Cystotomy Tube / Tail Pull Management - my own cat! :-(

Re: Cystotomy Tube / Tail Pull Management - my own cat! :-(

Anthony Todd — Sun, 03 Aug 2014 14:38:21 GMT

Sorry duplicated somehow.

Re: Cystotomy Tube / Tail Pull Management - my own cat! :-(

Anthony Todd — Sun, 03 Aug 2014 14:37:25 GMT

A very good sign IMHO; paralysed cats pee with no pressure at all, and half anaesthetised cats are very difficult . If you express him where and when he usually goes he will get the message.

I'm sure you know ,but you only need average pressure over the wholeish bladder and the harder you press the less effective it is...

Seems to take an age before the cat "lets go", but I'm sure you either know that or are finding out.......

After you've been doing it for a while he'll get the message [" a while" is deliberately vague usually days IMHE.]

Re: Cystotomy Tube / Tail Pull Management - my own cat! :-(

Sarah Bolt — Sun, 03 Aug 2014 12:38:22 GMT

Hi,

Thanks for that suggestion, it would make sense. I tried expressing my cat last ight and his bladder was not easy to express (I couldn't express any urine at all!), whereas immediately after his RTA it would express very easily with minimal pressure. I don't want to get hopes up, but would you think this maybe this is a good sign and that maybe he has some nerve innervation returning causing increased urtheral sphincter tone? Do you think it is worth trying a urethal relaxant and then trying to express him again, or better to wait and see if he does his own thing?

Thanks for the input :-)

Re: Cystotomy Tube / Tail Pull Management - my own cat! :-(

Anthony Todd — Fri, 01 Aug 2014 21:07:12 GMT

[quote user="Sarah Jervis"]no sign of trying to urinate yet[/quote]

I found that you could often get cats to urinate post injury or block if you took them to their usual peeing spot and manually expressed the bladder.

They seemed to learn to relax the sphincter pretty quickly.

If you are draining the bladder with whatever there is no muscle tone or reflex needed so, I guess, the cat could forget how and why to do it and forever?

Manual expression takes some practice but cat's seemed to get the idea pretty quick.

Better to wait until the bladder is pretty full so there is, hopefully, some signal delivered .

Re: Cystotomy Tube / Tail Pull Management - my own cat! :-(

Emily Nightingale — Wed, 30 Jul 2014 10:09:08 GMT

Is there any added benefit of using bethanechol chloride? I know there were problems sourcing it ( was is Arnolds that was manufacturing it??) for a while. Luckily I've not had any cases like this for ages but have had a few in the past and they can be so distressing initially but so rewarding once they start peeing for themselves again! Good luck with your cat. Sounds like he is in great hands and very happy.

Emily

Re: Cystotomy Tube / Tail Pull Management - my own cat! :-(

Anthony Dennison — Wed, 30 Jul 2014 04:45:33 GMT

One of our night nurses' cats disappeared for a week and came back with a tail pull injury; luckily her bladder was easy to express. She was very upset because she had seen other cats be given 48 hours to see if they can urinate and she thought it would be pts then. We waited, and as far as I know (currently on holiday) she was starting to urinate.

Completely anecdotal, but I often say to clients the 2 most important factors in neurology are time and patience!

Re: Cystotomy Tube / Tail Pull Management - my own cat! :-(

Sarah Bolt — Wed, 16 Jul 2014 22:03:35 GMT

Hi, just an update about my cat - he's now got a low profile mic-key tube in (technically a human paediatric feeding tube) and he's tolerating it really well. it's a bit fiddly to start with but once you get hang of tube plus wriggly cat (dreamies are an amazing distractor!! :-P) then it's fine. it's been in a week so far, started with a Foley but the only problem with that is the long tube which meant he had to wear a stretch net most of the time...

we're now 9 weeks post accident, no sign of trying to urinate yet which I know means prognosis for return of function is poor but he's very happy and not bothered by me emptying his bladder via tube (not so keen on expressing) so while he's happy then I'm holding on for a miracle! he is pooing ok so we'll see..!

