Agitation after general anesthesia earlier today

[fionasmom]

You have been meticulous with explaining Willy's progression, but I wondered if there was an actual blockage or just an inability to move the bladder and muscles involved. My 2 year old Rikki had this about 6 weeks ago and had to be catheterized, kept over night, etc. His report concluded that there was nothing in his bladder, but I found that both the resident and internist used the term "blockage" intermittently to signify the fact that he could not urinate. It was almost a point of semantics.

If Willy were unable to urinate as an after effect of the anesthesia or the buprenorphine as was suggested, it may never repeat itself hopefully.

Having nothing to do with you or Willy, I had a dog react in the same way to a fentanyl patch.

 

[cmshap]

If Willy were unable to urinate as an after effect of the anesthesia or the buprenorphine as was suggested, it may never repeat itself hopefully.

The more I think about it, the more I lean this way. Especially given that he's never had a blockage before. I understand that male cats especially can develop blockages at any time in their lives, but this was Willy's first one, in 11 years, and it occurred immediately after he had surgery.

The only other time in his life when he had general anesthesia was for his neuter surgery when he was much younger, and I had a different vet then.

Also, just a little more context to add:

Last night when Willy was starting to repeat is in/out litter box behavior, and I was getting worried, I set up a camera to try to record him, so that if I had to take him into emergency I could have something to show them how he was straining. But then he peed this morning, and I didn't look at the footage until now.

Last night, he was not straining or attempting to pee. He was just walking into the box, and walking out.

I thought about it, and theorized that he was probably scared. The last time he tried to pee before that, he couldn't, which was probably painful enough... but then I swept him up immediately after and took him to the vet for a traumatic procedure.

He was probably afraid of using the box again, maybe expecting something bad to happen again if he tries to pee. Whether that be experiencing pain, being swept off to the vet again, or both.

This evening, he is kind of meandering near the box, then coming back to the living room. He isn't doing it nearly as frequently as before, but I wonder if he still has some lingering trepidation. He hasn't peed again since this morning, so he is bound to have to go again before the night is through, so we will see.

I'm trying to stay quiet and keep my distance when I see him walking towards the box, so he doesn't think I'm going to bust out the carrier and nab him as punishment. Last time he peed, I was quiet and motionless on the couch (the litter box is in a hallway off my living room, which is out of sight from me, but still nearby).

 

[iPappy]

The more I think about it, the more I lean this way. Especially given that he's never had a blockage before. I understand that male cats especially can develop blockages at any time in their lives, but this was Willy's first one, in 11 years, and it occurred immediately after he had surgery.

The only other time in his life when he had general anesthesia was for his neuter surgery when he was much younger, and I had a different vet then.

Also, just a little more context to add:

Last night when Willy was starting to repeat is in/out litter box behavior, and I was getting worried, I set up a camera to try to record him, so that if I had to take him into emergency I could have something to show them how he was straining. But then he peed this morning, and I didn't look at the footage until now.

Last night, he was not straining or attempting to pee. He was just walking into the box, and walking out.

I thought about it, and theorized that he was probably scared. The last time he tried to pee before that, he couldn't, which was probably painful enough... but then I swept him up immediately after and took him to the vet for a traumatic procedure.

He was probably afraid of using the box again, maybe expecting something bad to happen again if he tries to pee. Whether that be experiencing pain, being swept off to the vet again, or both.

This evening, he is kind of meandering near the box, then coming back to the living room. He isn't doing it nearly as frequently as before, but I wonder if he still has some lingering trepidation. He hasn't peed again since this morning, so he is bound to have to go again before the night is through, so we will see.

I'm trying to stay quiet and keep my distance when I see him walking towards the box, so he doesn't think I'm going to bust out the carrier and nab him as punishment. Last time he peed, I was quiet and motionless on the couch (the litter box is in a hallway off my living room, which is out of sight from me, but still nearby).

Do you think there could just be some leftover "irritation" feeling from the whole thing?
What a week you guys have had, I'm hoping for some more positive updates!!

 

[silent meowlook]

Hi. Buprenorphine is almost always used post op in cats after they are unblocked and it is used usually two to three times a day while they are hospitalized. It is a great pain medication for cats. The injectable form can be absorbed through the mucus membranes of the mouth making it great for those cats that would prefer to not be injected. I have always had great success with it in the hospital setting, using the upper end of the dose. I have never seen urine retention in a cat while using it.

