It’s been a little over a month, and I need to update my account of Shadow’s perineal urethrostomy (feline P.U. surgery). Rather than tack on to the first post I made, I decided to go ahead and begin fresh here in a new entry. I’ve already gotten a few comments from readers who have gone through the same ordeal (or are going through it right now – good luck, Alli!), so I feel like it’s important to continue keeping an accurate account of the details.
We left off on 3.7.15, when Dr. Sykes pretty much performed a second, larger, p.u. Our goal was to get Shadow to leave the catheter in for a minimum of two weeks, and for hopefully an entire month.
I began Googling furiously, trying to figure out some way to prevent Shadow from removing the catheter. I knew of the existence of the “soft, floppy cone,” but when I looked into those I knew it wouldn’t stop him — he’d just crush it and go straight for the cath. It was when I was reading some threads on Reddit that I became aware of the “doughnut” – an inflatable pillow that wraps around the cat’s neck, immobilizing his head. Petsmart does not carry them, but fortunately, Petco does! And we have a new one in town! I headed over there right away and purchased their XS doughnut, rationalizing that it was the one recommended for cats, plus Shadow is a very small cat. Wrong. It was laughably small and did nothing. I returned it immediately and went for the S. Honestly, if you have a full size (10lbs+ cat), you may actually want to opt for the M.
Although the S was much better, I still didn’t quite trust it. I watched Shadow for at least an hour before he finally tried to go for the cath. He got really, really close – enough to scare me. So I took the next step, which is what the original Reddit post recommended – combine the cone and the doughnut. What do you know, that was the winning combination!!! It took Shadow just a little bit of time to get used to it, but the doughnut prevented him from getting the cone close enough to the catheter to mess with it. Success!!
3.11.15 – From my Facebook status, “Shadow is running around like a damn crackhead, eating everything in sight, trying to play with the laser, and repeatedly raising up on the cat trees to sharpen his claws. It feels great to see him acting so well, but I think I need to crate him for his own good!”
When I wasn’t working, I would let Shadow stay out of the crate because at this point, he was urinating through the catheter and it wasn’t dripping incessantly. I still kept my couches covered with spare blankets just in case, but it wasn’t really a big deal.
CB and I tried to give him as much lap time as possible, wherein we’d remove the cone and doughnut. While the doughnut seemed to be pretty comfy, the combination of the two definitely was not. It was important to us that he be allowed to feel “normal” when we could devote 100% attention to him. He LOVES being swaddled in “The Buddy Blanket,” which is what we call a really fuzzy blanket my mom gave me for Christmas this year. We often wrap him in it and sit him on our lap, and he’ll cuddle there for a few hours (spoiler alert: we are doing that at this very moment!).
3.20.15 – The catheter stayed in for two weeks!!! I took Shadow in for a recheck, and Dr. Sykes went ahead and pulled it because it had gotten so dirty. I had bought Burt’s Bees cat cleaning wipes, but Shadow would throw a fit any time I’d try to wipe him up. It was exceedingly hard to keep him clean and Dr. Sykes was worried about hygiene.
3.23.15 – Alas, things were not to stay perfectly happy. On this day, I saw Shadow squat 3 times in 15 minutes. He peed each time, but the frequency combined with him licking his crotch a lot worried me. I ultimately decided to be better safe than sorry and ran him back to the vet at about 7pm. I had to work the next day, and I couldn’t fathom leaving him home with a possibly full bladder all day.
Fortunately, his bladder was small, so he was definitely urinating. The opening to his new urethra was all bloody, so the vet (Dr. Edwards this time) ran a basic urinalysis. His urine was clean. The verdict? Overgrooming! Buddy was so ecstatic to be able to clean his crotch that he’d licked it raw. She rubbed some steroid cream on him told me to put the cone back on him again for a few days to discourage him from licking. I actually put the doughnut on him because I think it’s more comfortable.
