Recover from cystotemy surgery

Hi everyone,

I'm new to this forum, but a life-long cat lover. My cat Max is about 3 years old. He was a rescue that my girlfriend (at the time) and I brought in at about 4-6 weeks old. So he's been with me for a long time. About a year ago, he started showing blood in his urine and the Vet diagnosed him with crystals his bladder. An X-ray wasn't performed at the time though, and she said it's normal for some young, male cats, and to just keep an eye on him. She gave me medication to help treat it. Several months later the blood started again and I brought him in a second time for this same diagnosis. This time they told me to try to get Max to drink way more water, and to focus on wet food over dry food, increasing his wet food meals to three a day.  That seemed to help, until about a week ago, where the blood in his urine started again. Only this time, there was more of it, and it was darker in color. During this time, Max had taken up the habit of peeing in my bathtub every day, which I took as a sign that he was either peculiar (as he is) or that he wanted me to see what was up. He even started peeing in my kitchen sink.  So this past Sunday I brought him in to the vet for a third time.

This time they performed an X-ray and, sure enough, they saw a rather large stone in his bladder. The Vet recommended a cystotemy surgery. So I brought him in this past Wednesday. This is where it starts to get frustrating.

Wednesday afternoon, the Vet called with an update and, sounding all peachy and upbeat, told me Max did great under the anesthetic. But when I asked about the stone, he informed me that they were unable to retrieve it and that, they "suspect" that it passed into his urethra. I asked how that could have happened, and the Vet said the anesthesia relaxed his body and allowed it to pass into the urethra. But no worries, they could now have him slowly dissolve it with prescription food over time. At this point, I was fuming, because I had suggested we just do this from the get-go. Furthermore, they just cut my cat open for no reason and left him in a place where the stone was now in a worse position. I went to bed Wed night pretty upset.

Thursday, I went into the Vet, ready to raise hell. They brought Max out and he looked miserable. It was pretty depressing. But the Vet told me the surgeon had taken a new X-ray and, sure enough, the stone had moved to the urethra. She wanted to do a second surgery and, using catheters, push the stone back into the bladder where it could then be retrieved and analyzed. They told me they would not only waive the fee of the second surgery, but that they'd also give me a discount on the first surgery. But if they were going to do it, they'd literally be operating on Max within the hour. I wasn't crazy about my cat going back under anesthetic so soon. But they said it was best to re-open him when the stitches were still fresh.  So I agreed.

Come Friday (yesterday), I went to pick him up and got the update about how the surgery went.  Yet again, it proved frustratingly inconclusive. While pushing the stone into the bladder, it broke apart into a thousand pieces.  Like sand. They then flushed it out of him. An X-ray after the surgery proved that it was no longer in him, and his flow seems to be normal again. I was upset though because I was counting on them to retrieve the stone so it could be analyzed, but alas, they have no sample now.  Now, all of this backstory is leading up to the recovery process.

Max has been home with me since last night, and he seems very out of it. He has almost no energy and moves around slowly. He also seems to be in pain. Last night, he'd audibly groan whenever he sat up, and would moan every now and then in pain. I gave him his pain meds, and that seemed to help. But he keeps jumping from my bed to the floor, and then back up again, and I don't like that. Because every time he lands, he grunts in pain, and I'm worried that the activity the jumps do will cause his stitches to re-open (they're on the inside).  

He seems to be peeing okay.  He's gone from doing it in the litter box, to my bathtub, to even on my bathmat. But I just spied on him now while he peed in the litter box, and he noticeably groaned in pain while he did.  

Is this normal? He's had a lot of work done to his bladder and urethra, and had two surgeries in two days. The Vet said he'd going to be sore and tender down there.  That the walls of his bladder are enflamed. One of the meds they gave me helps to relax his urethra, so it doesn't hurt as much when he pees. But man, he's just so out of it. He'll lean his head down towards that area, and then just sit like that, like he forgot what he was doing, and is frozen in that half-stance. And all he does is sleep. I also can't get him to eat the prescribe 'Bladder Health' wet cat food. I have to mix his Friskies into it. But then he just eats that portion and doesn't touch the other food.

If anyone can provide any feedback or words of support for a similar situation they went through, I'd really appreciate it. I primarily want to know if he should still be in this much pain, while even on meds. And also, if it's the trauma from the surgery or the meds themselves that are making him this groggy and lethargic.

