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Cat: broken pelvis+tail, eating+pee+poo problems, I'm scared

For those seeking advice on caring for incontinent pets and animals with kidney-related problems.

Re: Cat: broken pelvis+tail, eating+pee+poo problems, I'm sc

Postby CarolC » Mon May 30, 2011 9:40 am

I do not have the whole answer, and I am not a vet, but I think you need a quick second opinion on what this vet said, or another vet. If you need links on anything I say just ask, some of this is linked in earlier messages in this thread.

1) you tried bethanecol and it didn't work 2) bethanecol should only be used with a urethral relaxant like diazepam because it causes the bladder to contract and you can't have the full bladder contracting against a closed sphincter or it could injure the bladder...yes, he is on diapezam but the urethra is not relaxed, therefore you are creating a risk situation by adding bethanecol to the mix 3) he just had cystocentisis which involved a puncture to the bladder to extract urine, therefore there is a weak spot in the wall of bladder, this increases the risk of rupture.

unrelaxed sphincter
bethanecol creating contraction
weak spot in wall of bladder

I do not know if the article I am copying here will apply to this situation but it might, and the author is a multiply-certified expert. It describes treatment of a cat where all other causes of cystitis (UTI, crystals, etc.) are ruled out. (click image)

mgt_cystitis.PNG


He did get himself to wee during relaxed grooming, the article mentions stress as a trigger of cystitis. I have heard that repeatedly inserting a cathether can cause irritation to the urethra, it seems possible this might increase the problem. I understand why they are doing it right now but I really think trying the medications listed in Dr. Hibbert's article would be better. They have not been tried yet.

_____________________________
EDIT: Idea. Print the page from the pdf, carry it to the vet, show him. He already knows the treatment he's trying may not work, he told you he's had to euthanize cats where this treatement did not work before. He may be willing to try different medication, especially when he sees the list of credentials of the author of the pdf, and how recently it was published.


http://www.ivis.org/proceedings/bvna/2010/bvna2010.pdf
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Re: Cat: broken pelvis+tail, eating+pee+poo problems, I'm sc

Postby barley » Tue May 31, 2011 1:52 am

Hi,

You mentioned that he was having a dry, hard stools... My male cat is in a very similar situation (but we are at the 1 year mark now). I found lactulose to be useful in an emergency in the beginning but overtime it would just cause messes when it would get too runny. So, I took him off the lactulose and I started feeding him high fiber dry food and it moves things along pretty much just fine now. The kind of food I'm using says it has 9% crude fiber. It's actually just the kind of dry food for long haired cats to prevent fur balls. Hope that helps.
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Re: Cat: broken pelvis+tail, eating+pee+poo problems, I'm sc

Postby Philacatshia » Tue May 31, 2011 2:25 am

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?


This happened with Bully often. I'd squeeze as much out of him as my muscles could manage, knowing that some had escaped me, and find a puddle under him next time he took a nap. I have found that he's easiest to squeeze when he's half asleep. When he's anxious to go outside, it takes a huge amout of effort compared to when he's relaxed. If he's being really difficult, I'll sneak up on him when he's napping, gently scoop him up and whisk him off to the kitchen floor for squeezing before he knows what hit him.

I'm amazed by all the drugs that Raz has taken! If one of your last-ditch options is to try taking him off of all drugs, be careful with the diazepam. I assume that cats, like humans, would need to be tapered off of diazepam very slowly in order to avoid withdrawal symptoms.

You two have made such excellent progress! I really hope you find a solution.

:thinking:
Bully: 10.5 year old male cat, at age 2 his tail was run over by a car, causing incontinence. His tail is amputated, bladder & colon are expressed 2x/day. Household livability depends on firm-ish poops and no bladder leakage.
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Re: Cat: broken pelvis+tail, eating+pee+poo problems, I'm sc

Postby critters » Sun Jun 05, 2011 12:37 pm

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!
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Re: Cat: broken pelvis+tail, eating+pee+poo problems, I'm sc

Postby maine_coonz » Thu Jun 09, 2011 6:25 am

CarolC: I did print the page, and showed it to the vet - see below for his comments.
critters: I've been thinking about a tube - see end of post.