That being said, Simbadol is the long acting Buprenorphine injection. It is no different than Buprenorphine except that it is much stronger.
Average standard Buprenorphine is 0.3mg/ml
Simbadol is 1.8mg/ml but, Simbadol is given SQ, where Buprenorphine is not recommended to be given SQ due to lack of absorption.

Buprenorphine is a schedule III narcotic. So is Simbadol. But Simbadol is given in the hospital, not sent home with the cat. It is more paperwork for veterinarians to send home a narcotic. Therefor most prefer to use Simbadol.

In my own personal opinion that I have from decades or using Buprenorphine and years of using Simbadol, I don’t like Simbadol. I’ve seen more hyperactive cats on Simbadol. I don’t think the pain is well controlled or as well controlled as with Buprenorphine injections or the oral route. The other thing is that Buprenorphine cannot be fully reversed. Therefor if you have a cat that reacts badly to Simbadol, you are stuck with that reaction for 24 hours. Buprenorphine only 8 hours.

 

[cmshap]

Buprenorphine is almost always used post op in cats
I have always had great success with it in the hospital setting, using the upper end of the dose. I have never seen urine retention in a cat while using it.

Perhaps white shadow can cite sources for the claim earlier in this thread that buprenorphine is well-known to cause urine retention in cats.

I should also remind everyone that I'm not sure what injection was given to Willy after his biopsy surgery, other than that it was described to me as a "24-hour injection." I will find out specifics next week.

That being said, Simbadol is the long acting Buprenorphine injection. It is no different than Buprenorphine except that it is much stronger.
Average standard Buprenorphine is 0.3mg/ml
Simbadol is 1.8mg/ml but, Simbadol is given SQ, where Buprenorphine is not recommended to be given SQ due to lack of absorption.

The syringes of oral pain medication given to me to administer at home post-catheterization are actually labeled as Simbadol, 1.8 mg/mL. Each syringe has 0.8 mL and I'm supposed to give every 12 hours, which I have been doing.

Edit: Willy had been pacing around the litter box, went in and out a few times over the last two hours. The last dose of oral bupe I gave him was about 30 minutes ago, and as I was writing this post, he did his second pee of the day.

Second edit: Actually, I think this was his third time today, and he sneakily peed for the second time in the middle of the day. I left his first clump in the box, reasoning that having the smell in there may entice him to go again later (I could be wrong about that, but I was just taking a guess). I just scooped that clump out, and it was big enough to feel like two pees in the same spot (I find it funny that I know his bathroom habits that well).

Three or more times a day is normal for him, so I am happy.

 

[Caspers Human]

Willy always had post-poop zoomies throughout his life

It's an evolutionary behavior.

A cat in the wild would have to be alert for predators that might be attracted to the scent, hoping to catch an easy meal. They run to get away from the scene as fast as they can in order to avoid any potential predators. Domestic cats run away from the litter box as a throwback to evolutionary days.

It would be a very bad day if they got caught by a predator while in mid-squat!

 

[Kwik]

You may be onto something.

First of all, I don't have detailed records yet of everything that was done, but I am going to get them next week. But I do know that the vet specifically said she gave him a "24-hour injection" for post-surgical pain.

Also, I'm not entirely clear on what was causing his blockage. She explained to me what causes urinary blockages in male cats, which can be a variety of physical blockages such as crystals or mucus plugs, and that they can spontaneously develop. But when she examined him, as I described in an above post, she said she couldn't 100% conclude if he actually had a blockage, as his bladder was full, but not hard like it would typically be.

However, after she cathed him and gave him fluids, she then told me over the phone that the cather went in very easily. Prior to the procedure, she explained that it can sometimes be difficult to get in in cases of more severe blockages. So this makes me wonder if there wasn't actually anything physically blocking his urethra at all.

I do trust this vet, but she was kind of rushed when dealing with this issue. Her hours on Fridays only go to 1pm, but this issue came up at like 12:30pm yesterday, and she stayed later as a favor to me to help Willy (as she knew that the cost of taking him to a hospital was going to be a hardship for me). So I can't say if she was able to fully investigate the cause of this, and I wasn't able to ask many questions.

I will check for what he was injected with, because if it was a 24-hour buprenorphine injection, I'd rather not have him get one again in the future.