Thanks everyone.

Max is still recovering from the anesthesia it seems. Normal behavior after surgery. Keep giving him the pain meds prescribed. It is great that he is eating already! That is major progress so soon after surgery. It has been a nightmare for some here and they ended up having to force feed/water their kitty. I would just keep offering him the mixed wet and let him eat what he wants from it. Add water for more moisture. After he heals up then you can get serious with the prescribed food. Watch his stitches so he doesn't irritate or tear them out. You don't want to have to go back to the vet for that! A cone will probably be needed because they are going to start itching!
Just keep him eating/drinking....he's doing well!
Do a search here...there a few that have recently been through this.

Hi Mosimom,

Thank you for such a nice response. In the two days since I posted this, Max's condition has been up and down. Some hours of the day I feel like he's recovering, and then others I'm not so sure. He's barely eaten since Friday. Maybe only a handful of times. So the food I keep putting in the bowl goes bad and I have to throw it out. I've been giving him Wellness brand (grain free) because he won't touch the prescribed stuff yet. But are you saying I can mix Wellness with the Friskies that he so loves? B/c the vet said that was a big no no. He said that we have to be very careful about the PH levels now in his urine, and giving him the old food might develop crystals again. Though honestly, if it gets him eating, for just the next few days, then I'm all for it. He hasn't even pooped since being home. That's a bad sign to me.

I had someone tell me I could feed him tunafish. Would you agree with this? 

As for the meds, he's on the following:

Amoxicillin - For infection

PenoxyBenzamine - To relax urethra/bladder

Buprenorphine - For pain

I'm not sure which one, but one of these is making him very lethargic. It turns him into a zombie where he just lies down all day. And the few times he's up on his feet, he's wobbly and almost tips over when walking around and trying to climb on couches. I really don't like seeing him like that. Do you know which of the three above drugs is causing that reaction from him? If so, I may decide to take him off it soon. 

Also, in the past hour or so that he's been lying on my bedroom floor, I noticed he's shaking, ever so slightly. Could this be a sign that he's developing a fever? He's peed a few times today, so I don't think there's a blockage. But maybe an infection has developed, and he's showing signs of it.

I have a call out to the vet, and am waiting to  hear back from him.  But in the meantime, maybe you could give me some peace of mind.

Thanks!

Oh, poor Max. I hate to scare you because I can tell how hard you are trying to take the best care of Max possible, but if he has not been eating much since Friday, he is at risk of developing fatty liver disease. Cats just cannot go long without eating. They cannot utilize fat like humans can. He must eat, so I would tempt him with anything he likes: tuna, treats, meat baby food, etc. If that doesn't work, you may need to syringe feed him.

The shaking is really worrisome. The combination of drugs are probably responsible for the lethargy and weakness. At this point, I would call your vet ASAP, describe the symptoms and see what they suggest, but he really needs food in order to recover and not develop secondary complications. Many vibes for Max.

Hi There @Max-The-Cat

His condition seems serious honestly, and not normal for a post-op patient.  The Buprenorphine can easily cause drowsiness, but what you describe along with the lack of food intake doesn't seem good.  I would urge you to call your vet and ask for a call back (many vets have certain hours when they call clients back) and discuss all of this with him and ask for permission to feed some of the old food just to get him going again.  And even in advance of that permission, some of the old food right now is probably in order.  He needs nutrients.  I think it very unlikely that a short term use of old food is going to get him to quickly re-block.

I agree with Vball, the shaking is worrisome too.

Stephen

Just tried calling my vet.  The secretary said he's busy at the moment with other patients, but he would speak to me this evening. (it's 3pm my timezone right now).

I said this could be an emergency, b/c he's not eating. Before I could finish my thought, she put me on hold. 2 minutes later, she returned and said the reason he's not popping is b/c he's not eating. (duh). She also said the doctor said I could feed him other foods for now, just to get him eating. 

I then told her my other concern was the shaking.  She put me on hold again, then returned 2 mins later and said "The doctor said he'll discuss it with you this evening." I replied, "That's not an emergency?" She said again, "The doctor said he'd talk to you about it this evening. " So I guess that means no?

