Perineal Urethrostomy or Let Him Go?

catsaremylife · Apr 19, 2016

Hi, I'm new to this site. I was sent here by someone who was kind enough to listen to my current problems.

I have a beautiful black cat, who is my son. He's a couple of weeks short of celebrating his 8th birthday. Which I'm afraid he won't make it to his birthday this year... Salem had a blockage not too long ago. I rushed him to the vet to learn he has stones blocking his male part so he was unable to pee. He was whisked away to the back room so the vet could begin treatment. He had to stay for a while because he's one of those I'm not going to eat, drink or use the litter box while I'm in a strange place.

He did come home and was fine for a total of 9 days.

He had to be taken back to the vet on Friday because he started squatting and couldn't pee. My heart started breaking again because I knew it was going to happen again. He stayed over the weekend and my dad brought him home Monday afternoon.

But before Salem was released, my dad told me what he had been told by the vet. This problem with the stones is going to keep happening and each time Salem is going to suffer. I have two options, one is to let Salem go so he won't have to suffer anymore and two is to have major surgery which would pretty much turn him into a female. Although in my dad's words. "How do you feel about having another female cat?" As I have a 9 month old calico.

I started to think while Salem was away at the vet's office that the kindest thing I could do for him the next time this happens is to let him go.

Since I was directed to Google this condition I'm starting to see stories where people have had their male cats go through the surgery and seem fine. (Though the recovery time is long)

From what my dad told me, the surgery is major and Salem might not live through it and if he did he might not live very long afterwards. And if so he's be in a lot of pain. Which just about brought me to tears. I shook my head knowing I wouldn't want to make him go through that kind of torture.

I'm no vet or certified cat expert. I do know my cats better than anyone else they are my babies after all!

It's not my fear of him being turned into a "female" I assume to my dad that's what it sounded like I know Salem would still be male. It's the fear of forcing him to suffer unnecessarily because I'm being selfish. Right now I'm really confused. Over the weekend I accepted this situation and accepted this is what has to be done. Let me tell you, it's a different world without Salem around and I knew I'd have to get use to it.

What should I do? I've always wanted what's best for Salem and I don't want to second guess myself. I want to know whatever I decide is the right thing.

Sorry if this is just a big jumbled mess of text rambling. I'm having a very difficult time right now.

crazy4strays · Apr 19, 2016

First off, welcome to TCS! I'm sorry for the trouble that your kitty has had. From all that I've heard, I don't think that blockages mean that you need to euthanize. It seems to be a pretty manageable condition.

What kind of food is your kitty on? Is he on any type of medication or supplements?

denice · Apr 19, 2016

If your kitty does need PU surgery it is major surgery with a long and sometimes rocky recovery. The question is does he need the surgery. I take it these two times are the only two times he has blocked? Was he given a special prescription food to dissolve the crystals?

Among people that have had this surgery done I have heard both sides, they were glad they had it done and there were no more issues, and those that said that had they known they wouldn't have had it done. The kitties whose owners second guessed their decision did make full recoveries. Their owners second guessed their decision because of the long rocky recovery.

There are people here who have kitties that have had it done.

This is one thread about post op issues http://www.thecatsite.com/t/296413/post-pu-surgery-scar-tissue-closing-up-urethra From what I understand scar tissue is a pretty common issue. If you do a search on PU surgery you will find other threads.

catsaremylife · Apr 19, 2016

Thank you. I know that wasn't the best way to introduce myself to a new site.

The first time I noticed he had a problem was two days after my birthday which was March 31. The vet later said that I caught this within the first 12 hours. The second time was last Friday.

When Salem came home the first time he was given Biomox (amoxicillin)

We bought 9 Lives Plus Care, but no prescription for special food.

Yes, he has always been a fan of wet food.

Since I was not there to drop him off or pick him up the second time I can only rely on what my dad told me. Which he said these were my two options the next time Salem becomes blocked. I'm guessing since it happened so soon there would no point in bringing him back and forth to the vet's office to put a catheter in him, stay a few days and come back. He'd just suffer each time so it would be best to allow him to pass on. But the way the surgery was described to me was he'll die anyway.

