Cystotomy Complications

I have been reading through the forums the past few days and have found a lot of good information. My wife and I just got back from the emergency vet. That is the same place where our journey began last Wednesday night at midnight. We're afraid of the situation we find ourselves in and we appreciate anyone's williness to read this and offer advice.

Abbi is a gray, 11 lb. domestic shorthair cat that we got 4.5 years ago as a kitten from the SPCA. She and her brother, AJ, have not had any history of medical issues. Last Wednesday night, Abbi started behaving very strangely. She was wandering the house trying to pee (unsuccessfully). She also vomited and was clearly very uncomfortable. We eventually ended up at the emergency vet where the doctor took an x-ray and quickly found two bladder stones. He expressed her bladder. We transferred her in the morning to our normal vet. She confirmed the location of the stones and thought that they may be calcium oxalate. 

Abbi had a cystotomy at 2:30pm on Thursday. The surgery lasted over 2hrs because one of the stones was in a difficult place in the urethra. Claiming success, the vet ordered that Abbi stay with them until Saturday for observation. Abbi continued to be on an IV to flush her system and she was provided pain meds. The vet tech very casually sent us home on Saturday  with no pain meds and stating that Abbi's urine was clear.

The weekend was hard. Abbi was uncomfortable, withdrawn and a bit disoriented on Saturday. We chalked that up to a very invasive, disruptive experience. She tried to pee in her box, but couldn't. She hadn't eaten or drank water since Wednesday and she continued to refuse. By Saturday night  we were concerned enough to syringe feed her newly prescribed wet food (Hill's c/d multicare) blended with water. She took a small amount and kept it down.

Sunday, things got worse. She began uncontrollably urinating (very small amounts) and it all was heavily mixed with blood. She still hadn't eaten. We fed her 15cc of blended wet food and water two different times. We did this in conjunction with her antibiotic (Clavamox). She drank voluntarily one time and was very uncomfortable all night. Her abdomen was and continues to be laterally distended. We thought she was possibly swollen from the surgery.

Today we took her back to the vet. They were fairly concerned about the blood in her urine (or so we thought). They put her on an IV and tested her PCV/total protein levels for anemia. The results came back normal. They also took x-rays which had clarity issues in the intestines. This raised more concerns because of the potential for fluid to be in the abdomen. They gave her some more pain meds (Buprenex). Unfortunately, Abbi's main vet was out sick today and Abbi's situation was apparently not critical enough to make it to the top of the other vet's to-do pile. He basically came up with a diagnosis plan, called the emergency vet and sent us over there so they could do the next diagnosis steps. Enough venting.

So tonight the plan is for the ER vet to perform various diagnostic tests including checking kidney levels, checking for "fat liver disease" and performing an abdominocentesis diagnostic test to check for urine in the abdomen. If needed, more invasive diagnosis/treatment includes a catheter/dye and a Jackson-Pratt drain to relieve excess fluid (if any is discovered). From there, more surgery may or may not be needed to close any tears in her urinary tract.

Thank you for listening. Any thoughts you have would be greatly welcome. It has been incredibly difficult to watch our loving, affectionate cat go through this. We're so afraid of losing her.

Philip

Philip,  

I'm hoping someone will come along soon that has more experience with your situation than I do. All I can do is express my deepest sympathies for what you and your wife are going through. If it helps at all, it sounds like you have both handled this situation perfectly and have done everything exactly right to try and help Abbi. I'm sending all my good thoughts to her tonight as she undergoes more testing. 

Please update us if you learn anything new. 

 Vibes to you, your wife, AJ, and, of course, Abbi. 

I am sorry you and your kitty are going through this!

For Abbi. Hopefully the vet can get to the bottom of this quickly, so she can feel better!

I don't have any experince or advice to offer, but I am sending prayers and vibes that they find out quickly what is wrong and get working toward making it better

Hi Phillip,  Unfortunately I have had recent experience with the same type of situation.  On Nov 1/12, my female cat, Desi, went in for surgery for bladder stones.  I knew there were problems when the vet didn't call me when she said she would.  When she did call me, she said the surgery took 2 1/2 hours instead of the usual 45 minutes because more stones had lodged in Desi's uretha since the week before when the first x-ray was taken which only showed one stone lodged in the uretha.  Like your cats, Desi's stone were calcium oxalate and had sharp points instead of being smooth. 

On Saturday, I took Desi home. The vet who discharged her said she hadn't peed since Friday but her bladder was soft.  She wasn't eating at the vets but he put this down to being stressed.  I call this vet "the idiot doctor."   Even I with no vet training could tell that she wasn't right.  But it was Saturday and they would be closed until Monday morning and the vet didn't seem concerned so I took her home.  Then mine and Desi's nightmare weekend began.  I didn't know it but there was a hole in her bladder and the urine was flowing into her abdominal cavity.   She had no interest in eating, but she drank almost constantly, hunched over the water dish.  Her abdomen was getting bigger and bigger.  I did manage to give her pain medication and the antibotics.  By Monday at 7:00 a.m. I took her water dish away because I was afraid her head would fall into it and she would drown.

I called the animal hospital and said I was coming in and it was an emergency.  Her vet wasn't there, but at this place there is always someone to cover another vet's patients.  This vet took her temperature and her said it was low.  He did blood tests and said that she was in acute kidney failure.  I call this doctor Dr. Doom.  Initially he wanted to wait for an ultrasound to be done, but the doctor who does their ultrasounds said a contrast x-ray would show any problems better.  The contrast x-ray showed there was a opening in the bladder.  They would have done the surgery to close the opening that day, but now she wasn't a good candidate for surgery.  They spent the rest of the day removing fluid from her abdomen and using some solution/medication to get her blood levels (I can't remember the correct name) down so that she could have surgery.  I had to take her to the Emergency Vet Clinic overnight so that she could be monitored, have fluid removed, etc so that by Tuesday morning they would be able to do the surgery.  The best thing that happened when she was discharged to go to the EVC was that a different vet (I call her the nice vet) discharged her and this vet was very optimistic.  I asked her if Desi would have any kidney damage as a result of this and she said No, there shouldn't be any lasting kidney damage.  With most cats as soon as the problem is fixed their kidney function levels go back to normal.  On Tuesday morning I took her back to the animal hospital and they did the surgery to fix the "tear" in her bladder.  The animal hospital's owner and the nice vet from Monday night did the surgery.  I was told that they checked thoroughly for more stones and flushed the urine out of her abdominal cavity.  This time she got sewed up with black stitches on the outside.

I asked them to keep her in to the end of the week so that she would be eating, drinking and peeing normally before I took her home.  One of the vets told me on the phone that one of the sutures had come loose, but I never heard that again.  The vet who did the original surgery said we don't really know why there was tear, but the stones were really pointy and sharp.  The original vet also said that Desi was never in kidney failure.  It just looked like that from the blood tests, because of all the urine in her abdominal cavity.

Since then Desi has continued to improve and now she is pretty much back to normal.  The only food she is allowed now is Medical Urinary SO (dry and wet) and she is only allowed 3 Hill's TD a day.  Poor Desi no more treats.  Since the calcium oxalate stones can not be dissolved but only removed through surgery, we have to try to prevent the stones from being formed.

Your last post was on the 14th.  I hope that Abbi is doing better now.

Denise