November 2016: Domino Setter

November 2016: Domino Setter

Reason for Nomination: Overcoming a severe Blocked Bladder

Domino is a beautiful black 6 year old male cat who was rushed down to us for an emergency appointment by his owners. They had noticed that Domino had been straining to go to the toilet in his litter tray since the previous day and now also seemed depressed and lethargic.

When the vet assessed Domino he was given a full exam. During this the vet palpated his abdomen and immediately identified Domino’s problem – Domino’s bladder was very full and firm: it was too full.  Cats, like humans, continually produce urine through their kidneys and this gathers in the bladder until they feel the need to go to the toilet. A bladder becoming overfilled, as Domino’s was, could only be caused if something was preventing Domino passing urine and emptying the bladder. Two main problems can cause this – that there is an obstruction of some description preventing urine being passed or that there is nerve damage to the bladder so the cat is unaware they need to go to the toilet. In male cats, the most likely explanation is a blockage. Sometimes the blockage is caused by bladder stones which travel down the urethra and get stuck and sometimes it is caused purely by muscle spasms or mucus forming a block.  Blocked bladders need urgent treatment; they are medical emergencies and, left untreated, are life threatening.

Domino was admitted for immediate investigation and treatment.

He was given essential pain relief to relieve the discomfort from his bladder.

A blood test revealed the severe consequences of his blocked bladder- due to the pressure continuing to build as his bladder overfilled, Domino’s kidneys had become compromised. His blood results showed his kidney parameters were sky high indicating the damage had been done. In addition his potassium levels (an important electrolyte in the body) were very high and the white blood cells were also raised indicating infection or inflammation. The high potassium occurs as it is not being excreted in the urine as normal, and when the level is high it can cause a bradycardia (low heart rate). Domino had a profound bradycardia which is very worrying consequence.

Domino was placed under an anaesthetic to be able to safely and comfortably unblock his bladder with a catheter.  This can be a difficult procedure depending on what has caused the blockage. However, with Domino we were lucky and the catheter passed quite easily. Immediately we were able to safely express lots of very dark bloody urine. A sample of this urine was collected to send to the lab to investigate if there was any infection or stones or crystals present in the urine which might explain why the blockage had happened.

Once Domino’s bladder was empty it was flushed and emptied repeatedly with sterile saline to remove any debris.  An indwelling catheter was then placed – this is a catheter which is left in for a few days after to ensure a blockage does not immediately occur again. The catheter was attached to a bag, allowing us to collect and closely monitor and measure the urine Domino was producing.

Domino was also placed on a drip to help bring down the high levels of potassium in his blood and to support his kidneys.

Over the next few days Domino continued to be given pain relief and medications to relax his bladder. He stayed on the fluids while we monitored his potassium levels and kidney values. Thankfully over the next few days the values gradually fell back to normal and we were pleased that Domino was improving.  During his recovery Domino needed his urinary catheter replaced as the original tube became kinked but Domino still was unable to urinate by himself as the bladder was too inflamed.  The urine sample confirmed that Domino had a nasty urine infection so we also started him on antibiotics.

Domino needed to be in hospital for a week in order to keep him comfortable, fight the infection and ensure his kidney values and potassium were all normal. Once Domino’s bladder was more comfortable and he was passing non bloody urine the catheter was removed. We were all keeping our fingers crossed that he continued to urinate without it in place! Thankfully Domino did not re-block and was finally able to go home to continue his treatment there. Domino has continued to make great progress and is now back to weeing normally and comfortably again!