Desperate - still struggling to express cat bladder

[amyestes]

I'm writing in a pretty desperate state. I would welcome any suggestions.

My mom's cat, Miss Kitty, was hit by a car in March. She had a broken leg and her tail remains completely limp. She came to live with me because my mom is disabled and could not care for her. Her leg has healed completely and she is very happy here. She runs, jumps, and plays in ways that make her seem far younger than her ten years. It doesn't seem that there has been any reason to amputate her tail so we haven't.

I have tried all this time to learn to express her bladder by myself. I can take care of evacuating her bowels, no problem. There were times when I thought she was regaining function. A week here or there when she pooped in the litter box on her own. A few occasions when she dribbled a little urine in the box. For about a month, both the vet and I thought I had gotten the hang of expressing her bladder. After about a month or six weeks, she started leaking I took her back in and they said her bladder was very large. I hadn't been doing so well after all. She was very sore. I couldn't stand the thought that (1) I had messed up so badly, and (2) I had been hurting her.

After that, I started taking her to have her bladder expressed at the vet's office again everyday. I tried with mixed success to express her between times at the vet. Leaking has been a continual problem. The smell and the need to limit her ability to roam freely in my apartment really gets me down. I boarded her at the vet during Thanksgiving so that I could visit my mom. They expressed her bladder twice a day there, and they said she did not leak. It was so amazing coming home to a clean home that didn't smell. I decided to take her 2x/day to the vet, and keep trying in between. I have been doing that ever since, but she is leaking at home still.

The vet's office here has been amazing to me. The people are wonderful and very supportive. They charge me $10 each time they express her bladder. I know here in New York that is an incredibly reduced fee, but it means we're now at $600/month just for bladder expression. They have all tried to teach me, and maybe I am just a very poor student, but I have tried their techniques and they have not worked for us. The trick of that reduced fee is that they don't really set us up with an appointment, someone just takes her in the back in the hospital area, takes care of her, and brings her back to me, so I do not get to be in the room with her and work beside them to learn. They have told me she is a difficult cat to express and that only two of the vet techs there can express her without someone else to hold her. I do not have anyone to help me at home. She has sensation but not the ability to pee independently. She will stand still for me for a minute, but just at the moment I am about to get a good stream, her bladder rolls or she wriggles away. I know this takes practice, but she hides when she thinks I am going to try to express her now. I don't know how many times in one session I should try before I am just being cruel?

I am not willing to give up on learning or on Miss Kitty, but I know I cannot continue this way. The smell issue is so depressing, I do laundry and clean all the time, and at the same time, I am trying to launch my own non-profit business. It's great because I am able to work from home; she has practically round-the-clock attention. But because my office and my home are essentially my room (we rent the other rooms in the apartment to support ourselves until the non-profit is able to pay us a salary), and in New York I have to take everything to a laundromat to wash, it's like its own 24/7 job. Plus the time and the expense...it's probably two hours a day walking to and from the vet, and the $600/month not including the Bethanecol and the wee pads and the laundry money. It seems like all this pressure would ensure I would find a way to express her bladder on my own, but I have really tried, and I have not been able to get there.

One vet recommended a permanent catheter to me. That scares me but I also think, whatever the surgery would cost, I have probably already paid for it once at least with all of the bladder expressions of the past several months.

My vet is a wonderful man; he has been extremely supportive, and I think they have done all they could find a way to help me. It is an incredibly busy practice and it is hard to get his undivided attention. So today I emailed him and asked him about the permanent catheter possibility or any others...

I would be really grateful for any advice. Has anyone else struggled this long to get the hang of bladder expression? Does anyone else have experience with a permanent catheter? If that's a terrible idea, what can I do to try to get a handle on this situation??? She is a wonderful, wonderful girl and I am so thankful to have her in my life. None of this is her fault and I do not want to fail her.

Amy

[CarolC]

Amy, I am just so so so sorry to hear you are having such a time with this. How awful for you, I can hardly imagine what you're going through, and in this weather. I can't believe the complications this has caused in your life. The vet trips, the trips to the laundry. You are a saint to keep it up (and thank goodness for your kitty's sake that you are). Wow!


I hope someone else will comment on the medication.

Here is an important quote from critters:

I found that bethanechol (sp) and phenoxybenzamine were at cross-purposes with my boys; PBZ worked better for those with spastic, tight bladders and beth. was better for those with loose, floppy ones. Buddy, who had the spastic bladder, was IMPOSSIBLE to express with beth.

