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maine_coonz wrote:I have no real idea how it happened, or why, but I was never so glad to see a mess in my life - my guess is that he was asleep, and the bladder relaxed - is this possible?
maine_coonz wrote:Week 10: Mon.May.30: The Vet called back this morning: he found absolutely no obstructions in the urethra. They observed him trying to urinate this morning, without success. He said that his guess was the detrusor muscle was clamped shut, and that the urethra also had high resistance. Sigh. That's what happened to Buddy.
He also said that he thinks the nerves are trying to regenerate (and possibly sending painful signals), and that the puddle I saw on Saturday was very symptomatic of this, and this could also be why expressing him causes him pain. The depressing part is that there is no way of telling how long it could take for the nerves to regenerate, or indeed to what extent they would regenerate. Because he is now "locked up tight" the only way to get the urine out of him is via catheter, and he says this isn't something I could do at home. Is this true? Has anyone done this themselves at home? It's not something you can really do at home. I brought Buddy home with a cath once in awhile, but most people can't.
He told me that there are no surgical procedures available for the problem, and the only thing we could try was medication. NOT true. Buddy had surgery to move his bladder and to install a tube in his belly to pee through, and it was called a urethrostomy.He said he was going to keep him for another 24 hrs and give him Myocholine (Bethanochol) together with Diazepam, to see if this would help. But he said he has seen this kind of problem several times before and the outcome is usually euthanasia.
I can't bear it, I really can't. After all this time, effort, money, etc, to fail at this point is just unthinkable. Especially when he is so healthy and happy in every other way. Tell me about it. Is it really not possible to catheterise him at home for a few weeks to give these #### nerves a chance to regenerate? Surely there must be some other solution? Somebody help please! I refuse to give in - his quality of life is so great, except for this one £$%^&* show-stopper. Arghghgh!
I asked him about using Prazosin and Dantrolene (which CarolC had told me about). He did know about them, and had heard good things, but he said "Forget it, no-one can afford this in Germany." It turns out that the cost is ca. Euro 30 per tablet (arrghgh).
For treatment of functional urethral obstruction due to increased external urethral tone:
a) 0.5 - 2 mg/kg PO q8h OR 1 mg/kg IV (Lane 2000); Osborne, Jurger et al. 2000)
Pill Book Guide to Medication for Your Dog and Cat wrote: It is common for animals to have difficulty contracting their bladder after a urinary tract obstruction. The bladder wall is stretched to the point where the smooth muscle in the wall does not function normally. Once the obstruction has been relieved, bethanechol may be used to stimulate the bladder to contract and eventually return to normal size.
Veterinary Drug Handbook, Fourth edition wrote: Bethanechol: Prescriber Highlights: Principle contraindications are GI or urinary tract obstructions or wall integrity in question
maine_coonz wrote:Week 12: Thu.June.09: I was up all last night reading about Urine Retention and didn't get to bed till 6am (I really must get a life one of these days), so poor Raz didn't get expressed till 13:30 (guilt, guilt). I sat down to express him with a heavy heart, fully expecting failure - but it actually went pretty well, and we were all done under 30 mins.
It's clear when he starts to help: he sortof lengthens himself, and straightens his back, and then the pee comes in a proper 'stream' (albeit a small one) rather than dribs and drabs. I wish I knew why he decides to help at some points but not at others. He got very annoyed towards the end, I think I make a bit of a painful mess out of getting him properly empty. That is so interesting about him stretching.
However, the evening expressing was truly bad: after 45 mins the towel was still as dry as a bone, Raz was very fed up indeed, and so were Julian and I. In desperation, Julian held all four paws tight and I squeezed Raz really hard, and finally got about half out, at which point we gave up.
Not a good day - I kept feeling like I was about to burst into tears all day. With good reason.
