I know my cats well,"
the lady said when I asked whether 8-year-old her male
neutered cat was having constipation instead of having
difficulty in urination. "I have 5 of them. I can
differentiate constipation from urination difficulty."
She had consulted Vet 1 twice on Monday and Wednesday but
the cat still had dysuria (difficulty in passing urine).
She said: "I find that the vet is not sure of what's
happening to my cat." When the cat does not get well, many
Singapore owners will lose confidence and seek another
opinion. Diseases take time to resolve with antibiotics
and the second vet usually benefits from the passage of
time to deliver an excellent outcome.
Vet 1 had told her that there was no major problem after
palpation of the bladder. She said that her maid had kept
a close eye on this cat and was sure that the cat had not
peed a drop of urine for the past 2 days.
I said: "I have the same finding as Vet 1 in that the
bladder is not full at all. So there is no urethral
obstruction. If there is urinary sand obstructing the
urethra, the bladder should be as big as a mango. If the
cat had not peed for 2 days, the bladder should be swollen
and can be felt easily."
The maid was holding the cat upside down for me to examine
his private parts. There was a purplish red tip of the
penis which was otherwise not swollen and normal in size
and colour. The cat had medications from Vet 1 and the
"normal finding" of the penis must be taken into account.
The lady was in the subway train on the way to the surgery
after work. Her mum and maid had brought the cat in first.
The cat had lost appetite today and had dysuria. She was
insistent that the cat had a problem with urination.
PHYSICAL EXAMINATION
1. Cat standing on the examination table. Palpation of the
bladder. Not swollen at all. Slight pain around the
bladder area but no significant reaction from the cat. The
cat became pissed off as examination continued. Feline
rage bubbled in her shaking body and hairs.
2. The cat was turned upside down. The penile length was extruded.
Except for a purplish red tip due to traumatic licking,
there was nothing abnormal. I asked the maid: "Is it
possible that the cat peed when every family member
including you were asleep? The bladder pain may have gone
for a while and the cat pees most of the urine." The maid
did not object to this comment. "Did you see blood in the
cat's urine earlier?" I asked the maid. "No," she said.
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 |
|
|
I re-examine the
cat's penis again for urethral plug and penile
inflammation. The owner was on her way to the
Surgery |
The cat suddenly
shot out urine onto the maid, the towel and onto the
floor. Too late to gather evidence but divine
intervention came. |
|
| |
 |
|
| |
A drop of
blood-stained urine was left over on the penile tip.
A picture is worth a thousand words. The owner no
more doubted that her cat never passed blood in the
urine |
WHAT TO DO NOW?
There was no doubt that the owner knows best. The cat does
not have constipation as the palpation does not reveal
hard faecal stools. Yet the cat does not have a full
bladder or blood in the urine history.
WHAT THE OWNER WANTS
An accurate diagnosis on what's wrong with her cat. In the
male dog, it is much easier to catheterise the dog's
bladder and get the urine out for examination of blood and
bacteria.
RE-EXAMINE THE CAT'S PENILE AREA AGAIN
I asked the maid to bring the cat to the operating room
for a re-examination of the penile area again under the
bright operating lights. My assistant pushed the penis out
from the prepuce. The prepuce and penile body were normal
pink. Only the penile tip was purplish red in colour as
seen in traumatic licking.
The cat was now getting angry with all these
manipulations. Suddenly the maid pointed to her right side
of her T-shirt and shouted: "The cat peed onto me!" She
managed a twist and turn. Much of the pee bombed onto the
floor. There was a big drop of blood-stained urine
remaining on the preputial area.
"Get a one-ml syringe," I shouted to my assistant. "Suck
out the urine for examination." In the meantime, I took
out my digital camera to take evidence for the owner who
was rushing to the surgery.
"You need a 2-ml syringe," my assistant went to the chest
of drawers to get one. That drop of urine would fill the
1-ml syringe. While my assistant was looking for the
syringe, the cat gave a turn to be upright. So, there was
no more bloody urine evidence. The maid was the witness.
The bloody urine on the floor was of no use as the floor
tiles were greyish in colour and anyway, the amount was
not that much. It was around 20 ml spread out on the
tiles.
The owner arrived. "The cat had blood in the urine," I
said. She looked at me for proof. I took out the digital
camera and got the image for her to see. Dark red blood at
the penile tip. She seemed satisfied. Nothing can convince
the doubting owner than real physical evidence of bloody
urine.
TREATMENT
The owner reluctantly agreed to the cat being warded one
day. Blood test would be done. The urine would be
collected the next day while the cat had a IV saline to
produce urine. I will then catheterise the cat and collect
the urine. After that, the bladder would be flushed well
with saline to get all urinary sand out.
DIAGNOSIS
In dysuria and haematuria in an 8-year-old cat of recent
onset, the possible causes are:
1. FIC (feline
idiopathic cystitis).
This is the most common cause.
2. Urolithiasis (stone or sand in the bladder).
Usually in cats over 10 years old.
3. Urethral plugs. |
In this case, the
tentative diagnosis is FIC but it may be a combination of
3 causes. After manipulation of the penile tip, the
urethral plug was loosened and the cat peed onto the maid.
TESTS
1. Blood test
2. Urine test - cystocentesis, catheterisation or voiding.
I prefer catherisation although some vets advocate
cystocentesis is said to prevent introduction of bacteria
into the bladder.
3. Urolith analysis (struvite & calcium oxalate usually).
ADVICES
"Stop feeding dry cat food," I said to the owner firmly.
"If you feed dry food, the cat may suffer from the same
lower urinary tract disease again and you will have to
spend money for treatment. Don't say I did not tell you."
The lady said: "My cat loves dry food. The other 4 cats
are also eating dry food. One of them is older than him
and has no such problem."
I said: "Not every person or cat will suffer from the same
disease or condition. This is the diversity of life."
CONCLUSION
This is one of those cases where the cat is presented with
no swollen bladder. So any vet will say that there is no
urethral obstruction. So the owner will lose confidence in
the vet and seek a second opinion. The second opinion was
no better than the first opinion till the cat delivered
the blood urine as evidence of a lower urinary tract
disease! Luck does
 play
an important part in living and in veterinary diagnosis
sometimes.
LINK:
A young male cat pees anywhere and has blood in the urine
|
TOA
PAYOH VETS