Good luck with your case :-)

Re: Cystotomy Tube / Tail Pull Management - my own cat! :-(

Tim Charlesworth — Wed, 16 Jul 2014 15:23:24 GMT

Hi Kishor, you can get "low profile" C-tubes for the larger animals but these are hard to find and then fit in cats and so we usually just use a Foley catheter. Silicone Foley's will be least irritant. The bulb tends to stay inflated for longer if you inflate then with saline aot air. Provided you omentalise them and put a few pexy sutures between the bladder and the body wall you should just be able to remove them w/o 2nd procedure when they are no longer required. I've only ever kept them in for 1-2 weeks or so. The presence of an anal reflex is a very good prognostic sign for return to function for your cat and so hoepfully you won't need it in for too long,

Good luck with the case,

Tim

Re: Cystotomy Tube / Tail Pull Management - my own cat! :-(

Kishor Mahind — Wed, 16 Jul 2014 11:21:42 GMT

Hi,

I've got a similar case, 1 yr old male cat with tail pull injury and inability to urinate on his own. He has got some anal tone and very comfortable and eating well and stable now after his trauma and we would like to give him a chance to see if the bladder tone returns. So planning to amputate his tail and put a cystotomy tube.

Any suggestions about types of tubes that can be used (especially if going to leave it for long) and where can I get them from?

Thank you in advance

Re: Cystotomy Tube / Tail Pull Management - my own cat! :-(

Kate Richardson — Sun, 18 May 2014 23:14:09 GMT

I have used foleys but not for more than 2 weeks so I honestly don't know how long they can stay in for. If they need replacing its simple to just pull out and insert a new one once a stoma has formed. There may be more permanent tubes on the market for long term use. Keep us posted x

Re: Cystotomy Tube / Tail Pull Management - my own cat! :-(

Sarah Bolt — Sun, 18 May 2014 16:07:51 GMT

Thanks for your reply. I have kept him on vetergesic today and he seems a bit brighter (although is out for the count now!!) - fentanyl might be a bit nicer for him, not sure if we have any at work but will investigate.

His cystostomy tube is a foley catheter - how long can I keep this in for? I guess most papers I've read said that if function is going to return then it usually does within two months so I had in mind that this would be my timeframe, assuming he remains happy and comfortable, but can I keep a foley catheter in that long if needed? He was tolerating bladder expression until his bruising really came out, and then he got a bit irritated by it all (don't blame him really!!).

He passed a small nugget of faeces this morning - he is on lactulose already. He didn't seem to know he was defecating though.

Thanks very much :-)

Re: Cystotomy Tube / Tail Pull Management - my own cat! :-(

Kate Richardson — Sun, 18 May 2014 15:14:21 GMT

It sounds as though you are being sensible and realistic and have lots of people supporting you and hopefully being honest with you. As long as he is comfortable and happy then no reason not to give it time, but do keep yourself prepared for him not recovering function. Keep the opiates on board as well as the NSAIDs, consider a fentanyl patch? Might even be worth gabapentin if you think there may be neurogenic pain? Given the trauma I would expect discoloured urine for several days, plus as you say there may well be myoglobin, so ensure hydration is good, some subcut fluids daily might be a good idea rather than having him hooked up to a drip. There will some inflammation induced by a placing a cystotomy tube initially but I would expect this to settle quickly, however it has been placed in an already inflamed bladder so may take a bit longer. If placed sterilely UTI shouldn't be a concern so I would monitor for infection with intermittent cultures rather than blanket antibiotics-sediment exam won't be very helpful unless you see bacteria as there will probably be neutrophils present regardless. Cats generally tolerate cystotomy tubes really well and I think we should use them more frequently. The great thing with them as well is you can allow some pressure to build up in the bladder and give the cat a chance to wee, knowing you can easily empty it if they can't.

Can he pass faeces? Lactulose useful to soften faeces with pelvic fractures, makes it a bit easier for them. Keep an eye on his electrolytes if he is not eating fully, just to make sure potassium stays normal, as can easily get a bit low and exacerbate the inappetance.

Fingers crossed big time for him and you, really hope he does recover. There is no way on knowing, I had one cat that had his whole tail removed by trauma and he regained full bladder and bowel function, so never say never.