Week 12: Fri.June.10: Expressing Raz this morning was definitely an all-time low to date. He was very full because I hadn't emptied him last night. Every single time I got a drop of pee to drip out, the little #### would squirm and wriggle and growl, and I would lose his bladder and have to reposition my hands. I do not believe he was in pain, but I am mystified why he should object so much. After 90 minutes of him cursing and swearing and generally making life as difficult as possible, I had only managed to get him 3/4 empty, but neither Julian nor I could stand any more crap from him, so we called it a day - at which point Raz leapt off the bed and into the litterbox, squatted and did a tiny pee all by himself. Oh, for heavens sake. But every time he does that, it is practice for his system...more power to him! We went outside into the garden for coffee and to discuss where we go from here. Julian said that he had had enough and couldn't go on like this any more. I must confess I too am getting pretty fed up and desperate. We decided to leave things as they are until Monday morning, and then talk to the vet about a possible Cystostomy, preferably one with a cap.
To cheer myself up I decided to spend the day gardening and ignore the mammoth amount of work on my desk. The weather was warmish, and all three cats came outside and helped sow grass seed. I saw Raz twice (!!) squat and do a pee - WFT is going on?? He caught himself a mid-afternoon mouse-snack, climbed the neighbour's scarily high tree, and generally had a good time<br /> Boy, what is the key? That he was warm? Did he perhaps have a bowel movement outdoors? Does he actually need to stretch some muscles that seem to have nothing directly to do with urination, like he does when climbing a tree, for his system to work easily? Surprise, surprise - at the evening expressing he was almost empty. He lay down and purred and purred, and I got about 8ml out of him with no trouble at all - we were all done in 15 mins flat, which is a bit more like it! Pray God this marks a turning of some sort.
Week 12: Sat.June.11: Something is definitely changing, although we shall see whether it is temporary or permanent. Gains in ability are permanent. Again this morning in the garden I saw Raz squat and do a decent-sized pee, and at morning expressing time Raz was again almost empty: I got about 10ml out of him. Maybe he needs to get out and exercise and do cat things in order to work out his tensions. Seriously? Then his whole system falls into line better?Same thing in the evening: again, less than 10 ml.
It is very odd: when we sit down for expressing and I start to massage Raz's tummy, his bladder is pretty firm and easy to find. But after 5 mins of tummy massage he relaxes, and his bladder goes all floppy, which does make expressing him a lot more difficult. I would have thought that the Bethanochol would force his bladder to be in a firm state. I don't understand. Me either. Raz spent the evening asleep on the small sofa, and dribbled pee - I haven't seen him dribbling for a couple of weeks, so why now?
Week 12: Sun.June.12: It's unbelievable - Raz was again almost empty both this morning and this evening. But the very best part is that it took less than 10 mins to express the remainder. Yahoo!! Yeah, you could live with that! I went through about 5 months of very difficult expressing with Katie before it started to improve. One of the things that seemed to improve it was PT, walking on the underwater treadmill. Maybe it was just a coincidence, maybe she would have gotten better anyway, but it seemed the overall exercise, on muscles that were not "connected to the bladder" helped her become able to help me when we expressed. It takes 2 minutes now. It used to take 25 minutes of strenuous effort, "corded veins on the forearm" as I used to say, and she weighs 6 lbs.
Week 12: Mon.June.13: This morning was again a breeze - Raz only had about 10ml in his bladder, and we were all done in 7 mins flat.
This evening it was hard to get him going. He had about 20ml in his bladder, and I think I got about half of it out, but he wasn't happy and wriggled and growled quite a bit, so we gave up after 30 mins. We shall see what the situation is in the morning. He dozed on the sofa beside me all evening, and again dribbled a bit.
Week 12: Tue.June.14: I saw Raz trying to pee early this morning, but without success. I presume his being extra-full due to not being emptied properly last night was motivating him to try. Expressing him took about 20 mins, and wasn't too bed.
At the evening expressing he wasn't nearly as full as I had expected, which makes me hope that he is doing some amount of peeing by himself. However, he did have a lump of poo just before his anal sphincter, which I haven't seen for some time, so I popped it out for him (he wasn't impressed). But what's interesting about this is that we haven't thought about his pooing for ages, but clearly he is not 100% back to normal. I know I sound like a broken record, but Katie is much easier to express when her colon is empty. It's not just hand position, it's almost like she only wants to do one thing at a time, and if expressing her bladder is making her feel like she needs to move her bowels, that makes her kind of uptight. I think she just wants to do one thing at a time. If I express her bowel first, she is more relaxed.
