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maine_coonz wrote:Our MC boy (8 months) got out of our cat-proofed (hah) garden on Thursday pm, and disappeared for two days. He dragged himself home at Sat. midnight, in dreadful pain. We immediately took him to the emergency vet, who said he'd been hit by a car. X-rays showed a fractured and bent pelvis, and gaps where his tail vertebrae should be attached at the top of the pelvis. They put him on pain meds, catheter, etc. and kept him in for observation. We brought him home on Mon, along with half a ton of meds: Meloxicam, Lactulose, Bethanechol, Diazepam. We were told the prognosis was very poor.
Eating problem: On Mon.pm he ate quite happily, ditto Tues.am. We then started with the Bethanechol (but not the Diazepam), at which point he refused to eat.
From The Pill Book Guide to Medication for your Dog and Cat:Bethanechol should only be used when the urethra is open, as when a catheter is in place, or with urethral relaxants, because bethanechol can cause contraction of urethral smooth muscle as well.
Diazepam would be the urethral relaxant in this case.
As soon as he smelled food, he would start to salivate, and then barf. I gave him water via syringe (although water is available, our cats don't drink it, just spread it around all over the floor and paddle), and waited for things to settle down. They didn't, he just lost a lot of weight. Wed.pm I started assisted feeding with a syringe, he doesn't love it but puts up with it. He still barfs, and not much goes down. I spoke to our vet and we took him off the Bethanechol today (Thurs). I pray this is the cause of him not wanting to eat. Our cats are raw-fed, and normally Raz is a real pig.
From The Pill Book Guide to Medication for your Dog and Cat:Bethanechol
Possible side effects:
Common: vomiting, diarrhea, increased salivation, and decreased appetite.
- how long will it take the Bethanechol to leave his system?
Donald C. Plumb, Veterinary Drug Handbook, Fourth ed.Bethanechol
duration of action after oral dosing may persist up to 6 hours after large doses
- are we doing him a great disservice in taking him off it?
- does anyone have experience with this drug causing nausea?
- do other cats with this type of injury refuse to eat?
I don't think it's frequent, I do not remember hearing that specific problem when cats with this type of injury were discussed here by their caregivers.
Pee problem: Raz seems to know when he needs a pee, and gets very agitated (it doesn't leak at all). He insists on repeatedly squatting in his litter box, despite the pelvic pain. I've read so much about expressing, studied every pic and x-ray I can find on google images, been back to the vet several times for lessons (he's a lousy teacher), and still can't do it. Perhaps one of his other staff can show you better. If you are taking him to the vet daily, at least that means he is getting emptied by someone, I think you are doing the right thing. Don't worry, they are used to people who have trouble expressing at first.
Here is an article with videos at the end.
http://www.handicappedpets.com/mediawik ... dog_or_cat
Raz will not lie on his side, he will only lie on his tummy, and even then my husband has to scruff him. His tummy muscles get very tense, and finding the bladder seems impossible. I suspect this is because of the pain. I think you need better pain control, even if he is quite doped up and doesn't want to do anything but sleep. He needs time to heal and time for the pain to go down and you must be able to handle him during this period. I would not care whether he can walk around or anything right now, you just have to be able to express him and he needs to learn what you are doing, and having him quite sedated would be my preference. I would get him something very strong and jI did find it once and got two great squirts going, but not since - I don't think he has one any more. He's now very cross about the whole thing, and as soon as I put my hand on his tummy he growls, hooks my hand really hard (ouch!) gets up and walks off. Because of the pelvic damage I can't use one hand around his spine, I've been trying to express him using only one hand. That is what I would do, too. You can squeeze the bladder like a lemon without pressing it against the inside of the body. If his hip area is even touched, he cries. Things are getting worse, not better.
- can I damage or hurt Raz in my rubbish attempts to express him? I've read that urine can get forced back up to the kidney!
I would not worry about that, I would be more concerned about his sore areas, the pelvis and tail.
- does his bladder really need to be completely emptied, or is it good enough to just get some out?
It's best to try get it as empty as you can, or the urine you leave may become a breeding ground for germs. Getting some out is better than nothing because he will be more comfortable.
- how will I know if he has an UTI?
