Help Edmund pee!
February 4, 2012 1:43 PM   Subscribe

My cat had a blocked urethra Wendesay. Three trips to the vet later, it is now Saturday. How do I tell if the situation is dire again?

Wednesday evening, Edmund sat in the litter box for half an hour trying to pee, unsuccessfully. Off we went to the emergency vet. It turned out his urethra was blocked. They unblocked it and gave him a load of subcutaneous fluids (and some painkillers). Thursday afternoon he seemed, um, broken, so off we went to the vet, again. They gave him more fluids and more painkillers and some muscle relaxant and said bring him back if he stops eating or drinking. Lo and behold, Friday morning he refused to eat the food we got at the emergency vet. There were normal-sized clumps in the litter box, but he dribbled urine in various locations around the department Friday morning as well. However, when we got to the vet, his bladder was a fairly normal size and he wasn't blocked again. So, new food and more fluids. This morning, there were again normal size clumps in the litter box and some smaller, but not tiny, clumps. But he still did a bit of urine-dribbling this morning and when he was in the litter box just now, he produced what seemed like a non-trivial amount of urine, but in drips, rather than a stream.

Is this normal? From what the regular vet said, it sounds like his urethra is still upset from the catheter Wednesday evening and the dripping is normal. But, well, I've got my oral exam/dissertation proposal/qualifying exam/whatever you call it on Monday and I'm transferring stress about that onto Edmund. Please give me criteria to use to attempt to act rationally.
posted by hoyland to Pets & Animals (11 answers total) 1 user marked this as a favorite
When this happened with my cat, the vet showed me how to feel the cat's bladder, so I could check if it was swollen too large... Can you get them to do this? As long as he's at least dribbling, he's not totally blocked, so I would not panic, (although I would worry, because it means he's not 100% well), but the main worry (so I gathered) is that if it's totally blocked, the bladder can rupture. So you keep an eye and make sure he's passing at least a little, or feel his bladder to make sure it's not too big and hard, and just give him a chance to get better, while being ready to take him in to the vet if he does become blocked again.
posted by The otter lady at 1:52 PM on February 4, 2012

Response by poster: The vet did show me how to feel his bladder, but, of course, I have no real idea of what's normal or acceptable. (Like an idiot, I didn't feel it at the time, when it was empty, but perhaps there would have been nothing to feel.)
posted by hoyland at 1:59 PM on February 4, 2012

IANAV, IANYV, etc. Did the vet keep him hospitalized for at least a day with a urinary catheter in place? Is he on phenoxybenzamine? If not, I would be asking the vet why not. Phenoxybenzamine for 5-10 days post-blockage, long-term stress reduction (Feliway, environmental enhancement) and often long-term amitripyline, in addition to an all-canned food diet are how the feline practitioners tend to recommend treating this problem these days. There is a lot of good information here (follow the links at the right for additional information). That said, if in doubt, I would take him in, a urethral obstruction is life threatening, and generally speaking, if the owner thinks something isn't right, something often isn't right.
posted by biscotti at 2:27 PM on February 4, 2012 [2 favorites]

If he is partially blocked, I would say he still needs to be seen asap - partial obstructions can become complete obstructions very quickly.
posted by biscotti at 2:28 PM on February 4, 2012

Vet student, but I'm not your veterinarian. I have worked in an emergency setting, and have seen quite a few blocked cats.

The treatment protocol I am most familiar with involves keeping the cat catheterized for 12-48 hours while administering IV fluids, pain medications, antibiotics, sometimes benzodiazepines for anxiety and an antispasmodic (phenoxybenzamine) to prevent the urethra from contracting. The catheter is removed and its urine production is monitored for several hours before the cat is sent home.

The biggest danger in a blocked cat isn't necessarily the bladder rupturing, but the metabolic derangement that results from the accumulation of nitrogenous waste (azotemia) and hyperkalemia (high concentration of calcium). This can kill your kitty, and it is why a blocked cat is an emergency.

If Edmund is still not urinating normally, he may become blocked again. If your first, second or third vet didn't insist on hospitalizing him, perhaps you should go to a different vet.
posted by Seppaku at 2:34 PM on February 4, 2012 [1 favorite]

Response by poster: Further information...

What the emergency vet did: placed a catheter (removing blockage in the process), flushed his bladder/urethra repeatedly. They noted they suspected urethral spasms because it was easy to get the catheter in, but they didn't get a good flow out right away. They sent him home with buprenorphine.

What the regular vet did: Thursday evening--expressed his bladder (said he wasn't happy about this), thought the difficulty urinating was probably due to the urethra continuing to spasm, sent him home with acepromazine and prazosin. The acepromazine is in pill form and he's doing a good job of spitting it out, getting the tablet wet in the process so it just smears on my fingers. Friday--said he wasn't blocked, pretty much, and different food.

All three occasions involved giving him subcutaneous fluids.
posted by hoyland at 3:04 PM on February 4, 2012

It sounds like you have communicated with your vet and explained Edmund's current state and that the vet doesn't feel the need to see him. If I'm misreading this, please go ahead and call the vet and get his read on the situation. All vets I've dealt with have been very cautious and always want to see the animal again if there is any chance of an issue. So I think you did your due diligence there.

For the bladder feel: It's pretty much just like you'd imagine: A full bladder feels like a full, taut balloon in the spot your vet showed you. If it feels slack in there the bladder isn't full. I've just subjected both my cats to a feel up to confirm since one goes kind of tense when you prod him and one stays floppy and in both cases it's pretty distinctive.

I know you didn't ask about this but I hate it when I have to deal with the spit out pills so in sympathy I want to help. My preferred pill method is to pry open the mouth and toss the pill into the deepest part of the throat so it's basically half swallowed and immediately clamp the mouth shut while massaging the larynx. You'll feel the big "GULP" when the pill goes down. Be fast and decisive and it will be over before the cat even realizes what is going on. I'd also recommend trimming the claws first to reduce the amount of flaying your cat will give you as you handle his mouth.
posted by tinamonster at 3:40 PM on February 4, 2012

I'm sorry to hear about your cat I hope he feels better soon. If you're having problems with the pills you should try pill pockets. They're like treats you can put the pill inside and my usually pill spitting, sneaky cat goes nuts for them and it makes giving him medicine much easier.
posted by SpaceWarp13 at 4:24 PM on February 4, 2012

IANAV. I have, however, had to rush two blocked cats to the vet over the years. I'm surprised they didn't keep him at least overnight and keep the catheter in while hospitalized, like Seppaku mentioned. There's all sorts of things that go go wrong after they clear the bloackage and most vets like to keep an eye on them and keep them medicated for a day or two.
posted by azpenguin at 4:26 PM on February 4, 2012

Try coating the pills with butter, that usually works well. And just MHO, and I suggest you do your own research and make up your own mind, but if this were my cat, I might be seeking another vet's input, ideally a feline specialist.
posted by biscotti at 5:16 PM on February 4, 2012 [1 favorite]

Ugh, hyperkalemia == high concentration of potassium.

"They noted they suspected urethral spasms because it was easy to get the catheter in, but they didn't get a good flow out right away."

Did any of the vets take xrays? Did they perform a urinalysis? If there are stones or particulates, they might show up on a radiograph or in gross examination of the urine. They could also repeatedly plug the urethra, resulting in continued symptoms after treatment.

I would also be concerned that the prazocin isn't preventing urethral spasms if he is still having difficulty urinating.

If Edmund was my kitty, I would take him seen by a vet. At the least, he's still uncomfortable. At the worst, his life is in danger.
posted by Seppaku at 5:28 PM on February 4, 2012

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