"The
owner's previous male cat had the same problem of dysuria (difficulty in
passing urine)," I said as I presented a 3-year-old male cat to the
Senior Veterinarian, Dr
Foo for radiography which is an X-ray of the bladder and kidneys.
"He died a few weeks later."
Dr Foo frowned. He had performed at least a thousand cases in forty
years of small animal practice and had a solid surgical reputation in my
opinion. Deaths from urinary bladder obstruction would occur as no
veterinarian could save every case and many owners had not complied with
instructions to take medication, change to a calculolytic diet or go for
a follow up. In most cases, the  cat refused to take medication or accept
a new diet and the owner could not do much.
I elaborated, "The owner did say that she had left the
post-operative care of her first case to her mother as she was overseas.
The cat would not take the medication and her mother had not consulted
any veterinarian. The cat then died. Probably due to urinary bladder
rupture and or kidney failure."
"No
point taking X-rays," Dr Foo said. "Nothing will be seen as
the cat with urolithiasis do not have solid stones."
"There may be obstruction by stones further up the bladder, in the
ureter or in the kidneys," I said. "Although urethral
obstruction in the cat is usually caused by an organic matrix which
would not be seen clearly on X-rays, sometimes there may be
crystals."
 |
 |
| No urinary stones seen on
X-rays |
X-rays
add to the veterinary costs and in the dog-eat-dog veterinary practices
of Singapore, it was the least cost that
attract the average pet owner. Overheads are high and if there are
no clients, there will be no revenue and the practice will have to close
within a year or two.
Dr Foo had been long in practice to understand that Singaporeans want
cheap and good services. The competitor was nearby. Younger
veterinarians in new practices underprice their services, a common
situation in the private sector.
He was experienced but he
could not command higher fees because the pet owners were not
sophisticated enough yet to pay a premium for veterans. In fact, his fees
were in some cases lower
than the competition!
The mean age (50%
of the cases) for urolithiasis in cats is 7 years old
and the range 1 - 22 years old, but this cat was only 3 years old. He
was a gentle slim cat with a "M" in his forehead, nervous about going outdoors and much loved by
the equally trim and fit lady owner, a career lady who worked long hours
into the night. She had said, "I hope you don't
need to neuter him during treatment as I wanted him to be a
father."
The cat was tranquilised and treated. It was difficult to dislodge the
organic plug inside the urethra. After some five minutes, the urine shot
out onto his hands.
The
obstruction was cleared and the bladder was pressed to allow more urine
to flow out. It was a relief as if we had urinary bladder obstruction.
Nurse Ann's joy was short-lived. The urine flow stopped suddenly. The
male cat urethra is very narrow and it was blocked again.
More
work at dislodging the urethral plug. Dr Foo inserted a catheter into
the urethra to let the urine flow out. Strong ammonia smell mixed with
blood. Infected smelly urine. The urine had a strong
ammonia smell as if it was kept for several days inside the bladder.
A
neck collar was worn to prevent the cat from biting off the catheter
which was sutured to the skin. Dr Foo said that the cat could go home
with medication and that would mean least cost. But would that be in the
interest of the cat? It was not easy for most Singapore owners to
medicate a cat.
It would have been better to keep the cat for the next 3 days to observe
and checked that his urinary obstruction and bleeding in the bladder had
stopped. But the practice would be known as "expensive" and
that would out price the competitors.
I had given him antibiotic
and dextrose saline injections to flush out any "sand" inside
his bladder. Two hours after surgery, he passed a large amount of
smelly blood-stained urine. Seventeen hours later, his urine passed the
smell test. It was not smelly and that was good.
Would his catheter get blocked?
The owner brought the cat back the next day as I did not want her to
incur more boarding costs.
The owner, being a doctor, would know what to do with medication and a
change from dry cat feed to a low magnesium diet. The urine and the
uroliths inside the urine were not sent for laboratory examination or
bacterial culture because that would increase the cost of treatment.
In private practice all over the world, the average pet owner usually goes for the cheapest
doctor.
Well, telephone consultations are free. I phoned the doctor five days later
to enquire about this gentle cat. I left a message on her busy mobile
phone for her to call me back. No call. I got her on her phone but she
was busy at consultation.
"I can't talk now," she said.
"Is your cat OK?" I had to ask as this was the only chance
since I did not expect her to return calls.
"Yes," she said and that was all. There were no return calls from her
despite leaving messages on her mobile phone. Singaporeans seldom
return phone calls unless they need to as they usually lead a hectic
life.
It was best not to persist. No news is good news, that is the
saying. I hope the cat had recovered well. I never got any visit or call
from this good general practitioner and so I assume that all
are well with this cat.
P.S It is May 5, 2011, 2 days before Polling Day.
The above case would be written some 5-10 years ago as you can
see my quality of digital imaging. Extremely poor but one has
to start somewhere and learn through reading photography
magazines and being hands on to improve oneself. Compare
to my recent photography below and you will know what I mean:
|
TOA
PAYOH VETS