Some UTIs do not have obvious symptoms, others will show blood in the urine, dark color, strong odor.
- how much time do I have to learn in, before UTI becomes a real danger?
You might expect a UTI in a week to 10 days, or under 2 weeks, without proper emptying. If he is on antibiotics for his injuries, they may provide a margin of safety. You could ask the vet for a prescription of antibiotics for a couple of weeks to give you some protection while you are learning to express.
- is it usual for cats with this damage to know that they need to pee? The vet was amazed, and said it was a very good sign.
Poo problem: our cats normally poo every couple of days, and the stool is small, firm, fairly dry and very low-odour. The vet gave Raz an enema on Tues. as he was concerned the old poo had been in his system for too long. Nothing whatsoever has arrived since then. We haven't used the Lactulose yet.
He will probably not object to the lactulose, my pets seem to like the taste OK, I would use it.
- should I assume that because the nerves controlling his bladder sphincter are damaged, the poo-controlling ones are too?
I would assume that because of the gap in his vertebra where the tail joins the body.
- will peristalsis still move the stool along the intestine?
Yes, but the movement will be slower and cats can become constipated and the stool can dry out in the colon. I would use the lactulose. It's good stuff.
- although he's not eating much, should the stool still arrive?
- how can I tell if he's constipated? I've tried to feel his tummy, but can't feel anything much.
The vet should be able to tell if he is constipated. The stool inside may feel harder than you were looking for, if you are feeling around for something soft you might try looking for something firmer.
- should I just use the Lactulose, or wait to see if I need to?
- has anyone experience of using ground flax seeds instead of Lactulose?
- given that he doesn't really drink water, would using Lactulose cause dehydration?
Raz is a beautiful boy, very affectionate, superbly healthy, delightful temperament (if a bit on the lazy side). He's very happy to lie in his new soft bed in whatever room we are in, he purrs whenever we talk to him or stroke him. His brother is quite puzzled why he won't come and play. I'm desperate to do the right thing, he's a real fighter, and I'm terrified that my inadequacies will lose him his life. It is kind of scary. I think goal number one is to get him to where you can work with him, and that probably means more pain control or a sedative. Once he is calm and lets you handle him, you can begin to make progress. This forum has been a godsend and a real mine of information, and I thank all who post to it.
maine_coonz wrote:Hallo CarolC and Cricket's Mom,
Thank you so much for your help, the moral support and info have been a real life-saver.
Meds: Raz is no longer on any meds as of Friday, and Sat. he sauntered into the kitchen, asked to be put on his stool (our cats each have a stool they sit on while I get their food ready), and sat and yowled "Where's my food!!!" He's been eating steadily since. Which is an enormous relief, he's already looking less gaunt. He's clearly in much less pain, and is walking a lot more easily.
Pee: I took your advice and went back to the vet to get a real "hands-on" expressing lesson. This time he was great (I think he finally understood how frantic and anxious I was feeling), took his time, and I think I've finally got it. I've also been stroking, tickling and massaging Raz's tummy in between expressing him, to try and get him to relax and think of it as fun. This is definitely paying off, I can now get him to lie on his side, cock one leg in the air and let me get on with it - no more scratching, hissing or growling. Yay!!
Whew! That's a huge relief.
Poo: This isn't looking good. The vet showed me where/how to feel the stool in his intestine, and it's clear there's loads in there, but it ain't appearing. He gave Raz something called Microklist Rektallösung (trans. Microklist rectal lotion). The website (http://www.microklist.de/) says it contains: 450 mg sodium, Dodecyl (Sulfoacetate), 45 mg sodium, sorbitol solution 70% (crystallising) 4465 mg, other ingredients: glycerol, sorbic acid, purified water. Usage: for short-term use in applications for diseases and constipation, which requires assisted defecation. God knows what all that lot do, because I don't!
The vet said we should see something within 24 hours, otherwise call him. So far (15 hrs later) nothing's happened.
I am not familiar with this but your vet seems good. There is a medication called cisapride that can help mobilize stool. You may not want to use it long term but it can be used for cases like this.
