apart. He is still 5 kilos (10 pounds, though being fed and eating a lot less than when he could still use his back legs) and so he gets 1.25mg in the morning and 1.25mg in the evening. We got him 4 comfy low litter boxes, so he has one close always. But in the following week he could pee less in his box again and was more leaking. The vet said he doesn't have a bladder infection and I am always checking his pee and the color and smell have not changed. So I thought maybe he needs a higher dose of the phenoxybenzamine.

For 3 days I raised his dose to about 0.67 mg a day (1.67 in the morning and 1.67 mg in the evening). In these 3 days peeing didn't go very well at all and when I spoke to the vet, she said I shouldn't raise the dose above the 0.5 mg per kilo (2 pounds) per day as he might vomit and get a shock, etc. so I lowered it to that again. Then about 2 days after I had lowered the dose again, he peed better again and since that he has peed/leaked less and less and today it is really bad, only 2 tiny 1 inch diameter peeballs in the box and no leaks and when I try to express him only 2 drops! I wonder if I maybe shouldn't have given up so soon on giving him the higher dosis since he was doing fine on it, no vomitting or dizziness or anything. His belly is very hard and round now, though having eaten little, and on top of that for the first day in a while he hasn't pooped despite water enema and lactulose. I am so worried again! This will be another sleepless night. I have tried expressing and I have been talking to different vets on the dose of the phenoxybenzamine but couldn't find one with experience with the medication of paralyzed pets with problems peeing because as one vet told me "they get put to sleep". Can anyone tell me what dosage phenoxybenzamine their cat is getting per pound. I have found vet med websites saying higher numbers for dosages than Jacky is getting. I so wish I could express him or find a vet that can tell me what meds would help him. Or both! So worried. The diazepam he is now refusing also (like the methocarbamol) but the PBZ is sweet and no problem.

[critters]

I don't remember how much Buddy took, but it was supposed to have been "overdosing." Frankly, I don't think they knew, especially back then, what they were talking about. No guarantees they do now! Even the "overdosing" didn't bother him a bit.

If he can resist, he has some muscle control. It's pretty common for cats, especially, to hit that (very annoying) point.