It's definitely become confusing and I'd hate to make the wrong decision on my cat's life. I know he can't be with me forever so I don't want him to suffer if he does have to go.

crazy4strays · Apr 19, 2016

Does he eat all wet food or a combo of wet and dry?

If he eats any dry, the first step would be to make him a wet food only kitty and completely eliminate the dry food. A good saying to remember is, "Dilution decreases pollution." If a cat is having recurring blockage issues, they need more liquid. Wet food is the easiest way to get more liquid into him.The vet may want him to eat a prescription wet food.

catsaremylife · Apr 19, 2016

He's always been a mixture of both. And I agree, totally. I need to make all of my children wet food only so maybe that will decrease the risk of having this happen again. The only problem I'm going to have is my dad. He tends to keep a supply of dry food around and keep their bowls full even after the vet said wet food is best.

crazy4strays · Apr 19, 2016

Just let your dad know that from now on the kitties will only have wet food, because that's what's best for them. Let him know that for your blocked kitty it's a matter of life and death and the vet has told you that wet only is what he needs. If you have any dry food left, I would suggest donating it to your local shelter, rather than trying to use it up gradually.

mackiemac · Apr 19, 2016

I've seen many more GOOD outcomes from the PU surgery than bad. Those who had the "bad results" were usually those cats with other issues in addition to the blockage and stones/crystals. But sometimes the recovery can take some time and it's easy to become frustrated. If this was Schrodinger, my Tonk-- I would do it if he were otherwise up to surgery. It saves a LOT of grief and suffering later. This is NO cause to euthanize if your Salem is otherwise healthy and has no chronic issues that would preclude surgery.

Wet food is EXCELLENT for cats like Salem, and there are many diets that can help reduce residue and help prevent stone and crystal formation. In fact, he should probably be only on wet food from this point on. Most of the big names have a pH normalizing diet by prescription. He would need the prescription food as opposed to an OTC diet, as they work MUCH better. Most of them seem to taste pretty good, too. I don't know, I never tasted a urinary diet. Tiki Cat Puka Puka chicken was as far as I got. It actually didn't taste too bad, really. And dang, it sure does smell good. But it's not a urinary diet that would help Salem

Do your best to encourage Salem to drink as much as possible. You can add things like low-sodium chicken or tuna juices to the drinking water to make it more tempting. You can try a cat fountain or "bubbler", which lets your cat drink from fresh moving water... many cats like to drink from rippling little streams, so he might enjoy a fountain. Some cats enjoy dabbling and drinking from a dribbling faucet, so that's something else to try. Of course, gravy-laden wet food is mostly moisture, so that's another way to slip extra fluid into his diet. Crazy4Strays put it well:"Dilution decreases pollution". She's absolutely right.

Hope Salem gets back to business (pun intended) realy soon, and you find a good solution to the problem-- whether that be medical or surgical.

~Mackie

jcat · Apr 19, 2016

I don't have any personal experience with this surgery or the recovery period, but there's a 15-year-old Angora at the shelter that had PU surgery five years ago, made a full recovery and has had absolutely no problems since.

catsaremylife · Apr 19, 2016

Thank you guys so much for giving me advice and helping me make a more intelligent decision on what should come next.

I know from what I've read so far about the surgery the outcomes are mixed. I've mostly seen stories with long recoveries and multiple surgeries. I'm one to do anything I can for my cats in this case Salem has had a hard year. Whatever the problem I drop everything and put other tasks on hold for the care of Salem (or one of my other two cats.) I'm even prepared to give up my trip this summer to 1) Help pay for his bills 2) If he's survived that long he needs me. I wouldn't run off and leave him. 3) If things don't work out I would be too sad to even think about traveling.

Willowy · Apr 19, 2016

He's only 8. . .I would do the surgery. But first try everything else---cut out the dry food, maybe use a prescription food (if he has the kinds of urinary problems that respond to prescription foods---some don't. Ask the vet), get him a fountain to see if it makes him drink more.

mackiemac · Apr 19, 2016

An AAFP feline practitioner might be a good second opinion. Feline docs ONLY work with cats, and would therefore have (probably) more experience with PU kitties (and cats that just make you go P-U!)