Week 12: Wed.June.15: A really yucky present beside my pillow this morning - a small poo! Raz must have come into the bed at some point last night, and he usually crawls under the duvet and makes bread like fury - which of course gets his tummy muscles going, with this icky result. I guess we are taking a backwards step at the moment (in the style of "two steps forward, one step back".
It took quite a while this morning to get Raz going - about 20 mins, but after the first drop appeared the rest came fairly easily, and we were all done in 30 mins. I definitely got the feeling that he was helping, but I can't explain how or why. That's what happened with Katie, she became able to help express. It turned a 25 minute ordeal into a 2-minute routine.This evening: Raz was very full, which I suppose means he didn't pee at all by himself today. But it went pretty well: it took 10 mins to get the first couple of drops of urine out, and then it came thick and fast. I still find it very difficult to get the last 5% out, which is when he gets fed up. About 30 mins all told.
Week 13: Thu.June.16: Expressing Raz this morning was another nightmare - 90 mins of pressing really hard, the pee would only come out drop by drop, he wouldn't stop wriggling and arguing - arrghghghg! And yet, and yet - we went outside for coffee and croissants and the little beggar dug a hole in my newly seeded grass and did a decent-sized pee. Go figure. I sometimes think it would be helpful to have a special forum on this message board where people can go to just vent and swear! And it should include a wall to bang your head against. Raz's issues seem to have resolved into a single one of peeing. I have read so much literature it is coming out of my ears. I found an absolutely brilliant description of the urinary system in Fundamentals of physiology: a human perspective. I think that his problem is getting the internal urethral sphincter to open - but I'm still reading about the urethral sphincters, so we'll see.
We are going to have to do something about the castration problem. Raz is getting seriously stroppy, and is beating the other two cats up all the time, which is making them miserable. I have no idea how this might factor into the situation...I understand it takes a few weeks for the hormone level to go down following neutering.The Vet phoned this evening to see how things were going, and was both disappointed and puzzled by my report of "Sometimes he pees and sometimes he doesn't." He says that just doesn't add up in a physiological sense. I offered up the idea that the healing nerves could be 'short-circuiting', so's to speak. He responded with a thoughtful "I wonder if there could be some tiny particle that sometimes goes into the urethra and partially blocks it, and other times doesn't." It would be great if that was the problem. I also told him that Raz was becoming impossiblly stroppy, and beating up the other cats all the time. So, in short, Raz is to go in tomorrow morning to have his goolies chopped off, and at the same time he will be catheterized and back-washed, to ensure there are *no* particles or anything else in his urinary system.
The evening expressing wasn't too bed, only 30 mins (feels like a holiday after this morning). It still takes 10+ mins to get the first drop of pee out, but I didn't have to squeeze really hard, thank goodness. It is puzzling why the pee only comes in a sortof fast dribble, though. Either his urethral sphincter is only partially opening, or there is something partially blocking the urethra (sigh).
Week 13: Fri.June.17: We took Raz to the Vet this morning to be castrated, poor guy. The Vet called for a chat this afternoon: he said the castration went well, but he wanted to talk about the peeing problem. He said that they had catheterized him and drained his bladder completely, did an x-ray to check how his sacrum was healing + an ultrasound on his bladder + washed out the bladder + urinalysis + every test under the sun (you should have seen the size of his bill!). But he said they were alarmed to find complete bladder atony, ie. the bladder did not contract at all after being emptied. He said this was really, truly bad, and understood that expressing him was difficult and time-consuming, but that I really needed to be a lot more aggressive and keep him as empty as possible in an effort to reverse the problem. He said we should therefore continue with the bethanochol+phenoxybenzamine for the moment.
