tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS   Blk 1002, Toa Payoh Lor 8, 01-1477, Singapore 319074   Tel: 6254-3326, 9668-6469, 9668-6468.  
04 March, 2015
  Focus: Small animals - dogs, cats, guinea pigs, hamsters, turtles & rabbits

Difficulty in urination (dysuria) in Singapore cats - Case studies
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   04 March, 2015  
First case was written around 2000
Second case was written in Mar 2015
Case study in 2000

"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 of the kidneys and bladder. "He died a few weeks later." 

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." 

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 bladder 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.
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.

Male cat urolithiasis  
Case study around 2015

On July 8, 2013, a grey male neutered 12-year-old cat had difficulty in urination for 2 days. I palpated the bladder. It was not swollen and so there was no urethral obstruction. 7 years ago, he had urethral obstruction and was catheterised by a vet and had recovered. He was fed dry food mainly and BURP canned food since 4 months ago. I gave antibiotics. I advised dental work and change to feline C/D diet.

Then in Feb 4, 2014, he had dysuria again for one day. He lost appetite. He meowed a lot after urination and so the owner brought him to see me. The bladder was painful on palpation but was not distended to omuch. No vomiting or drinking or peeing excessively. Blood test showed a higher level of urea 14.8 (7.2-10.8) and creatinine 177 (71-160). Platelets were low at 238 (300-800).

I gave dextrose saline SC, catheterised and irrigated the bladder with saline, gave antibiotics and Vit K1. X-rays showed a swollen left kidney (tumour or swelling?).

I phoned 2 days later and the grey cat was back to normal. He could control his bladder.

No news from the lady owner till one year later in March 2, 2015, asking about the price of dry food, Prescription Diet K/D and wanting to buy feline C/D.

In November 2014, she had consulted another vet. The cat had started to vomit prior to boarding him for 2.5 weeks from Sep to Oct 2014. He vomited more often and became thinner. So, she consulted the other vet who took a blood test which showed slightly elevated urea and creatinine levels.

He prescribed K/D. "How long did it take the cat to recover from vomiting?" I asked the working lady. She was in her late 40s. She had rushed back from work to buy the food.

"He took 2-3 weeks to recover from vomiting and now had put on some weight. No more vomiting. I just wanted to stock up the dry K/D and buy 2 cans of feline K/D."

The cat was fed another brand of dry food and BURP in the past but now she switched to dry K/D.

"My cat prefers the wet food nowadays," she said when we met today.

"I did advise dental work as the gums will be painful when the cat eats dry food."

"My cat is too old," she said the cat would be 15 years old in Dec this year and so no point spending money on dental. 

The cat would be on one tablespoon of K/D canned, canned BURP with low salt day and night and dry food K/D available. The cat did not have abnormal drinking.

It is a cat's destiny as to whether he has dentistry to relieve his tooth ache. Just like people as to where we live and earn a living. One client told me his friend's 11-year-old girl was missing for the past 3 days after going to the cinema in a country outside Singapore.   

This cat may not have kidney disease as there are no signs of drinking excessively.

If the cat had dental work 2 years ago to extract the rotten loose teeth, he would have a better quality of life but some cat owners do not want to incur medical costs. A cat can live a longer life if his diet and health are monitored closely together with your vet.  Vomiting and weight loss are signs of poor health, not necessary kidney disease as the cat does not drink a lot of water. It could just be bacterial infections from the rotten teeth and a simple dental work by the vet would have made this cat much more lively.     

This article is in the blog -  The cat has "kidney failure"

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