902. Searching for answers for a FLUTD cat that died after 5 days at Vet 1

It had been more than a week since I met the couple who was searching for answers to their cat's death and had written a report at:
http://www.sinpets.com/F5/20120235FLUTD-cat-died-searching-answers-Singapore_ToaPayohVets.htm


It was an emotional meeting for all of us as I did know Tobi too.
After some time to let sadness go away, today, at 5.30 am, I spared some time to review the case to find some more answers.


The cat was hospitalised by Vet 1 for 5 days to treat what the owner had diagnosed was a FLUTD recurrence. The cat was sent home on day 5 and he died at home. I am reviewing the case to search for the answers as to why he died. Experiences are learnt from failures or a death in this case. Every vet will have deaths and many times, the answers are not present.







Toa Payoh Vets webpages in chronological order

1. http://www.sinpets.com/F5/20110437urinary-tract-infection-amitriptyline-cystitis-toapayohvets-singapore.htm

2. http://www.sinpets.com/F5/20120235FLUTD-cat-died-searching-answers-Singapore_ToaPayohVets.htm

A review may give some answers and to prevent other deaths. Unfortunately, vets are not Gods and deaths will occur for various reasons.

HISTORY:

1. April 2010. The owners referred the cat to me for treatment after being treated by Vet 1. The cat recovered from the FLUTD. I treated the cat a second time in Nov 2010 and did not see the cat anymore. The case is recorded at:
http://www.sinpets.com/F5/20110437urinary-tract-infection-amitriptyline-cystitis-toapayohvets-singapore.htm

2. Feb 2011. The owners brought the cat to Vet 1 who then referred the cat to the main surgery and there the cat was treated by various vets (collectively called "Vet 2"). The cat was "fiesty" according to the medical reports of Vet 1 and was given sedatives IV and an indwelling catheter over the 5 days of hospitalisation. The cat was discharged on Day 5. He went home, had breathing difficulty and was sent back to Vet 2 for an emergency treatment. The cat was X-rayed to find out whether the chest had any problems causing respiratory distress. The X-rays were done around 45 minutes before the cat passed away.

The husband e-mailed to me about the cat's death and since the couple was not going to litigate, I volunteered to help to search for answers as to why a cat with a simple medical condition called FLUTD (Feline Lower Urinary Tract Disease) could just die and to give advises as to how to prevent a similar occurrence should they get another cat. The wife must have loved the cat a lot and that was 7 years of companionship. The husband was sad too as he just could not understand why the cat would die. I spared some time to meet and talk to them. This was the least I could do for a nice couple who cared very well for this hissing cat.

SOME E-MAIL CORRESPONDENCES
Fw: tobi's 11 page report + 2 x-rays
E-MAIL TO DR SING FEB 27, 2012


Dear Dr Sing

Please find attached copies of Tobi's reports and X-Rays (X-Rays were taken apprx 45 mins before his death)

Additiional information and our observations that are not in the attached reports


27/1/2012 - Tobi was given Convenia & Dexaason injections & injectable sedative29/1/2012 - Tobi was given Dexaason & Diazepam injections & Anaesthesia (Gaseous)
31/1/2012 - Tobi was Anaesthesia (Gaseous) - in attached report

31/1/2012 - ate a little, never ate again after this, behavior still normal
31/1 to 1/2/2012 - behavior still normal
2/2/2012 - lethargic, unusually calm
3/2/2012 - lethargic, urine scalding, disinterested,lying down the whole time
4/2/2012 - before discharge - could barely move, nose & ears cold, dried drool (brown colour), breathing slightly shallow
4/2/2012 - at home after discharge - hind limb paralysis, laboured breathing, eyes could not track movement
4/2/2012 - few minutes before his death at the hospital- somehow struggled out of his bed, gave a slight meow, convulsed, threw up and shortly after passed away

Thank you once again for sparing the time from your busy schedule to review. Even now, we are still coming to terms with the suddeness of it. I will call you tomorrow and perhaps we can arrange a time to meet at your convenience.

Best Regards
Name of husband




E-MAIL FROM DR SING DATED FEB 28, 2012




Please accept my condolences again.
1. I cannot understand why the X-rays are taken
2. Why were X-rays not taken earlier during admission?
3. Any urine analysis report?
4. How about the preceding vet's treatment report?

Were X-rays taken of the bladder area or not? There seems to be a big abdominal swelling in one X-ray. I will talk to you when we meet. Pl bring printed out copies.


SUMMARY OF SIGNIFICANT FINDINGS ON MEDICAL RECORDS
Cat admitted: 31.1.12. Owner complaint: Keeps licking on his penis.
Cat discharged: 4.2.12
Cat re-admitted: 4.2.12 after hours emergency. Died.


Cat behaviour: Hissing, fiesty, growls when approached from 31.1.12 to 4.2.12.

Sedatives given, mainly via IV:
31.1.12 Ketamine 0.2 ml, Valium 0.2 ml, Atropine 0.1 ml IV. Isoflurane gas to induce, local anaesthesia for urinary catheterisation, PDS 3/0 stitching catheter
Torbugeic 10 mg 0.5 ml IV

1.2.12 Valium 0.2 ml IV twice a day

2.2.12 Valium 0.2 ml IV 6 am and 0.3 ml at 11 pm. connect tom catheter to urinary bag.

3.2.12 Removed cathether.
4.2.12 Not as fiesty as first day. Salivation seen. Able to urinate normally.
Blood test significant findings: BUN 27 (10-30), CRE 2.1 (0.3 - 2.1)

4.2.12 After hours emergency. 36.2C . Very lethargic. FIV/FeLv test negative. X-ray lungs. Blood test significant findings: Lymphocytes % 9.6 (20-55), Neutrophils 79% (35-80), Eosinophils 10.4% (0-10). Platelets 140 (300-800)

Necropsy as requested by the owner:
Cause of death: unknown
All NAD except bladder wall thickened, slightly haemorrhagic.
Lungs with patches of atalectasis - PM change or secondary to dyspnoea towards the end??

Drugs used:
31.1.12 Inject baytril 0.3 ml intrabladder,Vit C 3m intrabladder. torbugesic 10 mg 0.5 ml IV.

Vit C 1000mg + 0.5 ml cefaxone IV BID, Ornipural 1 ml, Vibion l ml IV BID for first 2 or 3 days of hospitalisation.