Week 10: Tue.May.31: The Vet called this morning. It turns out that I misheard him on the phone yesterday - he said that he put Raz on Myocholine/bethanochol and Dibenzyram/phenoxybenzamine (*not* Diazepam) at the following doses:
Myocholine/bethanochol 10mg tablets: 3 x ¼ tablet daily = 3 x 2.5mg = 7.5mg / 24 hrs
Dibenzyram/phenoxybenzamine 5mg capsules: 2 x ¾ capsule daily = 2 x 3.75mg = 7.5mg / 24 hrs
He said these were very high doses, and not a great idea, but ok for the short term in this case. Anyway: he was very, very happy - he said that Raz peed all by himself this morning, and that 3 other people witnessed it (he called them in because he got so excited!). He wanted to keep an eye on him for a few more hours to see if the peeing was a one-off, and we agreed that Raz would be better off at home (less stress) so we could come and pick him up this evening.
So off we went later on to bring Raz home again - I'm sure I don't need to tell you how happy we were, as opposed to the journey taking him in on Sunday! The vet said that Raz clearly knows when he needs to pee, ie. he knows when his bladder is full, which was a good sign that the nerves governing this were in good shape. But he also said that it is possible that the pudendal nerves were damaged and that the urethra will never relax (without drugs) during detrusor contraction - and all we can do is wait and see.
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).
We brought Raz home, and he was clearly very happy to be here; he immediately had a dust-up with his brother, just to make it clear who was still boss. Poor guy, we hovered over him like brooding hens, watching to see if he would pee! Time passed, and he wolfed his supper, but no pee. More time passed, and then I noticed that he was leaking pee - but he still didn't go near the litter-box. We decided to leave him alone for the night and see how things went. For a relaxing evening (hah), I boned up (again) on:
- Problem-based Feline Medicine, Chapter 12 "The Incontinent Cat"
- Neurogenic Bladder (excellent in-depth explanation of how peeing works)

Week 10: Wed.June.01: Raz was still pretty full this morning, although he had clearly got rid of some pee during the night. I am not comfortable with leaving him full all the time, in case of nerve damage, so decided to express him. Joy and delight: it was soooo easy in comparison with these last weeks of struggle. He lay back and purred, and purred, and let me get on with it.
Generally speaking, a very good day, he clearly hadn't eaten much in hospital, so made up for it every chance he got. He did go in the litterbox a couple of times, but only tiny amounts came out (sigh). We expressed him again this evening; again, not at all difficult.

Week 11: Thu.June.02: Not much change from yesterday, although at expressing time he insisted in going in the litterbox beforehand and afterwards. I thought I had emptied him, but he clearly didn't agree, and promptly finished the job himself. Not nearly so much leaking today.

Week 11: Fri.June.03: I sat down to express Raz this morning - and found to my surprise that his bladder was almost empty - but when I let him out for his run earlier this morning it had been fairly full. So clearly something is working, although I've no idea whether he is still doing lots of small pees, or decent-sized ones.
I've noticed that when he is sleeping, he drips - but not when he's awake. Could this mean that the bladder sphincter is under some kind of conscious control??

Week 11: Sat.June.04: Raz's bladder was again almost empty this morning, although he clearly needed a poo. I let him out for his run and sure enough he returned shortly afterwards all nice and empty and begging for his breakfast. It's very hot now (June) and the cats find it enervating: Euclid ran across the garden this afternoon and collapsed with his mouth open when he got inside.
Disappointment this evening: Raz's bladder was fuller than I was prepared to leave, so we expressed him. What a nightmare! I think that was the single worst expressing experience since the beginning. He growled, and squirmed, and clawed, and generally made our lives as difficult as possible. I wish I knew what was going on - was he just fed up after not being expressed for a day, or is the phenoxybenzame not working well and he has pain?

