Sunday, February 24, 2013

1394. Follow up. Sunday. Cat with bladder stone

Sunday Feb 24, 2013
6.23 pm Yishun public library to type this report
Communications post-op is most important. The cat owner phoned me twice and left his name and phone number. My receptionist reminded me to phone him after my consultations. I was kept busy with the owners of a cat from an American couple regarding removal of the claws, a rat with nasal swelling on the right and a large skin lump on its back and a rabbit from Woodlands for "spay" from a Malay family who had stated incorrectly the gender. Two big terrapins came yesterday for Dr Jason Teo - one would not eat and the other one had puffy eyes and I had them cleaned and given eye drops and bask in the bright morning sunshine. I had to supervise a new vet technician as Mr Min would be moving on to better future after having worked two years with me, increasing his value to the new employer as an experienced vet technician.

Back to the cat with the bladder stones was operated on Thursday, 3 days ago. The owner phoned me yesterday and today to provide me feedback and that was important.

"My cat did not vomit after eating food. He drank a lot, around 375 ml of water and peed a lot," he said. "He laid on his urine and so his surgical wound is very red."

"It is good news that he pees a lot," I said. "This shows that his bladder is normal." I tried not to joke that this showed that his bladder was not leaking after my surgery.

"What should I do to the red area of his wound?" the owner asked.

"It is very difficult for me to know what you are describing," I said. "Was the cat licking the wound since you did mention about taking off the e-collar?"

"No, he is still wearing the e-collar."

Since the owner was working, I suggested that he changed the plaster covering the wound and replace with a new square one. "It could be the blood clot from the skin after stitching," I said. Will wait and see.

It seems that the cat with the renal impairment based on blood tests taken by Vet 2 on Wednesday (4 days ago) is doing well.  He did not vomit his food. I asked the owner to give 2 cans 6 times/day instead of feeding him one can of the K/D diet yesterday. He has a good maid and with home care, this cat should thrive.

Before I forget, the Thursday surgery in brief is as follows:

5 kg bodyweight. I gave xylazine 0.2 and ketamine 0.8 ml IM in one syringe. Isoflurane gas top up was necessary for a short while. Rectal temperature was 36.8 C after sedation as the cat was angry and we could not want to antagonise him more.

SURGERY to remove bladder stones seen on X-rays taken by Vet 2.
1. Catherise the bladder
2. Withdraw urine for urine analysis
3. Inflate bladder with 40 ml normal saline so that it is palpable.
4. Incise skin and linea alba.
5. Press out the distended bladder.
6. Incise at apex of 8 mm as I know the stone was around this diameter.
7. I insert an artery forceps to grab and take out the stone without making too big a bladder incision.
8. My assistant Min pumps in more normal saline as I closed the wound for a while.
9. 3 small pieces of stones of around 3 mm x 2mm flowed out with the bloody mucus and blood.
10. More irrigation of the bladder.
11. I stitched the mucosa 3/0 absorbable - inverting layer
12. I stitched the serosa similarly - another inverting laye.
13. To check leakage, I asked Min to pump in more saline via the catheter to inflate the bladder. No leakage.
14. I put the bladder back into the abdomen and closed up the linea alba (2/0 absorbable) and skin (2/0 nylon).
14. I put the bladder back.
15. Post-op baytril and tolfedine
16. Cat goes home in the evening as the cat was quite ferocious and nursing at home would be better as the cat would be hand-fed food (K/D) and medication.

Friday - Day 1 after surgery. I phoned the cat owner.
"Vomiting one hour after food and medication," the owner reported as he had given medication on the evening of the surgery. I advised not giving the tolfedine tablets, just the Baytril tablet from Vet 2 and give honey water by hand.

Saturday - Day 2 after surgery.
Vomiting once. Drinks a lot. Pees a lot. "There could be gastric ulcers due to the high BUN kidney disorders," I said. "That would account for vomiting. Feed less amounts"

Sunday - Day 3 after surgery.
Feedback in above paragraphs.  Will need to summarise all later,

Discovered and borrowed two thick books published in 2012 and 2013 from Yishun library.
1. Web Marketing All-in-one for Dummies. 8 books in one.
2. Social Media Marketing All-in-one for Dummies. 9 books in one.
Thick as a bible. No wonder most doctors and vets give them a miss.

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