I am feeling rather confused about this. Peristalsis moves the stool along the bowel. It then requires some effort on the part of the animal/human to push it out; but if this effort doesn't take place then surely the stool will eventually appear on its own? From trawling the web I understand that Raz's bladder and anal sphincter are closed, and the nerves controlling the opening phase are damaged; is this the exception, and incontinence the rule?
http://www.veterinarypartner.com/Conten ... ourceID=42
I'm not sure this is a scientific explanation, but it seems like in cats with tail injuries the stool moves slowly toward the exit, and if it is not evacuated the leading end nearest the exit begins to dry out, making it harder to move. The stool that is farther up the colon tries to move forward and hits a roadblock and it begins to bunch up near the exit, stretching the colon and forming a more solid mass, again making elimination more difficult. Your cat is recently injured, he's been on medication, he was not eating regular meals for a while, and he has been having some pain and may have trouble posturing to eliminate, so it is not surprising if he has not been eliminating regularly. Any cat might be constipated with all those things going on. There are cats with tail injuries who drop stools without really being aware of it and otherwise seem normal, and in some cases they may pass a stool but it does not break off immediately and remains partly in and partly out, because the sphincter cannot pinch it off, but the cat is leading an otherwise normal life. I think it is too soon to know what kind of ability your cat will have. You are saying his sphincter is in a closed position. It may appear closed, but I doubt if it is tightly closed with this kind of injury...is it? Anal tone refers to the ability of the sphincter to still have muscle control and be able to pucker. If you touch a sphincter with normal tone, it will flinch. Here is a photo of Foxie, who used to be on this message board. You can see the anus is in a permanently open position, lacking tone. It would be considered flaccid.
Please check with your vet before doing anything because your kitty has pelvic and tail injuries and possibly internal bruising that is all healing, but there are ways to help the cat eliminate stool with intestinal massage, or with enemas. Here are some videos where people are helping their cats eliminate. I have been unable to find any videos in English. If you use an enema, it is important to be sure it is the kind that is safe for cats, some enemas designed for humans are not safe for cats. Possibly an enema is the next thing your vet will try if the medication does not produce results.
http://www.youtube.com/watch?v=LbVxdFyGKjs (Expressing bladder and bowel of cat in standing position)
http://www.youtube.com/watch?v=iuMZ4hrijuY (Expressing bladder and bowel of small cat in midair)
http://v.youku.com/v_show/id_XMTczNjAzOTk2.html (Vet expressing cat's bladder and bowel)
In my web research I keep seeing the phrases "Diminished Anal Tone" and "Zero Anal Tone". Could someone please explain what they mean? Also, many articles/posts talk about urinary/foecal incontinence, which I understand to mean "leakage". But Raz has the opposite!
Yes, laymen usually think of incontinence as urinary dribbling. But it can also be the opposite, you are right.
Thanks again for all the help,
maine_coonz wrote:Hi again CarolC,
Acupuncture: Raz had his first session today. I'm incredibly lucky in that (a) I have a professional acupuncturist for a sister-in-law, and (b) she lives in the next street over! She loves Raz very much, and offered to come 3 times a week for a month or so. How fantastic is she?
Cisaparide: I did ask the Vet about this on Mon, and he said he didn't like to use it unless absolutely necessary; he wanted to give things a few more days.
Anal Sphincter: I had a good "poke around" this morning to see what's what. You can now really feel the stool in his large intestine, right up to about 1cm short of his anus. I tried to put my fingers (ever so gently) alongside the stool-nearest-the-exit, but Raz got really upset (hissed, spat, bit). The initial x-ray showed a broken (and crushed?) vertebrae, and I'm starting to think that this lies just above his anus. His anal sphincter is definitely closed shut; I tried the 'greased thermometer trick' and it took some fiddling around to get it in (it had no effect, by the way). Guessing here: might he be holding the sphincter shut because it hurts?
Maybe, I don't know. A broken vertebra must be so painful. Did you get a chance to read the link above about cats with tail injuries? One thing I've found with Katie (different case, she is a small dog with a spinal cord injury mid-back which causes tight sphincters) is that her sphincter stays tight until we get the stool started, but it relaxes some once it starts moving.
I just tried touching his anus again to see if it flinches (like wot you said), and it doesn't seem to, but its very hard to tell because he gets really antsy when I try.
