Several weeks ago, my cat had to be admitted to an animal hospital for
emergency surgery to remove bladder stones which were blocking his
urinary tract. A few hours before surgery, his BUN was 70 and his
packed cell volume % (PCV) was in normal ranges. Four hours after
surgery, his PCV% dropped into the mid teens. Four hours later, they
called and asked for permission to give him a transfusion, to which I
agreed.

When I saw him the next day, he was receiving a second transfusion
because his PCV% was still very low. He was also on a fluid line, but
was no longer catheterized. He did not regain normal urination after
surgery: he was either voiding small amounts where he was lying or
sitting or they were expressing his bladder. On the third day after
surgery, because he wasn't eating they decided that he was anxious and
discharged him. They gave me no meds for the urinary tract but just
said to observe his urination. I brought him back 12 hours later since
he was not peeing normally or eating. He was examined, and we were sent
home. About 15 hours after that I rushed him back in because he was in
respiratory distress. He turned out to be in congestive heart failure.

I immediately thought that he probably had cardiomyopathy, which had
previously shown no symptoms. But when I asked the first vet caring for
him on this round what had caused the heart failure, he said he thought
it was from 'transfusion overload' along with some pre-existing unknown
heart problem. They did an echocardiogram on him, and the only thing of
significance that showed up was 'mild to moderate diastolic
dysfunction'.

Fortunately, he survived being sedated, so he could be catheterized and
the CHF resolved after having fluid removed from both his pleural
cavity and his lungs. I was told that if they could get his urination
issues resolved, he would not be placed on cardiac medication. The vet
said he had an atonic (stretched) bladder, and that he needed to be
catheterized for several days for the bladder to regain elasticity.
Ultimately, he also found up with urethral spasms and after a course of
medication, some steroids and catheterization, he was urinating on his
own.

I became very suspicious at the point I realized he did not have
cardiomyopathy. I requested his records, and after eventually getting
all of them, discovered that during the first admission, he had
experienced an episode of fluid overload, which given the blood and
fluids being pumped into him on top of his lack of proper urination and
the lack of a catheter. Nothing was done to explore why he was not
urinating properly after surgery, even though bladder atony is not an
unusual occurence after having bladder stones removed. When I brought
him back in in respiratory distress, his PCV % was still in the teens,
and his BUN was 213 and his creatinine was over 6.0. When I checked to
see what his BUN had been when he was discharged the first time, I
discovered that they never did a full blood panel on him, except for
the one done before the operation.

I amassed a huge bill on his care - he was at a big name place in a big
city - and I complained to them about the fact that they sent him home
without resolving the urination, thinking that the kidney problems were
what put him into heart failure. They responded that they still felt it
was appropriate for them to send him home when they did etc etc. They
also made much of the anemia, but failed to mention that it had
occurred post surgery or to note that his blood factors were almost
normal 2 weeks after he was discharged the second time. That was before
I got the records however.

Now they are still defending their decision, altho they are offering me
a small discount that is not acceptable to me, given that their actions
almost killed him IMO. They now concluded that the combination of
transfusion and fluid overload and his urination issues put an already
existing heart problem over the edge, triggering the CHF.

If anyone is still reading this, do you know whether volume overload
from whatever source can cause damage to the heart all on its own. I
had the impression that it could, because it could be a life
threatening situation. After talking to a few human medical types (my
own vet is not being all that helpful for reasons I don't want to get
into, altho he was not involved directly in these events), they think
that it is more likely that the anemia was putting stress on the heart
because of declining oxygen right at the time that they were pumping
fluids into him, while his kidneys were starting to slow down, and that
that triggered the heart failure. If my cat was never diagnosed with a
cardiac problem, and has always received well care check-ups, how can
anyone determine that there was a pre-existing condition??

I'd be grateful for any comments on any of this. My cat pulled through
but seems to be at only 90% of where he was before.