Blocked cats

RE: Blocked cats

Kara Gibson — Wed, 20 Feb 2019 10:16:54 GMT

Some of these cases that have a component of urethral spasm can be difficult. I always radiograph to rule out stones and usually start them on prazosin and dantrolene early on, along side meloxicam when adequately hydrated and kidney function has returned to normal. Most of these cats have feline intersititial cystitis so in terms of recurrence focus has to be on wet diet and environmental modification as these are the only interventions which have been shown to improve long term prognosis.

https://www.ncbi.nlm.nih.gov/pubmed/16616567

This website has some good tips for improving the environment for indoor cats that can be useful for owners:

https://indoorpet.osu.edu/cats

RE: Blocked cats

Anthony Todd — Mon, 18 Feb 2019 18:50:32 GMT

[quote user="David Mills"]It comes around (we see about 70 a year) re tx for these post removal.[/quote]

If anyone has those sort of numbers they should do a paper. So much easier and quicker with computer sorting as 6x4 or punch cards and spears are not easy, accurate or detailed....

Posts here indicate it's still a problem!

We had the problem of the arrival of the dried food epidemic and the [futile] attempts to acidify the food leading to the totally new "oxalate" crystal or stone.

And, NO source of instant advice or trending patterns of problems like the internet!

Remember the JSAP which showed it was all because they were castrated, fat, and lacked exercise...........

Now you've got a balancing act between the two and some experts resort to secret magic [meaty] diets low in Mg++ and oxalate as a cure, back in the day indeed!

References, and my experiences, should be "pre or post" dried food 'cos the whole thing changed with that seismic change in cats' nutrition.

[what was the incidence of diabetes when all cats were on "6d of cats' meat" from your butcher??]

RE: Blocked cats

Anthony Todd — Mon, 18 Feb 2019 17:57:27 GMT

[quote user="Hannah Wynne Richards"]I hate Jackson's He/she must have been a prize fool to put the holes in the side, and not the tip.[/quote]

Oliphant Jackson went to enormous trouble to make people realise the fragility of the urethral mucosa and certainly would have hated what ended up in his name which I'm sure he had nothing to do with.

RE: Blocked cats

Anthony Dennison — Mon, 18 Feb 2019 16:33:00 GMT

We're a big practice so see quite a few. I'd say 90-95% are fine after 24 hours, but the 5-10% of complicated,recurring cases are right buggers to deal with. I think David's approach of a perineal urethrostomy if there's a recurrence within 3 months is a good one. Might suggest that for our next troublesome case.

RE: Blocked cats

Anthony Todd — Mon, 18 Feb 2019 10:08:18 GMT

[quote user="David Mills"]Our current protocol is second blockage within 3m, PU. [/quote]

So diet change didn't work?

Is the repeat blockage due to urethral stricture following the first procedure or more crystals?

I have no evidence apart from memory but, provided the diet was adhered to and there was minimal urethral trauma, there was no recurrence.

Er, until they got oxalate crystalluria from the "new" dried food.....

RE: Blocked cats

David Mills — Mon, 18 Feb 2019 00:09:33 GMT

It comes around (we see about 70 a year) re tx for these post removal.

I think the issue is that in some cats whatever tx you give they will fail. Some cats whatever tx you give they won't reblock. Having been a charity vet for years I'm not convinced anything works, or doesnt. I've tried unblocking and sending home (half come back), I've tried keeping them in for a few days (half come back at least).

We have vets who send on melox/prazocin/diazepam (funny how issues about oral Diaz issues go out of the window), some on one/two/none.

Re after catheter removal I normally do send them on amoxiclav for a few days post removal. We don't use closed systems I hate them, cats hate them.

Interestingly very few evidence points for therapy. Melox - no influence on outcome. Preds - positive....

Our current protocol is second blockage within 3m, PU.

RE: Blocked cats

Anthony Todd — Sun, 17 Feb 2019 18:18:25 GMT

[quote user="Liz Barton"]

I would have left the catheter in, then on removal do a quick microscopy of the urine. If no evidence of infection, no ABs. Bingo.

Has anyone tried the ACP/maropitant combination? One of our ECC vets uses it a

[/quote]

Not sure that I would diagnose a urethral infection by counting bacteria, particularly when a catheter had been inserted.? I'd be surprised if it was ever negative?

I used Acp as the only relaxant when unblocking cats as they would definitely react before I damaged the urethra [leading to "recurrent blockage" but actually urethral damage/etc.]

