Tuesday , 12 December 2017

Dr. Amanda Glew: Deblocking Male Cats (and other mammals)

Deblocking male cats and other mammals – by Dr. Amanda Glew 

The other day we had a male cat come in with the typical complaint of constipation. This is usually an indication of a urinary blockage- where crystals and mucous form a plug. The male cat’s penis is very small diameter, so that it blocks, and as a result the urinary bladder enlarges. The enlarged bladder causes the cat to go to the litter box frequently to strain, giving the appearance of “constipation.”

When I first graduated, this was such a common problem that I became quite proficient at doing male cat sex changes- removing the penis and basically making it open like a females opening- which is wider. This procedure, a urethrostomy, is rarely done nowadays with the advent of better diets. But there are still some diets out there that don’t help, and we get blockages.

When we have a urinary blockage, you must anesthetize the animal, which is tricky because kidney function is often affected. You then must attempt to pass a very small urinary catheter- even smaller than a darning needle.

Sometimes it deblocks quickly, sometimes it takes an hour. Once in place, you flush the bladder to reduce the chance of reblocking- the solution to pollution is dilution! This is also time consuming. Once that is all done, you leave the catheter in place, and if the urine runs clear the next day, you remove it, waiting with baited breath until the cat urinates on his own. This is usually a very exciting moment in the day at a veterinary clinic. Woops of joy can be heard as technicians exclaim “ Mr. Whiskers peed!” Clients often look confused. Sometimes, the cat bladder has been so stretched that it no longer contracts, and the cat cannot urinate just because of atony. This is frustrating as it requires daily bladder emptying, more medication, and therefore more cost to the client. This is why we have learned to give a large range in quotes- and hope that is a simple case.

Thankfully, having dealt with urinary issues over the last 26 years of practice, I have become quite comfortable at dealing with them. So when my father developed bladder atony from a prostate condition, and we opted for a permanent catheter going directly into his bladder, the understanding of what we call his “water works” was there.

There are still complications from this salvage procedure. Unfortunately, these were not really properly explained to my mother. It does not guarantee continence- at the beginning, he still felt the urge to urinate. When he gets a urinary tract infection, which he does quite frequently, he has the urge to use the old appendage, and becomes incontinent. Worse of all, if the infection is not caught early enough, his Foley catheter gets blocked with sludge- not unlike a male cat!

The other day upon the return from respite care, my mom noticed him to be urine drenched. When she called me to say that she thought the care facility had forgotten to empty his sac, that is why he was incontinent again, I quickly realized things were not right. Sure enough, upon examination, his permanent catheter was completely blocked. On palpation of his bladder, there was at least a liter of fluids. Of course he needed to go! But he could not, and with his Alzheimers, could not logically work through what was happening.

Being a Sunday night, knowing a trip to the emergency clinic would be futile- I set about deblocking my father- I flushed his catheter, placed another catheter in his dysfunctional appendage and flushed his bladder, all the time my father asking what I was doing. “I am treating you like a big cat dad, I am just deblocking you”. Fortunately, the procedure worked and my mom reported good urine production the next day. Never in my life would I have thought that I would be called into handling issues such as these, on my own father. But life has a funny way of challenging you, doesn’t it?

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