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Cat Forum / Health and Behavior / October 2004our cat needed a perineal urethrostomy....
Our cat had suffered his third blockage in eight months (his second within a month), and something like his fifth or sixth blockage of his life (he is over 9 years old) this past weekend. They were unable to catheterize him this time, the catheter would only go in a very short way and then just stop. The vet recommended (well, basically said they had to do) a perineal urethrostomy, because the only way they could drain his bladder at that point was with a needle. Of course, we said, go ahead; they are excellent vets (Berkeley Dog and Cat/Special Veterinary Services) and called a great surgeon in to do the operation. From all I can tell so far (he is still recovering) he is doing great although they claim he is very aggressive and angry, but is urinating well and eating voraciously (he always has). Still, I'm feeling horribly guilty. I realize that we did everything we could for him, we was on a special diet of C/D for over a year, and he is already being treated for an enlarged heart (a rare case, though, where the cardiazem seems to be reversing the condition, and prognosis is great! he was diagnosed with this after his first blockage of the past year, by worse vets; they catheterized him and anesthetized him and he became very ill, went into heart failure; this is when I found the new specialists who said "bah" to the original three-month-lifespan prediction, and he's now going strong, heartwise). I'm rambling, sorry, I'm looking to make sure that we did the right thing. He's almost 10 years old. I have no illusions that he will live forever. The surgery was very expensive, but I felt like he was definitely not at "death's door" and will continue to live a great life with this surgery. I just hope he doesn't hate us forever! Aside from the possibility of infections, are there other problems to watch out for that could result from this operation? He shares a house with two other cats , they all share one box but I try to keep it immaculately clean and use the blue silicone crystal litter which they like and seems to seperate out the waste much more successfully. Any tips, recommendations? > Our cat had suffered his third blockage in eight months (his second > within a month), and something like his fifth or sixth blockage of his [quoted text clipped - 33 lines] > > Any tips, recommendations? I had a cat that got the PU procedure after a series of blockages. No further urological problems for the rest of his life. I'd say you did the right thing right from the start. I hope you have many happy years together. Roby My Lightning had the PU surgery a couple of years ago when he was 6 or 7. It had to be repeated about a year later. He is OK now but is still on Hills CD. He is a happy guy now.  SignatureLarry - Owned by six cats > > > Our cat had suffered his third blockage in eight months (his second [quoted text clipped - 42 lines] > > Roby >He's almost 10 years old. I have no illusions that he will live >forever. The surgery was very expensive, but I felt like he was [quoted text clipped - 8 lines] > >Any tips, recommendations? My cat had PU surgery. I was very worried whether or not I wsa doing the right thing. Would he be okay psychologically without a penis? Would it be painful? He was fine after surgery. It took him a few days to realize that he must now squat instead of stand and pee backwards. His butt smelled a little for six months. I had to take him to the vet to get his anus area shaved. He had exploratory bladder surgery at the same time to rule out cancer so maybe that's why he couldn't reach around and clean as well. I was supposed to put tea tree oil on the new urethra area to toughen up the skin but I didn't. That stuff burns! You made the right choice. My cat was 6 or 7 when he had the operation. update: Well, he had the surgery Sunday night. We visited him last night and he was happy to see us, purring for the first time, according to the vets. We made the decision to keep him in the hospital until today, and I was planning on picking him up, but i just called in and they advised keeping him at least one more day, because they said he was not urinating consistently. They seem to think this is because of swelling, pain, and irritation from the surgery. Is this common? They are going to catheterize him to drain his bladder, give him something to decrease the swelling, and keep and eye on him for another day. They had a very good surgeon do this surgery, not a standard vet, so I'm very much hoping that there isn't a stricture or scar tissue already. I hate for things like this to come down to finances, but this is now