Monday, October 8, 2012

Case study of male cat's blocked bladder - struvites urolithiasis

Cat, Male, Not Neutered, Ginger, 10 months old.

"I was renting an HDB flat and living in Toa Payoh," the slim Malay woman said. "You gave me a car ride home as I was pregnant. Now her big son came with me to consult me regarding her orange male cat born on Dec 23, 2011 as her cat could not pee again after treatment by Vet 1. She had bought her apartment in North Singapore and went to the vet near her home. 

"I went to Vet 1 because the clinic is just downstairs," she said. "I can't afford the treatment again as I had already paid $240.00 on Sep 29. Vet 1 wanted around $800 but I can't afford the fees. Yesterday (Oct 1), my cat can't pee again."

"It is not cheap to treat this blocked bladder disease," I said. The owner wants an excellent outcome for one treatment. Is it possible? Yes, in some cases if the owner complies with vet instructions.

VET 1'S TREATMENT ON SEP 29, 2012
Urolithiasis with urethral obstruction
Cat has not urinated for 2 days.
Rock hard fist-sized bladder
IV catheter. valium 0.5 ml slow IV. Methone 0.08ml IM. Alfaxan 0.7 ml slow IV. Iso/O2 maintenance. Urethral obstruction unblocked. Copious saline flushed and emptied bladder.

UA.
pH 6.5  SG 1.05  Blood 3+, Protein 3+. WBC 3+, Urobilingoen 2+
Sediment:  struvites 4+, Bact +, RBC+, WCC+, yaline casts +
Advised hospitalisation and urinary catheter in the bladder for 2 days but owner was not in favour owing to budget constraints.
.
Owner was warned that bladder would be blocked in the next few days and the consequences of
cat dying. Home on clavomox for 5 days. RC urinary S/O diet for at least 6-8 weeks and re-check urine.

TOA PAYOH VET'S TREATMENT ON OCT 2, 2012
Owner agreed to the cat being hospitalised.
Case handled by Dr Daniel and his written plans were:
Cat 4.9 kg, 39.2C
1. Sedation xylazine 0.2 ml + ketamine 0.8 ml IM

Cat, Male, Not Neutered, Ginger, 10 months old.

"I was renting an HDB flat and living in Toa Payoh," the slim Malay woman said. "You gave me a car ride home as I was pregnant. Now her big son came with me to consult me regarding her orange male cat born on Dec 23, 2011 as her cat could not pee again after treatment by Vet 1. She had bought her apartment in North Singapore and went to the vet near her home.

"I went to Vet 1 because the clinic is just downstairs," she said. "I can't afford the treatment again as I had already paid $240.00 on Sep 29. Vet 1 wanted around $800 but I can't afford the fees. Yesterday (Oct 1), my cat can't pee again."

"It is not cheap to treat this blocked bladder disease," I said. The owner wants an excellent outcome for one treatment. Is it possible? Yes, in some cases if the owner complies with vet instructions.

VET 1'S TREATMENT ON SEP 29, 2012
Urolithiasis with urethral obstruction
Cat has not urinated for 2 days.
Rock hard fist-sized bladder

IV catheter. valium 0.5 ml slow IV. Methone 0.08ml IM. Alfaxan 0.7 ml slow IV. Iso/O2 maintenance. Urethral obstruction unblocked. Copious saline flushed and emptied bladder.

UA.
pH 6.5 SG 1.05 Blood 3+, Protein 3+. WBC 3+, Urobilingoen 2+
Microscopy: Struvites 4+, Bact +, RBC+, WCC+, yaline casts +

Advised hospitalisation and urinary catheter in the bladder for 2 days but owner was not in favour owing to budget constraints.
.

Owner was warned that bladder would be blocked in the next few days and the consequences of

cat dying. Home on clavomox for 5 days. RC urinary S/O diet for at least 6-8 weeks and re-check urine.

TOA PAYOH VET'S TREATMENT ON OCT 2, 2012
Owner agreed to the cat being hospitalised.
Case handled by Dr Daniel and his written surgical plans were as follows:
Cat 4.9 kg, 39.2C

1. Sedation xylazine 0.2 ml + ketamine 0.8 ml IM

2. Catherisation + lavage + indwelling
3. Baytril + tolfedine inj
4. e-collar
5. vibravet 50mg 1 tab sid x 10
6. multivit x 1 bot

Urethral obstruction
Cat has not urinated yesterday. .

UA.
pH 7.0 SG 1.015 Blood 4+, Protein 2+. , Urobilinogen Normal
Microscopy: Crystals Nil, Bact Occasional, RBC >2250, WCC 198, hyaline casts Nil, spermatozoa +

Advised hospitalisation and urinary catheter in the bladder for 2 days but owner was not in favour owing to budget constraints.
.

Owner was warned that bladder would be blocked in the next few days and the consequences of

cat dying. Home on clavomox for 5 days. RC urinary S/O diet for at least 6-8 weeks and re-check urine.


CONCLUSION
There have been a few cases of urethral obstruction in male cats seen by me recently. It is a common condition in cats. As to the cause, it is difficult to say.

In this case, struvite urolithiasis has the same conditions of alkaline pH, bacterial infection and struvite crystals. It can be prevented by the use of anti-struvite reduction diet like C/D but most owners are not educated sufficiently to get the cat to switch over to C/D for at least one month and then to maintenance C/D. For economy reasons, I advise C/D for at least one month and then canned food. No dry food at all times. This cat was fed dry food (Snappy Tom) since kittenhood as his dam is also eating the same. No urolithiasis problem for the female.

Follow up education for struvite urolithiasis is essential to ensure that the owner complies with the feeding of C/D. In this case, the cat rejected the C/D when given 100%. I had to educate the owner to give 5% of C/D + 95% of the commercial canned food and slowly increase to 100% over a period of two weeks. She was willing to listen as recurrence will involve costly vet treatment. She was able to medicate the cat with antibiotics given via the food. Many cats will not take antibiotics and many owners simply give up easily.

In strurvite cases, bacterial infection of the bladder needs to be eliminated and an acidic pH of the urine is maintained by feeding of C/D diet. It is extremely difficult to educate most Singapore cat owners and vets don't have much time to do so. Urine checks should be done monthly and 3-monthly but none will be done in most cat cases. The theory is sound but in reality, the Singapore cat owners generally are not interested in follow up urine analysis in 2012.

I noted that owners may buy one can of C/D and then no more news from them.








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