Week 11: Sun.June.05: Raz was full again this morning, so it looks like his self-peeing is currently not happening (sigh). We decided to take a "quality-time" approach to expressing him, as neither of us want to live through another experience like last night. So it goes like this:
- We all go into the "peeing room" together; Raz gets to run around while we put towels out and get stuff ready; he also gets some biscuits.
- Tummy massage from me + cuddles and strokes from Julian. I keep this up till the first drop of pee appears, which can take between 5 to 10 mins.
- Then we let him run around in the hope that he will go into the litter-box and attempt a pee, but usually he just tries to steal biscuits.
- Back onto the bed, two more biscuits, then we get to work with more massage; the pee comes in a few mins. A sortof "milking" squeeze seems to work well for him rather than a full-on squeeze; he wibbles his rude bits when he feels the pee coming.
- About 70% of the way through, we take a break and let him run around the room again. This is partly to give my hands a rest, partly to see if he will pee himself, and partly to let his bladder reform.
- More biscuits to coax him back onto the bed, and get the rest of his pee out, with more cuddles and chats. Getting him really empty is hard work and he does get a bit impatient.

This approach has worked consistently three times now, with no growling or squeals, so I can only conclude that he isn't in pain. However, it does consume about 40+ mins, which is rather tedious. But it seems to work!

Week 11: Mon.June.06: We did the "quality-time" thing again this morning, and again had 100% success. Thank God.
The vet phoned this afternoon for an update. He said that he had consulted with various colleagues over the weekend to see if anyone else had come across a similar situation, but without success. He was very disappointed to hear that Raz had completely stopped peeing by himself, and confessed himself dumbfounded. He said that we should continue as we are for another two weeks, and keep the medication at its current (high) level. He agreed this wasn't great, but said he was clear out of other ideas.
The "quality-time'"approach worked again this evening.

Week 11: Tue.June.07: Again this morning the "quality-time" thing worked well.
BUT not this evening - I gave up after 30 mins, having acquired approx. 2ml in total; Raz was starting to get restive. Fortunately he didn't have much in him to start with, say about 10ml. But he was leaking a tiny bit all evening ... go figure.

Week 11: Wed.June.08: Well, old Raz certainly was very full this morning, but after 45 mins of "quality-time" we finally got him empty. It was astonishingly difficult to get the first few drops to come, I had to squeeze pretty hard.
It poured all day, and all three cats sat on the back doorstop watching the high-velocity drops hit the step - they were patting the drops and playing with them, it was so funny.
This evening's expressing was a complete nightmare, after 30 mins of really leaning on him without even a single, tiny drop, we had a coffee-break. Again I had noticed earlier in the evening that he was leaking a tiny bit. The more I think about it, the more I disagree with the Vet, I don't think he has bladder muscle contraction issues, I think either (a) the bladder neck is stuck shut or (b) his urethra won't relax. Anyway, we finally got him fairly empty after nearly an hour, but I had to really squeeze. And rather scarily, he would sortof 'jump' from time to time and eep - I'm really worried that I'm forcing urine back up into his kidneys, and this is causing him pain. He struggled and fought quite a bit too. It doesn't seem to me that the drugs are having any effect at all anymore, we are pretty much back at the same point we were at 10 days ago on Sunday, May 29th. Where the #### do we go from here?
I did a lot of research on tube cystostomy and re-read Coc's Mom's posts about his 'button'. I tried to PM her to ask how he got on with it, but unfortunately she hasn't been around since Dec.2009 and the message is still sitting in my outbox. Anyone got any ideas? Anyone know any vets anywhere in the world who might know more about this problem than my two vets here?
Erasmus (Raz) + Euclid + Heimdall,
Living in Germany
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Re: Cat: broken pelvis+tail, eating+pee+poo problems, I'm sc

Postby CarolC » Thu Jun 09, 2011 4:12 pm

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).


I am posting this now, and may "double-post" afterward if there is something else to add on other comments.

I do not know if he meant Dantrolene or Prazosin. I am assuming (?) he means Dantrolene, because Prazosin looks like a common med and when I go to the Wal-Mart website (huge chain of department stores) it is on their list of $4 prescriptions...where you can get 30 pills for $4.