I'm sure your Vet did not come to any conclusions simply because there are a host of reasons thst can cause a urinary blockage,even stress can trigger something like this.... very often the slightest little blockage will cause retention ...the terrible discomfort will immediately prompt kitty to retreat from the litter box and the bladder fills more and more . Probably could be compared to a kidney stone,,every have one? I once had a kidney stone the size of poppy seed and was rushed to the ER feeling like someone was stabbing me.

The good thing is that you acted immediately without hesitation-Willie has gone through so much and both you and he are AMAZING guys

 

[cmshap]

I'm sure your Vet did not come to any conclusions simply because there are a host of reasons thst can cause a urinary blockage,even stress can trigger something like this.... very often the slightest little blockage will cause retention ...the terrible discomfort will immediately prompt kitty to retreat from the litter box and the bladder fills more and more . Probably could be compared to a kidney stone,,every have one?

And I want to make sure this doesn't happen again, so I am trying to keep him hydrated... but he's making it difficult.

I started a new thread specifically pertaining to hydration and Purina Hydra Care (which my vet gave me, but he refuses to drink). If anyone has other ideas or comments generally about cat hydration, please post in there.

I never had kidney stones, but my dad has had a long history of them, and he has said they were the worst pain he's ever felt in his life.

I personally have had medication-induced urinary retention, and I know how painful it can be.

 

[Kwik]

And I want to make sure this doesn't happen again, so I am trying to keep him hydrated... but he's making it difficult.

I started a new thread specifically pertaining to hydration and Purina Hydra Care (which my vet gave me, but he refuses to drink). If anyone has other ideas or comments generally about cat hydration, please post in there.

I never had kidney stones, but my dad has had a long history of them, and he has said they were the worst pain he's ever felt in his life.

I personally have had medication-induced urinary retention, and I know how painful it can be.

That's right so it does not actually have to BE blocked but is still referred to as a " blockage" - and stress in itself,any pain or discomfort ajd the anesthesia confusion can certainly cause retention which becomes horribly uncomfortable ontop of everything.. there's many factors to consider

What were Willie's normal drinking habits? Some cats drink a little frequently,,some drink more but less frequently- is he drinking less than he did before or are you just now noticing -in other words are you sure he's not drinking as much or little as he always has?

check your msgs too,lol

 

[cmshap]

What were Willie's normal drinking habits? Some cats drink a little frequently,,some drink more but less frequently- is he drinking less than he did before or are you just now noticing -in other words are you sure he's not drinking as much or little as he always has?

He is not drinking as much as he normally does right now; he is normally a good drinker. Today, I barely saw him take more than a few laps, and I've been at home all day. Of course I didn't have eyes on him 24/7 but I usually know when he is drinking; he is a loud lapper.

I'm worried about it currently because of what he just went through. Please post about this particular topic in the other thread I created, if you have ideas.

(I don't mean to make this confusing by starting multiple threads, but when I feel the subject is veering into a different topic, or I want to get fresh eyes on a particular question, I find it best to start a new topic and then add links between my related threads. This thread has already gotten quite long, and I want people who may not be following it to notice my new question.)

 

[silent meowlook]

They sent Simbadol home??? I have not heard of that being done.

 

[cmshap]

They sent Simbadol home??? I have not heard of that being done.

Indeed. See the attached pic (the smudge on the label is from water I splashed on it).

I also had never heard of Simbadol being administered orally, although I did find that it is a valid route of administration, just not typical. Buccal is mentioned in a study I found comparing ROAs:

Pharmacokinetic and pharmacodynamic modelling after subcutaneous, intravenous and buccal administration of a high-concentration formulation of buprenorphine in conscious cats - PubMed

I am hesitant to continue administering at this point, because he's definitely constipated now, and I don't want to make it worse. He pooped for the first time today since his surgery three days ago, and it was hard, small, and made him bleed a little bit.

 

[fionasmom]

Zoetis
That would surprise even Zoetis. They mention not giving it to the pet owner under prescribing information.

 

[cmshap]

Zoetis
That would surprise even Zoetis. They mention not giving it to the pet owner under prescribing information.

Which is funny because I am exactly the kind of person who should not be given Simbadol. I've been open on this forum about the fact that I am a recovering addict.

I have my own prescribed buprenorphine, however, which I've been taking for years and am very stable on. It's human-level dosage, which even on the lower end is greater than the Simbadol dosage.

However, it's surprisingly close to human-level when you think about it. The doses from my vet are 0.8 mL, so at 1.8 mg/mL, that's 1.44 mg to be given to my cat every 12 hours. So 2.88 mg/day.