I watched the youtube videos with great interest, but couldn't help flinching a bit - boy, those guys are really rough with the cats! But it was incredibly useful to see the massaging and bowel evacuation actually being done. I think I'm going to try a very gentle massage and see where I get with it - surely that's got to be better (less unpleasant for the cat) than an enema?
Yes, I would not try anything too forceful. The one video appears to be a vet or vet tech, and I assume the pet is newly injured and does not know the vet, and if expressing the bladder wasn't so important they would not put the cat through the handling. It is common that when you express the bladder, you are apt to cause stool to move, too, so she is emptying the cat both ways. The one with the man doing it shows very effective elimination, and thank goodness he made the video, but his cat is not newly injured. According to the text on his website, he is fostering this cat after it was injured in an accident, he has a dozen or so cats and is a cat lover. I don't know what would have happened to the cat without him. You pretty much do have to put your fingers up in the abdomen as he is doing (but you don't necessarily need to grasp the back quite so much) which is why I wanted you to check with your vet because I don't know if your cat is injured and sore inside. You can tell he is speaking kindly to the cat even though it is a different language. The one with the small black kitty is more interesting for the bladder expressing technique she uses.
(A bit later) The Vet just called to ask if the lotion yesterday evening had worked (unfortunately not). We then talked about massage, and he told me to give it a go, but to bring Raz in tomorrow morning if no joy. So I'm going to try that right now. One last question: is it possible to rupture or tear the intestine doing this? The people in the videos seemed to be quite firm (almost rough), so I'm guessing one would have to be quite clumsy to hurt the cat?
I think normally if you take your time and use your judgment you will be OK, but I do not know if your cat has internal injuries, which is why it is important to talk to the vet (as you did). Here is a topic from someone who had a cat with 16" of stool backed up.
It is sooo great to have this support while Raz and I work out an M.O. for ourselves. I spent most of last week smoking up a storm, crying my eyes out, stress levels through the roof, etc., etc. I thank my lucky stars I fell over this forum, one doesn't feel so desperately alone. God bless.
Thank goodness cricketsmom answered last night. How are you doing now?
It's 3am, and Raz and I are both completely fed up and stressed out. Raz can't pass any stool, and it's freaking him out. He is endlessly squatting in the litter box and growling and hissing and spitting.
To add insult to injury, he's hiding his bladder from me and I am having the most terrible time trying to express him (sob) - and I thought I had that licked
It is harder to feel the bladder when the colon is full. I would ask the vet to express him again.
I took him to the vet's this morning to see if they would give him an enema, but they didn't want to as he would have to be sedated and they felt he'd been sedated far too much over the last 12 days. The vet mixed up some mineral oil and water, and put it into his bottom to soak the stool and lubricate matters; he also said that he had broken the stool up into pieces. About 5 mins later a large lump came out, the vet looked pleased, and said more would come when we got home, if not then bring him back Fri.am. Unfortunately, that hasn't happened; all we have is a lumpy-looking bottom, with a closed sphincter.
What he did is what you can do. But please ask your vet if it is OK for you to do this.
I have done this, too. You form your hand into the shape of a lobster claw (wish I had a better description) and place in on the cat's abdomen and feel around till you find the colon, which will probably feel hard or even make you wonder if it is bone you are feeling. If you then pinch, the stool does break into pieces. This makes it easier to pass, and often the process of breaking the stool does make some come out. Once it is in pieces, you can continue mobilizing it toward the exit, and you may get a few more pieces, then do it again later. You do not have to pinch super hard to break it in my experience.
We started him on Lactulose yesterday (1 ml twice a day). I see from various posts that it will take 24 to 48 hrs to start working. Here's hoping.
Maybe you should ask them about the cisapride again.
CarolC, I found your post "Cat has spinal cord injury" where you talk about massinging the colon to move faeces toward the exit. I can feel the stool in the colon, it feels pretty hard to me (but the vet said it wasn't hard!). Raz let me massage his tummy for ages this evening, but we don't seem to be able to get anything out, despite vaseline, gloved fingers, etc. I do feel hesitant about squeezing as I'm afraid of something getting damaged. It all seems so hopeless (glum, gloom).
Your vet squeezed to break the stool. Perhaps you can have the vet show you how much pressure to use so you will know you are being gentle enough. I certainly understand wanting to be careful with him.