As I asked before I wonder if anyone has tried a human urethral dilator [forgotten the name, sold as "Maxiflo"....!!] infused locally which works brilliantly, orally, in human male urinary obstruction and avoids gruesome mechanical removal of ENORMOUS stones!

RE: Blocked cats

Liz Barton — Sun, 17 Feb 2019 16:06:42 GMT

[quote user="Michael Woodhouse"]

[quote user="Silvia Maldonado"] My question is how many of you would start on antibiotics once you remove the urine catheter?[/quote]

I wouldn't, but then I wouldn't have left the catheter in either.

[/quote]

I would have left the catheter in, then on removal do a quick microscopy of the urine. If no evidence of infection, no ABs. Bingo.

Has anyone tried the ACP/maropitant combination? One of our ECC vets uses it all the time, but I'm unconvinced by the results and have usually gone back to my usual protocol of diazepam/prazosin/metacam to go home after removing the indwelling.

[quote user="Emily Rainbow"]Might try the low dose diazepam with cat 2 and see what he does. (Cat 1 is a colleagues case). What sort of dose did you use?[/quote]

Usually 0.25-0.5mg/kg BID depending on how severe the spasm.

RE: Blocked cats

Julian Earl — Sun, 17 Feb 2019 12:04:13 GMT

There are a lot of papers and references on the EntrezPubMed site for anyone interested:

https://www.ncbi.nlm.nih.gov/pubmed/17422484

I hope this helps the discussion?

One paper from the USA in 1992 says this about urethrostomy: we suggest that perineal urethrostomy per se does not predispose cats to bacterial UTI, but surgical alteration of the urethral meatus combined with an underlying uropathy may increase the prevalence of ascending bacterial UTI after surgery.

RE: Blocked cats

Michael Woodhouse — Sat, 16 Feb 2019 22:06:05 GMT

[quote user="Silvia Maldonado"] My question is how many of you would start on antibiotics once you remove the urine catheter?[/quote]

I wouldn't, but then I wouldn't have left the catheter in either.

RE: Blocked cats

Silvia Maldonado — Sat, 16 Feb 2019 18:12:57 GMT

[quote user="Thomas Johnson"]

I wonder if we are seeing a different population of cats with urethral obstructions now compared to 20 or so years ago. A lot of the blocked cats I see have no crystals in their urine, and appear to have a combination of a proteinaceous plug and urethral spasm. My experience has been that placing a urinary catheter, flushing the bladder and then removing it is not successful, they re-obstruct straight away, the catheter needs to be left in place for 2-3 days. I also give antibiotics less frequently now and haven't noticed any change in outcome. They all get Metacam and of course dietary change.

[/quote]

Hi, team. Thomas' answer is by now the closest one I found to my question. I've got a 10 y.o. MN DSH blocked this morning for the first time. Electrolytes fine, x-rays fine, urine pH 8, proteins+++ and some leukocytes, no crystals at all, but definitely could feel a tamponade abut 2mm inside the end of urethra.

Unblocked relatively quick and easy, yellow transparent urine, recovering well, on metacam and fluids. My question is how many of you would start on antibiotics once you remove the urine catheter?

RE: Blocked cats

Anthony Todd — Wed, 07 Sep 2016 18:39:06 GMT

[quote user="David Mills"]This could dovetail nicely.[/quote]

Happy with that; get David Mills off my back , possibly, and he'd have to accept my citations....

RE: Blocked cats

Thomas Johnson — Wed, 07 Sep 2016 18:25:18 GMT

[quote user="Anthony Todd"]So when you've got a cat on a high oxalate diet and an acid urine you will get continuous oxalate crystal, or stone, formation so continuous bladder irritation and plugs containing crystals forming until the oxalate has been washed out of the system, thus apparent repeat blocking unless you do a urethrostomy, straight off which some owners may find a bit extreme.[/quote]

As a slight aside I saw a female cat recently that had 2 bouts of cystitis less than a month apart, urine was checked on the second occasion and I saw oxalate crystals. On ultrasound there were several small stones in the bladder. Obviously you can't dissolve oxalate stones, but they looked small enough for her to pass them, so I switched her to Royal Canin Urinary diet to prevent her forming any more, re-scanned her a month later and no stones.

