Cisco’s Surgery

Cisco’s transition to inside life had been going so smoothly.  He was fully integrated with Jake and Marvin and had been out of his “safe” room for almost 2 months.  In fact, we were just getting ready to put the “safe” room back to a guest room!  Things can happen very suddenly that change the course.  This is a very long account.  I decided to write it out mostly for my records.  Feel free to pass over this very long post.

Last Thursday night, May 11, 2017, Cisco came into our room for bed time.  As I was brushing my teeth, he came in to use the litter box.  Once I was finished, I noticed he was still in there.  I kept an eye on him and finally after nearly 10 minutes he came out.  I checked to see and there was indeed both urine and stool in the box.  I wondered if he was a bit constipated.

Friday morning emerged and Cisco seemed fine.  Yet later that day I noticed he was in and out of the litter box more than normal.  By early afternoon, he was going into the litter box and then he was crying.  I still wondered if he was constipated.  I had recently begun introducing home cooked cat food into his diet.  A change in diet can definitely cause constipation.  I kept an eye on him and started to worry.  We were headed out of town the next morning.  At 4 pm, I called the vet and she was concerned.  It sounded like a possible urinary blockage.  She suggested I take him right to MedVet since if it was a blockage, he would end up there any way.  Ugh.  It’s now after 4 pm on a Friday and a trip to MedVet at rush hour is not fun.

We arrived near 5:30 and Cisco was taken back for a check immediately.  It wasn’t long before we were told, it was a urinary blockage and he would need to have a procedure done.  Male cats tend to develop this condition due to anatomically having a very narrow urethra.  They put him under anesthesia and inserted a catheter to break up the blockage.  Then the bladder is irrigated to help remove any other toxins or tissue build up.  The catheter remains in place for 24-48 hours.  We were sent home knowing he would remain until Sunday evening or Monday morning.  We also went ahead and continued our weekend out of town plans.

Cisco did well with the procedure.  The blockage was a collection of struvite crystals.  When they viewed the urine sample, they found 50+ crystals and some blood.  It was then determined an ultrasound was necessary to check for any stones in the bladder.  Fortunately the bladder and urethra were free of stones.  This was good news. Cisco was monitored throughout the day and night on Saturday and was doing well.  The only complication was that he was not eating.

On Sunday morning, the catheter was removed and we waited to hear if/when he urinated on his own.  As long as he was urinating on his own, he would be allowed to come home Sunday evening.  I heard a few hours later that he had indeed urinated on his own!  I was so happy.  We made plans to pick him up early evening.

Unfortunately just a few hours later, I received another call saying that he could not urinate on his own.  There was no physical blockage, but his bladder was contracting, but no urine would come out.  They gave him a few more hours to see if the medication would help.  It did not.  The internal medicine vet did not feel that doing a recatheterization was a good idea.  With all of the spasms he would most likely do fine with the catheter, but then block again without the catheter.  It also is not a good idea to recatheter often as the urethra can then develop small tears.  They decided to manually express the bladder overnight and make a decision Monday morning.

Overnight he did well with the bladder expression, but my morning he was grouchy and in pain.  His bladder was growing hard again.  We had the option to recatheter or move forward with a surgical option.  We decided on the surgical approach as we did not want him to continue in so much pain.

The only other option was a PU surgery (Perineal urethrostomy).  During the procedure, the penis is removed and the larger diameter urethra that is closer to the bladder is sutured to the skin between the anus and the scrotum. This provides a new opening through which the cat can urinate.  I was told that even though this procedure sounds complicated, it is a very straight forward surgery.

The surgery was performed Monday afternoon.  He did very well and was resting comfortably.  Now we had to wait for him to urinate on his own.  The plan was to pick him up late day Tuesday.  He did well overnight Monday and urinated on his own.  When the surgeon went to check on him Tuesday morning, his bladder was still having spasms.  He would urinate only small dribbles unless a bit of pressure was applied to the bladder.  The surgeon felt, once the inflammation reduced and the spasms stopped, he would be fine.  We decided to go get him as he was very stressed and still was not eating.  Once home, he might settle.

When we arrived to pick him up, he had urinated on his own without any pressure applied to the bladder.  This was good news and made us feel better about taking him home.  He was happy to see us.  The instructions and medication list were both long.  I was a bit unprepared for how much of his fur was shaved.  Each paw had something shaved for a needle and his entire back end and part of his abdomen were also shaved.  He was also so very skinny.

Fortunately we still had the “safe” room ready.  We did a bit more clearing out.  I also had to get some special litter made out of paper called Yesterday’s News.  It was the strangest litter I had ever used.  It needed to be non clumping so it did not stick to the incision.  I also bought him an inflatable cone that I thought might be more comfortable than the plastic one.  In the long run, this cone was more comfortable, but he could reach back much further.  I decided to just stick with the plastic cone.

