Wednesday, December 24, 2014

Email from Cairo. Cat with FLUTD? Part 2

Email dated Dec 25, 2014 from cat owner in Cairo


Hello Dr Sing Kong Yuen,

Sorry for the late response, I was waiting for all test results to come in.

We live in Egypt, where vet care is really really bad, you will notice in the x-rays that they use inferior equipment, I had to take photos with my mobile.

Please help us, please, we are losing our boy and are devastated.

Our Persian boy is 7 and a half years old..

About two weeks ago he started squatting for urine but nothing would come out, he had shown some signs of excess visiting to the litter box around last March but with no blockage and the blood tests came out normal then, so the vet said it was an infection and after a 3 day antibiotic course he was ok, this time he vomited on Sunday and sneezed so we thought it was cold , then on Monday symptoms was clear , he spent the whole day in the litter box squatting with no urination at all, by evening we took him to the vet who emptied his bladder (and clear urine came out then) and told us not to worry , and prescribed him meloxicam and enrofloxacin , we returned home he kept staying in the litter box the whole night with nothing came out, and finally he woke us up at 8am on Sunday morning screaming of pain !!

We rushed to the only vet clinic we could find open this early, they had difficulty inserting a cannula and catheter tube up the penis, but eventually they relieved him off a huge amount of very bloody urine.

Later that day his vet catheterized him and put him on meloxicam and enrophloxacin again for 6 days and IV fluids to flush his body of the urine. and said the catheter would come off in 4 days and he would be able to urinate on his own as by then the swelling that blocked him would be gone, then he went on vacation, and his substitute insists on surgery (PU) with no promise that he will have control over his urination, provided that he makes it through surgery, that is if the catheter doesn't work. Until we made our minds, he was put on epicephine for another 3 days

4 days later the catheter came off, and by then his urine was clear... after 4 hours he was squatting again.. We had to spend the night trying to express his bladder but he kept squatting.. In the morning he was catheterized, bloody urine again, and later that day drew blood and urine samples...

His BUN was very high (93 out of 30), his creatinine (3.4 out of 2) not very high yet not normal though, his white cell count is gigantic, the urine contained few crystals of magnesium, and some blood. The xray showed no big stones but turbid urine, he has crystals, he was put on Vitamin C , Cystone, Synolux antibiotic for 6 days , Azodyl , while continuing the IV fluids.

To us surgery is out of the question because of his age and kidneys, and seeing how much the procedure is not sure-fire. He is on Royal Canin Renal S/O renal wet food now and still catheterized after almost 10 days.
Now we gotta get the catheter removed but we are too scared to get to square one , after all medications and antibiotics , we really don't know what to do?, will another catheter help? Or what?

He removed the second catheter today, the penis is very swollen and I don't suspect he will be able to urinate on his own again.

/UPDATE/ he went to the litter box, squatted, and urinated a fair amount, and left the box on his own, now he is roaming the house purring looking for a place to cuddle, he is very intent on licking himself all over, not just the penis. We still fear for the next time he has to go. It is 9.15AM Cairo local time

Thanks in advance Dr.
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EMAIL REPLY FROM DR SING DATED DEC 25, 2014
 







I am Dr Sing Kong Yuen. 

1.  X-ray shows bladder packed with stones (attached).
2.  My recommendation is surgery to open up the bladder to remove the stones.
Cystotomy to open up the bladder and removed all stones, including those from the urethra. Your vet will know what to do. Then put the cat on a prescription diet which acidifies the urine, antibiotics and pain-killers. The urine must be analysed monthly for at least the next 3 months. This will be my recommendation to clients.
3.  Your vet advised PU (perineal urethrostomy) which is another surgical option. 

4.  Coincidentally, I have a similar case in the dog and operated on Dec 23, 2014. The 9-year-old dog is OK at home now. See:
http://2010vets.blogspot.sg/2014/12/1150-westie-x-had-fully-packed-bladder.html
5. There is no other option for you and the risks of anaesthesia are always there. Best wishes.



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EMAIL TO DR SING DATED DEC 26, 2014


Hello Dr Sing Kong Yuen,

 
Thanks a lot for taking time to review the case.

We have a number of questions here
1- Are you sure the bladder shown in the x-ray is full of stones? the local vet said it was just inflamed and otherwise invisible and had to inject saline fluid through catheter in order to increase it's size enough to see in the x-ray, furthermore, when he's just been to the litter box, his bladder feels very deflated, like an empty sac. We are unable to properly monitor his urine but when we can, it appears clear, not turbid or bloody.

2- Can these stones be dissolved by medication? He is taking Vitamin C and Cystone daily, I am asking because vets in Egypt are unable to perform the surgery, they say it is too risky because urine might escape and infect him, they are afraid to do it.

3- He is now urinating on his own without a catheter, on average once every 2 hours, eating and drinking well for about 24 hours now, and appears overall happy, there was inflammation in the penis and urethra when the catheter was removed, so the vet prescribed Dexa to reduce the inflammation, he said all we needed to do now was monitor him for blockages. We researched Dexa and are reluctant to continue with it considering his renal condition.

4- I saw the case you performed on (the 9-yr old terrier), the X-Ray does show a very large number of stones, and I do thank you for saving his life.

We appreciate any help you might be able to provide in prolonging his life, and Merry Christmas :)

Dr,

One other thing, I have inspected the physical film I have here for the x-ray, in the photos, it does appear to have granules because the whole photo is somehow pixelated, but in the physical film it appears smooth and opaque.

Just a thought that might help. and sorry for disturbing you.
 
 
EMAIL REPLY FROM DR SING  DATED DEC 26, 2014
Pl send the actual X-ray rather than the handphone x-ray. Stones are small and the vet might have syringed them out now.  If cat is OK, then no need surgery. If urine pH is alkaline, given acidifiers and antiibiotics and follow up with Hills' prescription C/D food or equivalent from Royal Canin etc. . 

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