RE: Blocked cats

David Mills — Wed, 07 Sep 2016 17:13:21 GMT

[quote user="Arlo Guthrie"]

[quote user="David Mills"]Google is not appropriate for finding references. [/quote]

Reading your answer, I can't help feeling my question was a bit dumb in the first place. I mean, doh, what was I thinking. Of COURSE a google search is cherry-picking, both by the reader and by Google itself. Plus your other points.

[quote user="David Mills"]If we want serious academic debate, fine, but linking up the first three papers on Google is laughably amateur, and frankly not worth anybody without an agenda to push's time.[/quote]

I wonder how we might improve the quality of discussion when it comes to papers being referred to.

One thought that comes to mind is if I were to try and negotiate VetSurgeon subscriptions to studies published by better quality publishers, in such a way that linked studies could be embedded within the forums.

Or build a bespoke search tool that searched a number of specific locations, and then presented results within a forum post, in a stand-alone box.

Using this forum thread as an example, I am imagining something which would mean that instead of doing a google search and posting cherry picked results, a poster would press a new button marked 'evidence search', which would then produce a list of results taken from known sources, which everyone would be able to see.

[/quote]

RCVS knowledge may be able to help. I think it's around £150 pa to be a library member but this gives access to books as well so there may be a deal to be struck for electronic access to journals only. May need to levy a fee on members of this site though say £20 pa. Unsure.

Think it was Michael Woodhouse who floated the idea of a journal club. This could dovetail nicely.

RE: Blocked cats

Anthony Todd — Wed, 07 Sep 2016 17:07:07 GMT

[quote user="Thomas Johnson"]I wonder if we are seeing a different population of cats with urethral obstructions now compared to 20 or so years ago. A lot of the blocked cats I see have no crystals in their urine, and appear to have a combination of a proteinaceous plug and urethral spasm. My experience has been that placing a urinary catheter, flushing the bladder and then removing it is not successful, they re-obstruct straight away, the catheter needs to be left in place for 2-3 days. I also give antibiotics less frequently now and haven't noticed any change in outcome. They all get Metacam and of course dietary change.[/quote]

I think that's very possible! When crystals [which grow into stones??] were all struvite and cereal was, and is, high in Mg++ the manufacturers, while being careful with their words, [check the Hills blurb] added NH4Cl to their food to acidify the urine and ensure the dissolution of struvite but ensure the precipitation of oxalate....

So when you've got a cat on a high oxalate diet and an acid urine you will get continuous oxalate crystal, or stone, formation so continuous bladder irritation and plugs containing crystals forming until the oxalate has been washed out of the system, thus apparent repeat blocking unless you do a urethrostomy, straight off which some owners may find a bit extreme.

and a low oxalate diet is hard to produce.....

[sh1t, that's just an anecdote and I haven't mentioned that they're all stress related nor quoted from an "authority so dismiss it all]

[Jeepers, that EVBM toolkit isn't easy to use for a newbie]

RE: Blocked cats

Thomas Johnson — Wed, 07 Sep 2016 15:57:46 GMT

[quote user="Martin Atkinson"]

Are we into the commercial food conspiracy again. The majority of blocked cats I see are still being fed Go-cat.

Notwithstanding this, I find that the proteinaceous plugs still contains crystals if your examine them microscopically.

[/quote]

I'm not sure what's causing them, dietary change certainly seems to help, but whether that's because the diet they were being fed causes the problem or because the individual cat is prone to problems so needs the dietary change to prevent it happening I don't know.

I should probably start looking at the proteinaceous plugs under the microscope as well as a cytospin of the urine.

RE: Blocked cats

Martin Atkinson — Wed, 07 Sep 2016 15:51:38 GMT

Notwithstanding this, I find that the proteinaceous plugs still contains crystals if your examine them microscopically.

RE: Blocked cats

Thomas Johnson — Wed, 07 Sep 2016 15:44:05 GMT

[quote user="Anthony Todd"]In fact back-in-the-day, when struvite was king, and nothing else was considered, we managed to PTS two cats which repeatedly blocked and in retrospect were the first oxalate FUS I think we missed!![/quote]

RE: Blocked cats

Anthony Todd — Wed, 07 Sep 2016 13:07:40 GMT

[quote user="Anthony Todd"]Crikey, glad I didn't, and just gave good diet and water advice so it never recurred[/quote]

Er, except the oxalate[?]

Sorry, true, it does say they didn't recur,my exaggeration.