But apart from moaning (please forgive me!) we do have a very serious problem which I hope you can help with. Raz is continually licking his rude bits, and it's got to the point where there's no fur left, the skin is red and raw, and there are a few places where he's actually licked the top layer of skin off. I bathe him with warm water and cotton wool to keep him clean (which he loves having done) but he still insists on licking himself. I have been putting my hand over the area to stop him, which pleases him not at all.
Is there any antiseptic cream or something I can put on his skin to help, hopefully something he hates the taste of, which won't harm him if he does ingest it? Despite hours of web trawling, I haven't found anything. A last resort is an E-collar, but I am very reluctant to use that, poor guy is so fed up as it is, that would be the last straw, I think.
There is a product called Yuk-2-E, I don't know if they sell it there. http://www.vetplanet.net/yuk2e.cfm I would put the collar on him for the present time... You know, you might ask the vet if there is any chance he has a urinary blockage, such as stones or crystals or cystitis. It is easy to assume the licking is because he is injured and incontinent, but if he was not, then licking like that and repeated squatting would be a sign of cystitis in a non-paralyzed male cat. In a paralyzed animal, licking can be a sign of a urinary tract infection, which would actually be a very likely occurrence following paralysis, my dog got one even though I was expressing. This is why some newly paralyzed pets are put on prophylactic antibiotics the first couple of weeks.
One last question: do you think it would be safe for me to try to give Raz a warm-water enema at home? I've never done this (nor had it done to me). What's involved? Does one have to be trained to do it? I read CarolC's post "Urgent advice needed for incontinent Manx!" where you talk about your parent's doing this at home. I guess they had you as built-in support!
Actually it was my aunt and uncle and I wasn't there, but I am so impressed by what they did! Warm water should be safe, but I have never done it. I think you might need to ask the vet for equipment, and it would be best to have the vet show you how to do it the first time. Here they sell pet enemas at large pet stores, I do not know if they have them there. Here is a video, but your cat has a sore injured bottom and broken tail and you would certainly not be able to pull up his tail or rub his bottom like they are doing in this video...but it does show the equipment used. Right now it is probably best left to the vet and his assistant...
Since you are in Germany, do you speak German? I have been in contact with the lady who did the video showing how to express the bladder of her cat, and she is in Germany. This is the video I am talking about.
She is going to make a video showing how she helps her paraplegic cat empty his bowel, but that will take time and I think you need help right now. Is it possible you could contact her on the German message board? Her cat's name is Kruemel, and the message board she belongs to is here: http://handicats.forenking.com/index.php Even if you do not speak German, her English is excellent, and the admin on that board also speaks English.
maine_coonz wrote:Hi Guys,
You have NO IDEA how relieved I am to read this report!!
We just got back from vet again - I'm not going to add the bills up until August, by which time hopefully the worst will be behind us
We decided to go back to the vet we first took Raz to (they run an emergency all-night clinic) to see if we got something different than from our normal vet (who is great, but there's nothing like a 2nd opinion).
Stool Issues: The vet did another xray to see what the stool situation was. Turns out only the large intestine was full, the rest of the system was pretty empty (one of the blessings of raw feeding, I guess). He said he didn't think anaesthesia+enema was warranted, and showed me a large roundish 'plug' a few inches back from my poor guy's bottom. He said he thought things would move along if that was removed.
So the vet and I donned latex gloves and he gave me a lesson. Turned out the 'plug' was a large chunk of hard stool, matted hair etc. effectively damming the works. He/I pulled out all we could reach. Raz was definitely not impressed, but started looking relieved immediately afterwards.
That is just wonderful. I bet he feels so much better.
It's really scary putting one's finger up there and curling it around to scoop things out, I'm amazed the colon will expand to that extent!
Yes, it's really scary and unnerving to do anything when you know his bottom hurts, isnt' it? I think you have a good vet.
I am now armed with a bottle of mineral oil and a squeezy-bulb thingy; lol! Perfect description! this is only for lubricating things near the exit, and not for enemas. The vet explained about enemas, and I must admit I'm not confident about stuffing that much tubing up inside Raz without damaging something. He also said that doing this to a cat in pain is a truly bad idea, and that it would be best done under anaesthetic.