I also do not know what size of pill he referred to, assuming it is Dantrolene.

If he meant Dantrolene:

I'm looking at the Veterinary Drug Handbook, Fourth Ed., Donald Plumb, this is a professional reference for vets. (of course, double-check everything) It says Dantrolene is supplied in 25 mg, 50 mg, and 100 mg capsules. (glad it's not tablets) Here is what it says on dosage:

Cats:
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)


Note: there is an a) but there is no b) not sure why they did it that way, I copied it exactly and completely.

I think it would be an inconvenience to have to dose him 4x/day, but maybe it wouldn't be forever, nerve damage does gradually improve. It would be better than 30 minutes of difficult squeezing several times a day, with all the stress (inadequate word) that goes along with it.

I agree the medication may be cost prohibitive, especially at a high dose, (it's $43 USD) but possibly he might respond to a low dose or improve to needing only a low dose (I don't know). I do not know what size of capsule the doctor is referring to at 30EU, that makes a big difference, so we can cost it out for all 3 sizes. This would work better in excel but I'll make do. Figuring Raz is a 5 kg cat since Maine Coons are large.

25 mg capsule
low dose: 0.5 x 5 kg = 2.5 mg 4 times a day = 10 mg/day, so one capsule lasts 2.5 days, cost is €12/day
high dose: 2.5 x 5 kg = 12.5 mg 4 times a day = 50 mg/day, 2 capsules/day, cost is €60/day

50 mg capsule
low dose: 0.5 x 5 kg = 2.5 mg 4 times a day = 10 mg/day, one capsule lasts 5 days, cost is €6/day
high dose: 2.5 x 5 kg = 12.5 mg 4 times a day = 50 mg/day, 1 capsule/day, cost is €30/day

100 mg capsule
low dose: 0.5 x 5 kg = 2.5 mg 4 times a day = 10 mg/day, one capsule lasts 10 days, cost is €3/day
high dose: 2.5 x 5 kg = 12.5 mg 4 times a day = 50 mg/day, one capsule lasts 2 days, cost is €15/day

So best case scenario is €3/day. I am not trying to encourage you to spend money you cannot afford, it is clear you have spent so much already.

I will read your message again later, I have to go to the vet right now. I am so glad you still have Raz, I have thought about you so much. You (and your husband) are amazing. I will see if I can find a contact for the other vet when I come back.
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Re: Cat: broken pelvis+tail, eating+pee+poo problems, I'm sc

Postby CarolC » Fri Jun 10, 2011 2:13 am

OK, sorry for the double post, but after posting my message above, I had to take a cat to the vet. I am going to tell you something that I don't know if it will help, but it is something Jean always insisted, and she has a very-difficult-to-express cat named Jaimie. With Jaimie, she was very firm about the fact that her cat needs to be warm enough in order to be expressed.

Here is one of Jean's posts describing her cat.

viewtopic.php?f=5&t=11105&p=56225&hilit=+heater#p56225
viewtopic.php?f=4&t=6025&p=32981&hilit=+radiator#p32981

The only thing I can add from my own experience is, I live in South Texas, for example it was 96 degrees today. I do notice that when I let the dogs out in the yard and I pick up Katie and squeeze her bottom to express her bowel over the grass before we go back in, it is easier to do when she is super warm and relaxed, compared to indoors with the air conditioner running, standing over the toilet.

Here are some email addresses in case you or your vet wants to contact Dr. Hibbert. I cannot tell which one is current, maybe you can.

http://www.bris.ac.uk/vetscience/people ... rview.html
http://www.langfordvets.co.uk/contact_lvs.htm

It is so interesting that your cat has been able to do as much as he could, he isn't consistent and you need that, but it is wonderful that he has done as much as he has. It's like the answer is there or almost there, I pray it will be there in a dependable and consistent way, you all need a break.
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Re: Cat: broken pelvis+tail, eating+pee+poo problems, I'm sc

Postby maine_coonz » Fri Jun 17, 2011 10:28 am

Hi CarolC, Critters,

A very quick question: is it possible to reverse bladder atony?
Just a yes or no would be good right now. I will post in more detail later.
Many thanks,
Erasmus (Raz) + Euclid + Heimdall,
Living in Germany
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Re: Cat: broken pelvis+tail, eating+pee+poo problems, I'm sc

Postby CarolC » Fri Jun 17, 2011 12:06 pm

If you mean a flaccid bladder that has been stretched, it can be improved with medication (bethanechol chloride/urecholine).