Where are you located? I can't post links-- but I can sort of guide you in the right direction.

Go to the AAFP website. It starts with the usual "www", dot catvets (all lower case, one word), dot com. There is a row of tabs just below the banner at the top of the page. Click on the one that says Cat Friendly Practice (circle R). Mouse over that, and a menu should appear with the selection "Find a Cat Friendly Practice'. Click on that, and it will take you to the screen where you can enter your U.S. ZIP code and distance that you are willing to travel. If you aren't in the U.S., click on the small type below the ZIP code box for additional fields, including your country.

Be aware that not ALL of the good cat docs appear on this site. In fact, my own feline vet isn't listed and she is EXCLUSIVELY cats, probably one of the very best in the area. So you can try asking around for other cat-friendly practices once you find a listed one in your area. And know that even within a general multi-vet practice, there may be a vet or two that is the "house cat doctor" in the practice. One vet, for instance, might be a bird wizard, while her partner might be a "cat magician". So ask in your own practice, if there are several vets, which one is the best with cats.

Also, go on local social media sites like Nextdoor dot com if you have a website for your immediate area. You can often get some good recommendations for vets and other professionals in your neighborhood or nearby. That was how I found our current vet to replace the one we just fired. I had heard of her for a long time, but I had no idea what her "reputation" was. Apparently, she's quite well respected here.

If you have access to your state's veterinary medical board, you may be able to runa "background check" for any major violations or actions. That was one big reason we left our "old" practice. The new vet who took over after the founding doctor passed away does have major board action against him-- so serious that license revocation was a possibility. He wasn't revoked or suspended, but he still sux in my opinion... mainly, his issue was honesty and fair dealing violation. But if I can't trust a vet to be honest and fair with me-- I won't go there. He showed a streak of dishonesty, but more importantly-- he seemed unconcerned when my cats had bad reactions to his treatment, and he completely overlooked a broken fang, which was or is one of the major contributors to Schrodie's serious pain. The new vet saw it immediately, and even noticed that the break had indeed gone into the pulp. Painful! Needs to be extracted. How long would Schrodie have suffered on account of "Dr. M's" failure to notice this with a BASIC oral exam? It's not like the fang is way in the back of the mouth like a molar. He should have seen this as soon as he pulled the front lip back.

Actually, he should have taken me seriously when I pointed it out to him on 3 different visits.

How long has my cat been in pain because this vet didn't do his job correctly or diligently?

Anyway... background checks and local recommendations are a BIG help. Social media has really put opinions out in the open for anyone to see. It might be helpful to review them and use that as PART of your decision when choosing a vet to care for your precious furry family member.

catsaremylife · Apr 19, 2016

I'm not sure when he'll be blocked again, it's only been one day so far having him home.

As for the fountain, we tried that a while back but he was not interested in the flowing water. I could try hooking it back up again but Salem is very picky about his water. He 99% of the time refuses water unless it's in his bowl in the sink. He's always been like that from the time I took him into my home.

Sadly there are only two veterinarian offices in my area. The vet I see I have a high opinion of him and his work. He does a great job without charging a fortune to do it. I still have no idea how many times he's had to perform a surgery like this one, there is a good chance they have connections with other veterinarians since they have an emergency line open.

The only other clinics on that website are over 80 miles away. I know Salem wouldn't want to be stuck in his Pet Taxi, in a hot truck for that period of time.

catsaremylife · Apr 19, 2016

UPDATE:

Salem was outside then he came back in to use the litter box. He peed a little but afterwards started meowing like he was in pain. Every time he comes out of the litter box he starts licking his private area. I hate seeing him like this...

mackiemac · Apr 19, 2016

CatsAreMyLife said:
(Oops-- guess I'll have to work on the sizing next time)

These are vets who don't declaw. I'm sending you this because these are probably also vets who believe in thoughtful and humane cat care, and made a public commitment (by listing here) to provide that service to every cat in their practice, You might find some more names that are not on the list I sent you to earlier, and maybe someone is closer that is low key and "hiding in plain sight", just like a cat. I've discovered tiny little solo practices in the oddest places here. They don't really advertise, and the buildings are very low key. Unless you went there a lot, you'd never know there was a vet there. In fact... I worked for a vet just like that for several years. It was a wonderful experience and I learned a TON from that old-school vet-- whose medicine was just as good today as it was when he opened his doors in 1974. Yes, he kept up with the latest and greatest... but he also knew how to do old fashioned doctorin'. Sometimes, the old stuff works better than the newfangled stuff out there. He had a savvy way of knowing when to use what. I miss him-- he was a real good vet in a little corner with loyal clients, and those whose new doctors had no clue how to treat an old fashioned problem. I hope you find a great vet to add to your team, or that your good doctor can help your buddy.

