Thursday, January 7, 2016

2910. INTERN CLARA. CASE 1. A 14-year-old cat pees frequently outside the litter box. CASE 2. A 7-year-old cat has kidney failure

Jan 7, 2016

A rough script is written below. The intern has to edit,  integrate and present a compelling narrative with text and images first. Then the video to further enhance the veterinary education.


CASE 1

HOOK

(Video of consultation)

BKTP




In Singapore, most cats live in high rise apartments (3 images below) as around 80% of the population is resident in apartments. The cats have been adopted and are much loved as family members. 





INTRODUCTION
 
A 14-year-old female cat would not pee inside the litter box. She would pee drops of bloody urine outside the litter box. This was the first time this cat had pollakiuria and haematuria and the lady owner quickly brought her to Toa Payoh Vets for examination.

"Do you have another other cat in the apartment?" I asked as the cat could be stressed by other cats, leading to the urinary tract condition known as FUS (Feline Urological Syndrome) or FLUTD (Feline Lower Urinary Tract Disease).

"I have only one cat," she said.

I examined the cat (video).
The cat's nose and gums were pinker than normal indicating dehydration. I palpated her kidneys and bladder. She did not show pain. A few drops of blood-tinged urine scattered onto the examination table.

"I can feel a hard bladder the size of a fish-ball or 50% the size of a golfball," I told the lady who probably do not play golf.. "It can be either a bladder stone or tumour. An X-ray is needed to confirm the stones."

PRACTISE EVIDENCE-BASED MEDICINE
There are several laboratory tests needed to gather the evidence to confirm the tentative diagnosis of urolithiasis and to differentiate it from bladder tumours which are rare in cats in Singapore.

1.  The X-rays showed an empty bladder packed with small stones. The bladder walls are thickened.  The kidneys have a few small stones.








Such an old cat. High anaesthetic risk. Not to operate will mean kidney failure later.

2. Ultrasound to check out the abdomen and bladder. I did not advise this to lower medical cost. 

3.  Blood test - Abnormal findings were low platelets, slightly high blood urea and creatinine indicating acute renal failure.

I advised operation the next day before the cat gets acute kidney failure. She was not eating much but had not vomited yet.

I gave the cat a subcutaneous drip, antibiotics and painkillers on the day of consultation.

4. Urine test. There were a few drops of urine available. The crystals appeared to be urate.

5. Stone analysis.  The stones removed from the surgery have been analysed for its chemical composition.  Positive for magnesium, phosphate, calcium and oxalate. But not for ammonia.
Most likely calcium oxalate stones.  







VIDEO. blood collection and X-ray






RISKY ANAESTHESIA
A very old sick cat. High risk of anaesthetic death. The owner was informed of the risks. She consented and the cat came in the next day for  cystotomy by Dr Daniel.





He needed time to clear the bladder of small smooth brown stones. The surgery took around 50 minutes.













CONCLUSION
The lady owner consulted the vet promptly when her old cat had abnormal urination. Surgery to remove the bladder stones was done early. The cat survived the anaesthesia and surgery and is at home recuperating.  Everyone is very happy especially the lady owner.

Early detection and surgery save lives. If there was a delay, the old cat would have got kidney failure and a successful outcome of surgery would not be possible.




Follow up on Jan 16, 206
Cat likes to eat wet food nowadays. No more peeing outside the litter box like before the operation. This is what concerned the lady owner. Drinks normally. Stools normal. Overall normal.

In the past 5 years, ate commercial food -  Science Canned Diet Mature Indoor Cat  7 years and above canned food
Royal Canine dry for older cat 7 years and above indoor cat.

5 years ago, went to Toa Payoh Vets for constipation. Fussy cat. Does not eat other types of food.
Now feeding old canned Royal Canine and dry Royal Canine S/O.







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 CASE 2
A vomiting cat that cried when I palpated the kidney area. 
X rays show kidney stones. Blood test showed kidney failure (high urea and creatinine).
I advised home dialysis for 7 days, SC drips of 200 ml per day, after having done one in the surgery.

The owner did not believe my diagnosis and went to another vet who made the same diagnosis.





The cat went to ICU of the other vet and passed away 3 days later.

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