cat clipped by a car, trouble peeing

[dannape]

Hi,
My best friend's cat got clipped by a car, his tail is badly bruised, it just drags between his legs, the emergency vet wanted 2500.00 to amputate, but her regular vet doesn't even think it needs to be amputated. The problem is he can't seem to pee, he goes in the litter box and moves stuff around, but doesn't go. the vet thinks the nerves have been damaged,, and she has taken him in every single day (10) times so far, and the vet empties his bladder and then hydrates him with fluid, but by now he should have started going on his own. a week ago she gave her something called bethanecol suspension, 3 times a day, it's a liquid, and it's supposed to help his bladder contract, and she notices now when he cleans himself, that a little urine comes out, but he's still not going on his own. The vet gave her a 2 wk supply, and said if it didn't work, she might have to put him down. It would be heartbreaking, cause he is playing, eating, it's like nothing else is wrong with him.

She was wondering if anyone else has used this product, and if it worked, and if so, how long did it take?

I;m so happy i found this forum, i will look forward to any possible responses.

[Traci]

Was an xray ever taken? Vet needs to rule out pelvic fracture or urinary obstruction that may have occured due to the HBC incident. Many HBC cases have pelvic, urinary and other anatomical problems often combined and need to be addressed properly.

If the bladder wall is weak or if there are any mechanical obstructions as a result of the trauma, then bethanecol is not be the best choice. If no bladder wall weakness and no obstructions, then sometimes an extended course of bethanecol may be necessary, providing that no side effects have thus developed (like anorexia, vomiting, diarrhea, excess tear or saliva production, abdominal pain).

Another choice the owner should ask the vet about is phenoxybenzamine, which helps the bladder muscle to contract. It too is not without side effects however, not that all cats have side effects but those to be aware of include increased heart rate, low blood pressure, weakness, nasal congestion, and should not be used in a cat with known heart or kidney conditions.

The two meds can often be used together, but again, obstruction and weakened or stretched bladder need to be ruled out FIRST.

Also, whenever there is urinary retention, there is ALWAYS the potential for accompanying urinary tract infection, so a urinalysis should be done at the end of each treatment course, or, when symptoms of a UTI are evident.

The fact that the tail is obviously nerve damaged, may in fact be adding to stretching of the bladder, tell the owner to discuss that with the vet. Does the tail have any nerve reflex at all? He shouldn't be dragging the tail and should be able to lift it on his own if the nerve damage is not extensive. Tail damage can take weeks to months to heal and gain back nerve function, sometimes nerve function is not always 100% function. In some cases, it might be recommended to amputate the tail to prevent blood flow loss, or to prevent constant soiling because the cat doesn't have the nerve reflex to automatically use the tail when in the litterbox, etc.

As for the bladder, give this time, it is not uncommon for these injuries to take time to heal, ask about a potential second course of the behanecol and phenozybenzamine if necessary, discuss that with the vet.

Rarely, cats may not fully recover from a bladder injury and manual expression of the bladder would be necessary for life. That doesn't mean one has to euthanize the cat, one just adjusts to be devoted to the cat and learn how from the vet, to express the bladder. Be very careful and have the vet show the owner how this is to be performed, if you squeeze the bladder too hard, it can rupture and be fatal if not detected and treated immediately by the vet (yes, this would be an emergency).

Don't give up on this kitty, and if the vet isn't confident, then see a new vet, preferrably feline-only and one who is dedicated to treatment, monitoring progress and is not afraid to work with the cat and owner!

Lastly, tell the owner, INDOORS-ONLY!!

[dannape]

Thanks for such a quick reply, Yes, a full body scan was done, and there is no other damage, other than the bruised tail, and the nerve endings around that area..I'm almost certain they are not doing the urinalysis everytime they empty his bladder, she would've said something. I had heard that it can take months for the tail to heal and for him to start lifting it. I think that is why her own vet said it wasn't necessary to have it amputated.

I was with her the day the vet said, "i would show you how to do this, but if you do it wrong, or too hard, it could be fatal" and she has never brought it up again. I'm wondering if my friend should suggest it again, and see what the response is. And, believe me, she will NOT give up on this kitty, it is like her child.

Just for a little background. She has a closed in patio, and Sammi (cat) is such a chicken, that if a car drives by, he takes off into the house, and my friend has multiple sclerosis, and had just given herself a shot, and it makes her so very tired, she fell asleep on the couch, and Sammi found a little tiny hole, that he managed to squeeze out of. She is devastated .

She had to put her other cat down she had for 12 years, she spent almost $1500.00 in vet bills trying to save him and he died anyways, so she's not gonna give up without a fight, i can guarantee that.

[Traci]

The urinalysis shouldn't be done after each manual expression, it should be done after a course of medication, like the bethanecol.

Hopefully, the hole in the patio or wherever is repaired.

Again, don't give up, it takes time, sometimes weeks, sometimes months, it is always worth it to give it time and of course, have a committed vet working with you. I've seen and treated many of these cases, and Sammi is fortunate no other injuries occured.