RE: Blocked cats

Anthony Todd — Wed, 07 Sep 2016 13:02:45 GMT

[quote user="David Mills"]http://knowledge.rcvs.org.uk/document-library/ebvm-toolkit-2-finding-the-best-available-evidence/[/quote]

Thanks David, fair enough, didn't know that, will do in future.

RE: Blocked cats

Arlo Guthrie — Wed, 07 Sep 2016 12:58:19 GMT

[quote user="David Mills"]Google is not appropriate for finding references. [/quote]

I wonder how we might improve the quality of discussion when it comes to papers being referred to.

Or build a bespoke search tool that searched a number of specific locations, and then presented results within a forum post, in a stand-alone box.

RE: Blocked cats

Anthony Todd — Wed, 07 Sep 2016 12:53:00 GMT

[quote user="David Mills"]I could go on. But I haven't the energy, because we've been here before. If we want serious academic debate, fine, but linking up the first three papers on Google is laughably amateur, and frankly not worth anybody without an agenda to push's time.[/quote]

Trouble is, yet again, that when something contrary is cited it is dismissed, let alone personal experience, so we'll have to pick just the references that support some current dogma..

Some vets have had some trouble with PU so in some hands it's not the quick simple procedure, that's all I was getting at. The citation just supported that.

I never said my cats didn't reblock, please quote me.

In fact back-in-the-day, when struvite was king, and nothing else was considered, we managed to PTS two cats which repeatedly blocked and in retrospect were the first oxalate FUS I think we missed!!

RE: Blocked cats

David Mills — Wed, 07 Sep 2016 12:26:32 GMT

[quote user="Arlo Guthrie"]What's wrong with 'evidence found on Google', when it's published studies? (genuine question).[/quote]

Google is not appropriate for finding references.

http://knowledge.rcvs.org.uk/document-library/ebvm-toolkit-2-finding-the-best-available-evidence/

Googling things will bring up some references, but it will not give the inquirer all the evidence, so what we get - again, again and yet again - are cherry picked references with no study evaluation quoted to "prove" a point. Putting some boolean search terms into CAB abstracts or pubmed brings up around 400 pages related to PUs in cats, for instance, yet we have just three links here (and I suspect - well, know really - just the abstract read).

The Greek Veterinary Society journal, for instance, is mainly a review journal and of low quality. The JSAP paper is a retrospective with no controls (one of the main determinants of success of PU is surgeon skill, number of times the cat has been blocked, general health etc etc - in this paper there are 19 surgeons of "varying experience" and on quick reading no identification of failures according to surgeon, length of time or number of blockages encountered) and simply refers to a low number of cats in one hospital in Sweden so is poorly extrapolatable to UK London cats at the RSPCA, for example.

I could go on. But I haven't the energy, because we've been here before. If we want serious academic debate, fine, but linking up the first three papers on Google is laughably amateur, and frankly not worth anybody without an agenda to push's time.

I notice with wry resignation that my question about writing up a case series that shows his blocked cats "never" reblocked - quite at odds with all other anecdotal evidence out there - remains unanswered. C'est la vie.

RE: Blocked cats

Anthony Todd — Wed, 07 Sep 2016 12:05:09 GMT

Thanks Arlo, I quote the references only to make people aware that I am not making things up and post the links without too much care and no skill. [I've been accused of "cherry picking" if I don't...]

I am secure, in most cases, that if it is contrary to the current dogma it won't be even glanced at.

I, and others, can't win. If I make a statement I get told it's just an anecdote and therefore baloney and worthless.

If I quote a paper [and Google is better than going down to the RCVS library] I'm still derided.

Yet modvets can quote something from a textbook or what their lecturer told them or with no actual evidence at all["gloves" is a good example] and this is cast iron evidence, except there often isn't any, or even negative evidence when someone bothers to explore.

[sigh]

RE: Blocked cats

Arlo Guthrie — Wed, 07 Sep 2016 11:46:52 GMT

[quote user="David Mills"] Trial by evidence found on google. Have things got so logically fallacious in our world? [/quote]

What's wrong with 'evidence found on Google', when it's published studies? (genuine question).

Of course, I come a bit (aka completely) unstuck when it comes to knowing whether or not studies are any good. Normally, I'd say 'it's all Greek to me'. In the case of Tony's first linked study (JHVMS 2011 62(2) 150-160 PAPAZOGLOU & BASDANI), it really was all Greek to me

Anyway, have added links to the other studies (hope I have done it correctly, Tony).