Steps I've taken / will take in lieu of this call:

1. I just tried feeding him Friskies (the food he loves and normally ate) and it was unsuccessful. He just stares at the plate, on wobbly paws, with a slight shake about him. I then wipe some of the food on his paw. He licks it off, but barely. I then put some on my finger and carefully inserted it into his mouth. He chews slowly and chunks of the food fall out.

Keep in mind, I gave him his meds today about 7 hours ago. He's not due for another dosage until about an hour. But I'm honestly concerned about his state on the meds. Pain meds especially.

2. I'm going to go buy some tunafish right now from the local grocery store and see if he eats that.

3. The shaking concerns me. Also, he just seems too out of it. He keeps getting up and then walking over to other spots in the apartment, like he can't get comfortable. I'm worried he may be developing a fever, so I'm going to also buy a thermometer from the grocery store, that I can stick in his ear to get his temperature. I hear that, if his temperature is below 99 degrees or above 104 degrees, I should seek immediate medical attention.

Anything else I'm missing? 

ps

Attached are two pics. The close-up of his belly shows the wound where the bladder surgery took place. The stitches are on the inside. There was a piece of skin/flesh at the end of the wound I noticed Friday, when I took him home from vet, that was red... almost like I was seeing the inside of his flesh, rather than the grey natural color of his shaved belly. It concerned me so I kept an eye on it. As you can see in the pic, it's still a little red looking, but has dimmed in color. Is that normal?

The other pic is how he looks sitting on the floor of my bedroom, huddled up like he's just trying to ride this thing out.

I would also get some oral syringes while you are out and some smooth pate type foods. You can either get the pet syringes available at pet stores or pharmacies will have them and will usually give you a couple for free. Ask for big oral syringes.

I agree that something is wrong here beyond post operative recovery and medications. I hope the vet calls you back quickly and before they close for the night. Do you have/know of an emergency vet clinic just in case?

A normal cat's temp is between about 100.5 and 102.5.  If its getting close to closing time and you haven't heard from your vet call them back.

Hi guys,

Thank you all for chiming in with your concerns and your feedback.  Here's the update from the past few hours:

- I went to the grocery store and purchased a thermometer, some cans of tuna, some Sheba paté cat food, and I convinced the pharmacist to give me a wider oral syringe.

- When I got home, Max allowed me to take his temperature by sticking the thermometer up his butt. His reading was about 99.7. Is this a good, safe temperature?

- I then coaxed him out from under the bed with some tuna fish, and he ate about half what I put down. So that's a good start at least.

- Then, when it came time to give him his pain meds (every 8 hours), I held off. I wanted to see what would happen, and if not being on the pain meds would help him "come back to life" a little more.

- Then, about 10 minutes ago, the Vet called me back.  It was a brief call, but he said the tuna is fine. And that the shaking Max was showing was probably a reaction to the pain meds, and that yes, I could totally take him off them at this point.  But he said to continue with the antibiotic and the one that relaxes his urethra. I then asked if I could take the green bandage off his front paw and he said Yes, that I should have taken that off on Friday and someone at the vet should have told me.  (no one did).  And that it was probably causing him pain.  *sighs.

- He also said the pink spot at the end of his incision scar is normal.

So as of now, I'm keeping an eye on him. He's no longer shaking, and I'm confident I can get him to eat more soon. I think the pain meds were messing him up done good. So I'll be curious to see how the rest of the night goes now that I'm no longer giving him dosages.

Thanks, everyone.  Let me know if you think I'm handling this right.  The vet (Laurel Pet Hospital, in West Hollywood, CA) is 24/7.  So if he suddenly shows any scary signs tonight, I'll bring him there asap.

I am so glad to hear that he ate! And that he is no longer shaking. I am now wondering if the buprenorphine dosage was too high.

I would definitely keep an eye on him. Small frequent meals would be good as he gets his appetite back. Many vibes for Max's continued recovery. Please keep us posted on his progress.

My Mosi was on buprenorphine and she was a zombie too. I stopped it almost immediately and she was a lot better. There was no way she was going to eat while on that med. She was high and staring at the wall for hours. Most cats do well with the drug though.
You are doing good. Your goal is to keep Max eating and getting moisture (add water to his wet food too). You will probably have a hard time getting him on the prescription food as you've already seen. You may want to research alternative safe foods for him now. I bet you'll get lots of advice on the nutrition board here. Might want to stock up on food toppers such as tuna juice, bonito flakes, grated parmasan, etc. to bribe him in the switch.
What was he eating before the blockage?
Let us know how he is doing....