UPDATE:
Salem was outside then he came back in to use the litter box. He peed a little but afterwards started meowing like he was in pain. Every time he comes out of the litter box he starts licking his private area. I hate seeing him like this...

Click to expand...

Ouch, poor mite! Sad to say, it's sounding more and more like the surgery may be the thing to do. Forget the jokes about "turning him into a girl"... guys say stuff like that all the time. Heck, we ladies were almost WORSE, LOL! It was a running joke at one practice where I worked. Our clinic cat, Oscar, had the same surgery. We used to make jokes about him, but he really did fine after the surgery. He was about 12 when the doctor passed away and the clinic closed, so I am sure that Oscar hunts with StarClan now. (a reference to the youth-fiction Warriors book series by Erin Hunter... StarClan's hunting ground is where the Clan Cats' ancestors live, and where the fallen warriors and good cats go when they pass on.)

I hope he can get some long-term, "fur-ever' relief really soon.

~Mackie

catsaremylife · Apr 20, 2016

I'm trying to do whatever I can. I'm not able to just go grab things like I would want to. I have a can of chicken broth left over from the holidays but it contains onion juice... I don't have a way to go to the store unless I walk or someone takes me. I did set up the water fountain but Salem still has no interest in the thing. -shakes head- None of my cats seem to like it.

I sat on the couch early this morning and naturally a kitty found his way onto my lap for almost 4 hours until I had to get up. It was nice to be able to hold him before the noise of the day started.

I looked on YouTube for any further information but all I came across were a lot of bloody thumbnails (anyone who knws me, knows I can't stand the site of blood) only one person who showed their cat home. Not much other than that.

I'm getting more use to the idea of the surgery, but I wonder why it was put he wouldn't survive through it or not live long afterwards if there are people who have had success with it. Maybe it's just not a surgery the vet I use has really done all that often? I have no way of knowing any information unless I talk to him myself. Weird thing is I've never heard of the PU surgery until recently.

I'm frustrated and concerned at the same time.

mackiemac · Apr 20, 2016

CatsAreMyLife said:
I'm trying to do whatever I can. I'm not able to just go grab things like I would want to. I have a can of chicken broth left over from the holidays but it contains onion juice... I don't have a way to go to the store unless I walk or someone takes me. I did set up the water fountain but Salem still has no interest in the thing. -shakes head- None of my cats seem to like it.

I sat on the couch early this morning and naturally a kitty found his way onto my lap for almost 4 hours until I had to get up. It was nice to be able to hold him before the noise of the day started.

I looked on YouTube for any further information but all I came across were a lot of bloody thumbnails (anyone who knws me, knows I can't stand the site of blood) only one person who showed their cat home. Not much other than that.

I'm getting more use to the idea of the surgery, but I wonder why it was put he wouldn't survive through it or not live long afterwards if there are people who have had success with it. Maybe it's just not a surgery the vet I use has really done all that often? I have no way of knowing any information unless I talk to him myself. Weird thing is I've never heard of the PU surgery until recently.

I'm frustrated and concerned at the same time.

I don't drive, either, so I understand the extra level of complexity. It makes it very tough to quickly get to a vet if the cat is acutely ill or there's an emergency. Disconcerting is putting it mildly. I completely get your frustration!