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.


I am still a little worried about the cystocentesis (puncture of the bladder wall). I do not know how long you have to wait before the puncture is considered healed.

Veterinary Drug Handbook, Fourth edition wrote: Bethanechol: Prescriber Highlights: Principle contraindications are GI or urinary tract obstructions or wall integrity in question
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Re: Cat: broken pelvis+tail, eating+pee+poo problems, I'm sc

Postby maine_coonz » Fri Jun 17, 2011 4:37 pm

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.
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.

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.
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 />
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. 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.
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.
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!!

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.

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.
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.
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.
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." 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?
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.
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. 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).

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.
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Re: Cat: broken pelvis+tail, eating+pee+poo problems, I'm sc

Postby CarolC » Fri Jun 17, 2011 11:30 pm

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!
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Re: Cat: broken pelvis+tail, eating+pee+poo problems, I'm sc

Postby CarolC » Sat Jun 18, 2011 12:47 am

P.S. I may have something else to add, I need to reread your post when I'm fresh, instead of editing the same comments over and over!

Here is another interesting paragraph from http://www.vetlatranquera.com.ar/pages/ ... mal_40.htm

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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Re: Cat: broken pelvis+tail, eating+pee+poo problems, I'm sc

Postby critters » Mon Jun 20, 2011 7:16 am

There's so much stuff here it makes my eyes cross. :mrgreen: Expressing problems tend to have SO many components--HYPERtonic, HYPOtonic, experience, the critter helping (or hindering), as a small sample--that it can be difficult to sort everything out. It took me a long time to learn to express even though I "knew" the technique; learning what I was feeling was the hard part.
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Re: Cat: broken pelvis+tail, eating+pee+poo problems, I'm sc

Postby maine_coonz » Sun Jun 26, 2011 6:58 pm

Week 13: Fri.June.17: We really tried to express Raz this evening, but he was so incredibly hyper after the anaesthetic that it just wasn't worth the hassle; I will have to start my new 3-times-per-day regime (8am/4pm/12pm) tomorrow.

Week 13: Sat.June.18: Poor Raz still can't talk properly today - his usual loud chirp is a sortof muffled squawk. Added to which, he has horrible diarrhoea, which I understand can be an after-effect of anaesthesia. His castration wound is healing nicely though, no sign of any redness - although we are having to wash his butt quite a bit due to the diarrhoea, which he's being very stoic about having done.
I tried to express him by myself this morning, and after 20 mins of frustration, gave it up as a bad job. Later on Julian and I did it together, and I was somewhat alarmed to find that Raz is clearly finding the process very painful. I have read that catheterization can result in painful peeing for a couple of days, but he had no issues at all last time, so I am somewhat surprised this time round. I don't suppose a new Vet. Assistant did the anaesthetic tube and the catheter ... if so, I'm not pleased. Let them go practise on someone else's 100% healthy cat (grr). Anyway, I tried to pay special attention to getting him as empty as I possibly could, which unfortunately took rather a long time. It's weird, but his bladder is seriously 'floppy' since he came home - there's really no tone at all, and expressing him is very difficult.
He isn't his normal self at all - spent all day and night pretty much asleep. And he hasn't tried to pee by himself at all.