Hi Mosimom,

Tonight has been rough. I noticed Max was shaking again. He was under my couch for a few hours, so I didn't notice this, but when he finally ventured out, he was shaking a lot. First I noticed it in his stomach area. If I put my hand to it, it felt like a fast, random pulse. Then I noticed his head was shaking too.  I researched this, and it seems one of the  most common causes is hypoglycemia. which means he has low blood sugar and seriously needs to eat.  So for the past few hours, I've been trying a bunch of methods to get him to do just this.

1. I tried more tuna, but he wasn't eating it.

2. Then I tried the new Sheba pate food. He ate a little of this. I tried squirting more into his mouth, but wasn't that successful.

3. Then I had some success with squirting some maple syrup into his mouth. It got all over his chin and fur, but I think enough of it got in. (.25 ML maybe).

4. That seemed to stop the shaking a bit. I then tried a different method with the tuna, and kept it in the can. This seemed to draw him over and he eat a little more of it. Though not as much as I'd like.

Again, he's been home since Friday. It's now Monday night. And he still hasn't pooped. That tells me he just doesn't have enough food in his body.

I'll give it the night and see how he's doing tomorrow morning. But any other ideas for how to get him to eat are welcome.

I have grated parmesan cheese. Should I try sprinkling that on some of his food?

@Max-The-Cat

Good call with the potential hypoglycemia, although I'll go with what your vet said.  A hard to resist food is available only from your vet, its Hill's A/D and its loaded with calories, fish oil, and is often used when a cat won't eat anything else.

A lot of us will use very stinky foods like 9 Lives tuna to induce a cat to eat.  We use it medicinally not as a regular food, it is pure junk, but it will often jump start a cat who doesn't want to eat.  Just don't let him get hooked on it or any really junky food.

And its true it can take days for him to poop again, if he eats enough food he WILL poop :-)

Please keep us updated.

I don't have anything of value to add, except that many vibes for you and Max. You are a good cat parent.
(I would suggest sprinkling FortiFlora as an appetite stimulant on his food, but this is a probiotic and should not be given concurrently with antibiotics.)

I wonder if he should be brought into the vet for a sub-q treatment? Does he seem dehydrated? It could make him feel better and regain his appetite.
The shaking is a concern. You may want to make another call to the vet.

I would be trying all the junk foods such as fancy feast salmon at this point. Anything to get him eating. When you syring feed and water make sure you are shooting it in from the side and not toward the throat...don't want it to go into his lungs.

Wanted to add that the antibiotic could be making him feel a little nauseous and that could be why he doesn't want to eat. Just be causious if offered the antibiotic Convenia shot instead....it has been known to cause a lot of problems and even death in some cats.

Hi everyone,

I have a pretty scary update. I spent most of last night convinced that Max's shaking was being caused by hypoglycemia. So I did whatever I could to get him to eat. This included more tuna. Squirting salmon pate into his mouth (and no, I didn't know to only shoot it in the side of his mouth because that was another thing the Vet didn't inform me of).  I finally had luck feeding him about half a small can of Sheba Salmon food by using a plastic spoon, loading it with wet food, then propping his mouth open and rubbing the food on the roof of his mouth, so he'd have to chew and swallow it.  It was messy, and I hated doing it, but I seemed to get enough food in his mouth this way.

And yet, still, the shaking wasn't stopping. And it seemed to be getting worse. He'd walked four feet, wobble, and then nearly collapse down, and just sit there, looking exhausted. 

At around midnight, my apartment neighbors and I were all outside watching the blood moon, and my 88-year-old neighbor, Lee, wanted to come see Max.  She took one look at him and said I need to call the vet again. At this point, it was close to 1am. Luckily, the vet I go to is 24/7. I got a new doctor on the phone (not the normal one I'd been dealing with) and told him all the symptoms. I also told him that Max's temperature was now about 98.5. That alerted him and he told me to bring him in right away. 

