Wednesday, May 4, 2011

428. FLUTD - 3rd case. Incontinent and dysuria male cat

Things do come in 3s. This is the 3rd case within a short period of 7 days of a cat unable to pee normally. Dr Jason Teo saw the case at night on April 3, 2011. The owner called in the daytime to know about the progress as she was a student and worried about the veterinary costs. I do follow up during the day time as well as to teach my new assistant Mr Min in cat handling as he seemed to have a few cat scratches on his right hand. I did not ask how he got them yet but I know he has no experience handling cats.

"For the past 1 week, my cat could not urinate normally," the young lady said over the phone. "He dripped urine all over the apartment."

This is the 3rd case of FLUTD. Typical. Male, neutered, 5-year-old cat fed dry and canned food. A young cat inside the apartment sometimes fought with him but other than that, there was apparently no change in diet or environment. The owner did not want to pay for the urine and blood tests and so they were not done yesterday.

The owner needed to be educated that urine test must be taken to assess for the type and presence of urinary crystals (calcium oxalate as in my 2nd of 3 cases, none in my lst of 3 cases). Without urine testing, the vet just could not know recommend prevention programs effectively. Urine could be collected during catherisation as the cat was tranquilised, as part of the standard operating procedure for examination and to prevent misunderstandings from family members who might be misled that the vet was incompetent for not doing a urine test as expected of a reasonable vet in the same situation.

EXAMINATION 12-HOURS AFTER CATHERISATION LAST NIGHT
"The cat is fierce," Min said as the cat extended his claws when picked up for examination. I could see that this cat did not claw unless provoked further. I sedated him with the minimal dose 0.05 ml xylazine and 0.2 ml ketamine. He was quiet and isoflurane gas by mask anaesthesized him. I checked his bladder. It was empty and so I could not collect much urine. I could see red blood in the urine and he cat was slightly dehydrated. I gave him dextrose saline and antibiotics SC. The cat was given isoflurane for less than 5 minutes. After taking the gas off, the cat woke up fast and started to claw.

"Cover him with a big towel," I said to Min. A big towel must be ready for cats as it is hard to gripe an angry cat. This cat was the type who was not aggressive towards people. I saw that Min already had three fresh skin scratches on his hands and presumed he had got injured when holding some cats for my associate vets.

"Stroke the cat's chin," I taught Min to tickle the lower neck/jaw area. He felt strange and alien doing such an act. He had never heard of such soothing treatments. I presume that Yangon in Myanmar where he stayed does not have many cats. The cat quietened. I cut one of the two catheter' stitches while Min held the cat wrapped in a towel. Then we reversed roles so that he could gain some hands-on experience.

INITIATING CAUSE.
Unknown. There is another younger cat in the apartment. The urine and blood is being tested.

I phoned and discussed with Dr Teo the case to send the cat home to his familiar surroundings of food and litter box and to observe. The owner would be taking him home at night. She had given permission for blood and urine tests and these would be given to her the next day.

For all FLUTD cases, a urine test is advised. The young lady had a lot of questions as to what's happening. Without a urine test, it is very difficult to substantiate. Evidence-based medicine is good medicine. Follow ups will be done. Related themes happen in threes and since this is the 3rd FLUTD, I don't expect a 4th FLUTD soon.

P.S The other 2 recent cases are:
1. The hissing cat has difficulty peeing again
Initiating Cause - shift to new house recently.
Was treated by Vet 1 whose medical records did not indicate struvite. Cat was on Hills' S/D canned food for around 2 weeks as prescribed by Vet 1. No crystals found in the urine tested.
2 The cat cannot pee normally - 2 cases (the 2nd case in 2011)
Initiating Cause - humping by the other male cat for the past months is likely to traumatise this cat's penile area but the owner does not agree with this hypothesis. Calcium oxalate ++ present in the urine tested. This case shows that a urine test is very important for preventive measures.


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