Week 13: Sun.June.19: Raz seems a little better today, thank goodness the diarrhoea seems to have disappeared. He is eating like a horse, but still sleeping a lot, which I guess is no bad thing. Expressing him is a whole new ball game with this weird floppy bladder which I can't get hold of. I did some web-surfing to see what I could find out, and it turns out that the anaesthetic that the Vet used was Isofluran, which has a negative effect on acetylcholine levels, the chief neurotransmitters used by the parasympathetic nervous system. And low acetylcholine can mean urinary retention (arrghghghgh!) because:
"Acetylcholine acts on the cholinergic/muscarinic receptors found on the surface of muscle cells in the bladder wall; this causes the muscle in the bladder wall to contract, and thereby the bladder to empty. Low levels of acetylcholine mean the bladder wall is much more relaxed."
Could this be the reason his bladder is so floppy? I don't know, but I'm going to assume so, primarily because I'm fresh out of other ideas. Fortunately, choline (the amino acid from which acetylcholine is made) is found in meat, egg yolks and fish oil - so I've given Raz a raw egg + a whole teaspoon of salmon oil this evening.
We have also decided to slowly ramp down the Bethanochol because (a) I don't think it's doing a #### thing and (b) he's been on it much, much too long. I will give him 5mg per day for the next two days and watch what's happening.
Raz tried to pee this evening just before expressing time, but after squatting and scratching and squatting and scratching with no results he gave up.

Week 13: Mon.June.20: Raz did two pees this morning by himself, one fairly decent one and one tiny one. His bladder was definitely slightly less flabby at the start. I think I pretty much managed to empty him, though. I gave him a ¼ tsp of salmon oil with his breakfast.
We expressed him again mid-afternoon, then at midnight. At the moment it's very easy to start him off (which is absolutely wonderful!!), but I can't really get a decent flow going, just the annoying 'fast dribble'. I have noticed that he often has a tiny bit of pointed poo hanging out of his butt, which looks to me like the anal sphincter's 'pinching' ability is not (yet) working properly.
His Bethanochol is down to ¼ tablet twice per day.

Week 13: Tue.June.21: The morning and afternoon expressing went pretty well. I would love to know if the salmon oil is having any effect. He is still on ¼ tablet Bethanochol twice per day.
I had a car accident this afternoon - parked by the bank, went in to use the ATM, and when I came out my car was half-way down the street. It turns out the hand-brake cable failed, and damaged two other cars in its journey down the street (sigh). So now I have all the fun of vast amounts of insurance paperwork, ho hum.
Expressing Raz tonight was definitely more difficult than it has been over the last few days; he was more difficult to start off, and I couldn't get the 'fast dribble' really going. Even though it means I don't get him completely empty, I've decided to call a halt after 30 minutes, partly because he gets very restive after that and partly because my arms get so tired.

Week 13: Wed.June.22: Two more 'poo presents' on the living-room floor this morning; again indicative that his pooing isn't working as well as it could.
I'm sorry to say that Raz is starting to tighten up again. Starting him off is getting increasingly harder, and the 'fast dribble' is back down to drop-by-drop. But this morning I noticed that the poor guy has some scabs on his belly (which is shaved from him recently having had an ultrasound) and it suddenly occurred to me that one reason for him struggling and squirming might be that my fingernails are digging into him (DUH!). So I rushed off to the bathroom and cut them shorter-than-short, feeling like a complete and utter idiot for not having thought of this before.
I think I will try again to contact the Handicapped Forum over here in Germany to see if a more experienced person might be up for a visit from me, just to have another 'take' on the situation, which is becoming increasingly depressing. I did register back in April, but never got an approval msg from the Moderator.
Midnight: no msg from the Sorgenfalls Forum yet, unfortunately. I spent most of the evening surfing looking for a Holistic Vet nearby, with mixed results. I can buy into acupuncture and homeopathy, but leeches ??!!
Expressing Raz was sooooo difficult this evening, I had to lean on him really hard for about 20 mins before the first drop appeared; then another 20 mins of hard squeezing to get about 60% of the pee out, drop by painful drop. We stopped well before he was empty because we were all three getting really fed up.
I am having collywobbles about reflux as well as prostatitis - this amount of pressure just cannot help harming him. It is clear we cannot continue indefinitely like this - but yet, but yet, I really feel that if we could just find a temporary solution to buy him time, all would eventually be well! I don't know what to do.
CarolC, critters: do you know of any cats that have recovered all other functions with the single exception of urine retention? Am I kidding myself that he could recover? Can you think of any temporary solution to buy him time to recover, say 3 months? I have looked into the idea of a cystostomy tube, but the surgeon will permanently suture the bladder to the abdominal wall to do this, I'm not happy about that.

