It recently occurred to me that I have been talking up my success stories at work, but I haven't said much about my missteps. And there are plenty. Thankfully they are becoming less frequent the longer I am in the profession (as the saying goes, you learn something every day), but they happen nonetheless. I was reminded of that today, when I made a judgement call that didn't work out as hoped.
At about 10 am I saw a 2 year old male cat who couldn't pee. This is a surprisingly common occurance and I see about one of these guys every month or two. This problem is usually caused by plug of crystals and mucus that forms in the bladder and gets lodged in the urethra on the way out. If left untreated, the cat's kidneys will shut down and it will die within a couple of days. So emergency intervention is needed.
The standard protocol for these guys is to stabilize them if possible (and if needed) with IV fluids and treatement if their electrolytes are out of whack. Then you sedate the cat and attempt to pass a catheter into the urethra (starting at the tip of the penis) to he bladder. Usually you have to push or flush the plug into the bladder in order to relieve the obstruction. In the past, it was recommended to sew the catheter in for a couple of days in order to allow the bladder to heal from being stretched and the swelling in the urethra to go down. However, sewing the catheter in can be a pain. It can become kinked or clogged, the cat has to wear the cone of shame 24/7 in order to keep him from pulling the cath out, and it is a good way to introduce a urinary tract infection. So I believe that we are sewing in fewer catheters these days. Well, at least I am. I have had some pretty good success relieving the obstruction with a catheter but not keeping it in.
Anyway, this cat was difficult to catheterize and I cause quite a bit of swelling "down there" as I forced saline into his urethra to relieve the obstruction. However, once the obstruction was gone, he had a great stream of urine and the catheter passed super easy. I flushed his bladder several times and each time I pressed on it after filling it with saline, a nice stream of saline/urine came out.
So, time for another judgement call. Leave the cath in? Take it out? I decided to take it out and see if he was able to pee on his own. Every couple of hours I checked on him. No urine in the litter box (and he was on a high rate of IV fluids at this point). I could not express any urine when I pressed on his bladder. This dance continued until I left the office at 4:30 pm, knowing that I would have to come back later because he wasn't going to pee. Stupid cat.
Sure enough, when I came back (after running my kids all over town to their activities), there was still no urine and I still couldn't express his bladder. So I sedated him AGAIN and tried to express urine - no luck there. Couldn't blame it on urethral spasms at this point. He must have re-obstructed. So I passed a catheter AGAIN, but there was only a little bit of resistance until I was able to push through the obstruction. Again it became easy to catheterize him, but he didn't have quite as good a urine stream when I expressed his bladder. I guess I had to sew in the cath at this point.
Sometimes I'll take these guys home with me for the night and let them hang out in my bathtub so that I can check on them. But tonight I had to go straight to a meeting and couldn't leave him in the car. So he's at the clinic and I have to hope that he behaves and doesn't pull his catheter out, and that that catheter behaves and doesn't get clogged or kinked in the next 12 hours. Because if any of the these happen, it can further stratch and damage his bladder and we will probably have to start all over again.
And you wonder why I take Xanax every night to get to sleep?
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