Normally an animal with an injury in the tail area will be easy to express, not tight. Since the vet techs are having trouble, too, that makes me think it is not merely a matter of your technique. That's what makes me wonder if the medication is making her hard to express. Has she been on bethanechol this whole time, and you've been unable to express her this whole time? I'd suggest not giving it to her for a day and see how you do. It does not remain in the bloodstream long.

Here is a video showing something that is hard to describe. (I don't have editing software right now so can't insert captions.)

I am trying to show the technique I use for small dogs and cats. If you look at the tummy on the toy tiger, you see a white part and a spotted part. The line between them is where I push my fingers. In the video you see me demonstrating how far I push in, so my fingers are buried in a ditch between the white part and the spotted part. Do you see the little x on the tummy? By the time I am done pushing in, the x has popped out. That is where the bladder is. My fingertips are behind the bladder. (I guarantee it can't escape when you do this.)

[amyestes]

Carol, bless you and thank you so much for your reply. I am just at my wit's end and your kindness means a lot to me.

We have used two medicines since I have been trying to express her: diazepam and Bethanecol. We stuck with the Bethanecol and dropped the diazepam because it made her seem stoned. It has been a long time since she has done without the Bethanecol. I am going to try going without it for a couple of days and see if she is easier for me to express. We have not used PBZ?

Yesterday morning I took her in at 9 a.m., and then planned to take her back before the vet's office closed at 5 p.m. Work got in the way, and so I did not make it yesterday afternoon. I began trying to express her myself at around 6 or 7, and I tried several times until quite late last night without success. This morning, I was able to get three really good strong streams myself. If her bladder is really large I am generally able to do something for her. But still, when I took her in this morning, the vet tech told me that her bladder before he expressed it was about the size of a grapefruit. They said the vet had gotten my email and would call me later today to talk about surgery options.

It seems like a good idea to me to give it several weeks before I make a decision about any kind of surgery, and to use that time to try even harder to get this. Your video is great. Today, when I was successful, I do think I had my hands placed correctly as you show. It's much harder for me to feel anything when her bladder is smaller. I am going to keep trying and watching as I do it. I have asked Miss Kitty to please be patient with me and try to help me. Are you holding the small dogs and cats you express in this upright position when you do it? I think I have seen that position once before online. I am not sure Miss Kitty would go for it, but I am going to try.

I am going to try not using the Bethanecol for a few days. I will ask the vet techs for their feedback too, to see if they notice a difference. Some of them report back after we visit, "the bladder was large but easily expressed." I've noticed, though, that the ones who say that are guys with big strong hands who have been doing it for years. The vet techs who are newer to the job, or just aren't big burly guys, all have to have a second person. They tell me frequently that her bladder rolls out of their hands too, and that they have trouble keeping it and her still. And even Gus, the vet tech who took care of Miss Kitty this morning and whom I think is consistently the best/most effective, told me today he can only get her completely empty if he has someone to help him.

I am grateful for some new things to try. Thank you so much Carol.

Amy

[CarolC]

Hi Amy,

I hope you get other replies. I held the toy up for the video because I didn't know how to tape it with the tiger in standing position. I always do it with the pet standing on all 4 feet. I make a 'U' of my hand, poke it all the way in, pop the bladder toward the navel, and squeeze. The best suggestion I can think of if the cat wiggles is to put her on a formica countertop where there is no traction, and have her stand on her 2 front feet while you express her with her hind feet an inch off the ground.

Phenoxybenzamine takes a few days to a week to build up a therapeutic level in the bloodstream. Bethanechol does not stay in the bloodstream long so you should know pretty quickly if not using it is better or worse.

Here is a thread about a cat with a pezzer tube, but I'm afraid personally that would be my last choice as I know of a cat where the tube did not work out.

http://handicappedpet.net/helppets/view ... r&start=15

Did you watch all of the cat videos in the expressing article? There may be new ones since you last posted.

http://www.handicappedpets.com/mediawiki/index.php?title=Express_a_dog_or_cat#Cats_2

[amyestes]

Hey Carol,

Thank you again so much. I have not given the Bethanecol now since Thursday around noon. I haven't been able to tell a lot of difference so far -- either in how hard it is to express her or in how much she leaks between expressions, but will continue to monitor through the weekend. I guess one piece of good news is that I don't think she is harder to express or leaking more without the Bethanecol.