The trouble is, it's a bit of a circular problem. I have noticed that it has been getting harder and harder to empty Raz, the last 10+ml or so is almost impossible to get out, and the problem has been getting slowly worse. But I need to get everything out if we are to reverse this problem - how to manage this? Mmm, I'm not sure about that. I think it's good to get it all out so you minimize the chance of infection, however there is a "residual volume" that is normal. I do not think you need to get him completely empty for his bladder to regain tone. Here is an article that says the normal residual volume will be 0.2-0.4 mg/kg..http://www.vetlatranquera.com.ar/pages/ ... mal_40.htm wrote:The normal residual volume of urine after complete voiding is 0.2 - 0.4 ml/kg for both the dog and cat
I am now raddled with guilt that in fact I have created the whole pee-problem or at least made it worse than it was. As I read more, I understand more about how the urinary system works. Good bladder tone is crucial for the correct operation of the internal urethral sphincter; is it possible that by only expressing him twice daily I have in fact been contributing to making matters worse, because the bladder spent too much time being full? Dear God, please no. I don't think any of this is that simple. I have a feeling nobody else could do any better with him, and I can only think of 2 people I know who I could say with confidence that they would do equally well, and they both have a lot of experience. I wish there was something I or anyone could to do make it easier. You don't seem to realize that you are doing an OUTSTANDING job. And I thought the vet approved the twice daily expressing. This was from your earlier post, ahem:I also talked to him about the difficulty I have in expressing Raz three times a day, and he said that was an ideal, cats are individuals, and it was clear that twice a day was working just fine. The amount he had got out was about two teaspoons which he said really wasn't worth worrying about.
The Vet and I also talked again about Dantrolene. He said he only knew it as a people medication. I offered to email him various articles + the info CarolC sent me, he will look into it and we will talk again soon. The $64,000 question is whether it is Raz's external or internal urethral sphincter that's being the problem - or possibly both. The Vet said there's no way of telling short of surgery and then afterwards finding out that the wrong one got cut
We went to pick Raz up this evening, he was really, really glad to see us. But he can't talk properly, he is all croaky, and I can hear a weird sortof rattling sound when he breathes; but the worst thing is he's being really, really hyper. The breathing sounds like something to watch. I've never heard of that following neutering. He won't settle down, he just paces and jumps up, then down, then walk around ... endlessly. He wolfed 40 grams when he first came home, then another 40 grams an hour ago, and he's making it clear that more food is a Really Good Idea. I am feeling extremely trepidant at the idea of trying to express him while he is in this state (gloom, gloom).
How is he doing now?
CarolC: sorry about the very brief earlier post, but I had just got off the phone with the vet and we were walking out the door to go get Raz, so tme was short. Hopefully you can now understand what was behind my previous post about irreversibility. Is it possible after such a long time (3 months)? I must confess to feeling rather low this evening about it all. Oh, that's perfectly fine, I wish I'd been able to give a quick answer right when it was needed. I am thinking about this, trying to be logical. His ability to control urination is not gone because he was helping you earlier this week. Katie helps me. I believe he IS helping you. His ability to contract his bladder is not gone because you described a couple of days ago how it was firm, then you massaged him, then it relaxed. I do not understand why it was contracted, then relaxed, but it is not constantly flaccid. Anyway, he may need to tone up his bladder muscles and I don't know why he isn't consistent, but he is definitely better overall, if he can just continue improving before your husband and you both go right round the bend. Imagine how you would have felt 10 weeks ago to see him squat and pee. 10 weeks ago there was no way of guessing if he ever would again. Oh, if only he could talk!
Phenoxybenzamine has a slow onset of action, and the dosage should be increased slowly at four-day intervals. The urinary stream is evaluated as an indication of drug effectiveness. If the stream is weak, but of normal diameter, bethanechol may be used to increase detrusor contractility, however, bethanechol must not be used until the functional urethral obstruction has been relieved. If the urine stream is intermittent or narrowed, increased dosage of diazepam and/or phenoxybenzamine is required. Because diazepam has a very short duration of action (approximately 1-2 hours when administered orally), administering diazepam 30 minutes prior to walking the animal will sometimes aid in the management of reflex dyssynergia.
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