3.25.15 – Shadow was still squatting and straining frequently. I did not feel like things were right. We went back to the vet, and he saw Dr. Sykes. Once again, his bladder was small. Dr. Sykes told me that the frequent urination might be Shadow’s “new normal” because things have been off for so long and he’s kind of forgotten how to urinate regularly. Although the urinalysis on Monday came back clean, he went ahead and prescribed a liquid antibiotic, Veraflox, in case Shadow had developed a UTI that was causing burning. He reassured me that Shadow was fine, and told me to bring him back if he starts acting sick… you know, vomiting, not wanting food, etc.
Shadow spent the next few weeks alternating between frequently urinating/straining and acting perfectly normal. He would run and wrestle with Sky, climb on the cat trees, chase the laser, and so forth. However, he began to urinate inappropriately… on the floor, on the furniture, on a blanket, etc. I was reassured that urine was coming out, but I still felt like something was off. It also seemed like the straining became more frequent as time went on, even after he’d finished the course of antibiotics. I began to worry that he would prolapse his rectum, he was straining so hard. I put him back on Buprenorpherine for pain, figuring everything might still be irritated.
4.5.15, Easter Sunday – (from my Facebook account) I woke up this morning to find Shadow laying in a pool of his own vomit, crying and very weak. I got CB up and we took him to the emergency vet. He had completely closed up. The opening for him to pee out of was gone. We thought we were going to have to euthanize him, as sick as he was. The evet called his normal surgeon, Dr. Sykes, and they told us that they felt that if they could pass a catheter, he stood a good chance of fully recovering with a different strategy upon catheter removal. The evet, Dr. Amanda, worked at the surgery site with warm, wet gauze and opened it back up – it had scabbed over. Shadow geysered into her face. She came back to update us, and to ask if we wanted to proceed with the procedure. His bladder was still quite large although urine had already escaped.
CB and I debated but ultimately decided to go ahead and try, since the vet thought it was such a good chance.
She and her preceptor (vet student from Auburn, named Amber) worked on him for a long time before she came out to tell us that they could not get the catheter inserted. We were heartbroken. She told us we could take him home to let him pass naturally, or we could euthanize him. We made the decision to euthanize so he would not suffer. She stood up to go to the back to bring him out for us to hold him and say our goodbyes, when just like in a damn soap opera, Amber burst into the waiting room to announce she got the catheter in.
Dr. Amanda rushed back and a few minutes later Amber came out to tell us that he had a good urine flow and Dr. Amanda was stitching the cath into him. It was such a quick turnaround we could barely process it. We had came to the resolution to say our goodbyes and suddenly he was “fine.”
Apparently he has formed something that sounded like a “diverticulum” (it was a Latin word that sounded like “diversion”). Basically, there is a false entrance to his bladder that dead ends. Amber managed to work the catheter around that dead end and down the correct path. The flow is quite good.
Dr. Sykes has been saying the issue is not physical – there is a good pathway. What Dr. Amanda thinks happened is this: she theorizes that Shadow inflames easily. He was quite inflamed the last time Dr. Hill checked him out. Normally when a cath is pulled, all is well. She thinks the process inflames Shadow, which causes him to close. Then he stresses and strains and clamps and all of that basically just inflames him more. Most cats do not have this issue. Basically EVERYTHING that can go wrong with this PU procedure has gone wrong. Dr. Amanda says that this is incredibly rare and freaky and that most cats recover normally – and that Shadow still can.
I am meeting with Dr. Sykes on Tuesday to develop a game plan. What Dr. Amanda recommended is switching him from Prazosin (the urethra relaxer) to a different kind of urethra relaxer. There are several, and Prazosin is just the most common. We need to find one that works better for Shadow. She also thinks he should be put on an anti-inflammatory. The reason he wasn’t is that they are not at all common in cats and there are like 2 that are approved, and only for limited use. She says she has seen very good effects in using some NSAIDS off-label, and has several patients that do well on them. Since Prazosin and Amitriptyline are off-label anyway, using something else like that doesn’t scare me.
