December 21, 2015
I think he was already 90 when we first met. The blue eyes, the felt hat reminded me of my own grandfather. A little shorter than me, he was a kind man who had moved to the States when his family emigrated from the Azores. It had been a long time since he worked on a dairy, and his companion now was a black and white cat, Jimmy, vividly marked like a Holstein cow. On that first meeting, Jimmy was just in for a check-up and vaccinations. We talked more about Mr. B’s wife, who had passed away after eating watermelon. He blamed himself for letting her eat the seeds – she loved watermelon so much that she’d inhale chunks heedless of any seed that went with it. He knew the seeds had killed her. I suspected cardiac arrest was the underlying cause from the rest of our discussion. That afternoon we forged a bond that grew over the years. Jimmy’s owner lived independently in a small house in the country. When he could no longer drive a car he rode a three wheeled bicycle, humming along the back roads for miles at a time.
Jimmy came and went as he pleased, growing a little plump under the tender loving care of home, plied with a variety of foods on a near daily basis. One morning Mr.B brought him in, both quite agitated. Jimmy was having trouble walking, crying out, and Mr. B said he kept trying to pee at home. He didn’t think anything was coming out.
When I placed my hand over the cat’s abdomen I immediately felt a hard ball inside, about the size of a baseball. Just that gentle touch yielded a scream of anguish from Jimmy that made us all jump. That ball was the cat’s bladder, swollen near to bursting because the outlet was obstructed. The tube that carries urine from the bladder to the outside is called the urethra. Tiny bladder crystals or struvite, sometimes called “sand” had formed in Jimmy’s bladder. The crystals precipitated from a combination of minerals found in his food, often magnesium, ammonium, phospate. Thirty years ago we called this the Feline Urinary Syndrome. We blamed the diet – no one knew why, or which cats – and knew it could occur in both male or female cats. The crystals irritated the lining of the bladder and urethra, causing swelling, thickening, and pain when urinating. In male cats, the urethra is longer and narrows at the tip, so they can obstruct. If a big clump of “sand” passes at one time it acts like a cork, stopping up the bladder so no urine can pass. Of course, the kidneys are the last to know, so they stay on the job making urine, which fills up the bladder until it can’t get any bigger (or it ruptures). Everything comes to a screeching halt and the kidneys start to shut down (post-renal kidney failure). At this point the cat has a relatively short time to get help – under 24 hours – before it dies.
Treatment at the veterinary hospital is immediate; this is not a procedure that can be safely put off until lunch. Risks are high. The cat must be anesthetized and a urinary catheter threaded carefully backwards up the urethra (retrograde) using a sterile flush if necessary to break down the obstruction. The catheter is placed directly into the bladder and sewn in place, often for 1 or more days. An intravenous catheter is also placed to immediately flush the system and get the kidneys up and running. Blood tests tell the picture of the degree of kidney disease. The cat will have more blood tests before coming off IV’s to be certain that kidney function has been regained. Oddly, most of these cases are not infected with bacteria, though we use antibiotics to prevent a secondary infection once an indwelling bladder catheter is in place. Other names for this syndrome now include Feline Interstitial Cystitis and Feline Lower Urinary Tract Disease.
A change in diet may prevent recurrence of crystal formation. This requires a Prescription diet from your veterinarian. The food maintains the urine PH in a very narrow range that prevents formation of more crystals. In dire circumstances when a cat obstructs a second time, a surgery called a perineal urethrostomy (big words!) is life-saving. The surgery widens the urethra 3-4x more than before. The cat may still form crystals, but it shouldn’t be able to obstruct again.
Jimmy responded well to treatment and readily accepted his new diet. He died from other causes about 2 years later. His owner grieved. It was springtime, and Mr. B had his door open to let in the fresh breeze. He dozed off in his recliner and was startled upon awakening to find a black and white cat, boldly patterned, winding herself through his legs and around the coffee table. He knew it wasn’t Jimmy, but? He named her Susie. She had come to stay. Every time I saw them together we would marvel at how Jimmy must have sent her.
FUS=feline urinary syndrome;FIC=feline interstitial cystitis;FLUTD=feline lower urinary tract disorder. If you like words.
Christine B. McFadden, DVM
drmc@mcmenagerie.com