Week 14: Thu.June.23: The Bethanochol is now down to ⅛ tablet twice daily, ie. 2.5mg per day. I do not see any difference in his bladder whatsoever.
Morning: expressing went very well, Raz was relaxed and just let me get on with it. Still "drop-by-drop", but at least no wriggling (I feel like such a idiot for not having thought about fingernails before now).
Afternoon: Something has changed again. Raz was up and down the trees in the garden like a monkey, doing huge leaps onto the trunks and almost running up the trees. I've seen him climbing the trees from time to time, but he's always been quite careful, eg. choosing to use the garden bench to get up onto the lowest branch and not really going high. But today was quite different. He was also running around the garden chasing his brother and generally being in very high spirits.
The neighbours came over to complain about our cats crapping in their childrens' sand box. I felt really bad, that's a horrible thing to find in there. We talked about the problem, and I offered to make our own sand box (aka "kitty crapper") in our garden, plus buying them some pepper spray for theirs, and hopefully that might solve the problem. The neighbours had some extra sand left over and offered to let us have it, so Julian and I built a small sand box with a roof - and the boys love it, they christened it immediately!
Afternoon: expressing Raz was a joy and a delight, we were all done in 15 mins. Something is definitely changing. His penis came out at the start, and (relatively) large spurts of pee arced through the air - I haven't seen that happen since the very beginning. It then reduced to the "fast dribble", but it flowed out with very little effort on my part. Please, Raz, keep this up!
Evening: I completely forgot to give Raz his Phenoxybenzamine. Expressing him was a total disaster, we gave up after 30 mins having got exactly 5 drops out of him (sigh). He fought and struggled and complained, and was generally incredibly uncooperative. Is this because he didn't get any PBZ? I gave it to him at 2am (when I remembered).

Week 14: Fri.June.24: As of today, Raz is no longer on Bethanochol; I am keeping the Phenoxybenzamine at the same 7.5mg level for the time being. His bladder feels just the same as it did when he was on the Bethanochol: firm at the start, going flabby about half-way through. I guess that means it isn't contracting as the volume of urine decreases.
Morning: a piece of cake. Again, Raz's penis came out and we got about half-a-dozen really good spurts going, then back to the "fast dribble", but it just flowed out. We were all done in 15 mins. It is still impossible to get him really empty because his bladder gets so flabby, which worries me, because it won't regain its proper tone unless I get it empty, but he gets so cross when I'm messing around for ages trying to empty it. I don't know if he's improving, or whether this is a result of no Bethanochol + a high Phenoxybenzamine dose.
Afternoon: Again a breeze. Please let this be the start of something good.
Evening: Absolutely impossible, unfortunately, Raz has clamped up again; expressing was a "drop-by-drop" exercise. After 30 mins, I had only got him about 50% empty, and gave up.
I have contacted a proper Animal Acupuncturist to see if anything more can be done.

Week 14: Sat.June.25: Today I am trying an experiment: I am giving Raz his phenoxybenzamine dose 3 times instead of twice, each dose half an hour before expressing him. Here's hoping I can find a link.
Morning: just like last night, drop by painfully slow drop. After 30 mins he was only 50% empty, and I gave up. It didn't help that Julian and I had an argument about when he is to die.
Afternoon: again, almost impossible.
Evening: yet again, seriously difficult. And that is the end of the phenoxybenzamine experiment - back to twice daily tomorrow.
The acupuncturist phoned me this evening, to say she was currently on holiday but would call me first thing on Monday morning. I have my heart in my mouth over this. If she can't help, then it's Game Over.