becoming a massive financial burden on me (well over 3500 already, I'm sure it will go up if he has to stay two more days; plus the $1300 from last month's catheterization and hospitalization). I desperately hope that they don't have to reoperate, or, worse, find some other problem. > >He's almost 10 years old. I have no illusions that he will live > >forever. The surgery was very expensive, but I felt like he was [quoted text clipped - 18 lines] > oil on the new urethra area to toughen up the skin but I didn't. That stuff > burns! You made the right choice. My cat was 6 or 7 when he had the operation. > update: Well, he had the surgery Sunday night. We visited him last > night and he was happy to see us, purring for the first time, [quoted text clipped - 4 lines] > is because of swelling, pain, and irritation from the surgery. Is this > common? If the bladder was very distended it could've become overdistended or atonic. A really stretched bladder wall can become inca?pable of contracting enough to initiate urination - might take a few days to rest a damaged detrusor and return to normal. They are going to catheterize him to drain his bladder, give > him something to decrease the swelling, and keep and eye on him for > another day. > > They had a very good surgeon do this surgery, not a standard vet, so > I'm very much hoping that there isn't a stricture or scar tissue > already. Stricture (of urethral stoma) is probably the most serious complication associated with PU. However, most skilled surgeons that I know use the Wilson technique for PU which has reduced stricture incidence from 50% to about 10%. > I hate for things like this to come down to finances, but this is now > becoming a massive financial burden on me (well over 3500 already, I'm > sure it will go up if he has to stay two more days; plus the $1300 > from last month's catheterization and hospitalization). I desperately > hope that they don't have to reoperate, or, worse, find some other > problem. Try to relax a bit. Its sometimes a bumpy ride for a few days after this procedure. Seems like this vet knows what he's doing. Phil > > >He's almost 10 years old. I have no illusions that he will live > > >forever. The surgery was very expensive, but I felt like he was [quoted text clipped - 18 lines] > > oil on the new urethra area to toughen up the skin but I didn't. That stuff > > burns! You made the right choice. My cat was 6 or 7 when he had the operation. > Our cat had suffered his third blockage in eight months (his second > within a month), and something like his fifth or sixth blockage of his [quoted text clipped - 10 lines] > > Still, I'm feeling horribly guilty. You shouldn't, you saved your cat's life and probably gave him another 10 years of good-quality life! If he reblocked when you weren't around or couldn't get him to an emergency clinic he probably would have died from acute renal failure and/or hyperkalemia. . I realize that we did everything > we could for him, we was on a special diet of C/D for over a year, and > he is already being treated for an enlarged heart (a rare case, > though, where the cardiazem seems to be reversing the condition, and > prognosis is great! I think Cardiazem (diltiazem) works like magic in many cats with myocardial hypertrophy! It even reduces the risks of blood clots. he was diagnosed with this after his first > blockage of the past year, by worse vets; they catheterized him Its quite possible that your cat needed a PU because the previous vet may have caused irreversible tissue damage to the urethra while inserting the catheter. The urethral mucosa in blocked cats is very fragile and almost always inflamed and easy to tear. and > anesthetized him and he became very ill, went into heart failure; Oh no! My guess is the vet probably used ketamine to anesthetize him - ketamine is extcreted through the kidneys -- not a wise choice for a cat with a urethral obstruction. this > is when I found the new specialists who said "bah" to the original > three-month-lifespan prediction, I would have said a little more than "bah" about the previous vet - but I'm not a vet, so I could get away with cursing him out. :-> and he's now going strong, > heartwise). I'm rambling, sorry, Keep rambling! I love to hear success stories! I'm looking to make sure that we did > the right thing. You most certainly did. The wisest thing was going to another vet and getting a second opinion. > He's almost 10 years old. I have no illusions that he will live > forever. No, but you probably gave him another 10 years! I could live with that. The surgery was very expensive, but I felt like he was > definitely not at "death's door" and will continue to live a great > life with this surgery. Don't