I am working harder (by which I mean making more and more attempts) to express MIss Kitty's bladder on my own. I am torn right now between taking her once a day or twice a day to the vet, as sadly right now that $10/day can make a real difference. So I have great incentive to get this! But I'm really struggling with the issue of how much pain I am causing her. A few days ago we did a test in the vet's office with me grasping the vet tech's forearm as if I were expressing her bladder and he told me I wasn't applying enough pressure to push the urine down and out. So I tried yesterday applying more pressure, and on several attempts, I was able to get out a little bit of urine, with the bladder seeming very tight and rolling away from me at the key moment (as a result of her pulling away). She tries so hard to be patient, and she is so sweet. But I took her in to the vet right when they were closing last night at 7 (Gus the vet tech told me her bladder was *very* tight), and then got up at 3 to try to express her, and when she realized what I was doing, she practically begged me not to. During that month or so when I thought I was getting her bladder empty -- even though I really wasn't -- she would attack my leg after I expressed her bladder. I know that I hurt her. I could just cry I'm so guilty and ashamed. I don't know what I am doing wrong, and I am so thrown for a loop - *nothing* to do with animals has ever been so hard for me, I can't figure out why I can't get this. But I can't stand to have her begging me not to put her in the litter box; it's awful. And so today, I will take her as soon as the vet's office opens and try to find a way to go again at the end of the day. I have watched the videos and I think one thing that hampers us is scruffing really doesn't still her...she was attacked by an Akita before she came to my mom I think the injuries to her neck must have affected the scruff reflex with her.

Carol, would you mind sharing with me what happened in the case you know of where the pezzer tube didn't work? I don't want to go the surgery route but it is weighing on me where to go from here. I feel like I should know as much as I can.

Thank you so much.

Amy

[critters]

The biggest problem with Buddy's pezzer was that they left it WAY too long, so it dropped right out, and nobody would replace it. I expressed Buddy while he was lying on his back, and it took a good bit of pressure. He, too, wasn't necessarily thrilled about having it done.

[amyestes]

Dear Critters,

Thanks so much. I have referred to your much earlier post to me about how you express Buddy many times. I have tried but I am never able to keep Miss Kitty on her back. It's too bad because I thought your situation sounded so similar to ours, and I really appreciate you sharing it with me.

From my online research, I can't really tell what I would have to do to keep her safe if she did have a catheter. Would you be willing to tell me about how it worked with Buddy? Did you do anything special to prevent infection?

I also have a special appointment for the vet tech to work with me in the office tomorrow, and I am going to ask about other medicines.

Thank you so much!

Amy

[Jean]

Amy,
I wish we knew of someone near you who could work with you. You are near NYC right? I know of several rescues in that area but none of them have expressing skills. NYC is where my Kitty Caramel Apple came from. She is also paralyzed. She was attached by pit bulls. While expressing her I tried to really watch my technique. After expressing for 14 years it just kinda becomes second nature.
One thing my vet impressed on me many years ago was to really dig your fingers into their abdomen. You have to go deep to find the bladder. When I express Caramel I start just below her rub cage in the middle of her abdomen and bring my thumb and fingers together and gradually move toward her tail while physically searching for her bladder. Caramel had continual bladder infections until we added bethanechol to her prazosin and Robaxin. The bethanechol seems to define the bladder for me making it easier to locate it with my fingers.
It takes me about 5minutes to express her and then I go back in about 10 minutes and express more after the bladder reforms.
Several of my kitties fight expressing especially Chynna and Indigo my cats with Manx syndrome. They are both incontinent and caring for them is similar to caring for a cat with paralysis except they are ambulatory. I don't believe that I hurt them when I express them. They are just cats and do not like to be confined. Since you are still learning to express your kitty is just tiring.
Your devotion to your mom's kitty is just phenomenal. Bless you for caring so much. Jean

[CarolC]

Hi Amy,

In answer to your earlier question, it was critters' kitty I was thinking of when I mentioned the tube did not work out.

You mentioned the diazepam made her too spaced out. It might be worthwhile to try a lower dose. I know with cat pills you often end up putting them in a pill cutter and cutting them in quarters or whatever, usually they cut well, it depends on the pill. I can post a picture of the kind of pill cutter I use, from Walgreens, if you don't have one.

[amyestes]

Thanks so much CarolC and Jean! I am sorry I haven't posted again sooner. We are definitely making progress. CarolC, ***thank you so much*** for suggesting we try not using the Bethanecol. Jean, I think one reason my vet suggested it was for exactly the reason you mentioned with Caramel, so her bladder would be more taut and I would be able to feel it more easily. But even one of the vet techs commented after she had been off of it for a few days that she was easier to express. We will see how it goes -- perhaps I will ultimately need it but in a lower dose?? -- but for the mean time, I am back to being able to consistently produce a fairly strong stream, at least when her bladder is big. This wasn't the case for a long time, so it is big progress for us.