I currently take 4 mg/day, while the typical starting dose for most addicts is 8+ mg/day. At one point, I was down to 2 mg/day, but that was not quite enough for me to feel stable, so my doctor and I bumped it up a little.

2-mg buprenorphine films are one of the common human-level doses, so 1.44-mg syringes for a cat seems quite high (although as the study above indicates, bioavailability of buccal administration is significantly lower than subcutaneous).

Edit: And on 4 mg/day, I get constipated. As I mentioned above, my cat is definitely constipated now, so I feel like I should stop giving him Simbadol. The last dose I gave him was early this morning, so maybe 12 hours ago, and he just peed.

Any thoughts? I think he is peeing fine now, so I'm more worried about constipation at the moment. Especially since his last stool made his anus bleed a little bit.

 

[silent meowlook]

So, not to go against your vets advice, but that is way to high a dose for a cat.
Simbadol is given SQ to a cat and it is poorly absorbed SQ. The dose for Simbadol is 0.24 mg/ml as a one time dose SQ or once every 24 hours SQ.

Buprenorphine 0.3mg/ml is usually given at 0.03 mg/kg IM or buccal mucosa ( orally) every 6 to 8 hours.
So, if it was my cat, I would give a much smaller dose of about 1/10 of what you’re giving, but I would wait 24 hours from the last dose.

Better yet, discontinue and call your vet when they open. Try to talk to the actual vet as I feel some mistake has been made here.

 

[cmshap]

Better yet, discontinue and call your vet when they open. Try to talk to the actual vet as I feel some mistake has been made here.

I have discontinued, as I said, I am worried about constipation now.

Measuring out 1/10 of the contents of one of the syringes would be extremely difficult, as I'd have to barely squeeze out a tiny drop and then stop. I'm just going to cut it off completely and see how he does. I only have 2 of the 6 doses left that I was sent home with, anyway. And he is continuing to urinate normally.

 

[white shadow]

cmshap - just a few thoughts for you.....

First, to your request for a reference on urine retention as a side effect of buprenorphine: This statement is prominently listed in every veterinary drug 'handbook'/treatise * as a less serious potential side effect, after respiratory depression and sedation. Here it is in Plumb's Veterinary Drug Handbook: "may cause urine retention or difficulty voiding...particularly with high...doses". From the 2022 WSAVA Guidelines for the Treatment of...Pain: "Adverse effects can include...urinary incontinence/retention...However, adverse effects are usually associated with high doses. Less commonly...constipation can be observed." [ref] So, no old wives tale/urban myth/speculation, just reputable, accepted documented observation published by reputable sources. [* More 'common-access websites may be less inclined to mention secondary/tertiary side effects - e.g. I didn't see it on the VIN piece.]

[I've seen urine retention after surgery + buprenorphine administration in my own cats. I've only used 'regular strength' bupe and the cats took about a day to regulate. We have seen cases of retention on TCS and I remember writing to/about some, but that's several years ago. They were no 'big deal' because they resolved quickly. Given the emergence of the new long-acting products, I wouldn't be surprised to see more cases show up here. I should add that I never felt that my cats were in pain/discomfort.]

I saw some references earlier equating his not urinating to a "blockage".....that's a pure falsehood/bunk (and proven so by your Vet). "Retention", unequivocally, is not "blockage".

On the most recent 'events': It concerns me that you may discontinue this pain relief med. If he were here, I would continue with it, but at the reconsidered (properly calculated) dosage. So, that's only 1/10 and a couple of droplets.....well, so what? It's been safe and effective so far, and it's kept him pain free. All I'd be doing is adjusting the quantity.....and, we commonly do this with pain meds, more or less, up or down as needed to match the need we observe. He's been pain-free so far, pity if that were to change needlessly.

On the question of "constipation": Go back to the first paragraph above, to the quote from the Plumb's Handbook. Plumb says "may cause...difficulty voiding".....now, "voiding" is a bowel movement....and, he uses the phrase "may cause difficulty". That does not itself equate to "constipation" [constipation being the absence of sufficient water in the stool and colon which causes small, dry and hard stool]. My sense is that he is referring to buprenorphine's affecting the sympathetic nervous system, the "triggers" for urination and defecation.

Meantime you've written "He pooped for the first time today since his surgery three days ago, and it was hard, small, and made him bleed a little bit." Now, those are symptoms of constipation....no surprise, though, after the disruption by fasting to his GI system, and knowing that the longer stool remains in the colon/rectum, the dryer it becomes. So, again, not to give you advice, but, to say that if he were here/"my cat", I'd be giving him 1/4tsp Miralax immediately [a commonly used osmotic laxative without other drug interactions], and monitoring further BMs.