second guess yourself, you made the right call. > I just hope he doesn't hate us forever! Naa. He doesn't know you ordered the procedure. ;-> > Aside from the possibility of infections, are there other problems to > watch out for that could result from this operation? UTIs are a problem with PU cats - but keeping the litter box immaculate will minimize the likelihood of occurance. I assume the vet kept him for a day or two after surgery - so, the serious post-op complications were averted. He shares a house > with two other cats , they all share one box Uh ah, 1 box per cat plus 1. You need two more litter boxes. but I try to keep it > immaculately clean and use the blue silicone crystal litter which they > like and seems to seperate out the waste much more successfully. > > Any tips, recommendations? Keep tabs on his water intake and urine production - feed canned food, and shoot the other vet (just kidding). Good luck. Phil Update: well, not good. the surgery went well, but he went into heart failure two days after. He had been exhibiting "unusual swelling" around the sutures and they gave him some medication to control this, and he was also urinating incosistently. they recatheterized him, and after that, he went back into heart failure. They put him in oxygen with nitroglycerine for a day, then took him out of oxygen, told us he seemed to be improving. They sent him home with us yesterday, but he does not look good to me. He is not eating, I guess he is urinating although not in a box, I think it's drippling down his back legs; he is lethargic and tired, basically the way he was when he first went into heart failure in February. I don't know what to do. We've already paid them $5k for the surgery and hospitalization for a week, I'm afraid to stress him out by taking him in again for them to say, 'well he is recovering from heart failure." he doesn't seem to be obstructed but I can't really tell. I suppose I should call them and see what they recommend. I just want them to tell me what they can do within reason. He does not seem to be suffering horribly but he is obviously not happy. >> Our cat had suffered his third blockage in eight months (his second >> within a month), and something like his fifth or sixth blockage of his [quoted text clipped - 98 lines] > >Phil > Update: > > well, not good. the surgery went well, but he went into heart failure two days after. He had been exhibiting "unusual swelling" around the sutures and they gave him some medication to control this, and he was also urinating incosistently. they recatheterized him, and after that, > he went back into heart failure. They put him in oxygen with nitroglycerine for a day, then took him out of oxygen, told us he seemed to be improving. They sent him home with us yesterday, but he does not look good to me. He is not eating, I guess he is urinating although not in a box, I think it's drippling down his back legs; he is lethargic and tired, basically the way he was when he first went > into heart failure in February. Have they told you what to expect? It cannot be normal for him to just urinate down his leg, is it? I would get hold of one of the doctors and get him to talk to me. I am sorry you and your kitty have to go through this. After care is part of surgery--so they need to talk to you and tell you what to expect and how to make him comfortable. Best of luck. I am surprised about the outcome of the PU surgery. My lightning had it done twice with no complications. It had to redone to open it up further since he was still blocking. He has been OK for over 3 years now. SignatureLarry - Owned by eight cats > > > Update: [quoted text clipped - 16 lines] > After care is part of surgery--so they need to talk to you and tell you what > to expect and how to make him comfortable. Best of luck. I'm very surprised to, considering they knew about the heart condition, and I think maybe the medicine they gave him for the swelling may have contributed to the heart failure. Not that I think they had any choice at the time, and they did talk with his cardiologist when they did it, and she recommended going ahead. I know complications happen, I just hate it when they happen to my animal! >I am surprised about the outcome of the PU surgery. My lightning had it >done twice with no complications. It had to redone to open it up further >since he was still blocking. He has been OK for over 3 years now. >Have they told you what to expect? It cannot be normal for him to just >urinate down his leg, is it? they said he would dribble, so this seems to be what is happening. The aftercare they suggested was (aside from monitoring and clavamox) cold compresses 4 times a day (we're probably doing more than that); he is certainly