I was simply thinking of things that have had success with cats in the past in getting them to drink. That's why I suggested several tactics. Would your vet feel that doing sub-Q fluids (under the skin fluids) might be an appropriate way to ensure that Salem stays hydrated well enough to keep peeing freely, especially in this initial period? Many cats don't drink enough water to dilute their urine very well, and the sediment builds up. If he can get PLENTY of fluid, from whatever (safe) means... it's worth trying. The majority of cats take it like it's nothing. It doesn't faze them after the first treatment. You ca learn how to do it from your vet. A tech can teach you how to do it yourself. It is really not so scary and once you get a system down, it takes only a few minutes. Your cat might squeak out of surprise the first time or two and he will have a "camelback" for a short while until gravity moves the fluid down and his body absorbs it like a sponge, but it is NOT a painful task. It is something to consider discussing, another tool in the arsenal. Don't wait for your vet to be the first to suggest something. You can ask the same questions there that you ask here.That's what they are there for. Please don't be shy or afraid to initiate the discussion. YOU are Salem's advocate and his voice. Speak up, ask questions, give updates... don't feel like a pest. You aren't a pest by asking and talking. You're an active "steward" and player in Salem's health.

How long did he have the tomcat catheter in place at any time? Sometimes, the tube needs to stay in place and watched for just a little longer even after they begin flowing well. Dr. R, who I worked with for a long time, would keep that catheter in for a while, making sure the urine was clear and not bloody or cloudy before he would remove it. We would of course scrupulously maintain it and keep it clean, and if needed, we would change the catheter out completely after so many days. Once they're already open, it's easier to install the cath. It helps to let those tissues rest, without straining, which can cause more swelling, which makes the hole in his urethra smaller, which lets those crystals and debris get stuck more easily.

Is he having sandy crystals, or are these actual stones?

catsaremylife · May 9, 2016

UPDATE:

I haven't posted in a while, not that FireFox would allow me to log in either. Salem had to go back to the vet on Saturday and I was certain he would be having surgery this week. BUT the vet said he was unable to get the cath in so surgery won't be happening. I can put him to sleep today or take him home and wait for it to happen again.

I feel like I didn't get enough pics, videos, tell Salem I love him enough, hold him enough times, do anything and everything that I could have while he was here. Salem just went about his cat business most of the time when he wasn't sitting on my bean bag chair taking a bath. He even spent a few nights sleeping with another family member. Just Friday he followed me outside and we sat down together for a while. That was a good day.

The more I think about it the more I think I'm being selfish wanting Salem to stay with me a few more days. But will I regret not getting more pics/videos of him? Not holding him one more time? Not having his nose nudge my hand to be petted? And if I don't do it today will I regret not letting him go sooner? Maybe he has been saying godbye in his own way. But I don't think I've given him enough love these last few weeks.

Today is garbage day, Salem always hated garbage day. He'd run in the house whenever the truck came by.

I've never had to go through anything like this before so the tension of making the right decision is a difficult one. I want both of us to be happy but I want him to be happy even more.

Willowy · May 9, 2016

Aww, that's sad

. Is there any way to get a second opinion? I don't see why surgery would be dependent on being able to pass the catheter---isn't that why they do the surgery in the first place? I would want more answers, personally.

catsaremylife · May 9, 2016

Unfortunately, most people think I have a lot of vets in my area. ^^; I live outside of the hustle of the city so board certified vets who would have more answers are quite a distance from me. While I was at the vet's office today he said that the catheter has to be inserted to be able to know exactly where to cut during surgery. It's a very difficult process and if he misses the right spot we'll all be in trouble. I'm personally not familiar with the PU surgery I've read some stories and gained a little information. My vet is determined that he's not ready to give up on Salem. My dad was there and he asked when this happens again is there a chance to get the catheter in? Most likely, no. The vet said that when Salem comes back he'd like to attempt surgery if we're willing to let him try. If it doesn't go as planned then he'll put Salem to sleep during the procedure.

I'm stuck on the thought that no matter what, I'm going to lose my cat. I know that I have a little time left to spend with him so I've had my camera out shooting videos and taking pics as much as I can. I have to make every minute count.

I know Salem is not going to live forever it would be silly of me to think that. This is just the way things are and I'll have to let him go. But I did ask while I was there if I were being selfish wanting to keep Salem just a little longer. He said no, some people are but I'm not there yet. I'm just going to have to suck it up and accept this is goodbye for real this time. More than anything I want Salem to know I love him very much.

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