For now, he should be ok – the catheter is back in, and will remain in for at least another two weeks, maybe longer. CB has not let go of him since they brought him out to recover. We brought him home, and he is still resting in his arms, bundled up in his favorite blanket. Once he wakes up, it’s back to the cone and doughnut for our little buddy.
Please rest assured that he is not in pain and we are not torturing him. This morning is the first time his bladder has ever been full and he has shown distress. Yesterday he was even chasing the laser. The day before, he was wrestling vigorously with Sky. If we think that we are at a point where his quality of life is significantly degraded, or that we’re just torturing him, we will make the hard decision we already made once today.
later that day
Shadow did not really wake up. We have been back at the vet since 2:30. Heart rate and temp are normal, but he is severely dehydrated. They think his electrolytes are messed up but he is too dehydrated to get blood out of. We are waiting while he rehydrates. My poor buddy. This has been the worst Easter ever.
late that evening
He was severely dehydrated. The vet has been pushing fluids. She managed to get bloodwork, which revealed kidney issues – but it can also be showing that due to the dehydration. They are keeping him tonight and will recheck his blood work in the morning. I am worried he won’t make it through the night. Dr. Amanda is clearly worried, also. She said she may just sit with him all night. She will call me immediately if anything happens. My phone will be on and I will be listening for it to ring all night.
(from my memory) Shadow looked terrible. He was panting, but his heart rate was normal. His body temperature was on the low end of normal and it took several hours for them to get it up. He was so severely dehydrated that they couldn’t get blood from him very easily. They wound up shaving both of his front legs and his jaw in an attempt to draw it from various veins and from his jugular. He was high on valium during all of this, but he still felt enough to thrash about some when they were poking him. When Dr. Amanda finally got enough blood, the stupid machine was broken! A tech had to come in to fix it, and by that time the blood had clotted and they had to go through the whole process again. Finally, they got an IV cath in him and began giving him fluids intravenously (they had already been giving them subcutaneously).
At one point, they moved him into the “bear hugger,” which was a rather alarming-looking contraption. It was basically a giant pillowcase with a blowdryer attached… it inflated with circulating warm air, and Shadow was wrapped in the middle of it. His little head was sticking out and he’d sometimes open his eyes to look at me, but he was not very responsive. I had to leave him like that and I was terrified it was going to be the last time I would see him.
4.6.15 – (from my Facebook account) Some blood work is still elevated but it has all dropped significantly. Dr. Amanda said he was 100x better today – “a totally different cat.” A few levels are still high, but she “wouldn’t be surprised if they totally dropped” since they already came down so much. Happy day!! Now, time for cuddles because I just brought my boy home!!
Right after I posted that, I wrapped Shadow in the buddy blanket and sat him on my chest. He began purring like mad, and kept stretching his face up to meet mine to nuzzle me. He’d also periodically reach out and touch my face with his paws. It was insanely adorable. We stayed like that for several hours.
4.7.15 – I had picked Shadow up on Monday, which is Dr. Sykes’s day off, so I made an appointment to see him on Tuesday right after I got off of work. I brought copies of Shadow’s file from the evet, as well as copies of all the bloodwork. Dr. Sykes reviewed the files, then surprised me by saying he wanted to pull the cath Dr. Amanda had inserted and “go exploring” to see what the problem was. He suggested leaving Shadow there that night, since it was quite late in the day, and he’d work on him on Wednesday. We discussed it for a few moments before deciding that I would drop Shadow off on Wednesday night (because they’re not open by the time I have to leave for work in the morning), and he would work on him on Thursday.