I told him about your "lobster claw" massage, and he said that sounded like a wonderful thing to do.
And when we got home Raz rushed into the litter box and did his straining thing, and another poop appeared; he did this a couple more times. It's clear his anal sphincter isn't working, as they just sort of dangle around, but I took care of that for him.
I don't know how the plumbing and facial tissue are in Germany, but if you are using facial tissue and dropping it in the commode, it may clog the plumbing. I found that out the hard way here. I used to use facial tissue to pick up waste and throw it in the toilet, but facial tissue does not dissolve like toilet tissue does. Eventually I had to call a plumber. If you are just dropping it in the rubbish bin, then no worries. If you are flushing it, I recommend using toilet tissue.
Urine/Sore Skin Issues: The vet said he didn't think Raz has a UTI, but he took a urine sample to test anyway. He reckons that Raz is constantly licking that area because it's the closest he can get to the source-of-his pain. He gave me some stuff to put on the skin, and said I would have to E-collar Raz for a few days to allow it to work. Poor guy!
Oh yes, and he gave me points for the state of his bladder (nearly empty), yay!
But he said my "techinique" needed improvement, and showed me a different way.
That is a reason for licking that never occurred to me.
He also said that he thought we should re-start the Bethanechol, as it encourages the nerves to heal by stimulating the muscarinic receptors; This is interesting, I will have to look it up. it apparently also encourages intestinal motility and peristalsis. But we should stop it if it makes him sick again.
Nerve Issues: I got the vet to talk me through the view-from-the-top xray again, as I didn't really understand what he said on the night we originally took Raz in because (a) I hadn't educated myself on feline anatomy at that point, and (b) he speaks very fast, and my medical German is sadly lacking, and (c) I wasn't in a great state of mind at the time.
So it turns out that the sacrum has a gap on either side where it should be 'glued' to the pelvic bone. He said this isn't a huge issue, and is something that time will definitely heal.
More importantly, the first tail vertebra directly below the sacrum takes a huge lean to one side; this is where the nerves are either torn or stretched, and only time will tell. The vet said that ideally he would like to see a small improvement each week, and promptly gave Raz a battery of tests.
- He now has fully functioning reflexes in both legs.
- He has regained tail feeling in the first 3cm and the last 3 cm, but nothing in between (?? how can that be ??), but he can't move it at all. I've never heard of this. The vet made the point that even if he could move it he probably wouldn't, because that first tail vertebra (the leaning-over one) is the point of flexion, and it would hurt dreadfully.
- He is now walking straight (his pelvis leaned horribly over to one side in the beginning).
Bless his heart!!
- The vet thinks peristalsis is working just fine.
- Finally (excitement, excitement) I swear to God that I saw Raz's anus contract a couple of times when he tried to poo. But the vet said it might have been automatic, and not to get too optimistic. But I can't help myself!!
Wouldn't that be something?! I'm just so pleased that he went in the box and managed to use it, that is such wonderful news.
CarolC: thank you so much for the pointer to the handicats forum. I've joined, and am waiting to get the green light message. I would suggest you try to log in even if you do not receive an email. Sometimes it happens with forums that the admin activates you but you do not receive the email that was sent. When you try it, if you see "Logout" at the top, you will know you are logged in, even if you did not receive a confirmation.
click to enlarge
Yes, I had seen the German lady video before, but had no idea how to contact her, will now do so asap. How did you find the handicats forum? It's great to have it over in this neck of the woods, many many thanks for that.
I have a Youtube account, and I sent an email through Youtube to the person who made the video, and she wrote right back.
In fact, I tried her pillow+litterbox technique this morning, and it worked like a charm, (except that at the end I get lots of drips and she doesn't). My husband cuddles+strokes Raz while I make a mountain of work trying to express him. It's much less hassle than putting newborn-size nappies under him.
The fencing guys are coming on Monday to make the obviously-not-catproof fence absolutely Houdini-proof. I am *not* going here again! My husband is looking glum because of the cost, but he made the point that we could probably have paid for the fence twice over with what we're going to have shelled out for vet's fees by the time we're done. I wish, oh how I wish ... but one can't go back
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