Case of the Month: Clark PART 3

Urinary blockage is almost exclusively a problem reserved for male cats, and occurs when the urethra becomes obstructed. The urethra is the “tube” that drains urine from the bladder out of the penis, and it is very long and narrow. When the urethra is completely blocked, and the cat has filled his bladder to capacity, his kidneys stop making urine as there is nowhere for it to go. With kidney “shut down” the body is no longer able to remove toxins from the blood or maintain a proper balance of fluids and electrolytes in the body, resulting in kidney failure and eventually death if left untreated.

Initially cats may show signs of urinary tract inflammation, such as straining to urinate, frequent urination, blood in the urine, painful urination, or inappropriate urination (urinating somewhere other than the litter box). Once the cat becomes obstructed (blocked), they may attempt to urinate in the litter box but will produce only drops of urine or no urine at all. They may cry, move restlessly, or hide because of discomfort. Eventually they will lose their appetites, generally begin to vomit, and become lethargic. Complete obstruction can cause kidney failure in as little as 24 hours, and potentially death in as little as 48 hours.

Prognosis for recovery is often excellent if treated appropriately and in time. If sudden kidney failure does develop as a result of the obstruction, it is generally reversible and will get “back in check” with IV fluid therapy support. It is crucial to realize that the cat is at risk for re-blocking for a good week or two from the time of discharge. This is because the irritation syndrome that led to blocking in the first place is still continuing, and as long as the episode continues, blocking is a possibility.

We hope that this case study has been helpful in teaching you about this disease. If you have any questions or concerns about the blog, please do not hesitate to contact us at Pekin Veterinary Clinic. Please check back next month for our November case of the month!!

Case of the Month: Clark PART 2

Each day, Clark became more bright and alert during his stay at Pekin Veterinary Clinic. After days of intravenous (IV) fluids and urine collection, Clark's urinary and IV catheters were removed. We ran more blood work to ensure that Clark's kidney values (BUN and creatinine) had normalized along with his electrolytes. His blood urea nitrogen (BUN) was 14 (normal value 10-30) and creatinine was 1.1 (normal 0.3 - 2.1). Clark's potassium had had also significantly decreased to 4.0 (normal range 3.7 - 5.8). Clark was monitored for the rest of the day to ensure that he could urinate without the assistance of the urinary catheter.

After it was seen that Clark could urinate without assistance, he was sent home to his owner in the afternoon. Medications sent home included a pain medication an an anti-inflammatory medication. Since Clark had struvite crystals in his urine, it is important that he stays on a diet that prevents these stones from forming.

Currently Clark is doing very well at home. He is exclusively eating the Royal Canine S/O diet to prevent the struvite stones from forming in his urine. Clark is adjusting well to being back home and enjoying spending time with his family.

Please check back next week for Part 3 of the case study. In that section, we will discuss what you need to watch for at home to ensure that you recognize signs of this very serious but treatable disease.

Case of the Month: Clark

Clark is a 3-year-old male neutered domestic shorthair cat who presented to the Pekin Veterinary Clinic because he was straining to urinate and the owner was seeing blood in his urine (hematuria). He was also acting like he was in pain and was not eating or drinking at home. On physical examination, Clark's heart rate was greatly increased (tachycardia) and he had a large hard bladder on abdominal palpation. When Clark's abdomen was manipulated, he was extremely painful.

At this time, Clark was taken to our ultrasonography room to assess his bladder on the ultrasound and collect a urine sample by cystocentesis. The ultrasound showed that the bladder was very large, distended and contained a lot of foreign material. The urine sample that was collected revealed that the urine was very bloody and contained an abundance of what appeared to be crystalline material. The urine sample was sent into the laboratory for urinalysis. The urinalysis revealed that the bladder contained crystals (struvite) and blood from the inflammation of the inside of the bladder wall from the crystals.

Clark was in very critical condition, so it was decided between Clark's mom and the veterinarian that he needed to be treated as soon as possible for this condition. We started by collecting Clark's blood and assessing his kidney function and electrolytes. His blood work showed that both of his kidney values were highly elevated. His blood urea nitrogen (BUN) was 119 (normal range 10-30) and his creatinine was 9.8 (normal range 0.3-2.1). The electroyte that was dangerously high was potassium (this is a common bloodwork finding in cats who cannot urinate due to having stones lodged in their urethra).

Clark was immediately anesthetized to relieve his pain and so that we could unblock him by passing a sterile urinary catheter. We needed to unblock Clark as soon as possible to decrease his chance of complications from his condition. These potential complications included: bladder rupture from overextension of the bladder wall, irreversible kidney damage and/or adverse effects on the heart from the high potassium. Once anesthetized, we unblocked Clark's urethra which was blocked with multiple small crystals. After the urinary catheter was placed, we flushed that bladder with a mixture of sterile saline and lubricant to try to remove as many of the crystals from the bladder and urethra as possible.

A sterile urine collection system was placed on the end of Clark's urinary catheter so that his urine output and quality could be assessed. An intravenous catheter was placed in Clark's cephalic vein so that he could receive fluids to correct his electrolyte disorders and flush the kidneys to bring down the elevated kidney values. Clark was given oral pain medications to help keep him comfortable. He was also given an antibiotic to decrease his chances of getting a urinary tract infection as a result of the urinary catheter being placed. Clark rested for the remainder of the afternoon and evening without complication.

Cooper and Ruby

Cooper 
I would like to formally introduce myself. Many of you have had the chance to meet all the doctors and other team members here at Pekin Veterinary Clinic. What most people aren't aware of is; who around here actually keeps the clinic in running order.

That would be me. My name is Cooper. If you've had the luxury of touring my clinic, you've probably noticed a handsome orange tabby cat supervising the technicians and other team members in the treatment area. With so many women in one place, someone has got to keep them in line. Don’t get me wrong; they are all exceptional at their jobs.

Although, sometimes they get too busy, and I have to remind them that dinner is promptly at 4:00 p.m. Well, since I’m such a nice boss and don’t complain, I generally just stare them down and that usually sends that message across. But if that doesn't work, I politely let Ruby ring the dinner bell, since she never misses a meal. Most of the time, you can find me leisurely watching the commotion from the doctor’s desks, but every now and then I like to retreat. I like to get away from it all and spend some time in Dr. Jess’s office or even steal a few moments of music and peace in Tammy’s office on her window sill. It’s truly hard, you know, to keep such a busy clinic running so smoothly.
Signing out, Captain Cooper

Ruby
Hello. My name is Princess Ruby and I just want to let all my fans know that I didn't always look this good. These crazy people at Pekin Veterinary Clinic gave me a home back in March of 2011. I used to weigh a good 24 ½ lbs, and they thought that was too much for a princess like me to weigh. After some hard work for both me and the team at Pekin Veterinary Clinic, I now weigh 11 pounds and 4 ounces!!! I’d have to say that’s quite the accomplishment. Every woman knows dieting is NOT the most fun thing to do.

Now that I’m at home here, I want to share my daily life, trials of dieting, and how important I am here at the clinic. You see this place wouldn't run as smoothly if it weren't for me. Oh, and there is this annoying orange tabby here, they call him Cooper, and sometimes he thinks he runs this place but we shall see about that…after all, I am the PRINCESS.
We’ll chat again soon, XOXO
Ruby