At E.R. -- TomTom is blocked. Again. (**UPDATED**)

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JL and Chip

JL and Chip

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Well, here we go again. TomTom hasn't passed urine, except for a few drops, since yesterday, and he starting to show signs of trouble. So we made the 2 hour trek to the 'good' E.R. and I'm waiting for preliminary bloodwork results and to see whether they were able to successfully cath him (or whether they'll need to call in the surgeons).

For background and the story from our last blockage saga, see http://www.felinediabetes.com/phorum5/r ... ?8,1771515

Sigh. I really can't emphasize how fast this happens and how bad (and expensive) it can get. If i didn't know TomTom so well and if I hadn't followed my instincts that something was wrong, this would have been even worse...I had him to the clinic just yesterday.
 
Re: At E.R. TomTom is blocked. Again.

((JL)) Im sending good thoughts for TomTom, poor little guy, really hope it works out.
 
Re: At E.R. TomTom is blocked. Again.

Larry and Kitties said:
Have you considered a PU surgery (http://www.marvistavet.com/html/body_ur ... ckage.html) because of the repeated blockages? My civi Lightning had one about 10 years ago (really two) and has not not a problem since.
Click to expand...

The E.R. doc mentioned it briefly but indicated that the downside is an increased probability of infections. Have you experienced that with Lightning?

The doc and I talked about the possibility of pursuing further diagnostics to rule out causes other than FLUTD (such as cancer, a stricture, etc.). Does anyone have any experience or recommendations for what diagnostics/tests might be most revealing and helpful?

Assuming nothing is found, and barring significant negatives, I'd most certainly consider the PU surgery.
 
Re: At E.R. TomTom is blocked. Again.

Ny civi Lightning has not had any UTIs since his PU surgeries. My civi Stuart does periodically UTIs. However, he is missing a rear leg and and really sits when he urinates.
 
Re: At E.R. TomTom is blocked. Again.

Hi J.L.

Too much to type on this subject regarding medical management, etc. but I would never get a PU without a contrast study first. Keep in mind that a PU only removes the penis and distal urethra. If the problem is up higher, you will have wasted time and money and harmed the patient for nothing.

PUs are really hated on the VIN urology board - well - at least by one of the very outspoken urologists...I don't know about the others since they rarely post to VIN. Of course IF it is necessary....it is necessary....BUT....you better make sure that it is really necessary!!
 
Re: At E.R. TomTom is blocked. Again.

Oh so sorry to hear TomTom is blocked again. I remember past threads about things other people were doing and trying. Have you searched the old FDMB for info? I copied a few threads and have them in a file on my desktop if you want them.

Many moons ago we had a Manx boy who kept blocking, despite wet food and some kind of pills, and at age ten he had the surgery. So I know how awful that is. So sudden. This was over 25 years ago and the vet felt it was his last resort. He came through it fine and didn't have any problems. I'm not advocating surgery, just giving support since we dealt with that for many years.
 
Re: At E.R. TomTom is blocked. Again.

An alternative last-try option, especially for a cat blocking higher up, would be a cystostomy button. The button is an infant's gastro (feeding) button with a one-way valve. Using a button allows direct drainage (and rinsing) of the bladder, using a tube that clicks into the button. The risk, like with PU, is increased likelihood of infection. My Coco has a cystomstomy implanted due to nerve injuries that made it impossible for him to pee on his own.

laur
 
TomTom update

TomTom is still in critical care (I took him to the university this time, so he has 24-hour care and doesn't have to be moved).

He's leaking around the urinary catheter now -- only a small amount, but noticeable. It's still bloody. He's also refusing to eat. It has been at least 3-4 days now, so I've broached the HL topic. The anorexia was something that we didn't have to deal with when he blocked in July, so I'm concerned. His potassium has dropped due to the diuresis so they're supplementing in the IV fluids.

I caught the blockage early this time so he wasn't yet in crisis when we arrived at the E.R. If you haven't read jojo's post from July (see http://www.felinediabetes.com/phorum5/r ... sg-1771615 ), please keep those points in mind. It's easy to doubt yourself or wonder whether you're overreacting, but most often, if your gut tells you something is wrong, then something is wrong.

Per the E.R. notes, the July blockage was at the tip of the penis (assuming the notes are accurate); from what I got from the E.R. doc this time, the current block might have been further up. I need to double check that.

We're doing an abdominal ultrasound on Monday and will take it from there. Thanks for the input so far. I've been reading about the PU surgery. I also didn't know a cat could have a cystostomy...so that's more reading on my to-do list. The university is telling me it's a "three strikes you're out" regarding blockage before you need to go with the PU surgery. We're at two strikes now...and of course, Tom being a stray, who knows whether he blocked in his "former" life.

Continued good thoughts are appreciated.
 
If you are interested in more info on cystostomy / cystotomy, let me know. This might be a real option, especially if they already have to do surgery on the bladder anyway to remove the stones. Normally it would be done with a foley tube but that didn't work well for Coco at all. He hated it and pulled it out at every opportunity, which was when the diapers/covers worked loose. The button is so unobtrusive, he leaves it alone. Check out my photo links below, but go to Coco's folder. Sorry I can't get there right now to give you the direct link.

http://www.for-the-love-of-cats.com/Dis ... FLUTD.html says "Surgical intervention usually involves either a cystotomy or perineal urethrostomy. With a perineal urethrostomy, (often called a 'sex change operation'), the penis is amputated and the urethra exteriorised as a makeshift vagina-like opening, thus preventing any further blockage of urine. Although considered a drastic step, this operation is usually successful and stops further pain and disease in the cat and is recommended in male cats that have had a urethral obstructions three times or more. A cystotomy is much less surgically demanding and has a higher success rate if the cat is prevented form eating dry food in the future. It also has the advantage of being more cost effective in the long term as complications are minimal."

I have these articles if you PM me your email:

Stiffler KS*, McCrackin Stevenson MA, Cornell KK, Glerum LE*, Smith JD, Miller NA*, Rawlings CA. Clinical use of low-profile cystostomy tubes in four dogs and a cat. J Am Vet Med Assoc 2003;223(3):325-329.

Use of Cystostomy Tubes in Small Animals
Kei Hayashi, Robert J. Hardie | Saturday, December 20, 2003

Looks like there is a new for-sale article at http://www3.interscience.wiley.com/jour ... 1&SRETRY=0 .
Minimally Invasive Inguinal Approach for Tube Cystostomy
JONATHAN P. BRAY, RONAN S. DOYLE, CAROLYN A. BURTON
Veterinary Surgery
Volume 38, Issue 3 , Pages411 - 416
 
Hi there. I hope TomTom is doing much better and you don't have to deal with surgery any time soon.

I had a kitty block twice with crystals, and I was told I should probably have PU done for him, fortunately I was able to avoid it.

are you JUST dealing with crystals or is there an infection involved?
What is the PH of TomTom's urine?
what is TomTom eating these days? Have you been putting extra water in the food?
 
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