Wednesday, December 24, 2014

Hero's Christmas surprise, or feline urological syndrome hits home

Hero when he feels okay.
Yesterday didn’t go exactly as planned at SAT HQ. There I was quietly reading about chondrosarcomas in ferrets when I heard noises. 

Hero was acting very strange. He was running around, couldn’t get settled, jumping on the desk and then began open-mouth breathing (not normal in cats). As I chased him up and down the hallway attempting to auscultate his heart, he began to howl. I suspected some sort of cardiac event or thromboembolism, but he decided to give me a hint, jumping on my desk and urinating – a tiny, painful, strained expulsion of a little bit of wee and mostly blood.

When I didn't get the hint, Hero tried to spell it out on my notes.
So I bundled him into his carrier and off we went to work, where x-rays revealed a bladder full of tiny uroliths, and - more concerningly - a few uroliths lurking in his urethra. If you have a urethra, you'll probably understand that passing stones through it is potentially agonising. Hence Hero's open mouth breathing. It was a sign of serious pain.

He was a bit more relaxed once the pain meds kicked in...
NOT what you want to see on a lateral radiograph of your own cat. A bunch of uroliths having a convention in the bladder, a couple waltzing around the trigone of the bladder (the bit where the bladder meets the urethra)...BUT...WORSE...on the far right you can see some uroliths and chunkettes of sludge in his DISTAL URETHRA. These were obstructing his urinary tract. Having an obstructed urinary tract is a) painful and b) not compatable with life.
Thing is, he's never had signs of urinary tract disease before. He just went from zero to obstructed in no time. On Christmas eve eve. And so it was that this evening I stayed back - with a very devoted team who agreed to assist despite Hero's ungracious in-clinic behaviour - anaesthetised him, catheterised his penis to flush the offending uroliths BACK into his bladder, and then performed a cystotomy to remove all of the evil blighters so his urethra could be once again patent.

You can see the catheter here, The bladder is more distended as I've flushed the uroliths back into it. Seems simple? It took an experienced nurse, an experienced vet (moi), a LOT of patience, and several rounds of gentle flushing before the catheter could be advanced at all. Good catheter technique is essential as urethral trauma predisposes to strictures and, you guessed it, greater risk of obstruction in the future.
The angry bladder inside of Hero. Not happy, Jan, as they say. Photo taken by Vivian Lang.
The stones that so traumatised Hero's urinary tract. 
Definitely an improvement. There is a smidge of urethral sludge just caudal to the pelvis, but a little diuresis and a dissolution diet should sort that.
The rest of the evening was spent watching Hero recover, organising a culture of his urine and submitting his uroliths for analysis to ascertain the best course for preventing further episodes.

So, Christmas plans have been thrown into disarray and probably scuttled, but at least for the night we've won the battle for Hero's urethra. 

UPDATE: despite having just three legs and an Elizabethan collar to contend with, Hero easily removed his drip last night, and I removed his urinary catheter this morning. The next step is to ensure that he can urinate voluntarily, which can be a bit of a waiting game with cats - especially ones with "shy bladder syndrome". So I'll be asking Santa for a big stream of healthy cat urine this Christmas.