Re: Cystotomy Tube / Tail Pull Management - my own cat! :-(

Sarah Bolt — Sun, 18 May 2014 07:57:45 GMT

[quote user="Michael Woodhouse"]

I'm sorry to hear your cat is not well. Would you have put the cat through all this if it was not your own?

Given the history I'd be pushing very strongly for PTS in this case.

[/quote]

I have asked myself the same question, and I asked colleagues whether I was being cruel to keep him going, so it is something I have considered. He has been rolling around purring so I don't think he is very distressed (he does let you know when he's cross!) and I have read a lot of papers that suggest that nerve function can up to two months to come back. As he is coping fairly well (better than I am!!!) I want to give him that chance. One paper specifically said do NOT put these cases to sleep too early as they can do well.

It's a fair point and something I have pondered (reluctantly). I have told colleagues to be honest if they think I am keeping him going for my sake rather than his, but they all have said they don't think I am at present. He is just tucking into breakfast now, seems a bit happier back on the vetergesic. My other half is my voice of reason too and he thinks he seems relatively happy, all things considered. I think I'd be a lot grumpier if I had broken bones and such!

Re: Cystotomy Tube / Tail Pull Management - my own cat! :-(

Christina Smith — Sun, 18 May 2014 03:05:32 GMT

Opiates. Great for pain relief but supress appetite and reduce gi motility. Very difficult to assess normal

Re: Cystotomy Tube / Tail Pull Management - my own cat! :-(

Michael Woodhouse — Sun, 18 May 2014 00:56:42 GMT

I'm sorry to hear your cat is not well. Would you have put the cat through all this if it was not your own?

Given the history I'd be pushing very strongly for PTS in this case.

Re: Cystotomy Tube / Tail Pull Management - my own cat! :-(

Linda Filshie — Sat, 17 May 2014 22:14:33 GMT

[quote user="Sarah Jervis"]

Okie dokie, will stick to the vetergesic for a bit longer. Thank you very much for your help, you're right, obectivity has gone right out my window over this last week! He does seem to have perked up a bit, and since writing my first post, he has tucked into half a bowl of dinner, so its not just clients pets that 'did do it at home, honest!'!!

Thanks very much :-)

[/quote] You're most welcome. Glad to hear he's eating

Re: Cystotomy Tube / Tail Pull Management - my own cat! :-(

Sarah Bolt — Sat, 17 May 2014 21:51:30 GMT

Thanks very much :-)

Re: Cystotomy Tube / Tail Pull Management - my own cat! :-(

Linda Filshie — Sat, 17 May 2014 21:35:10 GMT

I'd probably stick with vetergesic for another couple of days - while I love NSAIDs I don't think they quite cut it for broken bones. That said, my mum had a hip replacement last year and as she can't tolerate opiates she only had paracetamol! She was in a hell of a lot of pain though - far more than I would be happy seeing an animal have to tolerate.

Re: Cystotomy Tube / Tail Pull Management - my own cat! :-(

Sarah Bolt — Sat, 17 May 2014 21:30:22 GMT

He was on methadone and metacam initially, but after the tail amp seemed lots more comfortable so dropped down to vetergesic and then still seemed really comfortable so tried with metacam only today - seems to have been fairly comfortable when I picked him up for cuddles but when found that temperature had risen, I gave him a vetergesic injection in case his temperature rose due to pain. That was an hour ago and just re-took his temperature and its back down to 37.7C, so I guess he is maybe not as comfy as he seemed...

Re: Cystotomy Tube / Tail Pull Management - my own cat! :-(

Linda Filshie — Sat, 17 May 2014 21:24:30 GMT

It's horrible when it's your own animal - I think it's much easier to be objective when it's someone else's.

As far as sleeping a lot goes, anyone who's been through major surgery or trauma will tell you that you tire easily - I'm certain the same holds true for our animals. However it could be a sign of pain. What are you using in terms of analgesia?

I guess a cystotomy tube might make him more prone to a UTI - especially if the bladder wall is quite compromised. I'd probably bung him on an antibiotic while awaiting a culture result personally.