Upon getting there, they took him to the back surgical area, and I spent the next 15 mins alone in the waiting room, with no answers. Finally, the doctor came out and gave me the news: As he feared, Max's electrolytes were dangerously down, due to dehydration. In fact, they were so down, he was worried about kidney failure, which then leads to cardiac arrest. In other words, he was telling me Max might not survive the night. At this point, I sort of went off on the guy.  I said I blamed this vet for all of this. That Max was in their care only 3 days ago, and that no one warned me of any of this. I wasn't given any instructions except for when to give him the meds. I wasn't even warned about the possibility of dehydration. Furthermore, when I called yesterday at 1pm to tell the vet about the shaking, they passed it off as not a big deal and said the vet would discuss it with me when his shift ended at 6pm. I told them this was inexcusable and that they needed to do everything they could to save Max's life. At this point, the vet told me a pretty moving story about a dog he tried to save a week earlier, by administering CPR. And that, he eventually lost him and it devastated him. He said he treats every animal that comes in there like a loved one and that he would do whatever he could.  

He told me he was putting Max on liquid treatment right now to try to raise his levels, and that they would monitor him all night, but that I should prepare for the worst. If, come this morning, his levels weren't rising enough, they were going to suggest taking him to a 24 hour emergency clinic better prepared for liquid therapy. 

At this point, I was devastated and felt like I might break down.  He told me to sit down for a bit.  He was going to check on Max to see how he was taking to the liquid and then come back with my estimate. About 20 mins later, I got the estimate.  $800 on the high end.  $400 on the low end.  So this would put my total bill for all of this vet work at about $2,000.  But of course, I paid it. Before I left, they let me see him one more time, and even allowed me into the back surgical area of the office. They had Max on a table, with a heat blanket on him to raise his temperature. Already, he looked a little better, with some light returning to his eyes. So I left feeling a little hopeful.

This morning, at 7am, the doctor called (as he said he would) to tell me that Max was looking way better. His electrolyte levels had returned to normal. He still wasn't out of the woods though, and they want to keep him there for a few days to monitor him (which is probably what should have happened after the surgery), but that he didn't think it was necessary now to bring him to that emergency clinic for the liquid therapy. I asked him what he thought might have caused this, and he said he was a little stumped at first.  In the 8 months he'd been at this vet, he hadn't seen a cat with levels that low. But he deduced that, after the surgery, Max was so knocked out from the pain and all the meds, that he simply wasn't hydrating properly. I was watching him and it seemed like he was drinking enough. I even monitored the water levels in his electric fountain and continually had to refill it. But I guess it wasn't enough. 

I'm going to call in later today to see how he's doing. I'm still pretty rattled, but feeling a *little* hope this morning. Also feeling sort of helpless. I liked this one particular doctor, but his shift ended at 8am, and now Max might be in the hands of someone incompetent. I say that because, I now no longer trust the original doctor. I wasn't given any warnings that this could happen, nor was I properly instructed on how to best monitor Max. Furthermore, I think Max should not even have been permitted to leave the vet so soon, after having two surgeries in two days. 

I'm trying not to wallow in that anger and just think good thoughts.  But the cat has been through hell. And 1 week ago, he seemed perfectly healthy.

I am so sorry that you and Max are going through this.

I am so glad you took him in and got him the care he needs. This new vet sounds good and caring. Can you request that he be Max's primary vet? Hopefully he left good instructions on what needs to be done while he is off. Many many for Max.

Just spoke to vet again. It's 12 noon PST where I am, and the last update I had was from the good vet at 7am this morning. He had to leave for the day, but I spoke to a very nice technician who said Max seems to be doing better. They have him on an IV drip giving him all the liquid and nutrients he needs. She said he hasn't eaten yet, but she's doing to try a few methods and different foods. She said that not eating though wasn't a huge concern, b/c of the IV drip. She also said the atmosphere of the vet usually spooks animals and gets them stressed. And that regaining his appetite might take a little while.

But she said he seems more alert. He watched her as she walked by his cage, and he's walking around a little. She also said he's getting a lot of care and is front and center in the back area. So that made me feel good.

I'm going to go visit him in a few hours. Maybe that will help get him to eat.

I am so sorry. You have to be under a lot of stress right now. It sounds positive that Max is getting hydration and looking a bit better.
Did you ask about feeding him while there? Will they syringe feed too? I'd make darn sure because it has been too long already. I hate
for them to have to put in a feeding tube on top of his problems.
Is your schedule convenient so you can visit him often? If you have a worn shirt or pillow case with your smell to keep with him then it might help his stress from being away from home.
Max has been on my mind all day.....