Cisco was not happy to be shut in his room.  He so wanted out.  It took awhile to calm him down.  He did manage to eat a small bit, but he kept pacing and running into every wall with the cone.  He was a bit frantic.  It was only 30 minutes or so home that he tried the litter box.  It was awful to once again see him in there for long periods with no urine production.  He did this over and over a few times before getting really tired.  We watched him closely as we did not want the cone to fall off.  The incision was swollen and red and he was not to lick it at all.  At bed time, I went to give a bit more food and medicine.  He takes his medicine like a champ!  Yet the litter box issues started again.  He did not cry, but he was definitely straining.  He had a small blood clot that feel off from straining.  So then there was a bit of blood.  I felt a call was needed to the vet.

After hearing the situation, we had to take Cisco back to MedVet that night.  Of course it was nearing 10 pm.  Once there, it was determined that thankfully he was not blocked, but the continued spasms and then some mental aspect might be causing the issue.  His bladder was very small and soft.  We had a wonderful emergency vet.  At first she wanted to try an “off label” antidepressant to see if that would calm him.  Yet while discussing the situation, she thought of trying gabapentin for the nerve pain as well as the sedating properties.  This drug is often used to calm cats that are terrified of vet visits.  It also is approved for use in cats.  We decided to try the gabapentin as well as some sub q fluids.  We were back home around 1:30 am.

I decided it was best to sleep in the room with Cisco.  I really needed to keep an eye on him.  I slept fitfully as I was concerned about him.  He got up around 3 am and once again attempted the litter box. Of course once again nothing came out.  He then became frantic and was trying to get out of the room.  He kept banging his head against the gate and then attempted to jump it.  He would not calm down at all.  I had to get my husband to help.  I tried placing Cisco in a large dog crate, but he got his paw stuck.  We then put him in the large carrier we use for him as he couldn’t move too much.  My husband said he would stay with Cisco as I was as frantic as Cisco.  He needed calm and I was definitely not calm.

Once I left the room, Cisco calmed within 20 minutes.  He was then allowed out of the carrier.  He settled under the bed side table before getting up around 4 am and finally urinating!  He did well the rest of the night.  I arrived with breakfast around 7 am.  He was happy to see me and was able to eat.  After breakfast it was time for medicine.  He then went pee again!! After all of that he was ready for a nap.  We continued to watch him throughout the day.  The surgeon called and wanted us to bring him back in so she could have a look.  I told her it would be very stressful for him.  She agreed that I could email her pictures and we would talk later.  After looking at the pictures, she thought he was a bit swollen, but agreed if he was eating and urinating fine we could talk again on late Thursday or early Friday. My husband and I either took turns in the room with him or watched him from the wireless ip camera we set up.  He did really well until 6 pm when the gabapentin must have worn off.  He was once again agitated and trying to get out of the room and trying to get the cone off.  It took almost an hour for him to calm down.  Fortunately he stayed calm the remainder of the evening.  At bed time, he was given the rest of his medication.  My husband slept in the room with him again.  Cisco did great.  He slept all night getting up only once to pee and poop!

Today he is having a pretty good day too.  He is eating like a champ and having no issues in the litter box.  So far all day, he sleeps for 2+ hours and then is awake for 15-30 minutes.  He is very cuddly today which is good to see.  He so wants out of the room and will cry at the gate.  The cone makes him quite agitated.  He tries very hard to get it off.  I am concerned about the damage he could do if the cone did come off.  Marvin and Jake have seen him through the gate and both are a bit freaked out.  Hopefully next week they can have a visit in Cisco’s room.

This is all a day by day process.  I have read many accounts about this surgery.  Each day that passes is progress, but we are not out of the woods yet.  I was so hoping he would not need any more trips back to MedVet until the recheck on May 26.  Unfortunately the surgeon emailed me today that she really wants to see him tomorrow.  She will be unavailable all weekend and would feel better seeing him in person.  We will definitely make the trip.

Here he is with his dreaded cone. Note the unhappy facial expression.

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4 Responses to Cisco’s Surgery

  1. We had the same issue with Moon when we first brought him in. He blocked in the first year he was inside, but we did not have to have the surgery. We did find that a low carb (as low as you can get) and a low mineral load (senior) food will keep the crystals under control so they don’t continue to irritate his bladder. We feed a zero carb low mineral dry food and meat only canned food. He’s been crystal free for 5 years now. Feral cats, because a wild diet is so different, tend to have issues with carbs and minerals if they are over sensitive. We also had to have Moon on different “calming” medications because stress exacerbates what’s going on with the bladder.

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  2. We also use InClover’s Flow chews because they are so soothing to the bladder. Moon used to get stressed induced cystitis in the spring when we opened the windows. The chews fixed that issue.

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  3. Trish K says:

    You and your husband are SAINTS! The care and attention you give to your cats is VERY impressive. Thanks for your journal on this…very informative for me, for the care I try to give to our feral cat.

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