Nothing in the notes told the story of the difficulty cathing Shadow, so I filled Dr. Sykes in on the details. He became indignant and said “Do not ever put this cat down because a catheter cannot be ran! He is MY patient and that is MY decision and I AM NOT giving up on him!! If anyone ever suggests that again, you have them CALL ME IMMEDIATELY!” It was quite surprising and also quite heartening. He says that it is a point of pride now for Shadow to recover fully… that this is “the best, most perfect p.u. he’s ever done… and the only one with complications… so he’s going to get it right!!”
4.9.15 – Dr. Sykes called to tell me that he had successfully gone exploring. He was flabbergasted that Dr. Amanda had such a hard time getting the catheter inserted, because it “slid right on in” for him. He said he even took a much larger catheter and inserted it with no problems. He went ahead and made the opening slightly bigger, and stitched the “Slippery Sam” model cath (the flexible, more comfortable one that Shadow had previously kept in for two weeks) in to him. This time, he said, we were going for the whole month. He is still trying to determine if the issue is physical (the hole closing) or neurological (Shadow’s bladder and urethra not communicating well with each other). He wanted to keep Shadow for a few days for observation since he had come so close to death on Easter. He told me he had an IV catheter in him and was giving him fluids as a precaution since he did not recover very well from the last sedation.
4.10.15 – I visited Shadow! He was SUPER happy to see me and it was difficult to leave him. He was still receiving IV fluids.
4.11.15 – Shadow came home!
4.12.15 – Shadow is still straining. When I go to wipe his bum down really well, I see that one side of the catheter has come loose. SHIT! It’s pretty late at night, and it’s Sunday, so I figure I’ll take him in tomorrow and have them restitch that side. Dr. Sykes is off Monday’s, but I figure someone else will do it.
4.13.15 – I wake up at 6am to see the catheter is completely detached and is protruding about a centimeter. Shit shit shit!!! I can’t be late to work because it’s my first day on a new project, so in desperation I call my Mom, who is on her first day of a week of vacation. She agrees to come get Shadow and take him to the vet right as they open. I put him in his carrier, confident that he can’t turn his head in there with the doughnut+cone on. I figure they’ll be able to stitch the catheter back in.
….yeah, no. By the time Mom got him to the vet’s office 2 hours later, he had already managed to get the damn thing out. It was laying under him in the carrier! This time Dr. Neal takes care of him. Apparently, she came out into the waiting room and told Mom, “I don’t know how the hell he did that!!!” Me neither, cuz he was wearing the damn cone and the doughnut just like last time!!! The stitches were even still knotted! He must have somehow just ripped them out of his skin.
My mom relays via text messages that they are all out of the Slippery Sam catheters and just have the large, rigid “Tomcat” catheters. Since it’s going to be in long-term, they don’t want to put one of those in Shadow. They want to observe him all day and sedate and insert a new Slippery Sam tomorrow. I am relieved that he is being monitored.
Later that afternoon, I received a call from Dr. Neal. She wanted my permission to go ahead and sedate Shadow and insert a Tomcat cath. He had been straining frequently in the box, and she called Dr. Sykes and they decided that would be the best course of action. I give my consent, but tell her how Dr. Sykes had the Slippery Sam attached that Shadow managed to keep in for two weeks… he had a piece of surgical tape across it, a hole cut in the tape for the cath to protrude from. The tape was sutured to Shadow instead of the actual catheter, which was able to protrude slightly. Dr. Neal says she will attach it in four different places to make sure he manages to keep it in.
When I get off work, I go visit. Shadow is coming out of sedation and is adorable.
4.14.15 – Shadow comes home. He is wearing a ridiculously giant cone. Like, it’s so bad he can barely walk in it… it drags on the floor and weighs his head down. He started off in a size 10, spent the bulk of this time in a size 12.5, and is now wearing a 15!!! RIDONK!
4.15.15 – I watch Shadow strain in the litter box. Straining with the cath is futile, because it’s all coming out. He’s just doing so because it’s irritated. Poor guy. I feel so bad for him. WAIT A MINUTE WHAT THE HELL I notice as he strains and heaves his little butt, the cath pops off!!!