dribbling on himself. I'm assuming that maybe he isn't making more of an effort because of his exhaustion from the heart problem. I just gave him a compress and he seems unchanged, no worse than when they sent him home, so I don't think I'll take him into emergency today, but keep and eye on him. When his heart went bad before, it was four days before he started rebounding, he only ate reluctantly. My worry is that his spirits are so low, he has a stupid code around his neck, he's uncomfortable, that he might just not try to eat at all. Although he has been drinking water which is good. I would get hold of one of the doctors and get >him to talk to me. I am sorry you and your kitty have to go through this. >After care is part of surgery--so they need to talk to you and tell you what >to expect and how to make him comfortable. Best of luck. <zeno_a@NOSPAMemail.com> wrote: > >My worry is that his spirits are so low, he has a >stupid code around his neck, he's uncomfortable, that he >might just not try to eat at all. Although he has been >drinking water which is good. A valid worry. Poor baby. I have heard that some people try chicken baby food, or smelly tuna, to get sickly cats interested in food. Maybe there is some sort of liquid supplement? update: he wasn't obstructed, and wasn't in heart failure: he's constipated! They too xrays and found a LOT of stool backed up in his system. He's hospitalized again and receiving a stool softener in the hopes they don't have to do an enema (which could cause an infection on the surgery site). Whew! Much better news than I was expecting. Thanks for listening. ><zeno_a@NOSPAMemail.com> wrote: > > [quoted text clipped - 5 lines] >food, or smelly tuna, to get sickly cats interested in food. Maybe there is >some sort of liquid supplement? > update: > he wasn't obstructed, and wasn't in heart failure: he's constipated! Yay! I do believe this is the first time I have cheered constipation! Wonderful news. You know, it is pretty common after major surgery. When people have back surgery, for example, you have to get them up asap so that they will have a bowel movement. (Apparently activity, i.e. getting up and around, has something to do with a functioning bowel. As many old folks know, constipation can be serious--it can actually kill. This is why there was such a range of herbal laxatives in the old pharmacies, some of which were strong poisons if one took too much. Belladonna is one of these, and I actually have a relative who died of laxitive overdose back in the 1800s. (No Darwin Award jokes, please. I believe he was an aberration in the gene pool.) >They too xrays and found a LOT of stool backed up in >his system. He's hospitalized again and receiving a stool softener in the hopes they don't have to do an enema (which could cause an infection on the surgery site). Whew! Much better news than I was expecting. I sure hope this works, and kudos to you for taking such good care of your cat. He is very lucky to be so loved and I'm sorry you both have to go through this. Sometimes it seems we have to really be on our toes to get the info from vets that we need, on top of everything else. It's a good thing you listened to your instincts and got him back in. Keep us posted. << update: he wasn't obstructed, and wasn't in heart failure: he's constipated! >> Well, that's good. Let us know how everything comes out (and that isn't meant as a pun cuz I'm sure he feels awful). Candace (take the litter out before replying by e-mail) See my cats: http://photos.yahoo.com/maccandace "One does not meet oneself until one catches the reflection from an eye other than human." (Loren Eisely) Bad news. Last night, our kitty passed away. We're still not entirely sure why. We went in to visit him, there was a little delay while we waited in the waiting room (actually, about 20 minutes); the emergency vet came in looking sad, I did not feel good about that. He said our cat had just passed away. They had gone to pick him up and bring him into us and he had gone into cardiac arrest. They spent a lot of time trying to resusitate him but nothing was working. I'm still very confused about what happened. When I'd talked to them earlier in the day, they said he had not moved his bowels, was very depressed and lethargic, but they thought there was still a good chance everything would work out alright. Treating the constipation was difficult because he was showing elevated renal values; they would usually treat this with hydration, but his heart condition made that difficult, because you can put a cat into heart failure with overhydration. So they were doing a moderate amount. I'm not sure what else was going on. I have to say at the moment, well, I'm obviously upset. And