[dannape]

Traci,

I just talked to Laurie, and she just got back from the vets. The past 3 times they have had to use a catheter on him instead of just manuall expressing the bladder. She almost didn't ask, but managed to say, "what now"? and the doctor said it's not lookiing good, that medicine really should have worked by now. Laurie stopped there, because she didn't want to ask what she meant, cause she doesn't want to hear "put him down"

The vet said, "you could always take him to a neurologist" What exactly would be the reason for that? I asked Laurie " are you sure she didn't say urologist" and she goes, I could swear she said neurologist.

She is just heartbroke and doesn't know what to do. You suggested another medicine, and said it helps the bladder muscle to contract, but isn't that what the bethanecol does?

I don't even want to think about how much money she's already spent, she's been making daily trips to the vet for 2 weeks, i know it shouldn't be a money issue, but she's having money problems, and she lost her insurance at work, she can't afford to go bankrupt and then have him die anyways.

[Traci]

Both meds generally work for the same purpose, and for various conditions. There's no harm in trying both, or a combination of both (again, providing that side effects are monitored for).

The vet most likely said neurologist, who can help her determine how much nerve damage there is, and if there is a likelihood of recovery. He can perform simple, non-evasive evaluation tests as well as other diagnostics to rule out various problems. The vet also might have said urologist, meaning, a veterinary urology specialist, which might be the better option. The vet should have referred you at once knowing she is either doubtful or doesn't have the experience to deal with this particular case.

The neurologist will need either the previous xrays from the other vet(s), and/or may want to take his own, plus all records from the previous vets (these can be faxed between vets). He or a urologist may also want to do a cystogram or similar type test, or even ultrasound to determine the bladder's true structure and ability to function and to rule out mechanical or traumatic obstruction/injury that the other vets might have missed. An ultrasound could be useful. Having all the previous records from the other vets will incur less charges since the neurologist will already have that information.

While these cases and conditions can be tricky, you should NEVER EVER rely on one vet opinion, many other vets have a great deal more experience in these cases and might be able to pick up on something the other vet missed.

I'm not trying to give false hope, but it is worth every minute and every dollar to get a second opinion, preferrably from a feline-only vet and/or that of the neurologist or feline specialist. Whenever a vet gives grim diagnoses, that's when the owner should always think twice and get a second opinion. Why rely on one vet's opinion when there are qualified, board-certified specialists available who have better knowledge and experience! Again, whenever there is nerve damage present, it can take weeks to months to recover, patience is the key. But it sounds to me like there might be some other damage to the bladder that needs proper diagnosis and treatment and is worth pursuing.

[dannape]

Thanks Traci,

I am going to print off what we've talked about so far, and she's taking it to her vet to discuss tomorrow. Apparently she was not giving him enough of the bethanecol, and 5 days ago, she started giving him the correct dosage, and it was 4 days ago, that they had to start doing the catheters on him, cause she couldn't get the urine out. Do you think that's because of the medicine, or because he just tenses up when they try to get the urine?The timing seems a little coincidental to me. Again today the vet said it wasn't a good idea that she express the bladder cause if she presses or squeezes too hard, she could do more damage.

There is a place called "The Cat Doctor" down the street from her house, she might consider going to.

She also said that the tail is broken right at his back, at the base of the tail. She can touch it and it doesn't even phase him.

[Auntie Debbie]

Prayers for the little kitty. I hope something can be done for him.

[Traci]

Tensing up doesn't prevent manual expression of the bladder (by the vet).

Something is causing the bladder not to constrict and relax, whatever that is needs to be detected by a vet with more experience (the neurologist or urologist).

Again, it takes time for the meds to take effect.

I had asked before, does the tail have nerve function at all? Is there blood flow to it, or is the tail extremety cold? If there is no blood flow at least, then amputation would probably be adviseable, since no blood flow causes tissue to become necrotic.

Did the vet suggest limited activity (restricted activity) to prevent further damage to the tail and spine? Is the owner following through with those instructions?

As for manual expression of the bladder, the vet is right, owners shouldn't be doing this unless they are taught properly by the vet, however, I didn't mean to suggest the owner should be doing that at this point in time, only when a diagnosis might determine the need for expression for a lengthy time.

The owner also needs to know that with frequent catheterization, this can lead to increased risk of urinary tract infection (which is treatable), which is why I suggested the urinalysis at the end of each course of medication, or at any time the cat is experiencing symptoms of a UTI (little to no urine output, blood in urine, squatting in unusual places, crying out, abdominal pain).

Again, have the owner see a new, more qualified vet. It would be more cost effective to go directly to a feline specialist, particularly for the need to detect any mechanical or traumatic injury that might have been missed by the current vet.

Did the vet mention the possibility of the pain aspect? Some injuries are painful enough to cause the cat to retain urine. It's a long shot, but worth discussing.

[dannape]

Laurie has been instructed to take the cat back to the emergency vet place, because they have the neurologist on staff who can check his nerve endings and see how much damage there is, and if there is a chance of recovery.

She watched him in the litter box, squatting and just waiting and waiting, and nothing came out but a little feces. Today the vet expressed 1/2 the urine from the bladder and then had to use the catheter to get the rest out.

I don't know what's going to happen at this point. She has good days and bad, and i think today is a day where she's thinking he's not going to recover. I just keep praying for her and for Sammi.