I threw that damn cat in his carrier and floored it to the vet’s office. I’d just gotten out of the shower, it was 9pm, and I had soaking wet hair and was wearing my pajamas. Whatever. He wasn’t getting this sucker out!!
Dr. Johnson was the vet at the clinic tonight. He explained that luckily, only one side had come undone. I told him exactly how it had happened. Apparently my cat has amazing glutes, and he’s been popping those suckers off. That’s why the only one that stayed with any success was the one that had wiggle room! Dr. Johnson numbed Shadow up and gave him something to make him a bit woozy (but not full sedation) and stitched the Tomcat cath back to him. This time, he used half-inch stitches and gave them some slack. He showed me that the catheter had room to pulse in and out of Shadow while he strains. He also recommended that after I wipe Shadow’s bum down, that I put some diaper rash ointment on it to help protect it from the urine. I’m a damn mom and this is my baby.
Oh yeah, and Dr. Johnson also laughingly tells me that they’re all making bets on Shadow… whose cath will stay in him the longest?
I can tell you one thing. Since we know how he’s getting the caths out now, he’s going back to the smaller cone. No sense torturing him with this giant monstrosity when the 12.5 is perfectly fine for keeping the cath in (as evidenced by how he kept the slack one Dr. Sykes inserted for 2 weeks without issue). At least now he can turn around in bed without banging his head on all 4 walls of the crate.
4.19.15 – I dread weekends now. Do you know why? Because the vet’s office is closed at noon on Saturday, and doesn’t reopen until Monday morning. And emergency vet care is not always covered as “continuing care,” unfortunately (Easter was expensive, but worth every penny). I watched Shadow carefully all weekend, checking the catheter frequently. He has actually stayed on my lap the entire time I’ve written this post, swaddled in the buddy blanket. He just jumped down and asked for more food, so I fed him. He’s voracious! The vets have all told me to let him eat as many calories as he would like, so I feed him about 4 times a day (morning, when I get home from work, dinner time, and snack right before I go to bed).
I hesitate to type this because I may jinx myself, but so far, so good. I think we’ve finally realized how the caths are coming out and we’ve got a strategy to prevent it.
Still, I think I am going to take him back to the vet tomorrow evening when I get off work. Dr. Sykes is off tomorrow, but I want him to check Shadow out on Tuesday. I don’t think he should still be straining like this. Also, it’s normal for urine to be bloody after having a cath inserted… but Shadow’s went from bloody to yellow to back to bloody again. He’s also squatting more frequently. I suspect he has finally gotten a UTI (and no wonder, after having 3 caths inserted in less than two weeks). I know the game plan is to leave the cath in for a month and then culture it to see if he needs to be on a specific antibiotic, but I fear he’s in some discomfort now. And I don’t want him to feel pain while he pees for the next 3 weeks. I am hoping he’ll be put on an antibiotic that will alleviate that.
Also, it’s exceedingly hard to keep his bum clean, especially right underneath the cath and around the stitches. He screams and fights and CB has difficulty restraining him while I wipe him down. And frankly, I’m afraid to be aggressive in doing so because I’m afraid I’ll pop the cath myself when he thrashes. I’m going to ask if they can give his bum a good cleaning while he’s there. I feel kind of guilty about that (like I’m being a terrible mom because I can’t keep it super clean), but I think it’s better for me to ask for help now before it gets too dirty. Hopefully it won’t be a problem. I don’t want to treat them like groomers when they are medical professionals, but I don’t really know what else to do.
My mom’s been perfecting a dog biscuit recipe and she just bought a set of cute dog cookie cutters. She’s offered to make a batch for me to deliver, and I think I’m going to use the cutters to bake some sugar cookies or shortbread cookies and take the whole lot to the vet’s office. If I’m going to be a pain in the ass (or a neurotic cat mom that is constantly there), maybe cookies will help soften the blow.