very conflicted. I know they did all they probably could, but I still have questions: why did they release him on saturday to come home, when he was obviously still sick? he was so backed up with stool, how was this not noticed before? He hadn't moved his bowels all week it seems. But they didn't mention this or seem to take note. I know he began to have a lot of health problems and I know (from past experience) that things can be unpredictable. But we spent $7000 on treatment for our guy. And now I'm not getting the answers I expect. Why would a cat go into cardiac arrest suddenly? This isn't the same as heart failure. I don't really know what my options are. I do like these vets, or at least had a good experience until now; and I have no real reason to think they didn't give him the best care possible, but I still have doubts. How do you ever know???? Very sad. My wife is devestated (she has never lost a pet before). ><< update: >he wasn't obstructed, and wasn't in heart failure: he's constipated! >> [quoted text clipped - 10 lines] >"One does not meet oneself until one catches the reflection from an eye other >than human." (Loren Eisely) I should also note that he was only 8 1/2, had had blood work done and showed no previous signs of kidney disease, just the cardiomyopathy and crystals. This does not equal a terminal case to me. >Bad news. > [quoted text clipped - 47 lines] >>"One does not meet oneself until one catches the reflection from an eye other >>than human." (Loren Eisely) > I should also note that he was only 8 1/2, had had blood work done and > showed no previous signs of kidney disease, just the cardiomyopathy > and crystals. This does not equal a terminal case to me. I'm so sorry :( Cardiomyopathy could complicate any illness. You did your best. >I know he began to have >>a lot of health problems and I know (from past experience) that things [quoted text clipped - 7 lines] >> >>Very sad. My wife is devestated (she has never lost a pet before). I'm so sorry you have to experience this. I can't imagine how horrible it must be. It's bad enough for your cat to die but under such circumstances and at such cost... My cat had PU surgery and he acted as if nothing had happened immediately afterward. He was 10. He also had exploratory bladder surgery so they opened him up all the way. I can only think maybe they gave him too much anesthesia? Or pain relievers? That can cause constipation. Maybe he was older and had other health problems? Maybe he wasn't fit for surgery to begin with? My cat's PU and bladder surgery was I think $1,200 but this was 7 years ago. $7,000 seems high. Again, I'm so sorry your family and cat had to experience this. I'll keep all of you in my prayers. Thank you everyone for your kind words. At the moment I'm also worried about our other two cats, the other male in particular, they were very close. Even though he had been in the hospital for some time, they now seem to know that he is not coming back, very strange. They are very depressed and lethargic today. Maybe I'm projecting though. >>I know he began to have >>>a lot of health problems and I know (from past experience) that things [quoted text clipped - 18 lines] >$7,000 seems high. Again, I'm so sorry your family and cat had to experience >this. I'll keep all of you in my prayers. > Bad news. > > Last night, our kitty passed away. I'm so sorry, you did so much to help him. I don't know how to answer your questions but I do hurt for you. zeno_a@NOSPAMemail.com writes >"...Last night, our kitty passed >away. We're still not entirely sure >why..... we spent $7000 on >treatment for our guy...." I'm sorry to hear the sad news about your kitty. You spared no expense in trying to help him. If you feel up to it, and you want to find out a bit more about what happened, you can contact another vet (perhaps at a vet school) to request/review the records. That vet might be able to explain what was going on with your sweetie and what the (other) vet was doing for treatment. Perhaps that will provide some comfort. zeno_a@NOSPAMemail.com wrote in news:6tbun0han1r5oofg9e8p2d9crmlv9cv46r@ 4ax.com: > Bad news. > > Last night, our kitty passed away. I'm so sorry about your dear kitty. It's so hard to lose a beloved pet. --Catherine << Very sad. My wife is devestated (she has never lost a pet before). >> Oh, I'm so sorry. I had thought this would have a good outcome. My condolences to you and your wife. Poor kitty, you did all you could. Candace (take the litter out before replying by e-mail) See my cats: http://photos.yahoo.com/maccandace "One does not meet oneself until one catches the reflection from an eye other than human." (Loren Eisely) |
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