In early August a rescue group arrived at the Gateway Animal Clinic with a big 18 pound neutered male cat that had been returned from a foster care owner due to a persistent urinary tract problem. Mr. Bobtail was suffering from chronic recurring cystitis and urinary blockage.
This sort of condition is all too common in male cats. Essentially the metabolism of the cat allows for the creation of sand like crystals within the urine. As the cat urinates these crystals proceed down the urinary outflow track and through the penis into the litter box (hopefully!).
All too often these crystals begin to collect and form larger urinary stones. A combination of crystals, irritated bladder secretions (mucous and blood) and stones can become larger in diameter than the pathway within the cat’s penis (urethra). As the cat tries to express the urine and sediments the animal literally becomes blocked.
As the kidneys continue to function the blockage creates a complete distention of the bladder. Mr. Bobtail’s bladder was as big as baseball when he arrived at the clinic. Once the bladder reaches this sort of crisis size, back pressure on the kidneys causes them to shut down. At this point any cat is in critical condition.
A “blocked” cat is a clinical emergency. These situations cannot wait until the next day. Immediate relief of the obstruction is necessary to re-start kidney function and begin reversing the metabolic impact of the obstruction related kidney failure.
Anesthesia and the placement of a catheter (small plastic tube) into the urethra of the cat and up into the bladder is the first step. As for Mr. Bobtail we accomplished this with some difficulty. The long term collection of sand and stone material within his urinary tract has led to a dense obstructive mass of debris. After finally getting the catheter in and urine flow resumed, we took a radiograph.
Unfortunately our suspicions were confirmed. Mr. Bobtail had not only developed a thick collection of crystals, but a large number of stones had formed. Most of these stones were way too large to ever pass through his normal urinary tract. The stones are visible on the radiograph as a collection like a bunch of grapes in the bladder.
It is important at this point for the readers to understand the implications of Mr. B’s clinical condition. Here, in a nutshell, were his medical problems:
- Short term kidney failure – reversible with fluid treatment over the next few days.
- The catheter was literally his life line- if he pulls out his catheter, he goes right back to being obstructed.
- A surgical perineal urethrostomy will provide him with a long term solution to allowing him to pass the smaller urinary crystals.
- Long term kidney/urinary formula special diets are a must for his long term kidney health.
- A bladder surgery will be necessary to remove the larger stones. Attempting to dissolve the stones with dietary measures is not a quick fix type solution.
- The financial costs to implement two surgeries and a prolonged hospital stay were way beyond the budget of the rescue group.
Scenarios like Mr. Bobtail’s are not uncommon. Catastrophic surgical and medical problems complicated by financial reality. Many veterinary institutions refer cases of this complexity to specialty facilities. There is always the sad reality that complicated cases with this magnitude of problems lead the owners to choose euthanasia as the only alternative.
Through a cooperative effort with the entire staff of Gateway Animal Clinic (greater than 50% fee reduction), Project Noah ($300 support), the rescue group and an anonymous donor ($600), a financial cap was placed on the entire surgical and medical therapy needed.
The Healing Process:
First step: We performed a perineal urethrostomy on August 5th. During the surgery the surgeon noted that the entire floor of the pelvis and the out flow tract were dramatically scarred down. Considerable fibrosis made the surgical loosening and repositioning of Mr. B’s urinary tract a bit more complex. Mr. Bobtail had suffered a car injury two years ago. His tail had been pulled from the vertebrae so it was removed, thus providing him with his name. It was that previous injury that led to the fibrosis and scar tissue in the pelvic canal.
To make matters worse, prolonged irritation from crystals and stones jammed against the urethral tissues made surgically suturing these tender tissues to the skin a real concern relative to post-op healing.
Second step: post-op pain management and healing. Mr. Bobtail proved to be a remarkable patient, the kind every surgeon dreams about. He was eating and acting totally unphased by his surgical restructuring the day after surgery. When I visited his cage the day after surgery he demanded his usual head rub, but quickly returned to munching some canned C/D.
Third step: Ten days later we performed a cystotomy (bladder surgery with stone removal/ the stones are visible on the surgical drape along with the specialized surgical stone spoon removal device!).
Fourth step: Again he was dream patient. By the next day he was his old hungry for food and personal recognition self. A week later he was feeling good enough to be a little tired of being in a cage… he expressed his displeasure of being confined with a series of well rehearsed tragic facial expressions and when that didn’t work he let out some powerful meow while head butting the cage door. The staff succumbed to his charm and gave him free roaming privileges before we opened and during the evenings.
Fifth step: Pain management and antibiotic therapy were discontinued after four long weeks of intensive therapy and care. Mr. Bobtail is currently recuperating and urinating a nice big stream, back in the custody of his rescue group. He will need a consistent diet of Hill’s C/D to minimize bladder infections. However with the success of the surgery he will pass any of the small crystals that may form before they can develop into stones.
Epilogue: The challenges that complicate the medical and surgical aspects of the management of this cat’s case are mind boggling. Money is always an issue. The veterinary profession can do marvelous things in this day and age but everything costs money. Time is money, skills are money.
Often the process is so daunting the system fails and the cat is mercifully put to rest. Thanks to the collaborative efforts of all involved, the mercy extended to Mr. Bobtail extended beyond euthanasia to a new lease of life. He was a remarkable patient. He is a really amazing cat. On behalf of all of us, thanks to everyone involved and for Project Noah for caring and working hard enough to make the world a little more humane than it was before we collaborated in saving the life a really cool cat.