Sacral avulsion

Re: Sacral avulsion

listhestar — Mon, 08 Oct 2012 20:02:20 GMT

[quote user="Iain McAllister"]

Thanks for that - unfortunately these neuro tests are impossible to perform as cat is v feisty - did have a look at his anal sphincter but under sedation so diff to assess - the spincter is closed - ie not gaping and when I did stretch it - it returned to a closed position but am not sure whether this would indicate tone or just a normal "recoil" of the muscle

Might try and get hold of bethanacol tho

thanks

[/quote]

If its any use I had a cat with the same type of injury and after 3 weels of management the cat returned to full function (we just removed his tail) and he has never looked back. Those owners were very keen to give the cat all the time he needed and cost wasnt an issue (lucky I know).

Good luck

Lisa

Re: Sacral avulsion

Iain McAllister — Fri, 05 Oct 2012 12:27:05 GMT

[quote user="Mark Lowrie"]

The main thing with these cases is to check a couple of things initially to establish a prognosis to see if it is worth giving them time.

1) Check tail base sensation. If there is no tail base sensation then it is stated that 40% do not regain normal urination

2) Check perineal sensation and anal tone. If there is no sensation/flaccid tone then it is stated that 50% do not regain urination.

If these two things are present then prognosis is pretty good and certainly worth some perseverance.

[/quote]

Might try and get hold of bethanacol tho

thanks

Re: Sacral avulsion

Mark Lowrie — Fri, 05 Oct 2012 12:11:08 GMT

The main thing with these cases is to check a couple of things initially to establish a prognosis to see if it is worth giving them time.

1) Check tail base sensation. If there is no tail base sensation then it is stated that 40% do not regain normal urination

2) Check perineal sensation and anal tone. If there is no sensation/flaccid tone then it is stated that 50% do not regain urination.

If these two things are present then prognosis is pretty good and certainly worth some perseverance. Given the bladder is large and easily expressed I would not be worried about the use of dibenyline as this is, as you say, used in paradoxical cases of increased urethral tone where you have a difficulty expressing (this presentation is relatively less common). Bethanecol should help increase detrusor tone in the bladder and so is the best option for now and I believe it is still available – I used it this week.

Recovery can take a long time if perineal sensation and tail base pain are absent but I would usually give these cases 6 weeks maximum. After this time it would be very unlikely to see a recovery. If tail base sensation and perineal sensation are present then recovery is likely to be a lot quicker than this.

The references for the above come from a JSAP paper (Tatton and others 2009; 50, 593–596).

Re: Sacral avulsion

Utlendigur — Fri, 05 Oct 2012 11:30:14 GMT

I was having a clear out last week and found an advert for bethanacol (10mg and 25mg tablets) from Glenwood (www.glenwoodpharma.co.uk) distributed via Mawdsley-Brookes (www.mawdsleys.co.uk). It said "bethanacol returns to uk market" so sounds like it is available

Re: Sacral avulsion

Simon Neuhoff — Fri, 05 Oct 2012 09:02:05 GMT

I am lead to believe that a surprising number of these do regain bladder function if you give them long enough - the last time I spoke to a neurologist about a similar case he suggested 6-8 weeks at least of management. The difficulty of course lies in managing the client for this time - hard to be upbeat about the prognosis and it can be very heart breaking to give up after that amount of time.

I know of one cat who was given time but never recovered bladder or feacal control. He is manually expressed and evacuated by the owner twice daily (very decidated people!) and has been doing fairly well for 7 years or so now. Along the way though he has had multiple UTI's, perineal urethrostomy as a result of this, started self traumatisign the tail severley years later and had this amputated so it hasn't been all plain sailing. He may be one of the more expensive cats in the country but overall the quality of life has been pretty good IMO and the owners are happy.

Temperament in your case might be a bit of a factor!

Re: Sacral avulsion

Rob Loxley — Thu, 04 Oct 2012 22:56:34 GMT

Good article in In Practice this year on tail pull injury management.