FWIW, there was an additional error made by whomever filled the Simbadol prescription. The label appears to read "Give the entire contents of one syringe by mouth (or into the space between the cheek and the gums)....". "Give by mouth" is standardized pharmacy 'lingo' applicable to drugs that are to be swallowed. Swallowing buprenorphine renders it useless as a pain reliever......it must be absorbed by the mouth tissue, and therefore must be placed into that "space between the cheek and the gums". This is not semantics, nor a minor point. It's a major error by the party dispensing the drug. (And, if they remain unaware of it, they'll likely repeat the error.)

Hope some/all of that's helpful.

 

[cmshap]

Here it is in Plumb's Veterinary Drug Handbook: "may cause urine retention or difficulty voiding...particularly with high...doses". From the 2022 WSAVA Guidelines for the Treatment of...Pain: "Adverse effects can include...urinary incontinence/retention...However, adverse effects are usually associated with high doses. Less commonly...constipation can be observed."

Thanks. I was asking because S silent meowlook earlier chimed in on this conversation and said "I've never seen urinary retention in a cat while using it." I am very familiar with buprenorphine for human use, as I've been taking it myself for years, but quite unfamiliar with its use in cats, so I saw some conflicting information in this thread and wanted to clarify.

If he were here, I would continue with it, but at the reconsidered (properly calculated) dosage. So, that's only 1/10 and a couple of droplets.....well, so what?

Because squeezing out a couple of droplets from one of the syringes I was given is damn near impossible, while holding down my cat by myself, and trying to administer between the cheek and gums. He thrashes his head, and I am doing it with one hand, so I have about a half-second window once I get the syringe in position. Then it would be a matter of depressing the tiny plunger with my thumb with just enough pressure so as to move it a fraction of a millimeter, but no more.

I'm sure someone skilled at dealing with cats and administering drugs could do it, but as I have administered the syringes thus far, I've noted that they are basically all-or-nothing when you push down the plunger, due to the stopper having friction that needs to be exceeded. They only have a tiny amount of liquid in them to begin with.

 

[white shadow]

What?.........Willy...fractious???.......Nahhhhhhhh, ce n'est pas possible, Monsieur!.........Who knew ???

Well, not me, I guess! See, I was imagining the patient to be a docile, gentle, sweet little thing who would head-butt you in thanks for his meds. Think of those pics we've seen. Hrmmmmm.....I suppose he would put his best foot forward in those, though. Oh well..........

I have a confession. When I read the notification of your post.......I laughed out loud with your imagery.....then, immediately felt guilty 'as hell'. I've been feeling so very badly for what you are going through, so admiring of your efforts and empathizing all the way along. Over the last ~20 years, five of my six have needed some degree of that constant diligent, hypervigilant management and supervision that you're demonstrating, and so, I know how draining it can be.

When I said "So, what?" I was giving no thought whatsoever to the practicalities, it was strictly in reference to the theoretical reduction of the quantity to be given...and, it was 'pronounced' from 30,000 feet. I was totally separated from my own memories of kneeling over a cat, needing and wishing I had at least two extra arms, and wrestling through to a not-always-successful conclusion. And, I, too, have gone through attempting to give only a portion of the already tiny amount in those tiny syringes. I do feel badly and I apologize for missing the most important part of that. Meantime (and, not to minimize what I've just said) it seems like you might have been able to let off a little steam there. If that's the case, then perhaps it wasn't a total disaster.

If there'll be an extended delay in him getting his next dosing (before you can get the Rx sorted out), perhaps consider ditching a portion from one syringe beforehand. That could save you from some of the problem at least.

 

[Kwik]

cmshap
It's not uncommon here in Fla thst we give patients the oral form of meds like this IF & when very familiar with the patients owner-,having said that,hmm?

I've not caught up yet reading the discussion since I was here yesterday so I'll refrain from putting in my 2 cents just YET ..... Because the conversation seems to be hovering around expected ,common & our less likely adverse reactions and possible side effects which is really not the issue- Willie has had urinary retention & now he's constipated,I'd stop the med,call your Vet ask for non Rx alrernativd like a little Miralax and laxatone ..... IF he seems to have pain or discomfort you can discuss a different Rx,that's was post operative only'-,correct?