I mentioned in an earlier post, I think, that one of the vet techs was going to give me another lesson. I was determined not to be "taught" this time but to show what I have been doing so I could receive real correction. I am so glad we did this. I learned two things that are so important to me. One, the vet tech said to be able to express as much as I was able to meant I knew how to feel the bladder and was "doing it right," or at least right enough that I didn't need to worry anymore that I was a hopeless case. Then she worked with Miss Kitty to finish expressing her bladder, once I felt I couldn't do any more. All this time, the vet techs would bring her back to me in the lobby after expressing her in the back and say, "Her bladder was very large but easily expressed." I know they meant to report the facts and put a positive spin on them, but every time I heard this, I felt like such a failure because it was never "easily expressed" for me. It helped me to see exactly how angry Miss Kitty was/how much she grumped/what sounds she made when the vet tech was expressing her; to realize that a certain amount of this (way past my comfort zone til then) was normal; and that she got over it pretty quickly. These two things, combined with the vet techs urging me to try expressing her in the sink again so that I could hold her more at my arm's level, have made all the difference.

I have been expressing her in the sink now for several days. It is still tricky because of our boarders, but I have been trying to do it every 8 hours. I think part of the reason it works is that it's a fairly small sink, and when I get her in the right position she can feel the faucet above her and it makes it harder for her to squirm. The first day after I had been trying on that schedule (including one time right before we went to the vet), I asked the vet tech who is great with her to rank the size of the bladder on a scale from 1 to 10, with 10 being the biggest ever, and 1 being empty. I was so disappointed when he said it was a 10! The next day I tried with her every six hours, and the vet tech scored it as a 6. Sometimes I am able to do enough that she doesn't leak in between. Most of the time not. But she only leaks in her sleep, and as long as I keep the pee pads in her favorite places, that is pretty manageable. We are back down to one vet visit a day. I don't want to stop going until they tell me that they are confident I can get her bladder pretty empty on a consistent basis.

The thing I am still struggling with is, after usually 2 or 3 good squeezes that produce a strong stream, I know she still isn't empty, but I can't feel her bladder very well. Also, if there is anything I could do to help her not leak (without causing her any discomfort or more problems), I sure would like to. Jean, ***thank you so much*** from the very bottom of my heart for taking the time to observe yourself with Caramel and share your technique with me. You have definitely given me new ideas to try. I am curious about the medicines you mention - prazozin and Robaxin? I don't know about those. What do they do? Also thank you for letting me know how much time you allow between efforts to express her bladder. Maybe I am just not allowing enough time. I am going to try allowing more time between tries tomorrow and see if that helps.

You are right, I am in Manhattan, on the Upper West Side, but in a very convenient place to travel just about anywhere in the NYC-area. If there are other people working with bladder-impaired kitties in this part of the world, I would definitely love to meet them.

THANK YOU!!! You are both angels to me, and to all those animals lucky enough to be in your care, wow.

Amy

[amyestes]

P.S. - she has a new favorite place - need more pee pads.

[critters]

Buddy didn't just flop on his back and wait to be expressed--if only!! I held him on his back on a pad of towels by scruffing him then expressed him with the other hand. With the tube, things were to be as clean as possible, especially when it came time to drain it.

[CarolC]

Amy, I was SO happy when I read your message. I love the part about seeing how she acted when the vet tech expressed her. I can see how that would help a lot. Then you know that when you get the same reaction, it is normal! And I love the part about seeing how she got over it afterward. That's just wonderful. I know BendyMom has mentioned how much Mimosa would yowl when she expressed, so it is not just your kitty. I hope it gets even better.

[amyestes]

Thank you all SO MUCH! I just returned from the vet where they did not charge me for bladder expression because they said her bladder was so small it was hard for them to get more out! I just want to say that EVERY SINGLE DETAIL you have shared about how it works for you has helped me so much. We are now expressing in the bathroom sink 3 - 4x/day. Jean, your comment about waiting 10 minutes after you first try with Caramel and then "the bladder has re-formed" was like a revelation. I just didn't know! And Carol, I have continued to watch your video and think about making my hands do what yours are doing. It's amazing what a difference it makes. I think after two good reports in the past two days from vet techs who knew how much I was struggling, I am going to try taking tomorrow off from going to the vet and take her in again on Tuesday to see how I am doing. It is so important to me to avoid the mistake I made in the past when I thought I had it and I really didn't. But this does seem really hopeful, and I think we both deserve a day off from making the trek to the vet.

[Jean]

Oh, you made my day. I'm so glad for you and your baby. Your determination has made the difference. It is great to work with someone who doesn't give up. Pat yourself on the back !!!!