Week 14: Sun.June.26: Morning: Raz was very full, and his pee got going almost immediately with a few really good spurts; but when we got about halfway he started complaining very loudly, and twitched and struggled as if he was in serious pain. Julian held him down and I kept going regardless, but after the allotted 30 mins he was only half empty, and had seized up solid again - nary a drop to be seen.
Afternoon: Absolutely hopeless: after 30 mins we had managed to express about 10 drops of pee. Now I am getting worried about crystals forming because there is so much residual urine. Poor little guy, he clearly needs to pee - he dug about 5 holes in the garden this afternoon and tried to pee, but without success.
Evening: Surprisingly, Raz was not as full as I had expected, given our earlier failures. As usual, his nice, firm bladder turned into a flabby balloon after 10 minutes of massage; and after 35 mins I had managed to get exactly 6 drops of pee out of him. I could feel that he still had quite a lot left in there, but it was not going to come out. Yet another total failure.
I contacted Claudi over at Sorgenfells this evening, and (bless her heart) she has offered to take a look at Raz to see if she has any more success with him than I do. I will wait until I have spoken with the Acupuncturist tomorrow morning before getting back to her.
Should I put Raz back on the Bethanochol? Is this what's making him impossible to express? But he's been on it way longer than is normally recommended. What to do !?!?!?
Erasmus (Raz) + Euclid + Heimdall,
Living in Germany
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Re: Cat: broken pelvis+tail, eating+pee+poo problems, I'm sc

Postby CarolC » Sun Jun 26, 2011 11:27 pm

I can only think of two other people who had/have this situation of a cat so difficult to express. One ended up doing surgery and the other has provided 30-minute expressing sessions for years now. I don't think either of them tried Prazosin, I've only heard of it for this recently. This study says it is more reliable than PBZ. I would be glad (truly would, I would love to) to send a donation for Raz to try that medication, (just need your Paypal address and tell me how much the vet says it would be).

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC227024/

For what it's worth, I spent the price of a new car on my cat over the holidays for a blocked ureter and lost her in the end :cry: when everything else about her was fine , I don't think I'll ever be the same and I don't want you to have to quit before you've tried everything. I don't want you to look back and think, maybe such and such would have worked.

Did you ever try the technique of warming him, as Jean suggests?

On the floppy bladder, the bladder will not necessarily reform itself promptly after it is partly expressed, it can take longer. BethT used to express her dog Waffles (into a pail) while watching TV, then express again 30 minutes later. The express-rest-express technique is based on how long it takes for the bladder to reform, 5 minutes may not do it. I think if you find yourself dealing with a floppy bladder and getting nowhere, I would quit right then and try again in 30 minutes or whatever. Sometimes on the first express of the day I do not get Katie completely empty, but if I don't get it all at 7 am I know I have another chance at 11:30am and we get it all then, that is part of the beauty of expressing 3-4 times a day, it takes the pressure off so each individual expressing session isn't so high-stakes. There are times when I just have to say, "I think we can live with that", knowing that that time we did not get completely empty but I'm not going to stress about it.

I pray this works out for you, the only thing I know for sure is, healing is occurring a tiny bit more every day even if he looks much the same. It is hard to put it into words but I noticed with my dog the tiniest increment of improvement could have far-reaching effects, it's kind of a binary off/on can't/can situation. That slight bit of improvement that seems like nothing turns out to be the difference between can't and can for function X or Y or Z. All of a sudden your pet can do something you didn't dream, how did this happen? The truth is the nerves had been healing a tiny bit at a time for weeks or months in the background where you couldn't see it till all of a sudden you notice your pet doing something new and exciting, where did that come from?! I wonder if e-stim would do anything for him, I don't think I've heard of it used for a tail injury but I don't know why not.

I am so sorry you are going through this. Claudi seems nice and her cat does not pee a strong stream either, I hope she can help.

:angel:

P.S. Rereading your post one more time, there are some cats who will behave as if scruffed (ie. hold still and cooperate) if you attach clothespins (spring loaded clothespegs) to the scruff of their neck. Here is a link demonstrating it (for a cat receiving fluid therapy). It may be too much to hope for that Raz is such a cat but you won't know unless you try.

http://www.felinecrf.org/giving_sub-qs_ ... _peg_trick

Thanks for the information on the affect of anaesthesia.
CarolC
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